Andrew Laming (Bowman, Liberal Party) Share this | Hansard source

What an important debate to be having tonight. I can see a farrago of members from around the country and a battle of Titans between a physician and gastroenterologist, so it will be interesting to see where it lands. As a humble ophthalmologist, I do want to make a few observations, having worked in the professions in the late nineties and subsequently as a bulk billing ophthalmologist prior to coming to this place. Out-of-pocket costs were a massive issue then. I confess to not having looked at this issue for around five or 10 years. I recall it as being around 15 per cent of total costs of being out-of-pocket for Australian health consumers. That was about third in the world, after a couple of European countries. I thought I'd better update that, with this motion before the House, and it is, in fact, 18 now. It's a longstanding and intractable problem for health systems around the world, particularly high-quality ones like Australia that allow a private sector. We often forget the additional dimensionality in health care, which is how quickly you get the care. Something Australia is extremely proud of the speed of access to care, which is better than many countries that can claim lower out-of-pocket costs. A great example of that is the UK, where I'm sure many of us have worked. You simply sit in a queue and wait in the NHS system for months, but you don't pay. Let's remember that out of pockets is a single-dimensional analysis of this problem. We also want highest quality care and timely care, because that's all wrapped up in survival rates, of which Australia is rivalled by many other countries at the highest end. The Netherlands is probably regarded by consumers as the best in the world at the moment. But the point I wanted to make today is that this is not an insignificant issue. I commend the member for bringing it before us.

For Australians, $1,200 a year on average is a lot to be paying. I do want to point out that there's a big spread in those numbers. There's a significant skew towards those that are privately insured, but that doesn't mean it's not a massive issue for low-income people who want to get one consultation and are asked for hundreds of dollars or one MRI and have to find $100. That is extremely difficult for them, and it's a tragedy for me as a member of the profession to say that knowing how to navigate your way through, knowing the right questions to ask a GP or knowing to ask whether there's a slightly cheaper option is something Australians never do with the doctor because they feel they shouldn't bring money into it. The great sadness for me is that some of my colleagues don't do the right thing in finding the most appropriate and cost-effective way to get through some of these issues. They're lumped onto drugs that are way too expensive when there is a cheaper option. They're sent off to just one specialist and they don't realise that, like everything, they need to shop around. But shopping around is something we just instinctively don't do for health care.

I want to also touch on what I think is a very important issue, and that is that the answer to all of this is not managed care and the US model. I think we'd have agreement across the Chamber about that. The 2019 agreement signed between nib and Cigna Corporation in the US is of great concern for me, because what we may see is, instead of those out of pockets ostensibly coming down, they're simply pocketed by someone else. You may well make it cheaper for the patient, but the profits are captured by a corporation, which quite innocently and Orwellianly claims that they deliver choice predictability, affordability and access to quality care through integrated capabilities and connected, personalised solutions that advance the whole personal health system. What are they proposing they're delivering, and what is nib up to? You'd be right as a professional and as a clinician to say, 'If you start just signing up one from my profession and saying, "Will you agree to do the nickel-and-dime cataract operation for $100? We'll send all the work to you, and everyone else is cut out of the system."' You see very quickly this great system that we have starting to break down. My greater concern than just a singular look at out of pockets is the risk that we may well think that US managed care is a solution. So to everyone listening—there are thousands out there listening—go to sendtheeaglehome.com.au. The Americans may well have turned up here in a sweetheart deal with nib, but, for anyone who had that policy, be mindful. Send the eagle home—we can sort this out without arrangements with US managed care companies.

The last observation I'll make—and I hope you'll forgive a slightly political and partisan one—is about those who were here under the former Labor government, the member for Gellibrand formerly being the health minister. I just need you to know: if you're talking about an intractable problem like this, you can only look at the period that the Labor government were in power to see what their solutions were to the problem. There have been considered and concerted attacks on private health rebates, which does obviously and self-evidently raise out of pockets. But more importantly was the idea of Nicola Roxon to press the button and say, 'Let's just halve cataract rebates.' We had the grandma campaign, where we saw the incredible second-round effects of halving a rebate. This was saved by a rear-guard action by the ophthalmologists. Labor's solution at the time to fix the problem was to halve the rebate. I'll tell you what: you might have assumed it was superficially seductive, but in the end all you did was throw out of pockets through the roof. So Labor's record of finding solutions to this problem isn't good. (Time expired)

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