House debates

Wednesday, 27 August 2014

Matters of Public Importance


3:14 pm

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

I have received a letter from the honourable member for Ballarat proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The Government hurting Australians with its increased cost of medicines and unfair GP tax.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

3:15 pm

Photo of Ms Catherine KingMs Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | | Hansard source

It is a very important matter of public importance to talk about what is happening with our health system and what this government is doing to punish patients across the country. The Abbott government's GP tax and the hike in the costs of essential medicines is bad for patients, bad for doctors and bad for the overall health of our nation. Hitting people with a tax when they are sick and then hitting them again for the tests that they need and again for the medicines they need is a massive assault on those least able to afford to pay: the sick, the weak, middle- and low-income families trying to get access to the health care that they need for their children and for their ageing relatives.

What sort of government is it that introduces as its almost sole health policy a policy that is designed to stop people going to the doctor when they are sick? We finally heard from the Treasurer today an admission of what we already knew from Senate estimates: it is a million visits to the doctor a year that this government wants to stop. Which one of those million visits is this government is prepared to say is unnecessary? Is it the person who thinks they have a persistent headache and finally thinks, 'Maybe I'd better go and get this checked out' and finds out it is something much more serious? Is it the mother or father who is worried about the cold that their kids have and suddenly realises that it actually may be something a little bit more serious; maybe his child has asthma? That is a million visits forgone each year.

What sort of government thinks that as its health policy it is good to stop people going to the doctor and stop people filling out their prescriptions? It is policy designed to stop them seeing the very people who are best able to judge what treatment they need to cure them or to prevent whatever problems they have becoming worse and leading them to even graver health—and budget—outcomes in the future.

A recent campaign in Australian Doctor magazine calling on the Abbott government to rethink its GP tax was supported by 2½ thousand doctors and 500 other health professionals. It is an astonishing piece from a profession not generally known for its militancy. But these are not just names on a petition; they are frontline GPs who will be directly impacted by this policy and know exactly how disastrous policy is for their patients and for the health policy of our nation. There is Mary Barson from Bellbrae in Victoria:

A $7 co-payment will make regular visits for some patients unaffordable. I genuinely fear that they will refuse visits, fail to have proper management of their heart failure/diabetes/chronic lung disease/urinary tract infections/etc and will end up in hospital at huge expense and inconvenience.

I am furious at the short sighted nature of these proposed reforms.

Dr Richard Walukl tells the story of the 66-year-old pensioner who first sought assurances that the GP tax had commenced before visiting his surgery to check out his persistent headache. He was rushed to hospital, where he collapsed in emergency and had a haemorrhage. The GP writes:

I am 100% sure that if co-payment was already applicable he would have gone home and died.

That is a GP in our community saying, 'Do not introduce this GP tax.' That is the true cost of this unfair, regressive and downright disastrous attempt to prevent patients seeing a GP.

Already surgeries across the country are reporting that patients are missing appointments because they fear that the tax is already in place and that they cannot afford it. As the Consumer Health Forum of Australia told the Senate inquiry into out-of-pocket costs, some would have to choose between paying for food, paying for heating or paying for their health care. Seven dollars may not seem much to some in this place; but, when you are on a fixed or very limited income and every dollar of your pay packet is accounted for, the GP tax and higher medicine prices will mean often something will have to give in those budgets, and what will give is the visit to the doctor or the follow-up prescription. The consequences of that could be disastrous.

In fact, this entire policy is premised on the hope that people will stop going to see the doctor. That is the only way this minister can actually say that is where the sustainability is in this argument. We know not a single dollar from the GP tax or the hikes to medicine is going back into Medicare or the PBS, so the only way this government's argument about sustainability can stack up is that they want a million fewer visits to the GP and they want to see a reduction in the number of scripts filled. What sort of health policy is that?

The alternative for patients who cannot afford the GP tax is, of course, to head to the already overcrowded emergency departments, further blowing out waiting times. But the Abbott government has two answers to this. First is to rip $50 billion out of the public hospitals, putting at risk the huge work that has been done to improve emergency department waiting times through the national emergency access target and the great commitment from clinicians to actually improving those. Then it also says: 'A really good idea would be if state governments then slap a tax on you when you take your sick kid to emergency as well. That would be a really good idea as well.'

This GP tax and this medicine price hike are bad for patients, bad for doctors and bad for our nation's health system. We are not supporting and will not support the unfair GP tax and we will not support the unfair hike on the cost of essential medicines. Labor will never support this government's deceitful and disastrous bid to destroy Medicare. And we are not alone in this. The Australian public do not want your GP tax and your medicine price hike, Prime Minister. The health professionals do not want it either. What you face in your own party room is your own MPs telling you that people in communities across the country are not accepting this blatant broken promise on health.

This is a Prime Minister who promised no cuts to health but then ripped more than $50 billion out of public hospitals. This is a Prime Minister who promised before the election no new taxes and then turned every GP and chemist in the country into an army of tax collectors, taking money for the government out of the pockets of people trying to access the health care that they need.

The Treasurer says, 'No, it's not a tax,' but he thinks North Sydney has a high rate of bulk billing and that a traffic gridlock means there must be a millionaires' convention in town. Well, Joe, your own budget papers show that, combined, your GP tax and the medicines hike is a $5 billion hit to family budgets over the next four years alone. That is not just a tax, Treasurer, that is a monster tax.

The Prime Minister told the Australian people, 'It has always been my position that if you go to an election saying something, you should keep that commitment.' Members opposite cannot be trusted. Their words mean absolutely nothing when it comes to the health care of this nation. They could not have been clearer: no new taxes and not cuts to health. Then in their very first budget, they ripped more than $50 billion out of hospitals and whacked all Australians with a big new tax on health.

We must protect Medicare. It is always up to Labor to defend Medicare from this mob opposite. Australian families should not be paying for the Prime Minister's broken promises. It is worth going through, in a little bit of detail, precisely what this government wants to do to health care in the budget. The budget imposes a $7 GP tax on every consultation, with $5 of this replacing the fee paid to doctors and $2 going to the doctor. The health minister keeps dismissively saying that it is up to the GP whether they charge that fee or not and that GPs can still bulk bill. What he never goes on to say—and I hope that he does now—is that if they do, the fee paid to GPs drops $5 and then, on top of that, they lose the bulk-billing incentive. The combined effect of this is that any GP who does continue to bulk bill patients will potentially—depending on where they are—lose up to $14 per consultation. In Australian Doctor, Dr Anthony Hodge from Tasmania said:

In Tasmania—the state with one of the highest unemployment levels and most disadvantaged populations—if I don’t charge the co-payment I will lose $14 a consult for 85% of my patients. Who can afford this …

Does the government want to stop us visiting the elderly and infirm?

Clearly, it does. They want to see a million GP visits forgone.

This is not just about budget savings; this is about the Liberal Party's fundamental opposition to Medicare. The Prime Minister and the Treasurer plan to make it harder for Australians to see their doctor, and that will only put more pressure on the health system in the long term. These changes will end up costing more, and putting Australians at risk. It is lazy policy; it is bad health policy to deter people from seeking early care and treatment. It will lead to complications and it will lead to further health problems for people in our community. The price of this policy is bad health outcomes— (Time expired)

3:25 pm

Photo of Peter DuttonPeter Dutton (Dickson, Liberal Party, Minister for Health) Share this | | Hansard source

I am very happy to contribute to this debate. The government is absolutely determined to make sure that Medicare has a bright future and that we can afford a world-class health system—

Mr Champion interjecting

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

The member for Wakefield!

Photo of Peter DuttonPeter Dutton (Dickson, Liberal Party, Minister for Health) Share this | | Hansard source

and by Labor's approach it is evident to all Australians that they have no grasp of reality whatsoever. They were a shocking government. They were the worst government since Federation and they are demonstrating at the moment in opposition that they have no opportunity to turn that around. These people have no comprehension of how to pay, how to manage money or how to provide services to people on a sustainable basis, because they rack debt up every time they get into government. Then, of course, it is our job to come in and clean up Labor's mess. It is known to people at a state level and it is known to people now at a federal level. It happened after the Hawke-Keating years and it happened after the Rudd-Gillard disastrous years.

I am not going to stand by and watch Medicare collapse under its own weight in this country. I want to make sure that we can provide the changes for today so that, with an ageing population and with the demands that a modern society like ours has on the introduction of expensive medical technologies, we can be the first adopters of things like robotic surgeries. All of that comes with huge expense—and people want us to pay for that. People want us to pay for genetic testing, which is just around the corner for the Australian population, which maps the DNA of the body to indicate what predisposition people may have for particular diseases. DNA testing indicates to people the cancers they may be likely to have later in life; it says to people that they may have a predisposition for a particular disease and, if they have children with a carrier of the same gene, there is a greater likelihood that that that gene may be carried to their own children.

These medical technologies will have to be paid for, not just next year but over the coming decade and beyond. If the Labor Party want to pretend to the Australian public that we can have four out of five services for free when people see a GP in this country, they are kidding themselves. I do not think the Australian people will fall for it.

What is it that we propose that is so offensive to the Labor Party? We say that we want Australians who have the capacity to pay the $7 co-payment to make that contribution and we will retain bulk-billing for those who cannot. I want bulk-billing to be about providing for those who cannot afford the $7. As the Treasurer said in question time today, there is a second safety net so that if, within a calendar year, a concession card holder or a child under the age of 16 goes to the doctor, has a blood test or an X-ray—

Opposition members interjecting

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

The running commentary by the member at the table is not required.

Photo of Peter DuttonPeter Dutton (Dickson, Liberal Party, Minister for Health) Share this | | Hansard source

or a combination of 10 services over the course of a 12-month period, they can then revert back to a bulk-billing arrangement so there is a maximum impact of $70. I want to contrast that—because the Labor Party has made a lot of that, and the shadow minister made a lot of that in her contribution only a few moments ago—to the way in which Labor has approached the same co-payment principle in relation to the Pharmaceutical Benefits Scheme over many, many years. Now, quite cutely, the shadow health minister in recent weeks, in some sort of populist attempt to thrust herself into these discussions, has described the PBS co-payment as a tax. It really is quite deceptive, because if you look at the history of Labor, Labor introduced a co-payment for concession card holders on the PBS. They introduced a co-payment for concession card holders and they want to somehow reject that historical fact. But the historical fact is that the Labor Party doubled the contribution for concession card holders when it came to the money that they want people to contribute for their own scripts. So when somebody who is the sickest and the poorest Australian goes to the chemist and hands over the script, they pay $6.10 for each and every medicine until they get to 60 scripts in a calendar year. This was introduced by the Labor Party. Let us have a look at the figures. For 60 scripts, at $6.10, that is over $360 that that sickest and poorest Australian will pay before they move on to free medications. There is a safety net—quite appropriately so—once you get to 60 scripts or so. We support that and we want to make the PBS sustainable—absolutely. The impact is $360 on that person. Yet the Labor Party want to pretend that somehow the principle of applying a maximum $70 co-payment to that concession card holder or the child under the age of 16 is incredibly offensive and bad policy. The Labor Party need to explain to the Australian public why it is sound logic to apply a co-payment to the PBS but not to Medicare.

Over the last couple of months the government has made its case well in relation to the expense under Medicare. People know that over the last five or six years Medicare expense in this country has gone up by 42 per cent. They know that 10 years ago we were spending $8 billion a year on Medicare and today we spend $20 billion a year. The Labor Party run around saying people pay the Medicare levy through their tax and that should cover the $20 billion. That shows you how bad they are at economic management. The problem for the Labor Party is that we do not raise $20 billion through the Medicare levy. We do not raise $15 billion through the Medicare levy. We do not even raise $11 billion a year. We raise about $10 billion a year through the Medicare levy. So there is a $10 billion gap, and it grows and grows and grows each and every year. Why? Because the $10 billion is growing at a slower rate than the $20 billion expense. So that gap blows out each year and that is why we say that we should ask Australians who are capable of doing so to make a contribution of $7 when they go to the doctor so that we can address that gap and provide for all of that future medical expense.

That is absolutely logical, it is sound, and we are continuing discussions in good faith with the independent senators—who on this topic and many others are much easier to have discussions with than the Labor Party. People on the crossbench in the Senate actually understand that there is a problem. The Labor Party will not even acknowledge that that is a problem. That is quite ironic because there were two independent reports commissioned by Labor when they were in government—not Liberal Party work and not Labor Party work. The Labor Party commissioned two independent reports, by Christine Bennett and Simon McKeon, both of which came back to Prime Minister Rudd and Prime Minister Gillard saying health spending in its current form in our country was unsustainable and, secondly, that we should put more money into medical research.

We do both of those things in this budget. We are not asking for a $17.50 contribution such as operates in New Zealand. We are not saying that the co-contribution should be $16 as it is in some parts of Europe. We are not even saying it should be $15 as recommended by the Commission of Audit. We are saying $7 is a reasonable contribution for people to make. For people at the margins, who cannot afford the $7, we have retained bulk-billing. That is what bulk-billing should be about, not having 83-odd per cent of services free. That is not what bulk-billing is about. Bulk-billing is about providing support to those who cannot afford the $7—and we have the secondary safety net, which is incredibly important.

The shadow minister, in her MPI today, made reference to the increase in relation to the PBS co-payment. Yes, in this budget we have said that we want to keep the PBS sustainable. We spend about $9.3 billion a year on medicines in this country. We have got one of the best systems in the world and I will fight to protect it. I will fight to make sure we can afford those cancer drugs. I am looking at some drugs at the moment that cost $200,000 or $300,000 per patient per year, for which people pay $6.10 when they go to the doctors. We are talking about increasing that $6.10 by 80c. That is what we are recommending in this budget—80c. Some of those scripts that people fill for cancer are worth tens of thousands of dollars. As a health minister, I am extremely proud of the fact that we provide to people those life-saving drugs worth hundreds of millions of dollars on a daily basis.

We will continue to do that but, if we want to do it into the future, we cannot pretend that that money can come from nowhere. Labor racked up an enormous amount of debt. As the Treasurer said today, our country is paying $1 billion a month of interest on borrowed money each and every month. If we do not do anything about it over the course of the next 10 years, that $1 billion will blow out to $3 billion a month. Do people pretend that we can continue to put money into health or into pharmaceuticals with that sort of debt? No, they do not. We are providing a balanced approach. We will fight for the future of Medicare. The Labor Party should get out of the way.

3:35 pm

Photo of Stephen JonesStephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | | Hansard source

On this side of the House, all Labor members of parliament are celebrating a very important anniversary. This month marks the 40th anniversary of the passage through the federal parliament of the bills which brought Medicare into place—the introduction of the most historic healthcare reforms in this country. It did not come easily. Gough Whitlam took the Medicare policy to three elections and still could not convince those opposite to support the legislation. So we saw the first and only joint sitting of parliament, which was convened to break the deadlock with the Senate. But even after the legislation was voted up by a joint sitting of parliament, did those opposite give up? The answer is no. A defiant leader of the coalition, one William Snedden, made a firm promise which echoes down the generations. He said: 'We'll fight this till it is finished because that is what we believe in.' So while we on this side of the House hold the flame for universal health care, those on the other side of the House are the heirs to that solemn promise of Billy Snedden's. They were doing it in 1975 and they are doing it today: they are trying to wreck universal health care in this country.

The member for Ballarat has pointed out that this tax will do exactly what it is designed to do. This horrendous tax—this $7 charge on people who are sick, who want to go and see the doctor—will do exactly what it is designed to: it will stop people going to the doctor. Where is the sense in that? Where is the sense in not having people go to the most efficient place in the health system to have their ailments dealt with. Instead of that, the policy of those opposite is to have them forced into the emergency wards of hospitals. Where is the sense in that? What is this tax and this PBS increase going to do? It is costing the country around about $5.8 billion—ripping it out of the pockets of consumers and it will do exactly what it is designed to do: keep people away from their GPs.

If that is not bad enough, if you look—and this should be a concern to you, Deputy Speaker Scott—at the areas where these policies are having the greatest impact, the top 12 electorates which are hurt most by the GP tax and the increase in medicines are in regional Australia. Gippsland, total cost $38 million over a four-year period; Hinkler, $38 million over a four-year period; the seat of Murray, $32 million; Gilmore, $33.7 million; Cowper, $31 million, and; Lyne, $32 million. We know that the increased charges on medicines alone are going to rip in excess of $112 million out of regional Australia. Knowing this we have to ask ourselves: 'Where is the National Party?'

In 1973 the National Party was led by a real leader with courage, because in 1973 the then Leader of the National Party, Doug Anthony, was willing to cross the floor. He was willing to cross the floor in the interests of country people and country electorates. I ask, through you Deputy Speaker Scott, the members of the National Party: do they have the courage of Doug Anthony to stand up for the people in their electorates and do the right thing? Because the people in country Australia are calling out to their members, saying, 'We rely on you.' A former member of that side of the House, Fred Chaney, had this to say:

Crossing the floor is the stuff of which parliamentary heroes are made.

You have the opportunity to see some heroes.

Mr McCormack interjecting

We have the opportunity to see some heroes on that side of the House to stand up for their electorates.

Photo of Michael McCormackMichael McCormack (Riverina, National Party, Parliamentary Secretary to the Minister for Finance) Share this | | Hansard source

When have you ever crossed the floor?

Photo of Stephen JonesStephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | | Hansard source

Some of them might be saying, 'It might not be good for their careers.' There have been members on that side the House who have been willing to cross the floor in defence of something they believed in.

Mr McCormack interjecting

Photo of Bruce ScottBruce Scott (Maranoa, Deputy-Speaker) Share this | | Hansard source

Member for Riverina!

Photo of Stephen JonesStephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | | Hansard source

Let's see them stand up for their electorates on this issue.

Mr McCormack interjecting

Photo of Bruce ScottBruce Scott (Maranoa, Deputy-Speaker) Share this | | Hansard source

Order! Member for Riverina!

Photo of Stephen JonesStephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | | Hansard source

Because we know there are National Party members who are scared to death on this issue.

Mr McCormack interjecting

Photo of Bruce ScottBruce Scott (Maranoa, Deputy-Speaker) Share this | | Hansard source

Member for Riverina will desist!

Photo of Stephen JonesStephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | | Hansard source

Well, stand up in this place for the people that you represent.

Photo of Bruce ScottBruce Scott (Maranoa, Deputy-Speaker) Share this | | Hansard source

The member for Riverina was being grossly disorderly and is lucky to be still in the chamber. You were being been grossly disorderly, along with others. I was trying to get your attention.

3:40 pm

Photo of Andrew SouthcottAndrew Southcott (Boothby, Liberal Party) Share this | | Hansard source

You have got to smile when the opposition, in prosecuting their argument that the government do not support Medicare, have brought the stunning exhibits from more than 40 years ago! What we need to do is talk about some more recent history. We talk about some more recent history when the Prime Minister was the minister for health. Here is a question for you: which government added dental services to Medicare? Which government did that? It was the Howard government. Which government expanded Medicare to allied health services in the treatment of chronic disease? Who did that? Who was the health minister who expanded Medicare to introduce access for physiotherapists, dentists, podiatrists—for other allied health? Who was that? Who was the health minister who expanded Medicare, who improved Medicare? It was the current Prime Minister.

When you look at our health system and you look at how the health of our country compares, we do pretty well. We have one of the highest life expectancies in the world for both men and women. We see that improving. We see one of the lowest smoking rates anywhere in the world, and that has been from concerted action over the last 30 years from state and federal governments. We see vaccination rates improving. That was something that was a very proud achievement of a former coalition health minister, Michael Wooldridge, who actually saw Australia have the sorts of vaccination rates that we should enjoy. We have seen over the last 30 years the five-year survival rate from cancer increased from 47 per cent to 66 per cent more recently. We have seen a dramatic fall in people having a heart attack and dramatic falls in death from heart attack. We have seen death from asthma and COPD dramatically decreasing over recent times as well.

There is no doubt that Australia has a very good primary health care system. We have a well-trained GP workforce and we have multidisciplinary care. But as good as it is there is further improve improvement. The OECD has said that even Australia, which by all standards is regarded as an efficient system and by all standards is regarded as a good health system, still has room for improvement in efficiency and we have room for improvement in life expectancy. We do face a number of challenges into the future. The major challenges are how we manage chronic disease and what we do in terms of the coordination of health care so that people with conditions that do not need to go to hospital are able to be cared for better in the community.

As to what the opposition are raising in this point—their opposition to what is a modest co-payment—we have more than 100 million non-referred GP services, and it is reasonable for any insurer, especially the government, to say, 'What are we getting in return for that?' The opposition's approach is to say: 'The sky will fall in. It will be the end of the world as we know it.' But when you have a look at the health system, what you see is that Australia enjoys a great health system. We have a great primary health system.

In the past, the coalition has shown that it is the best friend that Medicare has ever had, and this government will continue to show that by strengthening primary care and strengthening the PBS. We need to make sure that it is sustainable into the future. We have seen growth in health expenditure and growth in PBS expenditure increase well above inflation and well above the growth of the economy in recent years. This is a modest proposal which will improve the sustainability of our health system under the challenges we will face in the future.

3:45 pm

Photo of Nick ChampionNick Champion (Wakefield, Australian Labor Party) Share this | | Hansard source

If this government is the best friend that Medicare has ever had—because that is what the member for Boothby is asserting—it certainly does not need enemies! This is a budget of broken promises. It is a budget of regressive cuts—$80 billion in cuts; $50 billion out of hospitals alone. It is a budget of increased taxes on working families. And it is a budget that contains a visceral hatred of Medicare. It is a budget that jacks up the cost of medicines. It is a budget that slugs you $7 every time you enter a GP's waiting room, every time you get a blood test, every time you get a scan—it is a cascading, all-encompassing, multiplying, $7 hit on the family budget. And it just does not stop. It continues on and on and on; it is not $7—it is multiples of seven.

Those who are on the pension, who have a chronic illness, who have asthma, who have pneumonia, who have diabetes—they are all the people who are going to suffer: the sickest, the most frail, the most vulnerable. We know that one million visits to the GP will be denied every year, and $5 billion in increased costs and increased taxes will be passed on to families over four years. This is a full-scale assault on Medicare. It is a full-scale assault on fairness. It is a full-scale assault on the Australian way.

It is not about sustainability as the minister said; it has not been about sustainability for the last 40 years. This is about instituting regressive changes to health care in this country which the coalition have championed since the 1970s, and championed in the 1980s and 1990s. And do not take my word for it. On 14 February 1986, John Howard said that if the Hawke government:

… had not been elected to office the Commonwealth Budget would not contain the absurd and bloated expenditures on Medicare that honourable members opposite have added.

On 21 August 1986 he said that, if elected, they would:

… put choice back into Medicare by a number of steps. Firstly, we will allow individual Australians to opt out of Medicare; that is, not pay the levy provided they take out private insurance. Secondly, bulk billing will be abolished except for such people as pensioners who really need it.

So that is what John Howard said in the 1980s. We know, of course, what they said in the 1990s. In the 1990s it was Fightback! I pulled Fightback! out of the Parliamentary Library just to see what it said. Some members in the chamber would remember Fightback! of course. On page 7 in the executive summary it says: 'Bulk-billing will be retained for over four million pensioners, healthcare card holders and the disabled but will no longer be available to other Australians, and the government monopoly on medical insurance will be abolished and there will be provision for gap insurance and medical bills.' That is on page 7 of Fightback! Then on page 52 of this document it says—and this will ring a bell for those opposite: 'The best way to contain costs is to introduce a price signal for health services. Bulk-billing will be abolished with the exception of the four million pensioners, healthcare card holders and the disabled.' So this is Fightback!in 1992 or 1993. It brought me to the Labor Party. It brought in the member for Hindmarsh, who said, in August 2013, that it made him join the Liberal Party. He was so excited about ending Medicare and stopping bulk-billing he decided to join the Liberal Party. And here he is in parliament today.

The member for Boothby talked about former health minister and now Prime Minister Tony Abbott and what a great record he had, but we know that he broke promises in 2004, and we remember his commitment on Four Corners when Ticky Fullerton asked him:

Will this Government commit to keeping the Medicare-plus-safety-net as it is now in place after the election?


TICKY FULLERTON: That's a cast-iron commitment?

TONY ABBOTT: Cast-iron commitment. Absolutely.

Of course, we know what he did with that 'cast-iron commitment'. He broke it, just like he has broken his promise to the Australian people last election of 'no cuts to health'. And what do we find? A $7 cascading co-payment, on every GP visit, on every blood test, on every scan. And those opposite are silent because they know that this is political poison—particularly those in the bush; particularly those in the outer suburbs. This is poison. It is poison for those working families and it is electoral poison. And if I were you, I would be marching down to the Prime Minister's office and telling him to change his strategy a bit. (Time expired)

3:51 pm

Photo of Jane PrenticeJane Prentice (Ryan, Liberal Party) Share this | | Hansard source

I had to laugh earlier today when the Leader of the Opposition delivered a press conference moaning about the health portfolio while he stood in front of a wall of pain medication. I do not know about the rest of you, but when I hear any of those opposite continuously whining about the government's health policies while offering no alternatives, pain relief would not go astray!

When it comes to Labor frivolously flouting their unfounded presumptions about health policies and how Australia can sustainably afford growing costs, their ideas—or, more accurately, lack thereof—are about as effective as trying to solve an algebra question by chewing bubblegum. Like the delinquent child in the classroom, their erroneous and disruptive comments get in the way of real solutions and real action. They may as well put down their pens, stop doodling, stop shooting spit-balls at the teacher, take the 'Kick me' signs off their colleagues' backs, and listen to the adults in the room.

The coalition government is the only party offering a plan for a sustainable health system. I see that in today's MPI the opposition is accusing the government of hurting Australians by increasing costs to health. Those opposite must be experiencing chronically fluctuating episodes of awareness to have forgotten their own record in the health portfolio and how much they have hurt Australians.

After experiencing some kind of election-induced amnesia, the Labor government broke their promise to Australians on private health insurance. They repeatedly promised, to our faces, that they would not change the private health insurance rebate—yet, behind the backs of all Australians, they made repeated attempts to undermine private health insurance and increase the costs for the 11 million Australians who have private health insurance. The amnesiacs opposite seem to have forgotten that while in government they jeopardised the listing of new medicines on the PBS.

The Labor government delayed the medications for patients suffering from schizophrenia, chronic disabling pain, lung disease and many other conditions, for months. The coalition have delivered on our commitment to restore the independence of the pharmaceutical listing process. In fact, we have gone even further. The independence of the PBAC has been restored, and its recommendations will not be ignored. We have listed or extended the listings of 221 medicines—twice as fast as the previous Labor government. That is right: we are helping Australians, not hurting them.

Those opposite obviously prefer to remain in a euphoric state of denial, conveniently forgetting the billions of Australian taxpayers' dollars that they    wasted en masse while in government. After Labor promised to build 64 GP super clinics at a cost of $650 million, they only managed to build half—the rest remaining open paddocks. Labor's Australian National Preventative Health Agency wasted $463,000 to fund a study into the 'fat tax' on junk food, despite both major parties already ruling out this option. They also spent $236,000 on a fake music festival. Just think: if those opposite had not wasted billions of dollars on failed policies, no doubt thought up on the backs of drink coasters in an effort to gain publicity, we would not be in the situation we are now, losing $1,000 million a month—that equates to four new hospitals a year—in interest repayments alone. That is not fixing the debt; it is just in interest repayments.

Those opposite must be living in a parallel universe if they think that they have a strong record when it comes to health. Labor promised to slash elective surgery waiting lists; yet, under their watch, the average national waiting time for elective surgery increased. Labor attempted to tear $400 million from medical research in 2011. Then they ruthlessly ripped $140 million out of medical research before the election—hiding it in budget jargon.

Labor allowed health bureaucracy to balloon while frontline services, private health insurance and other areas faced cuts. Labor created more than 10 new health bureaucracies while in government. They preferred to fund bureaucrats and consultants rather than doctors and nurses. Those opposite need to stop with their floridly psychotic behaviour. They need to stop hoping their nonsensical delusions will somehow fix the legacy of debt and deficit left behind after their chaotic circus of a government. Leaving our children, grandchildren and future generations to pick up the tab is not a responsible option. Labor's complaints are chronic; however, their constructive solutions are mythical.

It is clear that when it comes to health and repairing the budget, only the coalition can be trusted. Only the coalition can help Australians.

3:56 pm

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

I rise today to speak on this matter of public importance—and it is of great importance, especially to the people of my electorate of Lalor. As with many measures in the Abbott government's budget of broken promises, when you add up the combined impact of the GP tax and the increase to medicine costs and when those numbers are crunched, we see Lalor topping the charts with an estimated cost to our community of over $52 million. That is $52 million taken out of our community and out of our local economy because it will have to be spent on going to the doctor and paying for prescriptions.

Our pain does not stop there, because we will be sorely hit by the $50 billion cut from hospitals and the scrapping of preventive health funding. We are heartily sick of being top of the pops. And we are heartily sick of projecting the compounding effects of this cruel budget on families. The truth is that our community keeps featuring because it has 60,000 families making their way in the world. In fact, in Lalor we are a microcosm of the broad Australian community. So I speak today for Lalor, but I speak also for middle- and low-income Australians.

When I think about the community of Lalor, I also think of other growth corridors that will surely be suffering in similar ways. I think of    Cranbourne South in the seat of Flinders, and I think of Minister Hunt—and I wonder where he is today to speak on this MPI; I think of    Pakenham in the seat of McMillan; and I think of Frankston in the seat of Dunkley. All of these electorates in the state of Victoria are held by Liberal members of this House. They are all in the top 40 in this week's charts. Given that their members are not speaking out in this chamber or, one suspects, in the LNP caucus or in cabinet, I speak for them today in this MPI. I speak for Lalor, I speak for Australia and I speak about their anger. I speak about the anger about the Prime Minister and the Treasurer promising before the election that there would be no cuts to health and no new taxes but now smashing that promise. I speak of the anger about higher costs to visit the doctor and to buy needed medications and about the effects that will have on people accessing the medical care in the primary sector that they need, resulting in fewer people accessing health advice.

In my own home, someone I care about deeply has found himself making decisions about going to the doctor and about filling prescriptions, because he has a large monthly bill for daily medications and he is really considering it with these threatened increases. I can only imagine how this translates to the 10,000 pensioners in Lalor. I have heard from several people who are on the disability support pension due to chronic illness and who have very real fears about how they will survive when they must pay more for prescriptions. I hear Minister Dutton and those on the other side of the chamber consistently cry, 'Labor introduced the PBS co-payment' but they deliberately omit that Labor also increased the pharmaceutical allowance to compensate pensioners and that allowance was paid weekly. Every time the PBS co-payment rose, so did the pharmaceutical allowance. They fail to admit that it was Prime Minister Howard who broke that nexus in 1997. They omit the targeted and responsible savings Labor made like the means testing of the private health insurance rebate. They omit that Labor made medicines cheaper by simplifying price disclosure.

It is little comfort to the people of Lalor that they will take this hit, that they will have their long-term health possibly compromised by reduced household budgets and by their capacity to pay. It is little comfort to them to know they will do this to fund a research fund that may find cures but that will be useless to them if the universality of our health care system is smashed in the process.

So we have smashed promises, smashed commitments. We will have, if the government continues to pursue its unhealthy agenda, smashed household budgets. We will have in my electorate smashed lives. Those opposite argue they have to do something. I say to them: you do not have to do this; you should not do this.

4:01 pm

Photo of Steve IronsSteve Irons (Swan, Liberal Party) Share this | | Hansard source

I rise to speak on today's MPI. One thing I remember Kim Beazely said many years ago was: we have got our version and you have got yours. I think we are hearing a bit of that today. We are hearing the version of those opposite who have left us in a situation where the current health system is not sustainable in its current format. We as a government were not elected to keep those opposite's budget going, we were elected to make changes and that is what we are going to do to fix the budget and to invest in medical research for better health care in the future. I cannot see how that is possibly hurting Australian people.

This government is doing exactly what we were elected to do—that is, clean up those opposite's mess by developing and implementing a budget that puts Australia back on a sustainable path to surplus while investing in key areas such as health, education, infrastructure, and the many welfare measures the government has in place.

What those opposite have failed to realise after six years of being in government is that the answer to everything is not simply throwing money at it without a long-term policy framework that is appropriately costed. It is the opposition's lack of strategy and vision and their inability to manage minor projects, let alone Australia's entire economy, that has forced this government to make decisions and reign in unsustainable spending levels.

I see the Minister for Communications is in the chamber. He has just received the report that describes the inability of the previous government to deliver economic infrastructure or any other budgetary decisions. We will be waiting centuries before we ever get a surplus from those opposite.

When it comes to health, education, infrastructure, and many other policy initiatives, those opposite simply do not have a leg to stand on. Let us not forget Labor's attempts to roll out their $650-million GP Super Clinics project, where 64 Clinics were promised in 2007, and, by the time they were booted from government, only 33 had been delivered. Of course, if those opposite want to attack this government's record on health, I should also mention the Labor government's repeated promise that they would not change the private health insurance rebate yet they means tested the rebate in 2009 and 2011 and removed the 30 per cent rebate on lifetime health cover in 2012 after they had repeatedly promised they would not.

The reality is that under the Labor government Australia was progressively living beyond its means, which led to every taxpayer being faced with billions in deficits that are projected to rise to $667 billion if we do not fix the unsustainable spending path those opposite put us on.

The pressure on Medicare, the PBS and public hospitals continues to increase each year due to Australia's ageing population, chronic disease and higher costs. What this government is simply asking is that all Australians contribute to our health system by making modest contributions to the costs of their care. Those opposite have repeatedly attacked the introduction of a GP co-payment—a payment that actively invests in finding cures for diseases through a $20-billion medical research future fund. Of course those opposite would be against this when they ripped $140 million out of medical research last year by tricky accounting in the budget.

Instead, this government is investing in the health of every Australian while still maintaining safety nets for those who may struggle to afford the payment including concession-card patients and kids under 16 years, who will only have to pay the contribution for their first 10 visits a year before reverting back to the bulk-billing system. We consider this is a fair contribution from patients to help support a system that currently funds 263 million free Medicare services a year.

The Pharmaceutical Benefits Scheme is another area where those opposite have no credibility, with medications for patients suffering from schizophrenia, chronic disabling pain and lung disease amongst others delayed for months under Labor when they deferred the listing of medicines already recommended by the Pharmaceutical Benefits Advisory Committee. An example in my electorate was a young lad called Christian Dierkxon. He was one of only 10 people in Australia to have Hunter's disease. After pressure from his local member to get him onto a life-saving drug program, the child moved into my electorate. Even with pressure from two members and the media, it still took the Labor government 12 months to get him onto a life-saving drug program. Labor have no record of worrying about people in health. They have no record economically. What they should be doing is voting for this to make sure that we keep a sustainable Medicare system and take the concerns of the health of Australian people into the future.

4:06 pm

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

We heard from the Treasurer today that the impact of the $5-billion increase in the co-payment and the prescription charges will have the impact of reducing doctor visits by one million a year. It does not really give you a localised personal perspective on the nature of the issue. We heard the member for Boothby today describe it as 'modest'. We had the Treasurer compare it to beer and smokes. The member for Gilmore said it was just like a cup of coffee. We can probably answer that with comments by credible sources such as the AMA that said for practitioners, particularly those GPS providing care to patients in disadvantaged areas, the impact of the co-payment may make their practices unviable. Many patients in those areas will not be able to afford the co-payment and the GPs will not be able to charge it. Similarly, the Consumers Health Forum noted that the organisation is disappointed that the budget has not addressed underlying structural problems within the system, out-of-pocket costs and preventative and public health. On the one hand we have credible national organisations and on the other we have some parliamentarians who say that it is all peanuts.

In my electorate of Werriwa 96.2 per cent of visits are bulk billed, which is the seventh highest rate in the nation. I have looked at today's figure of one million and my estimate is that, if you look at that level of bulk billing, if you look at the socioeconomic characteristics, if you look at the reality that health problems are greater in poorer areas, then you have to say that the impact in Werriwa is going to be at least 10,000. That is a conservative estimate of the people who are not going to visit the doctor because of these changes.

I want to cite a local constituent, Dillon Tudor, who puts it in a personal perspective. His email said:

Hi there, I am a 21 year old uni student. I live at home with mum and my stepfather. The GP contribution will be the worst thing about this budget. My mum works hard to make ends meet at home for me and my 2 brothers. And this 7 dollars is just not affordable. When my 6 year old brother needs to see a GP mum is throwing away money that could contribute to groceries or bills. The financial situations of families are tough for most in Sydney. And just to make things better for mine I have been saving up to set up a (starting amount) $600 fund for my mother so when she is feeling the pinch she has something to reach into. Good to know she will have to eventually throw most of that lot away on something that should be free.

That is the real impact locally.

Statistics from the Family Medicine Research Centre at the Sydney School of Public Health noted that, before this change in 2012-13, 5.8 per cent either delayed or did not see a doctor because of the existing cost structure, which was before we even started going down this road. It is a road that the Treasurer says will lead to $1 million worth less visits. When that reliable research centre made that statement, they also said that a larger price signal than that as suggested in the media will arise. They noted that their figures were probably an underestimate for a number of reasons including the fact that one-quarter of consultations for people over 16 years of age actually led to $14, which is two visits. They also noted the additional cost of other than GP hospital pathology.

There is more research from other institutions. The Healthy Communities studies showed that in Medicare local areas, in 2011-12, a rate of between one per cent and a high of 13 per cent of visits were called off or delayed because of the then existing cost structure. Fifteen per cent of prescriptions were not utilised because of the cost structure.

The scare campaign from the coalition suggesting that we have to be alarmed at the level of costs in this country also has to be answered. As a percentage of GDP, Australian government spending on health is the 10th lowest of the 33 countries in the OECD database and the lowest among wealthy countries. What we have is a scare campaign which is designed, not to make Medicare efficient, not to save it, but to actually destroy it. That was shown by earlier speakers who noted that doctors will be, basically, $14 out of pocket if they maintain bulk billing. This change is designed to persuade doctors to abandon the system. It is designed to make sure it does not exist.

In the United States—a system the coalition government aspires towards—8.3 per cent of GDP is spent by the US government, which is higher than the 6.4 per cent spent by Commonwealth and state governments in this country. This is very clearly going to lead to the further impoverishment of people. It is going to lead to a lot of— (Time expired)

4:11 pm

Photo of David GillespieDavid Gillespie (Lyne, National Party) Share this | | Hansard source

The mainstays of our health system, the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme, public hospitals, private hospitals and health insurance are all vital, but we need a bit of a reality check. Ten years ago the Commonwealth was spending $8 billion a year on the Medicare Benefits Schedule and, today, that is $19 billion. Without policy change, in 10 years' time it will be more than $34 billion. We need to ask the members on the other side: has our population more than doubled in that time? Has our government's income more than doubled, in fact, gone up 122 per cent like the Medicare Benefits Schedule payouts have? The answers to both those questions are no and no. So, I ask the opposition: how are they going to pay? Are they going back to the 'magic pudding' school of economics and just print money? Are they going to borrow money from overseas and increase our national debt? Are they going to put it on the nation's mortgage and rack up a mortgage that we have to pay off and then put it on the credit card?

The Medicare levy raises only $10 billion of the $19 billion on the Medicare Benefits Schedule. That is before the payments are made to the states for hospitals, or payments for the PBS, so there is a giant disconnect. What are the opposition proposing? Should we be like the NHS in England? When I was working there in the 1980s the NHS levy, the equivalent of our Medicare levy, was about 10 per cent of the taxable income. I do not know what it is now, but I bet it has gone up. We read in the papers from England that that nation is discussing introducing a co-payment because their system is not sustainable. Hang on, that is what we are trying to do here. So, it is time for a reality check.

The changes are quite reasonable, but I admit there will be a change to some practices and for some people. There is no avoiding that fact, but they are reasonable changes. As I have said in this House many times before, we try to be sensible and manage the nation's finances and the health system, and that is what this is all about. A $5 portion of the levy will go into the Medical Research Future Fund. It is staying within the health portfolio. There are projected dividends of $1 billion once the total gets to $20 billion, and the discoveries made from research should deliver health benefits to everyone.

A bulk-billing practice will change because they will need to ask for the $7 co-payment. The $2 can be used in a bank at their discretion for people that really cannot cope with the $7 co-payment. In my practice that happens; it is just a reality. My electorate of Lyne has more pensioners than any other electorate in the country, so I know how tough it is for some people, and managing off a pension alone is tricky. This will introduce the thing that some people seem to see as an existential evil, but I see as an existential necessity, and that is a price signal to both the patient and the doctor.

We have great doctors in Australia, but some of them have grown up with 100 per cent bulk-billing practices and they have never had to self-ration their services, because patients have never had to reach into their own pockets. They never say, 'Doc, do I really need this?' or 'Can't I come back in a fortnight or a month?' or 'Do I really need that blood test and an x-ray? I think I'm getting better anyhow.' There is a need for rationing, because, as I said our costs are going up and up much greater than our revenue is going up and up and much greater than our population is growing. We are all getting older and we are all going to retire with lots of requirements for a strong health system. What we are doing is trying to ensure that our health system is sustainable.

I think the opposition are being a bit hypocritical considering that, when they were in government, they cut a billion dollars out of the health budget in 2012 and they froze the MBS in 2013 on every item, not just this—and the then minister said, 'It's only going to cost 70c for the average consultation. (Time expired)

Photo of Bruce ScottBruce Scott (Maranoa, Deputy-Speaker) Share this | | Hansard source

Order! The discussion is now concluded.