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

At the beginning, I would just like to say that, in talking about health policy on the Labor side, I stand in the shadow of giants. Some of those giants were Ben Chifley and his government, who introduced in 1949 the PBS, which had been much talked about prior to the legislation being brought into the House—and the Curtin government, who during the war years, certainly recognised the need to help subsidise the cost of medications for all Australians. On the back of that legislation, we have been able to introduce fantastic health policies from then on, including our wonderful immunisation program, which has been the envy of the world. Following the Chifley government, we had many other great Labor leaders. The prime ministerships of Arthur Calwell, Gough Whitlam, Bill Hayden, Bob Hawke, Julia Gillard and Kevin Rudd developed health reforms for all Australians.

My career as a doctor started in 1972 as a medical student, and I well remember the talk of this new policy, Medibank, which actually revolutionised health care for Australians. Up until that point, medical costs had been a leading cause of bankruptcy in Australia. Medibank revolutionised health care in Australia, and I well remember when it came in and what a wonderful change it made for the ordinary Australians who, up until that time, had really struggled with health care. Of course, it was dismantled by the Fraser Liberal government, and then there were several iterations of partially-effective health insurance schemes by conservative governments. It wasn't until the onset of the Hawke-Keating government and the advent of Medicare that we in Australia really developed a universal healthcare policy that enabled all Australians to access fair and reasonable health care. It is important to note that part of that Medicare agreement led to a cooperative arrangement with the states, and also with private health insurance and the private health care industry, that enabled fair access to comprehensive health care for all Australians.

I started my private practice in the week that Medicare first started in Australia, in February 1984. Medicare revolutionised health care for many families in my electorate of Macarthur. I can remember seeing families who had not been able to have access to a paediatrician before because they couldn't afford the cost. It really did revolutionise health care in the electorate of Macarthur.

I am really pleased that my medical colleagues, the member for Lyne, David Gillespie, and the member for Higgins, Katie Allen, were able to speak in support of this bill, the National Health Amendment (Safety Net Thresholds) Bill 2019, and the amendment. But I do think it is a shame that they do not recognise that there has been a change in the last 10 years, and that health care for ordinary Australians is less and less affordable. That is one of the reasons why I'm in parliament.

It's fantastic to hear my very good friend and colleague the member for Dobell, who has worked in the public hospital system for a long time with some of the most disadvantaged members of our community. I know how much she recognises the way that health care in the last few years has really changed in Australia and that we are at great risk now of developing a two-tiered, American-style healthcare system where the poorest in our community get the poorest health care and have the most difficulty accessing it. We are seeing this already in the public hospital system with the collapse of the public hospital outpatient system, with longer and longer waiting lists and more and more difficulty accessing public hospital outpatient clinics for many people, and with greater gap costs for people accessing private practitioners, particularly specialists. The increasing gap costs are making visits to some specialists, such as ophthalmologists, ENT surgeons, cardiologists and neurologists, virtually unaffordable for many Australians. That is not to say that that is true for all Australians. Of course, people who have the financial ability can access specialists very quickly, and, through the private health system, can often access hospital waiting lists very quickly. But in the public hospital system we're seeing increasing gap costs for private consultations, and longer and longer waiting lists for public outpatient clinics. In fact, many hospitals don't have public outpatient clinics. For the paediatric ENT surgeons in my electorate, there is no ENT public outpatient clinic. I know at the Sydney Children's Hospital it's virtually impossible for a child to access a public outpatient clinic, so people are forced to see private practitioners and pay increasing gap costs. It makes it very difficult for the very poorest in our society to access top-notch health care.

I welcome any steps that address issues in affordability and access to health care. This bill in a small way does help people address medication costs. Through this legislation, once a patient reaches the safety net threshold their co-payments are reduced—for people not on concession cards they are reduced from $40.30 to $6.50 and for people on pension cards they are reduced from $6.50 to zero. I certainly welcome this reduction in the safety net thresholds for the PBS, but I must say that the government can and should be doing a great deal more to address the healthcare and medicines affordability crisis that we now know has occurred under their watch.

Don't forget the horrendous 2014 budget. This Prime Minister and members of his cabinet were the ones who wanted to introduce the GP co-payment and they wanted to introduce increased costs for concession card holders when getting medication. That was a horrendous and shameful budget. It really did a lot towards giving the okay for increasing the gap costs for a whole range of medical treatments. It was very shameful.

It really is a sad state of affairs when Australians are forgoing filling their prescriptions because they can't afford them. That's the reality that we are presently faced with. The government's own data confirms that this is happening in Australia in 2019. As more eloquently stated by the member for Isaacs, the shadow Attorney-General, the difficulty in affording medications is worse in the most disadvantaged electorates, so rural, regional and outer metropolitan areas are where these difficulties are occurring. That to me is really a travesty. The universal health insurance scheme that we have in Australia is about trying to make access to health care and medication more affordable for the poorest in our community, because of course the poorest in our community tend to be the sickest. The government are turning their backs on it.

I know that people have good access to health care at the North Shore Hospital, and they would certainly let you know if they didn't. In my electorate in outer metropolitan Sydney it's more difficult for people to access health care. I have on a number of occasions had to ring some of my specialist colleagues and ask them to bulk-bill patients so that they can have access to care. I contacted a neurosurgeon for one lady and a cardiologist for another. For a man who was going blind I contacted an ophthalmologist so that he could have his cataracts done. It's the reverse of what should be the case.

The government denies that there is a problem. I'm pleased to hear that some of the member for Lyne's colleagues who obviously are quite wealthy and live in the United States think that we have a good system, but I can tell you that a lot of people who live in outback New South Wales or even in outer metropolitan Sydney have real difficulty affording prescriptions and have real difficulty affording health care for their children. The government denies that that is the case and pretends that this very small move is going to make a difference to the everyday lives of many Australians.

We know that some of the most disadvantaged and the most vulnerable people in our society are being hit the hardest with health costs and that in the most disadvantaged areas the rate of people who are skipping their prescriptions is twice as high as it is in the least disadvantaged areas. There is no disputing the fact that the cost of medicines is contributing to the growing inequality in health care that we're seeing in Australia. When 10 per cent of patients are skipping their prescriptions in some of the most disadvantaged areas of our society we have a crisis on our hands. I'm not normally a catastrophiser; I'm generally an optimist. I think the majority of Australians do have access to pretty good health care. But we need to face the reality that many of the most disadvantaged are not accessing the quality of 21st-century health care that they should be in Australia. It's time we had a real look at our healthcare systems to see how we could better provide for the most disadvantaged. Many of those opposite do not share the same belief as me, and time and time again they've sought to make it harder for ordinary Australians to access the care that they need.

I have spoken in this chamber on a number of occasions about people being locked out of health care. We see that in public hospital waiting lists. For some of the surgical specialties—ophthalmology, ENT surgery, gastroenterology, endoscopies, et cetera—there are enormous waiting lists. And the waiting lists are worse in outer-metropolitan, rural and regional areas than they are in the inner-city areas. As I said at the beginning of this speech, we are at real risk of developing an American-style, two-tiered health system where those who can afford it have access to the very best of 21st-century care, and those who can't afford it are condemned to very poor health outcomes because they get very poor health care. We've been heading further and further down this path since the coalition government has been in power. Instead of taking the necessary steps to address this, those opposite have actually sought to make matters worse. Once again, it's the 2014 budget that comes to mind, with the increasing gap costs and the increasing out-of-pocket expenses for a whole range of health services. If they'd had their way, this government would have forced Australian patients to pay an extra $1.3 billion over four years to access the medicines they need. Thankfully, Labor's opposition in the parliament prevented those measures from being enacted in 2014 and stopped the government's attack on some of the most vulnerable in our society. We support this bill, the National Health Amendment (Safety Net Thresholds) Bill 2019, and it does reduce some of those costs, but I would stress the fact that the most vulnerable are falling further and further behind in health care.

I just want to say a little bit more about the PBS. The minister is very prone to crowing about his very special abilities to list drugs on the PBS. I know that the PBS for many, many years has been bipartisan. It acts on bipartisan advice. It separates the political arm from the enabling arm of the PBS through the PBAC. That's very important, so that the specialists involved in assessing these medications are able to give evidence-based reasons why they should or should not be listed. We know that there will be an absolute tsunami of new drugs being considered for listing on the PBS in the next few years. We know that because medicine is changing dramatically. It's much more data driven and there's much more technology in developing genetically targeted drugs. For example, there are some very rare diseases that now have genetic treatments that costs in the hundreds of thousands of dollars per year. We're all going to be faced with how to deal with this, no matter who's in power—and that's why the PBS is a very good, bipartisan system. It annoys me to see the minister crowing about his abilities when he's asked about this in question time on the floor of the House. The PBS is bipartisan. I will say that again: the PBS is bipartisan, and the minister should not be trying to politicise the PBS. It is absolutely shameful. Those on the other side who are involved in health care should know that and understand that, and I'm sure they do. I will call the minister out every time he tries to politicise our bipartisan PBS. We support this bill and the amendment, and I thank the House for its indulgence.

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