House debates

Wednesday, 16 July 2014


National Health Amendment (Pharmaceutical Benefits) Bill 2014; Second Reading

3:16 pm

Photo of Andrew GilesAndrew Giles (Scullin, Australian Labor Party) Share this | | Hansard source

These changes would have a real impact on people's lives. I think, again, about unfilled prescriptions on top of the impact of doctors visits deferred or cancelled due to the impacts of the GP tax. I note the COAG Reform Council report that was released in early June of this year which found that 8.5 per cent of people in 2012-13 delayed or did not fill their prescription due to cost. In disadvantaged areas, such as some areas within the Scullin electorate, the figure goes up to 12.4 per cent and for Indigenous people it goes up to 36.4 per cent—over a third. The last time the Liberal government, the Howard government, increased the tax on medicines in 2005—by 21 per cent at that time—filled prescriptions for some essential medicines fell by as much as 11 per cent. That is what we are looking at—a real impact on ordinary people's health and a real impact on the health of the most vulnerable in our community.

These changes are, of course, part of an ideological campaign to get rid of Australia's universal healthcare scheme and create a two-tiered user pays system. I think of the minister's contribution in question time yesterday, which was very revealing in many respects but particularly when he spoke of bulk-billing as a safety net, fundamentally misunderstanding the universality of our present system which is so important to Australia's social compact.

Astonishingly, the changes which are before us go beyond the recommendations of the Commission of Audit. The changes that are proposed and that we are discussing in relation to the concessional co-payment go beyond that wish list of the IPA and the Business Council of Australia. That is just staggering even for a government so blindly ideological as this one. It is not only that the language of the Commission of Audit informed the budget; its recommendations have been found wanting by some of the ideologues opposite.

These price increases come off the back of cuts of $80 billion to Australia's public hospitals and schools, the GP tax and hundreds of millions of dollars being cut from preventative health, dental health and Australia's health workforce, including the nurses we spoke of yesterday who are of no interest, it appears, to members opposite and particularly the minister. So Labor does not support the changes contained in the legislation before us. That is true as the legislation sits, but it is particularly so in the context of the broader changes and impositions this government is putting on the Australian community—the taxes for visits to the doctor, the taxes on pathology and medical imaging visits and fundamentally the derisive attitude to preventative medicine, which should be at the core of our health agenda.

Since the budget, I am sure most of my colleagues and, indeed, some members opposite have been inundated with correspondence from constituents who are deeply frightened about what this budget will do to them and their families. Of all the issues that constituents raise with me, health is at the forefront of their concerns. The Scullin electorate has the highest bulk-billing rate in Victoria, and I am very proud of that fact. It shows the great work that is being done by a range of local doctors, Medicare Locals and others in the community to ensure that people have access to effective primary health care. People have an assured acknowledge and lived experience of universal health care. It means that when they get sick they do not have to worry about going bankrupt to get treatment such as in the US and in the fantasies of some members opposite and the IPA. Older constituents tell me they remember the time before Medicare. They remember the pain and the fear of being told they did not have enough money to get treatment that they, their children or other family members needed. Yet this is the vision those opposite are taking us back to. This is why the response in Scullin and across Australia has been literally overwhelming. So much for sustainability. Our health system is something I am proud of. I am proud to support it and to reject this legislation.

Photo of Mrs Bronwyn BishopMrs Bronwyn Bishop (Speaker) Share this | | Hansard source

I call the honourable member for Chisholm.

3:20 pm

Photo of Ms Anna BurkeMs Anna Burke (Chisholm, Australian Labor Party) Share this | | Hansard source

Thank you, Deputy Speaker, but I will point out—

Photo of Ms Anna BurkeMs Anna Burke (Chisholm, Australian Labor Party) Share this | | Hansard source

My apologies, Madam Speaker. I was actually going to point out—and this is why I was stumbling over my words—that 'the Hon.' does not attach to former Speakers unless you go to the Governor-in-Council, so it is never attached to me. Whether that makes me honourable or not, I am not sure!

Photo of Mrs Bronwyn BishopMrs Bronwyn Bishop (Speaker) Share this | | Hansard source

All members in the House are honourable!

Photo of Ms Anna BurkeMs Anna Burke (Chisholm, Australian Labor Party) Share this | | Hansard source

Thank you, Madam Speaker. I rise to speak against the National Health Amendment (Pharmaceutical Benefits) Bill 2014. This is a grossly unfair piece of legislation that is being forced upon the Australian public and it will hurt the most vulnerable. Labor will oppose this $1.3 billion tax grab on medicines, because it will hurt. We will see, if this goes through, that it will not create an increase in the tax base. It will actually decrease the tax base because pushing people away from going to the doctor and away from fulfilling their necessary scripts will put them back into the health system. To see this anyone need only to look at research that has been done over many years, particularly in the United States on their health system where they, bizarrely, spend more per capita on everybody's health but everybody gets a lesser benefit because it is at the emergency end. We have such a sustainable and great system because we provide the services at the front end, at the primary care end, because it is affordable to go to the doctor and it is affordable to get your scripts filled. This bill will see an increase in the pharmaceutical benefit co-payment for general patients go up by $5 to $42.70, and for concession card holders it will go up by $0.80 to $6.90.

The Prime Minister has again said today that the $7 co-payment they are proposing for GPs is reasonable. It is not a big impost. Try telling that to people on full pensions and to disability pensioners, who are already struggling to make ends meet. Try telling that to the many self-funded retirees in my electorate who are living on a part pension and rely on the Health Care Card to ensure that they have sustainable health care. That is what they rely on.

I can speak from the personal experience I have with my mother, who absolutely rattles with the amount of medication she takes. One is a cancer drug. Luckily, it is not for cancer, but it is for a very serious blood disorder she has. It is a very expensive cancer drug and if she does not take it she will die. I know she does not want to make the choice between the diabetes pill or the arthritis pill—I cannot even name the number of mediations my mother is on. Every time we have ended up in an emergency department—and, sadly, I have done that on occasion with her, and prior to my father's passing I did it with him—I have had to rattle off the number of medicines they were both on. It is quite frightening. For them, an increase in the amount would actually be a huge impost for them. Both of them had a bit of super—not a lot—and they live on part pensions. They live within their means. Any change, any slight change, to their cost of living by increasing the cost of a script will have a detrimental impact upon their existence and their way of life.

Time and again we have heard that the COAG Reform Council report released in early June found that in 2012-13, due to costs, 8.5 per cent of people delayed or did not fill their prescriptions. In disadvantaged areas this figure is 12.4 per cent, and for Indigenous people it is a staggering 36.4 per cent. Again, this legislation will hurt the most disadvantaged. So much for a budget that was sharing the pain. This is not sharing; this is inflicting pain.

Look at what happened the last time a Liberal government increased the tax on prescriptions for some essential medicines. It was in 2005. We are not talking about something that is not essential. We are talking about blood pressure tablets, cholesterol tablets, diabetes medication and so on. Prescriptions for these medications fell as much as 11 per cent.

Today in question time the Leader of the Opposition sought to table a petition from 3,000 doctors concerning this. It was not some union group. My you, I do not see why we demonise union groups. It was from GPs and specialists, who are already seeing their patients raise concerns in this area. One story within the petition talked about the patient who arrived at the doctors and went to the reception and said, 'Is the $7 co-payment already in?' The receptionist said, 'No, it has not come in.' The patient said, 'That is good, because I think I need to see the doctor as a I have a slight headache.' Sure enough the patient went in and their blood pressure was over the roof and they had to call the ambulance. The individual collapsed and was raced off to hospital for emergency surgery. Just imagine if the receptionist had said, 'Sorry, mate, the $7 is in.' The patient would have said 'I cannot afford that,' and gone home, where they would have probably passed away. This is the sort of system the government is trying to force upon Australians. It is unfair and it is unnecessary.

The co-payment in the Pharmaceutical Benefits Scheme in some ways is more insidious than the doctor's payment, because most people actually are not aware it is out there yet. But they will when they go to get their scripts filled. They will be standing at the pharmacy saying, 'Which script do I fill. Which one is more important to keep me going.' In my electorate, which has a higher proportion of people over the age of 65, this is a grave concern. They wait to reach the mark before they get their scripts. Most of them, like my mother, do it in three months, when they have got to the max and all their scripts are free. The government is proposing to increase that rate, as well. This again will be a huge impost on many people in my electorate.

My GP recently told me a tale, which the pharmacists backed up, of a young couple who arrived with a very ill baby. They were given two scripts. One was an antibiotic and one was a pain reliever for the poor child. They went to the pharmacy and said, 'Which one is the antibiotic. Just fill that one.' Mind you, the doctor had explained that the child needed both, because for the antibiotic to kick in the pain needed to be reduced so that the system would understand that the antibiotic was there to help. Those choices are genuine, and we should not be forcing them upon the public.

The ridiculous thing is that the PBS is actually growing in a sustainable manner—it actually has not blown out—because of some significant measures the Labor government took during the last parliament. We introduced price disclosure reform. At the time, the now minister and then shadow health minister, Peter Dutton, railed against these reforms requiring disclosure on pricing. He argued how it was unfair and that these drugs were coming off the list. No they were not. We were actually saying to the producers to charge appropriately for the drugs that were being dispensed. The changes in generic drugs meant that there were now many drugs that were past the stage of being listed and could now come down in price. It is just a simple matter of saying to the companies to charge an appropriate rate for the drugs they are selling and the Australian taxpayer is funding.

At the moment the government spends about $9 billion a year on the PBS. With accelerated price disclosure the real rate of growth in the PBS is on a sustainable footing. So this budget measure is not about actually creating sustainability. That is already there in the mechanism.

We need to ensure that this is a genuine reform. That is why we are opposing it—because it is not a genuine reform. The money raised will not actually go back into sustaining the PBS or Medicare. It will go into a medical research fund. So those people who are chronically ill now are going to pay for their diseases to be cured in the future. I just do not see why the sick have to pay for medical research. Surely that is a requirement of government. Many people have contacted me expressing concern about the changes to both the Medicare co-payment and the PBS. Most of them write not on their own behalf but on behalf of concerns for others. Tammy writes:

I am horrified by the Lib Gov proposal to introduce fees for GP visits which I understand to be in place of bulk billing. I don't rely on bulk billing and am fortunate to not have to. I am writing to ask that you do what you can to resist this change - parents less fortunate than I should not have to choose between taking their children to the doctor and other expenses.

Robin writes to me:

l am sure you would agree this is a nasty tax; nothing for the rich, a burden for the poor. Yet Hockey promotes it as right and proper for the rich to pay; no mention of the burden on the poor.

This is the essence of what is coming through from my electorate. People are very concerned—not for themselves, not for their hip-pocket nerve but for those less fortunate than themselves.

We do not just need to rely upon Labor members to speak against this proposal. A recent study was conducted by the Family Medicine Research Centre at the Sydney School of Public Health, relying on data from the Bettering the Evaluation and Care of Health Program, which is a continuous national study of general practice activity. The researchers say they have been conservative in their assumptions. They found that the government's proposed Medicare co-payment and its increase in the Pharmaceutical Benefits Scheme threshold will send a bigger than anticipated price signal. I quote from an article in this regard by Michelle Grattan:

If both policies were introduced, the average annual extra cost to a patient, which increases with age, would be A$36 for children up to $122 for people 65 and older.

A young family of four would expect to pay $170 in co-payments for GP visits and tests, plus $14 for medications — $184 more annually.

That is a huge impost on the family budget. The article further states:

A self-funded retired couple without Commonwealth concession cards could expect to be up for an average of $189 in co-payments for GP visits and tests, plus $55 for medications — totalling $244 more.

An age pensioner couple with concession cards would pay an average $140 in co-payments for GP visits and tests plus $59 for medications — $199 extra.

The research comes as the Medicare co-payment faces defeat in the Senate …

…      …   …

They found that more than one-quarter of adult GP consultations involved at least one test, which would make for a minimum out-of-pocket cost for the consultation of $14 in co-payments. About 3% of adult GP consultations involved imaging and pathology — making for a minimum $21 in co-payments.

All of this adds up. The article continues:

Different people use health services at different rates, with the average number of GP visits made by the Australian population who visited a GP in 2012-13 being 6.6. The rate increases substantially with age, from an average of 4.5 for children to 10.5 for people 65 and over. …

"Therefore, the introduction of co-payments will not have an equal impact across the population. It is the high users, usually the older, sicker people in our community who will be the most affected," the report said.

…      …   …

"Compared with other OECD countries, Australia already has one of the highest levels of out-of-pocket health costs. Through introduction of the co-payments the government aims to 'ensure health services are sustainable and used efficiently'.

But this is not the case. It continues:

However there is no evidence that any modelling was performed to assess the effect of co-payments on deterring people from seeing a GP, or the flow on effect on hospital emergency department attendances."

In 2012-13, 5.8% of people delayed or did not see a GP because of cost, and this was a greater barrier for those from disadvantaged areas.

"Discouraging people from using primary care health services flies in the face of all international evidence.

"It is likely that the increased costs due to these policies would deter more people from seeking early treatment or from taking necessary medications. This is a concern when areas in Australia already have 13% of their population delaying or not seeing a GP due to cost, and 15% doing the same for prescriptions.

Why take an axe to the area that saves the budget the most money: primary health care? Why put an impost here? Study after study shows this, as the article states:

"Overseas studies have shown that there is little evidence of health care cost reduction from introducing co-payments. The evidence suggests that long term health costs will be higher due to patients deferring necessary care, resulting in increased hospitalisation and progression of disease," the study said.

"International evidence overwhelmingly suggests that the most efficient, effective and equitable health systems have a strong primary care focus.

"We believe that if Australia is to maintain an efficient and equitable health care system, general practice requires investment, not reductions."

The researchers are saying this; it is not out of the mouths of the ALP.

More and more studies go on to find that the overwhelming issue will be that more people will choose not to go and see a doctor and more people will choose not to get their medicines. This will put costs onto the health system; it will not reduce costs. This is a callous measure that does not achieve the aim it is seeking. Why are we impacting the most vulnerable to bandaid a budget emergency that is not happening? Why are we doing this to the people in our community who can least afford it? Many people in my community already pay, as I do, a co-payment to see their doctor. Many people in my community will not feel the pain, but many well. Certainly those in the older age bracket will make the choice of seeing the doctor and getting their script filled or not doing that. That is not a choice that an Australian should have to make.

3:35 pm

Photo of Laurie FergusonLaurie Ferguson (Werriwa, Australian Labor Party) Share this | | Hansard source

It might be said that this budget has many facets that have attracted criticism from the general public and from the media. An instance of that was the presentation in this parliament today of a petition by thousands of Australian doctors concerned about what the Prime Minister, on his high income, believes is just a modest co-payment to visit a doctor. There have been major assaults on the living standards of pensioners through the indexation change. Family payments have been severely cut. This measure is also of deep concern. It requires a higher co-payment by the general public and it increases the safety net threshold each year.

It has been argued that this is all about making sure that our Pharmaceutical Benefits Scheme does adhere to the long-term aims of timely access, quality, safety, efficiency, efficacy, quality use of medicines et cetera. However, I would argue that it is not driven by those facts. It is driven more by an ideological determination by this government to shift the cost of the system to the average person in this country. Obviously, in the end that means those people whose health situation means that they are more likely to have these prescriptions and are more likely to visit doctors.

The real factors driving the cost of our health system are not the visits by people to doctors or the use of pharmaceuticals that are subsidised by the Australian taxpayer. The reality is that other facets of the system are driving that cost—a tripling of the population between 1973 and 2013, or the increase in the population aged over 65 years of age to 3.3 million. The wider use of far more costly technologies has some relationship not only to medical research and drives by the pharmaceutical sector but also to the consequences of the ageing of the population. It is not a surprise that the health system's costs are going to rise. It is not a phenomenon that in any way is found only in Australia. It is not something that is identified only with a system that has a first-world pharmaceutical benefits scheme. It is a reality that is consequent upon factors such as those I just mentioned.

The government's invented emergency should be seen in the context of international comparison. The last OECD figures I have come across gave figures for health care as a percentage of GDP amongst OECD countries, in document 2010/09/028. At that stage, health care as a percentage of Australia's GDP was at 8.7 per cent. That compared with Canada at 10.1 per cent; France at 11 per cent; the United States at 16 per cent and Sweden at 9.1 per cent. Our rate is lower. That is who we should compare ourselves with—first-world developed nations. I know this government likes to compare our debt levels with those of Swaziland, Lesotho, Chad, Niger et cetera, but I think the comparisons this country should make are with these first-world countries. Another interesting statistic is that in the much-vaunted US system that the government would like to go towards—which is such a disaster and which American presidents from Theodore Roosevelt onwards have tried to change more to what Australia now has—the percentage of government revenue spent on health care as a percentage of the overall cost is 18.5 per cent. In Australia it is 17.7 per cent.

We have a situation where that much-loved Canadian administration of Mr Harper still has a pharmaceutical benefits scheme that is so attractive that $1 billion a year is spent by Americans crossing the border to utilise Canadian pharmaceuticals. The Prime Minister is at pains to associate with the Canadian Prime Minister—who of course gained a mere 38 per cent at the last Canadian election—on matters such as Tamils and human rights, but in regard to health care he is very significantly out of tune with Canadian practice.

This is an extremely serious measure. In 2012-13, 197 pharmaceuticals were subsidised by the PBS at a cost of $8.8 billion. It is a very serious matter, particularly for those people who are going to be impacted upon by these changes. I note that this is not the first time that a government of the other stripe has ventured in this direction. The Howard government was guilty from January 2005 of a 21 per cent increase. It had an outcome. It had a result. It had something they desired—an 11 per cent reduction in people filling and utilising their prescriptions.

Whilst those opposite might congratulate themselves on this change, significant players in the health sector are extremely critical of the change. The Consumers Health Forum of Australia has made the following comments:

As highlighted by CHF’s 2013-14 Federal Budget Submission, rising expenses for both government and individuals have underlined the need for new approaches to pay for healthcare that will result in more effective, targeted treatment, and reduced out-of-pocket costs.

The CHF is also disappointed in the failure of the budget in critical areas such as rising out-of-pocket costs. It went on to say:

Costs present a considerable barrier to access to health services for some consumers as the COAG Reform Council’s recent report showed with findings that the proportion of people who delayed or did not see a GP due to cost has increased—

that is, the people who are actually affected by this—

from 6.4 percent in 2009–10 to 8.7 percent in 2010–11, along with other evidence of financial barriers in access to specialists, dentists, prescriptions and diagnostic tests.

These barriers are greater for consumers from lower socioeconomic groups—

such as in the electorate of Werriwa, which I represent—

Australia is also comparing increasingly poorly internationally.

That is the comment of the Consumers Health Forum. It went on to say:

Delaying or reducing access to treatment will not only have implications for individual consumers. There could be major long-term budget implications, particularly if a person’s health deteriorates and they need to access care in the acute system.

It went on to attack both this and the doctors co-payment.

The Family Medicine Research Centre at the Sydney School of Public Health at the University of Sydney has also been extremely critical, making the point that in assessing the impacts it took 'a conservative approach'. It noted:

It is the high users, usually the older, sicker people in our community who will be most affected.

…   …   

There is sufficient evidence that the introduction of a co-payment will change patterns of health service use, and that there will be different impacts for different patient groups.

That is in regard to another aspect of this government's budget. It went on to say:

The average annual additional cost increases with age from $36.27 for children to $122.17 for patients aged 65+.

It also said:

Overall, there is little difference in the average additional amount that general and concessional patients would have to pay over a year … The only real difference would be among patients aged 65 years or more — as concessional patients would have their co-payments for services capped at $70, while general patients would not.

Once again, an organisation that is actually interested in the impacts on consumers and in the people who will suffer the outcome of this is highly critical. They went on to say:

It is likely that the increased costs due to these policies would deter more people from seeking early treatment or from taking necessary medications. This is a concern when areas in Australia already have 13% of their population delaying or not seeing a GP due to cost, and 15% doing the same for prescriptions.

Overseas studies have shown that there is little evidence of health care care cost reduction from introducing co-payments. The evidence suggests that long term health costs will be higher due to patients deferring necessary care, resulting in increased hospitalisation and progression of disease.

They concluded:

… these proposed policies will create a larger price signal than that suggested in the media to date.

In other words, they are saying that it is going to be far worse than what has been estimated in the general public.

In the document from the Australian Bureau of Statistics Australian social trends, March 2011still applicable today—there was comment from the ABS that many people report they are unable to access the care they require because of financial considerations. They noted that almost one in 10 delayed getting or did not get prescribed medication because of the cost. That is nine per cent, or about one million people. Additionally, they noted, more than twice the proportion of people in the most disadvantaged areas found cost a barrier to receiving prescribed medication compared with those in the least disadvantaged areas—12 per cent and 5.4 per cent respectively. We know every medical survey in this country and overseas indicates a correlation between poor health and serious illnesses in poorer socioeconomic areas, and here we have a situation where the same international and Australian statistics indicate there is going to be a tendency of people not to fill these scripts when changes such as this are made.

The Australian Institute of Health and Welfare noted:

In general, the higher people's incomes and education, the healthier they are—a phenomenon often termed the 'social gradient of health'.

People living in areas of low SES are also more likely to place themselves at risk of lifetime harm from alcohol than those in high-SES areas. There are a variety of indicators of that.

So we have a situation where there is a correlation between people's low income levels, other indicators, health problems and a situation where they in turn are less inclined to go to doctors when there is a co-payment and less inclined to take the medications necessary. This is a severe attack on the health rights of Australians. It is covered by a supposed crisis in the budget which did not stop the government reducing revenue by the abolition of the mining tax and which did not stop the government increasing massively payments to wealthy Australians for parental leave and other measures which have worsened the budget. It should not be the case that people in southwest Sydney, whether in Macarthur, Fowler or Werriwa, are the people who are the victims of these changes. This medication is life threatening in a situation where people have other huge pressures on themselves and are now being forced by a government which at the same time brings in not only co-payments but also measures to make it financially advantageous for doctors to end bulk-billing.

This is a government which is not driven by an attempt to preserve the Pharmaceutical Benefits Scheme system, which is, admittedly, historically world renowned; it is a government that is bent upon basically moving the costs of the system from the overall taxpaying public to the people who are using the service most often. As has been indicated by every indicator, they are predominantly those of the aged population in this country—the same people being hit very hard in other parts of this budget.

3:48 pm

Photo of Graham PerrettGraham Perrett (Moreton, Australian Labor Party) Share this | | Hansard source

I rise to speak on the National Health Amendment (Pharmaceutical Benefits) Bill 2014 and state up-front that I am proud to be a part of the party that will oppose this $1.3 billion tax increase on medicines. Why? Because it will hurt Australians. It will hurt almost every Australian, and I guess it is important that we see it through the prism of that horrible budget visited on the Australian people back in May—a budget that seeks to divide, change and conquer Australia and turn it into something that it is not and I hope will never be. This particular policy indicates that attack by the government on the view that the collective should support those that need help versus the view of the government that the individual is paramount and, if the individual can look after themselves, 'I'm all right, Jack, and forget about the rest.' That is the fundamental message of that budget delivered by Prime Minister Abbott and Treasurer Hockey and that is why we are opposing this particular budget initiative.

When it comes to health, we do have completely different approaches. We have seen it historically: Labor was the party that brought in Medibank in the first place. The conservative side of the chamber tried to tear it down under Malcolm Fraser. Labor under Bob Hawke brought in Medicare, and obviously John Howard saw that it was a part of the Australian fabric and accepted it. However, this extreme government that we have—this Tea Party collective that has taken hold of the ministerial leather—has tried to take down a universal approach to health care.

I notice that the COAG reform council report released in June found that, when it comes to filling prescriptions, one in 12 people back in 2012-13 delayed or did not fill their prescription due to cost. Obviously that has health implications for people. Let's look at what happens when you move to disadvantaged areas for people not filling out their prescriptions. The figure then jumps up to one in eight people not filling out their prescriptions. We know what happens if people do not fill out their prescriptions. If you are only taking medicine every second day or if you have a course and drop one of them then the efficacy of the medicine can be completely negatived. You can actually waste money by not taking the full prescription course. The saddest part is that this same COAG reform council report said that, when it comes to Indigenous communities—and I say this in particular for the Indigenous affairs minister, who is Prime Minister Abbott—more than one in three Indigenous Australians did not fill their prescription due to the costs associated. We know full well, as does the former health minister, the current Prime Minister, what will happen when you put an extra price on medicines.

This $1.3 billion tax needs to be seen through that prism by a former health minister who knows the consequences and knows that means—and I am not being dramatic here—that people will lose their lives. That is the reality of people not following prescribed courses of medicine. The Indigenous affairs minister—the Prime Minister—knows that if one in three Indigenous people are not filling their prescriptions due to the cost then this $1.3 billion tax will be particularly visited on Indigenous Australians, who already have so many challenges when it comes to health, geography, education and other social disadvantages, particularly incarceration.

Let us put that in context. We hear from all of the speakers opposite—wait a minute; that is right, there were not any! There was one speaker. This great health initiative has been trumpeted by those opposite, yet this incredible number of people who cannot even get enough people together to start parliament on time could not find a single speaker for this piece of legislation. Not a single person from the backbench was prepared to defend it. That is ridiculous!

If this is really about the sustainability of the health system, the revenue would be going into the PBS and into Medicare. Instead, this is just a price signal. That is what it is. For some reason, those opposite can grab a price signal when it comes to health but not when it comes to saving the planet and the health consequences that will flow if we do not take steps to stop global warming. Those opposite run a million miles from anything to do with putting a price on pollution and global warming; however, when it comes to health, they are in like Flynn to put a price on the sickest people in society, particularly Indigenous people and those living in disadvantaged areas.

This once proud Liberal Party that used to believe in markets is all over the shop. They have got a distorted view of what they are about. As I heard the member for Corio say on television this morning, it is because they are an extreme government. They are not governing for that sensible middle of Australia. I see that John Howard, the former Prime Minister, is here in Canberra today. He understood what it was like to govern for the middle because he had a marginal seat. He understood that that is what Australia is all about. You do not need the extreme Tea Party ends or the Greens ends of the spectrum. You should govern for the middle. That is where the national interest is best represented. But those opposite have lost control of their agenda and are ignoring history.

This is all a part of their ideological campaign to turn Australia's universal healthcare scheme, set up by Labor, into that two-tier, user-pays system favoured by the United States, which has been shown by every sensible health economist to be a waste of money. When comparing the costs associated with medicine in the United States to those just over the border in Canada, there is almost a two to one cost differential, or even more in some states, because the insurance companies have grabbed hold and medicine has become inefficient. Basically, if middle-class people—teachers, firemen, nurses and the like—get sick, that can be the end of a family, the end of a dynasty, in terms of having a job and a way of life, and suddenly they are out on the street. That is not the Australian way. That is not the way we believe in. That is not the sort of Australia we want.

I ask those more sensible people opposite to grab hold of the agenda and come back to a sensible, fairer budget because we will not support Prime Minister Abbott's unfair slug on sick Australians. It is built on lies told before the last election. I clearly remember the Prime Minister saying that there would be no cuts to health. This piece of legislation before the chamber now has a strong odour of mendacity attached to it. It is a pong that you could smell west of Cunnamulla, a long way away, and the people of Australia have tracked it down.

Mr Marles interjecting

I think that is in the Deputy Speaker's electorate. He would know Cunnamulla very well—and west of Cunnamulla!

The reality is that this legislation, like so much of this budget, is about an ideology rather than a sensible approach to health care. It comes on the back of the $80 billion cuts to public hospitals and schools, a tax on doctor visits and the hundreds of millions of dollars taken out of preventative health. A stitch in time does save nine, particularly in health. The Rudd and Gillard governments discovered that we have been neglecting preventative health and that is where the savings are. Do not try to treat a diabetic or a heart attack victim when they arrive at the emergency department, give them some counselling beforehand.

These changes are trying to take Australia's health system back over 50 years. That is the reality of all these cuts. Early in his career, only nine months in, the health minister is in the running to take the baton of the worst ever health minister in Australia. That baton is being held in the Prime Minister's office. It is the baton that he received as worst ever health minister when he cut $1 billion from Australia's health system. So the member for Dickson will not have far to go to get the baton back from the member for Warringah. However, he should be ashamed of himself.

The reality is that the PBS works differently from the MBS. All of us pay a Medicare levy and high-income earners, thanks to Labor, pay a Medicare levy surcharge, but there is no such thing when it comes to the Pharmaceutical Benefits Scheme. So Labor does not support this legislation, especially in the context of all these other taxes that the government, which said they would not increase taxes, want to increase, including for doctor visits, for pathology and for medical imaging.

A few weeks ago when I was with the shadow health minister, Catherine King, in a medical practice in Moorooka we heard of the problems associated with trying to explain to patients, particularly those who have English as their second language, that they will now have to pay to go to the doctor. People will not understand the $2 in red tape and the $5 on the never-never that the GP co-payment will require. It will be so hard for medical practices to recoup that money—to get it off their patients.

The reality is when we were in government we did make some tough decisions—decisions that many in the Labor Caucus argued about because of the costs it would mean for the Australian public. But we made some tough decisions to make sure that the PBS was on a sustainable footing. There were tears and there was gnashing of teeth among the Labor Party when we made our changes to this, but we put it on a sustainable footing. The government's argument—that their intention is for the PBS to be growing in a sustainable way—is a complete nonsense. If that were the case they would invest this money back into the health system. That is the reality. Instead they are putting the money into the Medical Research Future Fund—a commendable initiative, I admit; we should be investing in funding future medical research. That is what the NHMRC is about. We, as a Labor government, would support that; we understand that. But this price signal of $2 in red tape and $5 for the never-never is all about putting out a price signal and putting fear into pensioners, the poorly paid, Indigenous Australians and, particularly, rural and remote Australians, when they are arguing it is all about putting the PBS back on a sustainable footing.

The reality is the PBS is actually growing in a sustainable way. At the moment we are an ageing society; one in five Australians is over 65. That brings challenges but we have had plenty of time to prepare for it, and I commend earlier governments for some of those initiatives. Let us have a look at the PBS. It is growing at a much lower rate than expected and, in fact, recent budget updates have shown that the PBS is actually growing at a slower rate than was expected. So there is no emergency—no emergency at all. It is not growing by accident; it is because of the decisions that Labor took—measures that were opposed, and campaigned against, by the very people occupying the government benches.

Those PBS price disclosure reforms—there was a lot of lobbying going on in the corridors of Parliament House when they were rolled in—have delivered billions of dollars in savings for the government. At the moment the government spends around $9 billion a year on the PBS. Accelerated price disclosure has slowed the real rate of PPS growth and put it on a sustainable footing. The member for Lilley Wayne Swan's last budget predicted that these savings would deliver more than $1.8 billion in savings. That is not acknowledged by the health minister in his many rants at the dispatch box. He is all about revisiting a couple of things that seem to eat at him for some particular reason, but he does not acknowledge the hard work and the hard decisions that were made by previous Labor health ministers.

If we look out to 2017-18, the savings would actually be about $20 billion—Labor's hard decisions delivering savings in the best interests of the nation. These savings should be used to ensure that more drugs are available—the drugs of the future and life-saving drugs such as Kalydeco. One of my constituents—sorry, Deputy Speaker Vasta, it was one of your constituents from Upper Mount Gravatt; I have sent it on to your office—came to see me a few weeks ago. She is suffering from cystic fibrosis and she is looking at getting affordable access to Kalydeco. I know how heartbreaking it is when these people turn up at your office. I do not have permission to name her, but she has a letter that I have sent on to the health minister seeking access to a drug that is routinely available in the United States, the United Kingdom and other European countries. Over 95 per cent of eligible patients in the world outside Australia will soon have access to Kalydeco, and she was asking when the health minister and the health department would show compassion to the vulnerable in our community. For anyone who knows someone suffering from cystic fibrosis, you know how tough a row that is to hoe. That is why we need to have sensible savings, not random, obscene savings such as this legislation proposes.

4:04 pm

Photo of Joanne RyanJoanne Ryan (Lalor, Australian Labor Party) Share this | | Hansard source

I welcome the opportunity to speak on this bill, the National Health Amendment (Pharmaceutical Benefits) Bill 2014, and I ask for indulgence. I am up speaking about pharmaceuticals and am probably in desperate need of some antibiotics, so I hope the House bears with me.

I welcome the opportunity to speak on this bill because nothing demonstrates the differences between the Labor and Liberal parties more than our history in government on health. Nothing demonstrates it quite so clearly; nothing at all. I note the number of times I have heard the Minister for Health, Minister Dutton, on his feet wanting to talk about Labor Party history. Again today in question time, the Prime Minister was giving us some kind of history lesson from across the chamber. I say, in opening, that sometimes the temptation to twist the facts becomes irresistible to those opposite.

Recently Minister Dutton made a call for those on our side of the chamber to answer for our 'astounding hypocrisy' on health, at the same time suggesting those opposite were working steadily and methodically to reform our health sector and ensure it remains sustainable. As an English teacher, I love to play with words; and I love the notion that the changes we are seeing to our health system under this government are described by the word 'reform', when what in fact we are seeing is the absolute undermining of our universal health program in this country. That includes the changes being suggested here—this $1.3 billion tax.

In my mind when I enter the chamber these days I remind myself I am entering the 'house of irony', but what we have heard from Minister Dutton goes so far as to be farce. The theatre of the absurd is occurring in here every day. Harold Pinter could not have written some of the things we are hearing about the history of the Labor Party and health, or thought of some of the resounding uses of language to describe what is an attack on Medicare and our health system.

We have Minister Dutton making all sorts of assertions about history and yet, when we look at the history, it is quite clear where the Labor Party stands when it comes to health and people's access to our health system. We do not have to go that far to remember Whitlam introducing universal health care into this country; we do not have to go very far—certainly in my lifetime—when Prime Minister Fraser killed it off; and then of course Prime Minister Hawke reintroduced our universal health program as Medicare. To say that this party would be doing anything that goes against those credentials is absolutely outrageous.

The argument that they put forward all of the time and that I have heard over and over and over again is this link to the introduction of a co-payment for the PBS by Labor. The twisting of the facts that is occurring on the other side, of course, is one of omission. They are omitting to tell us that when Labor introduced that we also increased the pharmaceutical allowance, so concessional patients received the equivalent of the cost of a script per week to compensate them. Every time the PBS co-payment went up so did the pharmaceutical allowance. They forget to mention that Prime Minister Howard broke that nexus in 1997.

They also forget to mention that when we introduced a co-payment it was not part of a budget that began the dismantling of the universal health care system. It was not part of a budget that ripped out more than $50 billion from our hospitals. It was not part of a budget that included a GP tax. It was not part of the budget that included pension cuts that will leave pensioners more than $4,000 worse off. It was not part of the budget that included family payments cuts that would leave families $6,000 worse off. It was not part of a budget that scrapped seniors concessions, increased the cost of petrol et cetera et cetera et cetera. We can take these things one at a time and the Prime Minister can stand at the dispatch box in question time and assert these things and omit the facts that the Australian public are very well aware of and probably do not need reminding of. They omit information that Labor made targeted and responsible savings in the health sector, including the means testing of the private health insurance rebate, which was opposed by those opposite—and that we made medicines cheaper through simplified price disclosure. They omit those issues every time they get to their feet.

They also omitted to tell people that Labor made unprecedented investments in hospitals, primary care, aged care and the health workforce—all of which this government has ripped money out of in this year's budget, and all after promising no cuts to health! And why? The question is being asked in my electorate in most households: why are we hearing this day in, day out? Why would anybody want to? The answer provided by those opposite is around the notion of a budget emergency that has now been dismissed by the economists. It has been dismissed in the community, because people understand, because people have a living memory of a global financial crisis. People understand that we have a AAA credit rating. So the furphy does not stand up to any kind of test.

I stand here today to oppose the $1.3 billion tax increase on medicines because it will hurt every Australian. It will hurt people in my electorate probably more than most other electorates, given that in Lalor we access bulk-billing services more than 1.5 million times per year, greater than anywhere else across Australia. If you extrapolate that in terms of visits to the doctor, how does that work in terms of the number of people accessing medicines? If they are the bulk-billing rates in my community you need to build into that the notion that there are 10,000 pensioners in Lalor who will be hurt by this $1.3 billion tax.

The COAG Reform Council report released in June found that 8.5 per cent of people delayed or did not fill their prescriptions in 2012-13 due to cost. I do not have to go very far to see that, because I have lived that memory. In my home somebody I care deeply about has a regimen of medicines that he should be taking daily, and across the last five years I have seen him in circumstances where he has been making those choices. Because when it comes to going to the chemist and having to get $170 worth of medication that is going to last you a month, you start to pause. I have heard him say to me a million times, 'But I am feeling well and I don't know that I need it.' It is not difficult for me to extrapolate that into the homes of pensioners, into the homes of families with young children who will be hard by this budget. It is not difficult for me to imagine and know that those facts are true.

The last time a Liberal government increased tax on medicines in 2005 prescriptions for some essential medicines fell by as much as 11 per cent. So we have lived history, lived memory of what happens when we put in increases that those opposite want to put in and fail to do what Labor has always done, and that is compensate those families and those individuals for that increased cost—to put in that safety net for those who can afford it least.

If this were really about the sustainability of the health system, as we keep hearing—building this notion, this picture of Australia in crisis, our health system in crisis, which we know is a furphy, we know from the facts—the revenue would be going back into the PBS, the revenue would be going back into Medicare. That is not what is going to happen here. It is going to go into the research fund. From the moment I heard it come from this Prime Minister's mouth I had to stop and question it. How could anyone stand in this chamber and suggest that they were going to tax the sick and the vulnerable so that they could put money into research for cures somewhere down the track—which, by that time, with this government in control, Medicare would be gone, and those people who had paid for it would not be able to afford to access the cure. It is absolutely outrageous that those things can be argued in this place.

These changes are an ideological campaign to get rid of Australia's universal healthcare scheme. We know that—we can see it—and Australians know it. Worse, it is to introduce a two-tier user-pay system. On this side, we will not support Tony Abbott's unfair slug on sick Australians, because it is built on lies told before the last election.

Some of Australia's most senior doctors have already warned that the changes in Tony Abbott's budget will put Australia's health system back more than 50 years—back to the dim, dark past. I think about that. The member for Moreton mentioned a family talking to him about Kalydeco, and I have had several families in my electorate talking to me about the same, and I have been on my feet about that in this place before. What comes to mind when I talk to them and what comes to mind when I think about this government and the changes it wants to make to our health system is that Americanised two-tier system—all of the episodes of ER, of Grey's Anatomy and that compelling episode that ran for a week on prime-time television that advertised the episode. Nine times out of 10 the most compelling episodes in those medical sagas that America produces for us are the ones where the poor family without the medical insurance cannot afford the life-saving surgery.

They are the most compelling, particularly in this country, because it is not what we live and it is not what we know, and it is not a world we want to walk into. Yet this government puts on the table things that are going to create that world in this country, this country that has always stood for the fair go, this country that is built on notions of egalitarianism—to think that we have a government that wants to embrace this kind of exclusion, this kind of health program.

These price increases are coming off the back of $80 billion cuts to Australian public hospitals and schools. They come off the back of that GP $7, that 'It doesn't really matter what the cost is, it's about the outcome.' It is about the attack on our GP business model that is hidden behind that $7 co-payment, that $7 tax. It is about the destruction of our universal healthcare system. I ask myself all the time: what is going on here? I think about this research fund. I think about the fact that we are going to make all of these savings to make Medicare sustainable, to make the PBS sustainable, that we are going to collect this money but not put it back in there—we are going to put it into the research fund. Then I remember why. I remember the addition to the slogans in the campaign. I remember the Prime Minister having to be the PM for women and the signatory PPL scheme, and having to be the PM for Indigenous Australians. I do not know if he has found his signatory policy for that yet, but he has certainly found the signatory policy for the PM who finds a cure for cancer.

I wonder about a country that can be in a situation where we stand here talking about undoing our universal healthcare system and hurting the PBS system—and all for one man's vanity. I really do wonder what we have come to.

What we are not seeing from this government—consistent with its approach to governing so far, especially when it comes to health—is a government that is saying to Australians everywhere, 'You pay.' Those of us on this side of the House will stand against that, will oppose that.

4:19 pm

Photo of Malcolm TurnbullMalcolm Turnbull (Wentworth, Liberal Party, Minister for Communications) Share this | | Hansard source

I move:

That the question be now put.

Photo of Ross VastaRoss Vasta (Bonner, Liberal Party) Share this | | Hansard source

The question is that the question be now put.

The DEPUTY SPEAKER (16:29): The question now is that this bill be now read a second time.