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

First of all, I thank the member for Gorton for her very kind remarks, which were probably undeserved, but I'm very grateful. I'll start by saying, if I can be allowed a short preamble, it's often said in my profession that, if you put 100 doctors in a room and ask them how to fix the health system, you'll get 110 answers. I admit my biases, and I have a very personal view of how we can improve our health system.

I've worked in health care in the public hospital system now for over half a century, and I'm in this House as a Labor member because the Labor Party is the party of health care. This was identified very well by my great hero, Gough Whitlam. It's important to understand that he's the one that introduced the original Medibank, the first national health insurance program, designed by Scotton and Deeble, two health economists, in late 1960s. It was done for a reason. It was done because we had an inequitable healthcare system where people who could afford it were getting very good health care, and many people were missing out on health care because they couldn't afford it. It's a little-known fact—but it is a fact—that the most common cause of bankruptcy in Australia prior to the introduction of Medibank was health costs. People were sent to the wall because of the costs they were incurring in providing health care. For me, Labor is the party of health care. I started my private practice, which I ran for 40 years, on the same day that Medicare became operational in Australia, introduced by the Hawke Labor government. I saw patients whose families couldn't afford to see a paediatrician in the past; they'd never seen a paediatrician in spite of the fact they often had significant disability. This was really a sign to me that Labor is the party of health care, and it's continued along those lines.

It's really important to note that, since the start of the first Albanese government, I can hardly remember a question being asked by the opposition about health care in this House at question time. I can't remember one. We have the now shadow Treasurer making comments like our healthcare system being 'a system designed to keep people ill to feed the benefits of the unions and the people that they are paid to represent and to maintain the political control by the Australian Labor Party'. What absolute tripe! This is coming from the shadow Treasurer. Can you believe it? It's just crazy. That is a quote from Hansard. So, too often, I hear those opposite talk about Medicare as if it's a burden, as if it's a thorn in the side of their attempts to privatise and make Americanised our healthcare system. When I hear contributions from the member for Goldstein, I don't hear a defence of Medicare. I don't hear support for one of the best health systems in the world. I don't hear a commitment to strengthening universal access to health care. Instead, what I hear is an ideological position that leans away from collective responsibility and towards an individual burden of health care. The member for Goldstein is always talking about how Medicare is broken and how people should pay their own way. He really has some crazy ideas about health, and I think that's replicated in many other members of the opposition.

This legislation is really important legislation that improves the transparency of our health system. As I've said, I ran a private practice for 40 years. I did have a position where I would bulk-bill people who I felt should be bulk-billed—including all those with healthcare cards, but also many with chronic illness—and privately bill others. The introduction of Medicare meant that the scheduled fee was 100 per cent of the recommended fee, and the Medicare rebate was 85 per cent of that scheduled fee. The 15 per cent gap was not paid by the government for bulk-billed patients, but the rebate was. That was because, by bulk-billing, you remove the cost of privately billing people and sometimes having to chase them for fees afterwards. That used to happen occasionally; we had to make sure that we could follow people for the fees because we didn't charge people upfront. They were allowed to pay the full fee once they received their Medicare cheque, usually in the mail. That 15 per cent gap was supposed to be the cost of having to get the fees from privately billed people.

What has happened over time, of course, is that the gaps got bigger as the rebate didn't increase in line with inflation. But we now have a point where many of the gaps are bigger than the actual scheduled fee, particularly for things like cataract surgery and some subspecialty consultations. They are often opaque; the patients aren't aware of them when they have their first consultation. The gaps can vary from specialist to specialist. Often these are not advertised, can be difficult for patients to find and can be quite a shock when they first see a doctor in consultation—especially with some of the procedural specialists, who charge quite large gap fees.

I'm not going to get into arguments about whether they're too much or too little. The reasons for specialist fees can vary. The costs of specialist practice are quite expensive. The training is now very prolonged. Many people go into medicine after a first degree. Their medical degree is their second degree and their specialist qualifications are often their third degree. The costs of running a practice, including insurance, have increased a lot. Rents have increased a lot. Equipment fees, which some specialists, such as ophthalmologists, require have become more and more expensive. The Medicare rebates haven't kept pace with the actual costs of doing medical business, if I can put it that way.

This bill does increase transparency and it does mean costs will be findable by patients prior to their consultation or hospitalisation. It is really important that people do get that transparency so they can find out how much doctors will charge them and how much they will have to pay out of pocket. It is very important to understand that there are some procedures that we do now that weren't available in the time of the advent of Medicare. Because the rebates don't exactly fit the procedure, sometimes the costs are much higher than for the previous treatments. It is reasonable, though, that specialists make their fees available for patients.

The bill delivers on yet another commitment by the Albanese government—to make health care more accessible for all. When you look at the things that we have already done in a relatively short period of time, they have made health care much more accessible and much more equitable—things like the bulk-billing incentives. In my electorate of Macarthur, over 90 per cent of GP consultations are now bulk-billed, which is a huge turnaround. The 60-day prescribing for common pharmaceuticals has been of tremendous benefit to patients. The maximum fees for pharmaceuticals, including making the maximum fee $25 for non-healthcare cardholders and just over $7 for healthcare cardholders, have made medicines much more accessible. Our increased training positions for nurses and doctors have made health care much more accessible. Our increasing scope of practice for pharmacists, nurses and allied health professionals has made accessibility much better.

There is much more to do; we know that. In rural and regional areas there are huge difficulties in attracting specialists and in getting people access to specialists. In my own field of paediatrics, in some areas of western New South Wales, for example, the waiting times to see a paediatrician are measured in years, not in months or weeks. This is delaying health care for some of the most vulnerable. There is much more for us to do and we are certainly working on it.

We also need to look at more innovative ways of getting specialist opinions for people who live in rural, regional and remote areas. Improvements in telehealth, which have been a real focus of the Minister for Health and Ageing, Mark Butler, have been a really important change in improving access to specialist opinions.

Our women's health packages have been dramatic in improving access to pelvic pain clinics and endometriosis treatments. The scheduling of new treatments for pregnancy control and for endometriosis et cetera has really made a dramatic difference for many women around the country.

This is part of the government's commitment to ongoing improvements in our very equitable health system. We do not want an Americanised system, in spite of what many in the opposition would want. We will deliver on our election commitments but we will also do more. This is a gradual process. We can't fix every issue immediately, but we are gradually working towards improvements in our health system that will make sure it is the best in the world. The introduction and passage of the genetic information bill has been really important, and it's something that the government committed to over a long period of time. It's yet another improvement in our health services.

This bill also looks at how we can make private health insurance more transparent and reduce the ability of private health insurers to change insurance programs and products willy-nilly, to phoenix some products and to continue to make large profits at the expense of people who are paying significant amounts for health insurance. My own personal view is that having three tiers of private health insurance is counterproductive to making sure our hybrid health system continues to work well. I would like to see private health insurance be one product—you either have it or you don't—and to have a community rating of risk through that private health insurance, rather than different levels of insurance, but that is something for another day.

There are many more things we need to do, but this is continuing the progress towards a better and better health system, which Mark Butler and the Albanese government are committed to, and I'm very proud to be part of it. I know that we can—

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