Andrew Giles (Scullin, Australian Labor Party) Share this | Hansard source

I rise to speak on the Health Insurance Amendment (Safety Net) Bill and in particular in support of the amendment by the shadow minister, the member for Ballarat. I am proud to have been here listening to my colleague the member for Franklin outline exactly why this bill should be rejected and the proposals contained in the amendment should be supported. I am proud to be standing with my Labor colleagues against changes that would adversely affect vulnerable people often at a particularly vulnerable time in their lives. The member for Franklin stressed the main theme here, which is that there may well be a policy case for change but the changes in this bill do not meet that challenge. The evidence has not been brought to bear. The evidence is not before us. This is particularly important in respect of this bill because the provisions contained within it cannot be assessed in isolation from the wider challenges in health care—wider challenges compounded by the attitude of this government through both of its budgets.

This is an opportunity to look at the Labor approach to health and the Labor approach to policy reform more generally. This government has a new Prime Minister who is very keen to talk up reform, but he is very reluctant to talk about what this reform is in aid of. We see this in the tax debate, where mellifluous sentences are strung together and there is much grandiose rhetoric but no real sense of what it is all in aid of—it is reform for reform's sake. Similarly we see 'sustainability' as a weasel word in the government's approach in respect of health—in respect of health generally and specifically in respect of some of the challenges this bill is said to respond to. We hear a lot about sustainability, which is of course code for cuts—cuts being the lazy approach to reform. There is a lot of talk about sustainability but no talk, really, about ensuring appropriate access to health care, much less talk about the real challenge here, which is improving the health and wellbeing of Australians.

I guess this lazy ideological attitude to public policy reform goes to the heart of the debate on this bill. As the member for Franklin very eloquently and effectively set out, we see assertion where we should have evidence—assertion in the place of evidence underpinned by a deep ideological preference for the private over the public. While it is important to acknowledge that there is a policy case to have a rethink about how the safety nets operate, there is much more work to be done if we are to take the government and the Minister for Health at their word on the intention of this legislation. These are issues that are so important to the people I represent. Universal health care is the most significant issue raised with me by my constituents, many of whom signed petitions in response to the various proposals of this government to introduce a GP tax. Universal access to health is of vital importance to the communities I represent and this legislation fundamentally damages that great principle, the foundation stone, of the modern Australian social compact. We should be slow to take government members at their word about this simplification process and in respect of some of the equity arguments that have been advanced in support of the bill. The reasons go to the detail of the bill, but also to its proper context.

We cannot see this legislation in isolation. It has to be considered in respect of this government's overall attitude to health. I talked briefly about the various proposals we saw for a direct GP tax, which has now been replaced by the GP tax by stealth—the rebates freeze, which represents a $2 billion cut to Medicare. And this sits with a $60 billion cut to public hospitals—that is a $60 billion cut, along with deep cuts to vital preventative health programs, along with the abolition of vital agencies such as the Australian National Preventive Health Agency, and along with cuts to public dental programs, cuts to mental health, cuts to Indigenous health, attempts to increase the cost of medicines—I could go on. But we are seeing a systemic attack on universal health care in Australia. This was exemplified by the recent attack by the minister on the principle of community rating; an exemplar of the privatise-at-all-costs, social Darwinist attitudes that underpin the deep policymaking preferences of those opposite.

In essence, we are talking here about cuts to the very notion of universal health care; the preference being—unstated, of course, and unargued for, unfortunately—to privatise health care in Australia. These were not arguments put to the Australian people before the election. In fact, the opposite arguments were put by the former Prime Minister in the Griffith by-election. These are not arguments which are advanced in the context of this debate. But this deep ideological suspicion of Medicare informs so much of the government's attitude. Liberals have been consistent in opposing universal health care in Australia for 40 years. Initially, they were up-front about this: they were up-front about it in the seventies, which saw the dismantling of Medibank; through the eighties, Prime Minister Howard was very up-front about his views on Medicare. Since then, Liberal party members have stopped talking directly about these views, but by their actions they give the lie to their stated commitments to Medicare. They are less honest about their views about Medicare and universal health care now—but, as we have seen over the last two years, this does not change the substance. This does not change the effect—the effect in this place but also, more importantly, the effect on people's lives and the potential effect on health care outcomes, driving us towards an even less equal society.

While all the talk of sustainability fills the rhetoric of government members, let us not forget for a moment that our universal health insurance scheme provides us with healthcare costs that are relatively low by OECD standards, while providing universal coverage. And obviously, there are major contrasts with economies like that of the United States in that regard. There are real fears that this approach to health care could lead to higher healthcare costs, for all the talk of sustainability. And this is not to consider the vital role that our universal healthcare system has in maintaining an effective social wage, in being a vital bulwark against inequality, both in an economic and in a broader wellbeing sense.

Looking at that context, I turn to the bill itself. I note that right across the healthcare sector we see very, very strong opposition and deep concern about the provisions in this bill. Strong comments such as those that have been made by Brian Owler of the AMA should be taken seriously. Of course, no-one here is suggesting that stakeholders should individually drive any reform process. But when concerns are voiced so seriously, they deserve to be taken on board. That has not been done. As well as the AMA, a variety of specialist bodies have also spoken out to express their concern. It may well be that these concerns could be addressed by a proper reform process. I think it is useful to reflect on the 2009 process considered by the former member for Gellibrand, Nicola Roxon, when she was Minister for Health and Ageing, where an evidence case was built in response to a stated problem. Here we have nothing of the sort. And, while simplification is generally a good thing in public policy—and clearly our rebate system and the safety nets that attach to it are complex and difficult to understand—simplification is not an end in and of itself. A single safety net is, I believe, a fine aspiration—but surely it is a means to providing effective access to health care at lower cost, and to health and wellbeing for all Australians, particularly in light of the sorts of circumstances we dealing with here, when individuals are faced with extraordinary, one-off events that can impose great financial pressures at very difficult points in their lives.

Again, let us think about the first principles that underpin this: we are trying to provide that form of insurance and, in doing so, maintain the principles of Medicare and the principles of universal health care which just about everyone in this parliament espouses, at least on paper. And, when we are mindful of these first principles, let us also think about the adverse consequences that we believe could arise from this bill, that have not been adequately dealt with by the minister or government members, maybe unintentionally, but which are adverse nonetheless. We have very serious concerns about these impacts. At a general level, we are concerned about the introduction of restrictions on the out-of-pocket costs that contribute to a person reaching the safety net, and about the reduction of amounts received back after the safety net is reached—noting, of course and only to be fair, the lowering of the safety net threshold. But let us be clear about this: some patients would be reaching the safety net sooner, but that is would be in the overall context of a $270 million cut, which makes it very clear that savings are to be made—that is, the savings claimed by restricting out-of-pocket costs that can accumulate to reaching the safety net and additionally by placing further caps on what is to be covered. There may be good reasons for some of these caps—I am sure there would be—but that case has not been founded in evidence. It is merely something that we are asked to take on trust. That is something we should not do with this minister or with this government.

Going beyond the general to some of the specific areas of concern that were touched on by the shadow minister in her contribution, very effectively and in some detail, and by the member for Franklin before me: we should not treat lightly the impacts on specific cohorts of patients; particularly, as I said earlier, at vulnerable points in their lives. I think about radiation oncology patients, and I think about those accessing psychiatric and IVF services, and I will touch on them briefly. These are important matters that deserve reconsideration by the government, through—ideally—acceptance of the amendment moved by the member for Ballarat, or through the Senate committee process. What we are really talking about here, stripped of the rhetoric, is a cut giving effect to cuts of $270 million to the safety nets through the abolition of the current safety nets and their replacements. These safety nets exist to serve a simple and important principle. It is all very well for the minister in her second reading speech to talk about the problems and the current arrangements, which this legislation is said to attend to. She is right to say:

The current safety nets are complicated and confusing.

But this is not the whole story, quite far from it. The shadow minister, the member for Ballarat, has said that Labor does not say the present arrangements are perfect and nor do we resist reform in this area, especially to improve targeting one of the issues purportedly this bill is to deal with. But we take a considered and respectful approach to this challenge—as we did under former Minister Roxon in 2009, as this government continually refuses to do and as our proposed amendment would provide for.

In the time remaining to me I will touch briefly on the specific areas of concern that I believe warrant a proper response. The member for Franklin ended her speech in touching on the issue of couples and individuals accessing IVF. Again, we need to take very seriously the concerns that have been raised by fertility services providers when they suggest, reasonably at face value, the costs per cycle could more than triple to between $10,000 and $15,000. This is a matter that we should give very serious regard to and think about the circumstances of those people considering IVF and how we should restrict access to that. These are debates that we should have through the front door not through this sort of default system. There have been some serious concerns raised by psychiatrists on the potential impacts on the patients they provide vital support and care for. The commentary of their professional leaders touch on issues like the cohorts of potential patients like the victims of child sexual abuse, which is a matter that is of importance and concern to all of us in the context of the royal commission. I suspect these impacts may be unintended consequences of the legislation but they prove the point. Similarly, radiation oncology patients who were formerly bulk-billed would be very seriously affected and their household budgets stretched—huge stresses and huge strains on people who are at a very, very challenging time in their lives.

In wrapping up, Labor accepts that there is a case for review, there is a case for change, but it should be founded in the evidence, it should be founded in first principles, and it should also be founded in a broader discussion about our approach to health. These provisions cannot be isolated from the broader settings of health policy and the broader decisions of this government, but this bill—through its hasty introduction and lack of consultation—will compound difficulties in the health system rather than alleviate them. The bill should be rejected and the amendment of the member for Ballarat supported.

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