House debates

Wednesday, 11 September 2019


National Health Amendment (Pharmaceutical Benefits) Bill 2019; Second Reading

4:32 pm

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

I am shocked to hear the member for Ryan and the absolute tripe that he talks about health care. Labor invented the PBS under the Chifley government. Labor under Gough Whitlam introduced Medibank, the first universal health scheme in Australia. It was universally applauded, destroyed by the Fraser government and reinvented by the Hawke government as Medicare in 1984. To hear someone from the opposite side promote their view of health above ours is just ridiculous. At the present time, Australians are facing increasing gap costs, increasing waiting times for specialists' visits and huge discrepancies in health care between rural, regional and metropolitan populations, so to hear the member opposite talk such rubbish about health care makes me feel faintly ashamed to be in this place.

I rise today to speak on the National Health Amendment (Pharmaceutical Benefits) Bill 2019 and I've been looking forward to discussing this legislation, as I was in the previous parliament before it was dissolved. So I'm glad that this legislation has been reintroduced. This legislation deals with the supply of medicines, amending part VII of the National Health Act 1953 and making two minor changes. Labor is pleased to support this amendment because it will provide easier access for many Australians who may be put at risk of not being able to get their PBS listed medications if pharmacies fail. That being said, it would be remiss of me not to take this opportunity to school the government on some of their failures in health policy, particularly in relation to the Pharmaceutical Benefits Scheme—but more on that later.

It's been well over a year since the 2018 budget was delivered in this chamber, and yet the first change set forth in this bill implements a measure from that budget. This measure is designed to recover the costs of the pharmacy approvals process. Much like the government's promised infrastructure spend, which occurs in a galaxy far, far away, this is yet another example of the government's figures being out and their ambitions seemingly outstripping their capabilities.

This legislation deals with the costs associated with applications to open and relocate pharmacies. I suspect that this is a topic that we will be dealing with quite a bit over the coming years. I have in fact been contacted by a number of pharmacists that operate or seek to operate within my electorate. They are well versed in their statutory obligations and regulations. I suspect there is a desire for further change in this domain, but plans on this have been curiously lacking from the health minister and those opposite. Applications to open and relocate are assessed by the Australian Community Pharmacy Authority, which then makes recommendations to a delegate of the minister. This bill seeks to recover costs that are associated with this approval process from the applicants themselves. The government's figures estimate that this recovery mechanism will save Australian taxpayers around $3 million per annum.

I referred earlier in my speech to the fact that I'd been looking forward to discussing this bill in the 45th Parliament and the fact that this mechanism was introduced in the 2018 budget and has only now been reintroduced. Members may find it interesting to know that the cost recovery component of this bill had actually been scheduled from 1 July 2019. This did not occur, because of the government's failure to bring forward this legislation for debate in the previous parliament. This is yet another example of the chaos and dysfunction that is at the heart of the coalition government. It is indicative of the fact that they consistently give up on governing and preserve their efforts for badmouthing unions and denigrating Labor. It's no wonder politicians get a bad rap when they see the vacillating and the lack of effort on the part of this government in health care. The delay in action from the government has meant that taxpayers have continued to foot the bill for the pharmacy approvals process for quite a long period of time—almost two years, in fact.

The second change introduced by this bill is an important one, as it deals directly with the supply of medicines to all our constituencies. Specifically, it aims to continue the supply of PBS listed medications in the event of a pharmacy going bankrupt or being passed into external administration. Under this bill, the Secretary of the Department of Health will be given a framework that will allow them to grant and revoke permission to a trustee to supply medicines listed on the Pharmaceutical Benefits Scheme at a location where an approved pharmacist has declared bankruptcy. That is quite important, particularly in rural and regional areas, where pharmacies are facing increasing cost pressures and access pressures and, therefore, are at risk of failing.

I welcome any steps that will seek to improve access to medicines for those who need them. The government says that this will ensure that continuity of access to pharmaceutical benefits is not compromised in the event that a pharmacy is bankrupt, and I'm pleased to support this legislation. However, there are a range of other barriers that the government is well aware of that are preventing Australians from accessing medicines and that are not addressed in this bill.

The first barrier I want to draw upon is affordability. We know that for many Australians access to healthcare services is severely limited, and in some cases health care is simply unaffordable. Recently I saw a child in my clinic at our local hospital with quite severe asthma, whose mother couldn't afford the number of medications that were required to keep this child out of hospital and keep him stable. She was forced to pick and choose between what preventative medications she could buy for him. Consequently, he had chronic symptoms and had had a recent admission to hospital with his severe life-threatening asthma. We know that for many Australians, particularly those that are already financially stressed, affordability of medication is a very big issue.

I've spoken previously about how out-of-pocket gap costs are soaring for patients and the fact that 1.3 million Australians are delaying or avoiding Medicare services each and every year due to costs. That is also true of medications. The government's own figures show that Australians are not filling their prescriptions, because they cannot afford them. The Australian Bureau of Statistics estimates that one in 14 people, or seven per cent of Australians, are delaying or avoiding taking their prescribed medications because of cost. This includes people with coronary vascular disease taking statins or people with hypertension taking antihypertensives. They are really putting their own health at risk because they cannot afford the medications.

In the next few hours I will be speaking in the debate on the Health Insurance Amendment (Bonded Medical Programs Reform) Bill 2019 about the disparity that exists in access to health care across Australia and the fact that life expectancies vary in an almost stepwise fashion from inner city to metropolitan, to outer metropolitan, to rural, regional and isolated Australians. There is almost a stepwise decrease in life expectancy across that continuum. This is something the government has failed to address. We know that in the most disadvantaged areas the rate of people skipping prescriptions, at over 10 per cent, is twice as high as it is in the least disadvantaged areas, at around seven per cent. There's no disputing the fact that the cost of medication is contributing to health inequality in Australia. And we know that health inequality is contributing in a very strong way to financial inequality. I am gravely concerned that we're becoming a society where only the wealthy are afforded access to health care. I think this is a tragedy, and it's something Labor has continued to try to address since the 1940s. Our universal healthcare system is at risk if we continue along this trajectory.

Shockingly, those opposite have sought to make matters worse. Members would do well to remember that the coalition, in their horrific 2014 budget, actually proposed to increase the cost of PBS medicines by up to $5 and sought to increase the threshold for the Medicare safety net. They also talked about a Medicare co-payment, further restricting the poorest Australians' access to health care. This would have been applicable even to pensioners, demonstrating how truly out of touch the coalition are in healthcare matters. It would have resulted in patients being forced to pay an additional $1.3 billion over four years for the medicines they needed. There's no doubt in my mind that this would have resulted in even more Australians forgoing the medications they needed, putting their health care and their own lives at risk. The government sought to attack those who needed health care, taking $1.3 billion from the pockets of patients, many of whom are among the most vulnerable Australians. In stark contrast, the government, in its chaos and dysfunction, was unable to bring forward legislation that would save taxpayers almost $3 million per year. How out of touch can you get!

It was Labor's strong opposition to these out-of-touch proposals that prevented the government from implementing this measure, which would have seen the cost of medicines increase. Their leader may well have changed, but Australians would do well to remember that this Prime Minister and this health minister were part of a cabinet that sought to make medication and health care more expensive for all Australians.

We all know how much the government and the minister love to turn the PBS listings into a theatrical event. They love to boast about how well they're doing and their ability to list on the PBS something that has been recommended by the independent TGA. In reality, the government's own figures paint a very different picture. In Senate estimates, the Department of Health revealed the truth that there are more than 20 drugs that this government will never list on the Pharmaceutical Benefits Scheme because negotiations on pricing with the manufacturers have broken down. The government has been unable to work with the manufacturers of these drugs and appears to have put it into the too-hard basket. That is in spite of the fact that these medications have been strongly recommended for listing on the PBS by independent experts, the Pharmaceuticals Benefits Advisory Committee. As we all know, the committee recommends that medications are listed when they stack up on clinical and cost grounds, so the government should be striving to reach an agreement with the manufacturers, not putting it in the too-hard basket.

The government will say that the fault lies with the manufacturers, that these companies are not sufficiently motivated to list these medications on the PBS at an appropriate price. This is a dismal argument. The process of getting positive recommendations from the PBAC is quite arduous and costly and can take years, and I think the manufacturers have done their bit. The determination for these drugs to be listed is evident through the steps taken by the manufacturers to succeed in obtaining their positive recommendations. The manufacturers want the drugs listed, the experts recommend that they be listed, but the government says no. Why aren't these drugs on the PBS? It is because the government has refused to offer a fair price and is failing to invest in our Pharmaceutical Benefits Scheme, which means that Australians are missing out on these vital medications.

The government are always quick to toot their own horn when it comes to listing medications. It's time they revisited these potential listings. The coalition needs to match Labor's commitment, taken to the last federal election, of an affordable medicines guarantee. The guarantee would have seen a commitment to list all drugs recommended by trusted experts, and the government is in a position not only to match our commitment but to honour it by listing these drugs. I cannot stress this enough: we must be doing more to ensure that all Australians have equitable access to the best quality health care. We need to address the growing disparity that exists in terms of access and affordability, to ensure that we do not wake up one day and realise we have an ineffective healthcare system, similar to the United States, that punishes the poorest and where only the ruling elite and fortunate few are able to access the best 21st century care.

I'm very worried about this. Those opposite seem to think it is some sort of scare campaign; it certainly is not. I know that access to health care in my electorate of Macarthur has become increasingly difficult for those who are the poorest. I still do a clinic in our local hospital. I see those who have struggled to access private care for their children and I see some terrible outcomes for those who are the poorest in our electorate. I welcome any measures that seek to address this, but it seems the government has no plan—no plan to actually look at the increasing gap costs and no plan to look at the increasing inequality in health care—and yet the actual statistics are staring them in the face. The National Party should be ashamed of itself in the way it's allowed health care in the bush to be so poor compared to that in the city. They've done very little to address it, and they need to address it urgently. I cannot say enough that the—


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