Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Hansard source

I begin by acknowledging that today is Remembrance Day, and I give thanks to all of those people who served, died, suffered or made sacrifices so that we could all live freely and in peace.

In speaking on the Health Insurance Amendment (Safety Net) Bill 2015 I support the comments made by the member for Ballarat and the amendment that she has moved to this bill. Before I talk about the substance of the bill, for the benefit of anyone listening to this debate and who is not familiar with the safety net system we have in place, I just want to briefly describe it.

Medicare sets out a schedule of fees known as the Medicare Benefits schedule, or MBS. Medicare rebates 100 per cent of the scheduled fee for a general practitioner and 85 per cent for a specialist. The patient pays the difference between the practitioner's fee and the rebate. Frequently, fees charged by medical practitioners are higher than the scheduled fees. Presently, there are two safety nets for people with high medical costs: the original Medicare safety net and the Extended Medicare Safety Net. Once a patient qualifies for the original Medicare safety net, which they do so by reaching a threshold, the Medicare benefit is then increased from 85 per cent of the scheduled fee to 100 per cent.

That the original Medicare safety net is calculated on the gap amount being the difference between the Medicare benefit received and the scheduled fee is part of the equation. However, even once patients reach the original Medicare safety net and they are therefore rebated 100 per cent of the scheduled fee, if their practitioners charge more than the scheduled fee they will still have out-of-pocket expenses, which is the difference between the Medicare benefit and the practitioners' fee. Once an annual threshold of out-of-pocket costs is reached, patients qualify for the second safety net—that is, the extended Medicare safety net, or EMSN as it is otherwise known. The extended Medicare safety net covers 80 per cent of the out-of-pocket costs from this point onwards, although it is subject to some caps for specific MBS items.

With that explanation, I want to turn to the substance of the bill. This bill gives effect to the 2014-15 budget measure referred to as 'simplifying the Medicare safety net arrangements'. It effectively replaces two safety nets with a single safety net. Whilst the safety net would have a lower threshold for all patients, and therefore perhaps more patients will have access to it, the amount of out-of-pocket expenses that count towards it is also lower. The amount covered once patients reach the safety net would also be lower.

Although a simplification of the system would be welcome, the fact that these changes provide savings of almost $270 million over the next five years makes it clear that the government's objective is not just to simplify the system but to make cuts to the health system of this nation. The objective is also to use those savings made by the government in order to fund the coalition's Medical Research Future Fund. The government have put themselves in this position because, when they first announced the Medical Research Future Fund, it was to be funded by their GP tax, or the GP co-payment as it was referred to. As we all know, and as history now shows, the GP tax was rejected by Australians because it was unfair. So it seems that the government are now looking for other mechanisms in order to pay for the Medical Research Future Fund and, indeed, are looking for other cuts they can make to the health funding of the nation in order to do so.

It also makes little sense to fund research for future cures at the cost of deterring people from seeing their GP and possibly, in turn, making them sicker right now. It is the same argument that was used when we—I believe quite rightly—argued that increasing doctors' payments would simply put off the medical problem, in turn making it worse and ultimately making it a higher cost to society. This bill does a very similar thing. It effectively says that we are going to take away money today from people, who will not be able to afford certain treatment, and then in turn put that into future research, which might help society. But the truth of the matter is that it is asking one sector of the society to pay for the benefits that another receives.

If the government also believe that some practitioners are rorting the system by exploiting the lack of price sensitivity due to most of the costs after reaching the EMSN being paid by government, they need to provide evidence of that. When Labor made changes to allow caps on specific MBS items, it did so on the basis of two independent reports which made the case for change. We have seen no similar reports with respect to the changes that have been proposed by the government in this legislation.

In summary, this legislation abolishes the original Medicare safety net and the extended Medicare safety net. It creates a single safety net system, but it also cuts nearly $270 million of funding from the safety net—in other words, $270 million of funding that would otherwise go to Australians who are in need of health services. The truth of the matter is that those changes will affect thousands of Australians, and affect them for the worse. Although the bill lowers the safety net threshold for all patients, restrictions on out-of-pocket costs that contribute to a patient reaching the safety net are introduced, and the amount that the patients receive back once they reach the safety net is also reduced. Indeed, we have seen evidence that these changes will severely impact on oncology patients, on patients needing ongoing access to psychiatric treatment, and on patients accessing IVF services. For some of these patients, the costs are likely to increase by tens of thousands of dollars. These are not minimal increases; these are amounts of money that for some people will be out of reach. For those people, it may well be a choice between getting the treatment and not getting the treatment, and I suspect that in most cases, if they had a choice, they would want to get the treatment.

In turn, it also creates a medical system where people who can afford medical treatment will get it and those who cannot afford medical treatment in this country will miss out—a system similar to what they have in the USA and a system that we in this country, for the last 40-odd years, have been able to say is not the right way to go. We have a universal health system in this country which has served the Australian people very well and has ensured that all people, regardless of their income, have access to reasonable medical services in this country. This is starting to break down that system. For a Prime Minister who continuously talks about fairness and creates a perception that he understands the struggles of low-income Australians, this legislation goes entirely in contradiction to the perception that the Prime Minister tries to create. There is nothing fair about making it more difficult for lower income Australians to get the medical help they need, and all this measure does is to increase the widening gap between the rich and poor of this country.

Not surprisingly, the AMA, the Royal Australian College of General Practitioners and the National Association of Practising Psychiatrists have all come out with concerns about this legislation. They have good reason to come out with concerns about this legislation, because they know full well, as the front-line service providers, the impacts that it will have on their patients, and they know full well that people who might need psychiatric assistance will not be able to access it. We have seen it time and time again. We hear debates in this place time and time again about mental health issues in this country and how the costs of mental health are also escalating year by year. We are going to do nothing to reduce those costs by cutting out services or by making services more difficult to access by the very people who need them.

It is likewise with oncology treatments. I have spoken to people in my own electorate who found the cost of oncology treatment to be already excessively high. People have come into my office and talked about the possibility of going overseas to where health costs might be a little lower in order to access the treatment that they need. These are people who do not have spare money and people who are actually struggling to find the money they need just to pay for the services that they desperately need. To make things harder for them is, I think, one of the most heartless and cruel things we can do. Deputy Speaker, I am sure that you have come across such families in your own part of the world. The stress and trauma caused by some of these serious and severe illnesses is something that we would not wish upon anybody. Yet through this legislation I believe we are making their situation much worse.

It is also, in my view, bad public policy to bring in this legislation. I say that for this reason: not getting medical treatment when it is needed ultimately leads to more serious medical conditions later on. I do think there would be a doctor out there who would say that if you need to go to a doctor, do not worry about it; just put it off. The more you put it off the more likely it is that the situation or condition will deteriorate. When it does the costs of treatment become much higher. Indeed, if the situation deteriorates to the point where the person is admitted to hospital, again the costs escalate. It is not good public policy to have short-term savings which in the long term add to the health costs of the nation. It simply does not make sense. It may well be that this government, in order to create those short-term savings, is prepared to transfer the costs onto state governments which would perhaps wear the bulk of the costs with respect to the hospitals, or directly onto the families themselves. Again, in both cases, whilst it might get the government out of its budget mess, it does not do anything to reduce the overall costs to society of managing health in this country.

I see this legislation as simply another piece of the jigsaw of the Turnbull government's plans to dismantle Australia's universal health system that has served this country well for some 40 or 50 years. I say that it is part of the jigsaw because to date we have seen more than $60 billion cut from Australia's public hospitals, attempts to increase the costs of medicines through changes to the Pharmaceutical Benefits Scheme and the government's ongoing GP tax through its MBS freeze, which represents a cut of some $2 billion from Medicare. That is $2 billion through that freeze, so that doctors have no choice but to ultimately pass those costs on to their patients. So the patient ultimately pays, but it is a cut being made by the government. We have seen hundreds of millions of dollars cut from public dental health programs, mental health and Indigenous health programs. We have seen $370 million cut from preventative health programs around the country. Indeed, I have a letter in my office right now from concerned people in my electorate who are worried about the impact that $370 million cut will have to the front-line services they are providing in my part of the world. Again, these are real cuts which are going to have an impact on the health and welfare of the nation. This latest round, where we see another $270 million of cuts being introduced under the guise that it is about simplifying the system, is simply another part of the overall package of measures that this government has for reducing the health costs to government by cutting funding to health programs around the nation.

I will conclude on this note: there are few things in our country that people care about more than health. Indeed, when you talk to people about what matters most to them, the issues which inevitably come to their minds and which they refer to are health and education—and for good reason. Without having good health systems in place we cannot attend to the health needs of the people who need them. Without good health, life is made very difficult. It is likewise with education—if you have a good education it gives you an opportunity to get on with life. Cutting funds to health and education, I believe, is a retrograde step for any country to do. Indeed, we should be doing the opposite because if we do we will have not only a healthier nation but also a more productive nation. With these comments I repeat that I support the comments of the member for Ballarat. We do not support this legislation and we will be supporting the amendment put forward by the member for Ballarat.

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