Wednesday, 28 September 2022
National Health Amendment (General Co-payment) Bill 2022; Second Reading
I'll just pick up on some of the remarks of the previous member, welcoming the member for Fisher's comments about the coalition commitment to Medicare. It's not a new thing. It is not a new thing at all. The coalition is very committed to Medicare. One would not have thought so in 2016, of course, and I think that's the problem the previous member is dealing with—the scurrilous campaign the ALP ran that was later termed 'Mediscare', when they said the coalition would get rid of Medicare. We had six years to do so. We did not. We supported Medicare. We increased the funding for Medicare. That kind of dishonest campaigning should be called out every time there is an opportunity, so I take that opportunity to do so.
This proposal is to drop the Medicare co-payment from $42.50 to $30. The coalition put forward during the campaign that we'd reduce it by $10. This is a $12.50 reduction which came soon after from the ALP. I think it is good that they matched it or even upped the ante. Those payments will be coming down at a time when people are under pressure. It's a shame that they will not coming down immediately. There is a wait time before this will hit the market at the end of the year.
Having said that, it shouldn't be forgotten that, in its last year in government, the coalition reduced the threshold for the PBS safety net to around $1.244, off the top of my head, down from $1,400-and-something. That is welcome. That's a very targeted response to the cost of living at the moment. By definition, those constituents that reach that threshold are some of the poorest and most disadvantaged in our community because they are on multiple medications, which means their lifestyle is probably already impeded, and in fact are often on welfare payments as well to fund their living or are at least on a limited and fixed income. So I think that was a very serious move to reduce cost-of-living pressures, and I welcome that. I was very pleased by the fact that we had legislated that before we got to the election.
The PBS is exemplary. The PBS stands alone in the health field as something that actually delivers an efficient, expanding service. Importantly, it keeps costs under control. The member for Fisher went through the increased spending that the coalition had afforded to health and aged care during the period in which we were in government. It was a little more than double, from $75 billion to $132 billion. That was a 100 per cent increase. When you look at the PBS, in 2012 it was operating at about $9.5 billion a year. It is now at $13 billion. So we have seen a roughly 30 per cent increase in the PBS over the same period that the rest of the system has had a 100 per cent increase.
In that time, we have been able to deliver a plethora of new medications to an expanding population. While I know a lot of the drug companies don't particularly love our PBS, I think it places itself in the marketplace around the world quite uniquely in that it enables us to get great value for dollar but is not so punitive on the manufacturers and marketers that they don't still seek to sell their newly developed drugs in our market. I sometimes shake my head in wonder at what has been able to be achieved with the PBS when I look at the ballooning costs not only in the health sector but across a whole range of other government expenditures.
One of the things is making those new drugs available in Australia. The approval process through the TGA has improved over the years. There is a great effort to make sure that Australians get the very best. It's not only in the drug field. There are associated things that the taxpayer contributes to which allow people to live there lives to the fullest.
Greg Hunt had a fabulous record while he was the health minister. In fact, we approved 2,800 new and, at times, incredibly expensive new drugs to the PBS, all the while keeping the lid on those PBS costs. Keeping the pressure on the drug companies is not the only way of keeping the lid on PBS costs. Some expiry of patents has contributed greatly. Blood pressure tablets and cholesterol tablets, for instance, are ones that Australians are very large consumers of and for good reason. They keep Australians alive longer. They keep them fitter and healthier.
But, of course, some of those very significant patents of the past have expired now, and we now have the listing of generic drugs on the PBS that are equivalent. Most of the original drugs remain on the PBS and are marketed into our market, but the manufacturers have had to reduce costs. They've had that period of protection that is afforded to them for the great cost that they commit to in developing these new drugs, doing the testing associated with them and bringing them to market, and it's right and proper; that's what a patent system works around. But as those patents expire it's also very important that the PBS then goes out to find the alternative suppliers, puts the pressure on the original suppliers and brings down the cost to the public.
I remember—in fact, you might remember, Deputy Speaker Freelander; I think you were in the place of the time—when we had a fairly strong debate in this place about the delisting of Panadol Osteo. I'm a little scratchy on the numbers, but at the time you could buy Panadol Osteo at the pharmacy for, let's say, $40. Actually, I think it was more than the cost of a Medicare bulk-bill rate. Or you could go to the doctor, get it prescribed from the doctor and pay $42.50. Let's say it was $60 at the pharmacy. You go to the doctor, pay $42.50 and get the Panadol as prescribed. In fact, by the time there was a pharmacy dispensing account and a whole lot of things that hung off the doctors' bills, it was quite expensive for the taxpayer, and there was a cry: 'If you take this off, we will not be able to afford Panadol Osteo.' Within a matter of months, if not weeks, the price of Panadol Osteo over the counter at the chemist dropped to the equivalent of Panadol Rapid.
It just shows that, while it is very important that the PBS is in place when it should be in place, there are times when it actually distorts the market and it should be out of the market. That's not 100 per cent relevant to what we are talking about with this bill, of course, but it does come back to this theme that I have been talking about, where the PBAC over a very long period of time and subsequent governments—apart from one time that I will come to in a little while—have managed the PBS in a very good way for Australia, providing maximum benefit to Australians across the board for minimal cost, about as good as you can get around the world. Anyone associated with that I give a pat on the back.
The coalition, of course, as I said, committed to a $10 reduction, and now we've got $12.50. I was going to say a bit more about Greg Hunt and the other associated things that actually came not through Medicare but through the health budget to assist people to live their life to the fullest. As you well know, Mr Deputy Speaker, I'm the co-chair of the parliamentary enemies of diabetes, and in fact the constant glucose monitors, set to be listed universally by the government before the last election, were matched by the then opposition and now the government, and it was a great move forward and something we campaigned for over many years. In the period before that, we had gradually campaigned to extend those constant glucose monitors.
I have told this story in the House on a number of occasions. I was at a function, the Port Pirie Smelters Picnic, in my electorate, and a young couple came up to me. From memory, I think they had a two-month-old baby who had gestational diabetes and was on a constant glucose monitor at the behest of the hospital but had to give it back and did not qualify for the constant glucose monitors under the current rules. I went and saw Minister Hunt at the time, and after speaking to him for five minutes he said, 'That's not good enough.' Virtually with the stroke of a pen, 30 similar families around Australia had that problem fixed. That was good, responsive government. That was a minister listening, being in touch and knowing what's achievable. It was a great outcome. I thank him still and that family thanks him still for that outcome. Of course, now it's universal, so we don't have to argue about such things, but it's a progressive step. The point is that the PBS isn't the only scheme in place to assist Australians to achieve their life potential.
One of the things we remember of course is that it has been the custom of health ministers to sign off on the PBAC recommendations. In the last 50 years I think there has only been one period when that did not occur: in 2011 the then Labor government put a freeze on listings due to budgetary constraints. Our budget is in pretty tough shape at the moment. We're heading into an October budget and I haven't heard any murmurs from the other side that there's any likelihood of being a move to stop listing new drugs on the PBS, but I absolutely say to the government: don't. Don't go down that pathway again. It hasn't been the pathway followed by the previous government and it's not one that should be followed by you.
When people come to tell me about advances in the health system they say that they'll save lives and will save money. It's one of the great paradoxes of our modern health system that the more lives we save the more it costs! I'm a living example of that as I stand here. I had life-threatening cancer just on nine years ago. I was saved by some very clever surgeons and a whole heap of radiation, which a lot of people don't seem to like either—I have some arguments about the location of the low-level radioactive waste management facility in my home community. But I was saved by the miracles of modern science. Since that time I've had a shoulder reconstruction and I've just had a partial knee replacement. Those wouldn't have cost the taxpayer anything if I had succumbed to the first ailment! Now, the point being there is that our modern medical system is saving people—absolutely—and getting them into useful lives. But we're all there for more complicated challenges later in our lives, and that's why these health budgets keep ballooning out rather than actually coming in when we think we're making all these particular advances.
I don't know that that adds anything particular to this debate; it is what it is. I'm not suggesting by any means that any of this should be curtailed. I'd like to think that my survival through that ailment, and the facts that I do pay the Medicare levy, invest in private health cover and am a significant taxpayer, would say that I hope I can square the ledger! But it is the case that the more things we combat things the more it will cost us, and this is something that government has to consider in the long term. It's one of the reasons that the health budget keeps growing at a faster rate than inflation or other indicators—the CPI, for instance—in our society. It's something that governments always have to be aware of: the increasing share that it's taking of the GDP or the government tax take. How we manage that, I think, is a challenge for both sides of this House, for the whole parliament, and not just now; not today or not tomorrow but over the next 10 to 50 years this will be an increasing challenge.
I have come roughly to the conclusion of my time, so I will leave the debate there. I look forward to these changes coming. I wish they were coming faster because, even today, we know that fuel is going to go up 22c tonight. So it would be good if we had this coming down the pipeline a bit quicker, but I think we've got to wait until January.