Rowan Holzberger (Forde, Australian Labor Party) | Hansard source

It's probably just a case of statistical probability that I follow the member for Riverina quite often. Potentially it's because the member for Riverina does a lot of speaking, which is something I try to emulate. There are many things that the member for Riverina does that I try and emulate. One is how he manages to create this bipartisan vibe while kicking the absolute guts out of us! I don't know how he does it, but it is something that I definitely want to try and learn.

There are a couple of points to make. When I look at the claim about bulk-billing being higher under the former government, I think that does underline the fact that there was a period, as bulk-billing was beginning to collapse under the former government, that happened to coincide with something called COVID, where the entire nation went and got vaccinated multiple times, and that artificially lifted the bulk-billing rate for that period. So I don't think it's really comparing apples with apples.

Again, I always try and remind people that, while I represent an outer suburban electorate today, I come from a regional town myself. I come from the bush, from Broken Hill. I worked on sheep and cattle stations around Broken Hill—literally out the back of Bourke. My dad met my mum in Mount Isa, and I was born in Brisbane and grew up in Broken Hill, so I'm not sure where that quite places me. I've always actually believed regional Australia should have its own state. The cities could have one state, and regional Australia could have another state—anyway.

I know the challenges that exist for people living in regional areas when it comes to finding medical care. I've got to say that it's not just in the backblocks. Even in the electorate of Forde, I talk to doctors all the time who struggle to find GPs. It is a challenge that I think the outer suburbs share with the regions. But I think the government is beginning to address that. If you look at one number, something like 17,000 doctors have joined the Australian health system over the last two years, the biggest number in a decade at least. I think that will go some way to addressing some of those shortages; 17,000 doctors is a shot in the arm to the health system.

Finally, the member for Riverina talked about the NDIS, kicking the proverbial out of us. I think it would be fair then to say that the problems we were left with through the NDIS and the aged-care system could easily have been dealt with, in the NDIS at least, in 2018 as the still relatively new scheme started to scale up. All the problems that existed then, when it was at a manageable size, could have been addressed much more easily but have to be addressed now, and now the problems are much larger and undoubtedly causing anxiety in the community. I think for the member for Riverina to put those problems at the feet of the government is really rewriting history. Again, it's a skill of his that I would like to learn.

At the heart of this legislation sits a bill and a philosophy that is at the heart of the labour movement—not just the Labor Party but the labour movement as a whole—and that is the realisation that, as much as workers struggle on the shop floor to improve wages and to improve conditions, there are just some things that you cannot achieve on the shop floor. There are some things for which you need the control of this parliament to be able to do. One of those things is to bring in a universal healthcare system. You need control of the government to do that. It is not something you can just achieve through the award or through an EBA. So it is that Medicare sits at the heart of the labour movement.

During my preparation for my contribution tonight I came across an article written in 2019, at the death of Bob Hawke, by ABC journalist Norman Hermant, and I'd like to read out a bit from it. The article was titled, 'Before Bob Hawke's Medicare, a visit to hospital forced many Australians into bankruptcy'. In the article, Norman Hermant wrote:

It was a huge change for Australians—not only from a medical care point of view, but for financial security.

With the death of former Prime Minister Bob Hawke, many are pointing to the introduction of Medicare as one of his signature policy achievements.

Before Medicare, most Australian families had to pay for private insurance to cover their expenses in hospital.

Author and associate professor Jim Gillespie from the University of Sydney said once you were in hospital, the clock was ticking.

"If you earned more than a certain amount of money, you'd have to pay. So, you'd have to have insurance for hospital or you'd have to pay out of your own pocket," he said.

Mr Gillespie said insurance could also run out during a hospital stay.

"Like private health insurance today, if you were on a lower level of it, which most people would've been on, you'd be covered for a certain number of days of hospitalisation. And people tended to stay in hospital much longer then," he said.

This meant when someone needed hospital treatment, often many families quickly faced enormous financial pressure. …

The situation in Australia before Medicare was similar to America today—medical expenses could push families into poverty.

"Hospital and medical expenses were one of the largest reasons for personal and non-business-related bankruptcy before Medicare," Mr Gillespie said.

"After Medicare they actually removed it from the published list of reasons because it fell so low."

The article goes on to say:

Maureen Buckingham was newly married and living in Sydney in the 1980s.

She remembered what it was like when you got sick before Medicare—even if you had private medical insurance.

"There were certainly times when you'd think twice. Do I really need to go to the doctor? Maybe I can struggle through [and] get there on my own," Ms Buckingham said.

Before Medicare, there was no bulk-billing, so the fees for a visit to the doctor had to be paid in full up front.

That changed once Medicare was implemented.

Mrs Buckingham's quote on thinking twice about going to see the doctor is something that all of us in our electorates have faced and heard about from people who told us that they would choose to put food on the table and feed their kids rather than see the doctor.

There's one last quote from this story, which I'll read out in this context. A former adviser, Bill Bowtell—some people in here will remember that he was an adviser to Neil Blewett, the health minister who introduced Medicare—said:

People were going without treatment. They couldn't afford going to doctors. They certainly could not afford expensive procedures in hospitals.

The reason I read that out is because, as I said, Neil Blewett was the health minister who introduced Medicare. There must be something lucky about health ministers from South Australia. There must be something good about health ministers from South Australia. We've got another health minister now, who I think—in all the years that I've been both a participant and an observer in politics, I have never seen one policy have such an immediate and positive impact as the policy to triple the bulk-billing incentive for all Australians. I don't think we have ever seen one policy change the country overnight, like we saw when that policy was introduced last November. In just one night in November last year, the number of bulk-billing practices in Forde doubled. They doubled overnight.

I think the changes to our tax policy, to level the playing field for first home buyers, might also have an instant impact. Perhaps history will record that our Medicare policy has a bit of competition for instant success, but I think that those changes to Medicare in November really have been more successful than the government could have hoped to imagine at this point. There's something about health ministers from South Australia. Maybe they all need to come from South Australia in the future!

I thought the article ended interestingly, because Medicare hasn't always been widely supported by everybody in the community. The article continued:

Despite the advance Medicare brought in terms of access to subsidised medical care, the program was not universally popular.

The Australian Medical Association (AMA), which represents the nations' doctors, was vigorously opposed to the change.

…   …   …   

"Right at the beginning, it was thought that there was an intrusion in the relationship between the doctor and their patient," AMA president Tony Bartone said.

…   …   …

At the time Medicare was introduced in 1984, the AMA was heavily influenced by developments in the United Kingdom, particularly the National Health Service.

"There was a concern … potentially unintended consequences along the NHS-style system, that we know is struggling and continues to struggle, would eventuate," Dr Bartone said.

Over the years, Dr Bartone said the AMA's position on Medicare had gradually shifted.

"Universality of access is a fundamental right and a fundamental equity issue … from that point of view, the AMA welcomes the history and the evolution that has led to today," he said.

However, it was not just the AMA that was bitterly opposed to Medicare. While the AMA has changed its position over the years, we're not so sure that the coalition has.

I'll look back at some of the things that John Howard said when it came to Medicare. He said:

The Government should have taken a knife to the expensive, failed Medicare system.

He also said:

Enormous savings can be achieved by radical changes in this area … Medicare is one of the great failures of the Hawke Government.

I'm not sure that statement from 1987 aged particularly well. He said that it was a cruel hoax and a fraud on the Australian people. He said that he would not stab Medicare in the back but 'would stab Medicare in the stomach'. He called it a total disaster, a nightmare. While the leopard may have tried to hide its spots, we know that it hasn't changed its spots. Even though they gave up, I think some time after the 1993 election, realising that they couldn't do what John Howard said and stab it in the stomach, they went around and tried to stab it in the back.

So we saw, all through the Abbott, Morrison and Turnbull governments, a freeze of the Medicare rebate, which led to a point where, when I was campaigning for Forde the first time, in 2022, I was coming across a trickle of bulk-billing clinics—like all of us in our electorates were—that were no longer able to bulk-bill because that rebate had been frozen for so long that the costs of running a practice had completely overtaken the rebate. The Abbott government had tried to introduce a co-payment in order to kill Medicare, but they couldn't get away with that. Instead, they froze the rebate. So in 2022 we saw what was a trickle of bulk-billing clinics ceasing to bulk-bill become a flood, and bulk-billing just collapsed. It was a crisis in our health system and it was a crisis in our communities, particularly our working-class communities.

The Albanese government—I think this certainly competes for most amazing public policy—methodically approached the issue by tripling the bulk-billing rate for pensioners and kids, immediately stabilising bulk-billing so that practices who were bulk-billing were at least able to maintain that. But then there was that night in November when we were able to actually bring it back to life. So the great Labor project continues. Bulk-billing under Medicare is something which can't just be achieved on the shop floor. But, because it's achieved through the parliament, it is universal, and it is that universality which is sacred to the Labor project and sacred to Medicare. To that end, I commend the bill to the House.

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