Julian Hill (Bruce, Australian Labor Party, Assistant Minister for Citizenship, Customs and Multicultural Affairs) Share this | Hansard source

This bill brings together a number of important strands of the government's ongoing work to improve and reform Australia's healthcare system. It brings together a number of elements that were contained in the bill that was considered by the previous parliament which lapsed in the Senate but which I note had been the subject of a Senate committee report recommending that those important measures be passed. The context is also important because it complements and links to all of the work—and I see the assistant minister for health here—which the government is powering ahead with, delivering on election commitments around cheaper medicines, Medicare urgent care clinics and all of the other reforms in the health system. I commend the member for Moore for his speech. Already in this place he's become a powerful advocate for his community but also has been courageous enough to share many of his own health challenges and highlight in a very personal way the importance of Medicare to everyday Australians. He's a real asset to the parliament.

To summarise the bill, the measures are principally intended to protect the integrity of Medicare, enhance the regulation of therapeutic goods and, importantly, vaping goods under the Therapeutic Goods Act and make minor amendments to ensure the smooth and consistent operation of the tobacco act. I'll just touch firstly on the Medicare integrity measures. These are not made-up. They implement recommendations from the Independent Review of Medicare Integrity and Compliance, known as the Philip review. Medicare and its programs help Australians pay for their health care. It's a world-class system that is rightly the envy of the world. My electorate in south-east Melbourne is home to many new migrants, people new to Australia, and one of the things they marvel at is that, when they become a permanent resident and then a citizen of our country, they get the little green and gold card which gives them access to the doctor, medicines and so on. Most people in the world do not live in a country where they can enjoy the kind of health care we have.

But money doesn't fall from the sky. It's incumbent on the government to make sure every single taxpayer dollar that goes into Medicare is managed properly and managed with integrity. That's important for the sustainability of the scheme. Of course it's important and a focus of the government to make sure every dollar is spent efficiently, effectively, economically and ethically by the public agencies that administer it, but it's also important for public trust because when taxpayers and citizens see rorting of public programs it undermines public trust in these universal programs which Labor governments introduce. Integrity really matters, and it is important that our agencies have the powers they need to support investigations, conduct efficient and timely and effective compliance activities and crack down on any rorting and misuse of the system that they see.

To contrast, we saw under the former government the shocking scandal of robodebt, sending fake debt notices to the most vulnerable Australians with the power of the Commonwealth logo for money they did not owe—absolutely shameful. It was a deliberate budget measure continued under successive ministers. If only they'd put the same amount of effort into pursuing rorting in schemes like the NDIS, which the government is now investing through the Fraud Fusion Taskforce and other measures, to find the crooks and charge and prosecute them.

My dad was a doctor. As I was saying to the assistant minister, I was a great disappointment to the family. I was supposed to be a doctor because he was a doctor and his dad was a doctor and his dad was a doctor—a line of obstetricians, one of them very famous actually. My mum was a nurse, and my uncle had two PhDs in nursing. I not only refused to do medicine, even though I did science and had the marks; I rebelled against my mother by refusing to go to Melbourne University—I went to Monash and studied other things. But I've got great regard, coming from a family immersed in medicine, for the work that doctors do. The vast majority of doctors serve their patients with care and distinction. My dad died when I was young, but Mum used to tell the story that when he'd come home and she'd do the monthly books for his doctor's surgery—it was back in the day where you could be a GP and a specialist obstetrician/gynaecologist—she'd get very frustrated at the end of the month and say, 'You haven't charged all these patients,' and he'd say, 'But they were sick. I had to help them.'

The ethos of care that most people in the medical profession exhibit to their patients is admirable, but the truth is there are also some filthy rich doctors who rort the system—absolutely unacceptable. Those doctors—we have seen the examples—come up rarely, but when they do come up they completely undermine public trust in our Medicare system. It's really important that those doctors are cracked down on with the full force of the law, and these measures to give agencies powers to conduct proper investigations and go after them are absolutely critical; I commend them.

As I said, this is part of the delivery of our ambitious health agenda, and one part of that, as many speakers, both government and opposition, have remarked upon in their own way is the government's measures to make cheaper medicines even cheaper and to reduce the general PBS copayment so that, when the bill passes, Australians will pay a maximum of $25 per script. I'll say that again. The Labor government is delivering on our election commitments to charge a maximum copayment, under the PBS, of $25 a script. The last time the copayment was $25 was in 2004. That's more than 20 years ago. This reduction represents a more than 20 per cent cut to the maximum cost of PBS medicines. Importantly, the bill is drafted so that, for all medicines that pharmacies can currently discount today, they'll be still able to be discounted. There's a specific provision in the bill to protect the availability of discounting, which is so important for competition and to many people who pursue and focus on saving every dollar.

One of the key cost-of-living measures is the reduction in medicine costs. It comes on top of the largest reduction to PBS medicines, which we affected in 2023. These measures will make four out of five PBS medicines cheaper. In my electorate of Bruce, more than $10 million has already been saved by people because of those changes, as at 31 July. As I said, it builds on action we've already taken to deliver important cost-of-living measures through the PBS through cheaper medicines—more free and cheaper medicines sooner, with a 25 per cent reduction in the number of scripts that a concessional patient has to fill out once the safety net kicks in. That was July 2022, and it was one of the first actions the elected Albanese Labor government took. Then, as I said, came the largest cut to the cost of PBS medicines in the history of the PBS, with the maximum cost of a general script falling to $30 from $42.50, where it had risen to under the Liberals, and then came the 60-day prescriptions, saving time and money. There was a little bit of an unhelpful debate. I think it's fair to say some of the pharmacy lobby went a little bit over the top. The sky was going to fall in, and pharmacies were going to close. There were going to be no pharmacies left. I remember them up there, yelling in the gallery and carrying on. Full credit to the health minister for persevering with this important reform.

Again, the former government had the advice. They'd been told, year after year, when they were sitting on the Treasury benches, that this was a reform that they should do for people with chronic health conditions and that there was no reason for them to have to go to the pharmacy every month and pay the prescribing fee when they were going to be on a medication for life. I'll give you an example. Often, when you talk about these things, people think of older Australians who may have more health conditions or be on more medicines or they think of people our age, my age, who may start to develop some health conditions, if they see the doctor regularly enough. But I got a rare phone call from my daughter when we made that change. Well, she calls me quite a bit, but it was rare that I got a call that said, 'Dad, you've done some useful.' I said, 'Oh, what's that, darling?' And she said, 'This 60-day prescribing is going to save me a fortune,' because she had just bought a house and her life revolved around keeping money in the offset account and trying to get me to pay for as many things as possible. That's a fairly predictable modus operandi. I see a bit of camaraderie across the chamber here; it's relatable. It's true. We've all been there, if we've got kids of that age. The point is she has a chronic DVT. She almost died, as I spoke about in the parliament at the time, at her request, to raise awareness of the issue. She got a DVT overseas. We were in Sri Lanka. They fixed her up in ICU, but she has chronic vein damage in her leg and will be a blood thinners for the rest of her life. There is no reason for people who suffer a chronic health condition to have to go to the doctor every 30 days, but, unfortunately, the former government failed to act. To this government's credit and to the health minister's eternal credit, he toughed it out and pushed that reform through, and it's saving hundreds of millions of dollars for Australians every year.

The final thing I'll just note is with respect to the measures in the bill that contribute to tobacco and vaping management. This is a really important amendment with respect to tobacco and vaping. As previous speakers—including, I note, the member for Warringah—rightly observed, it doesn't solve the problem of illegal tobacco or vaping, but it does contribute through the health portfolio to tightening the regulatory environment and taking steps in that direction.

Australia's efforts over generations now to curb smoking rates are world leading. People come from overseas to have a look at the public policy initiatives we put in place, a combination of education and interventions in the younger years and also excise increases over time. The combination of measures that Australia has taken in public education have seen smoking rates consistently decrease for a very long time now and flatline. That's a good thing. It saves lives and it saves untold billions in the health system.

But what we have been seeing in recent years, with the infiltration of organised crime into the illicit tobacco market and, of course, vaping, is deeply concerning, as previous speakers have said, and rightly so—vaping is bad for your health. Of course, people who are chronically addicted to nicotine can see their doctor and receive a prescription. If it's a harm minimisation approach—vaping versus cigarettes—then that might be the right choice for the individual. But the explosion of vaping in the next generation that we have seen and that the government is acting on is deeply concerning not only for the future health of our kids and that generation but also for society because we know that, as people become addicted to nicotine—a highly addictive substance—through vaping, at some point many people then start to transition to smoking cigarettes because, for a lot of people, it's actually cheaper to go and buy illicit tobacco than stick with the vapes. These are all publicly known facts.

There's obviously a lot of work underway. One of the responsibilities I have in the customs portfolio, with the Australian Border Force, is oversighting their fantastic, incredible work to intercept illegal tobacco and vapes at the border. You can think about it like this: there's pre border, there's at border and there's post border. The work that the ABF is doing with international counterparts on shipping and intelligence to improve our ability to detect at the border and disrupt production offshore is going well. We've seen record numbers in seizures of vapes and cigarettes over the last 12 months. Don't hold me to the figure, but I think it was in the order of 2.5 billion cigarette equivalents intercepted at the border through the fantastic work of the ABF. I've visited them in Perth and Melbourne and seen firsthand the work that the team does.

But, of course, as other speakers have observed, there is more to do in the postborder environment, particularly in working with the states and territories on tobacco and vaping. I commend the work of the Illicit Tobacco and E-cigarette Commissioner. It sits in the ABF but works across the whole of the Commonwealth and with all states and territories; there are in the order of 40 separate agencies involved, if you add up the consumer agencies, the health agencies and so on, to disrupt this trade. I commend the work that's underway while acknowledging that there's more to do and commend this bill to the House for making an important contribution to that effort.

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