Monday, 2 May 2016
Private Members' Business
Universal Health Care
I move that:
This House condemns the Government for its repeated attempts to undermine universal healthcare and drive up costs for patients, as evidenced by:
(1) its repeated attempts to introduce an upfront payment for visits to a general practitioner, including:
(a) a $7 co-payment;
(b) a $5 co-payment;
(c) a $20 co-payment; and
(d) the four year freeze on Medicare rebates;
(2) tearing up of the long term hospital funding deal agreed by all states and territories and endorsed by the Coalition in the 2013 election;
(3) the $650 million in cuts to Medicare rebates for pathology and diagnostic imaging which will force up the cost of scans and tests for patients;
(4) the $800 million in cuts to the health flexible funds which will force the closure of health organisation, including those providing support for drug and alcohol addiction, mental health and cancer support;
(5) abandoning the National Partnership Agreement on Preventive Health and abolishing the Australian National Preventive Health Agency;
(6) abolishing the Health and Hospitals Fund, cutting $1 billion reserved for essential health infrastructure;
(7) cutting more than $500 million in public dental programs and moving to scrap the Child Dental Benefits Scheme used by one million Australian children; and
(8) the Government's continuing plans to:
(a) raise the price of prescriptions by $5 for general patients and 80 cents for health care card holders; and
(b) cut the Medicare Safety Net.
As outlined in the terms of today's motion, this government—this Turnbull Liberal government—has been unrelenting in its efforts to undermine universal health care and drive up costs for patients across the nation. This is a government that has only ever seen health as a source of savings in the budget. Seemingly unable to imagine the long-term benefits of investing in the health and wellbeing of its citizens, health policy for this government is always about cuts and how best to disguise them. This government's relentless undermining of Medicare and universal health care in Australia has been widely criticised as bad policy, resulting in poor health, social and economic outcomes. Before members opposite launch into confected outrage, it is not just Labor that is concerned about this government's attempts to undermine Medicare; the Australian people are rightly incensed, as are the health experts, the doctors and the pathologists across the country, including those in my electorate of Newcastle.
It has been one health policy disaster after another for this government. Who can forget the multiple proposals for a GP tax imposing up-front co-payments ranging from $5 to $20 before the current four-year freeze on Medicare rebates that the AMA has aptly described as the GP tax by stealth. And it was this Liberal government that tore up the long-term hospital funding deal that was agreed to by all states and territories and which, indeed, they themselves endorsed in 2013. The resulting cuts have seen tens of billions wiped from the hospital budgets, including more than $150 million from hospitals that deliver vital patient care in the Newcastle and Hunter regions. Eight hundred million dollars has been cut from the Health flexible funds, which will force the closure of health organisations, including those providing support for drug and alcohol addiction, mental health and cancer patients. Last year a stay of execution of sorts was given to the highly valued GP Access after-hours service, which delivers care for people in the Newcastle and Hunter regions. Funding for the service was left out of last year's budget, but a strong community campaign forced the government to back down at least for the time being. I hope this year's budget is more considered and does not make the same mistake. This government has also abandoned the National Partnership Agreement on Preventive Health and abolished the Australian National Preventative Health Agency. Preventative health cuts stretch into Indigenous health, with funding cuts from the Deadly Choices program, which delivered health programs through the Awabakal Medical Service to Indigenous Australians in my electorate and the surrounding region.
The hypocrisy of this government was on full show yesterday as they announced funds for an Indigenous quit smoking program, having already stripped $130 million out of the Tackling Indigenous Smoking program back in 2014. Did they think that those earlier cuts would be forgotten? The Liberals have also abolished the Health and Hospitals Fund, cutting $1 billion reserved for essential health infrastructure and cutting another billion dollars from public dental health programs, and they have moved to scrap the child dental health benefits scheme. One of the cruellest cuts, of course, was the $650 million in cuts to Medicare rebates for pathology and diagnostic imaging, which will force up the costs of tests, X-rays and scans for patients everywhere.
The cuts to Medicare will force patients being treated for cancer and other serious and chronic health conditions to fork out thousands of dollars up-front for crucial tests. The Royal College of Pathologists of Australasia have said that pap smear tests could cost women at least $30 up-front if these cuts go ahead. Decades of work to improve women's health will be put at risk because of these cuts. The financial burden on patients is significant. It is estimated that patients will have to pay up-front costs of $93 for an X-ray, nearly $400 for a CAT scan and up to $185 for an ultrasound. Then it multiplies—if you have a serious condition you require multiple, regular scans.
In just eight weeks, more than 500,000 Australians have signed a petition opposing these cuts. Last month, hundreds of Novocastrians came together with the shadow minister and me at a Save Medicare rally to tell Malcolm Turnbull: 'Hands off our Medicare'. Mr Turnbull's cuts to Medicare will hurt every family every day. We know that no matter what this government says you cannot trust them with Medicare and the health of our nation. The only way to save Medicare is to elect a Labor government.
The element of the motion before the House today that I would like to focus on specifically is, as the member for Newcastle just referred to, pathology bulk-billing and the extraordinary claims that have been made. I will be tabling the Sonic Healthcare Limited half-year annual report in a minute—the member for Franklin can take her time to read that. Those on the opposite side, the Labor Party, have made a choice here and clearly they have chosen a multinational with an $8 billion turnover. I note today that shares in Sonic Healthcare are up 1.08 per cent to $19.63. They have had a successful run, most recently, I suspect, since those from the other side have been making extraordinary claims about incentives. No doubt this incentive was put in place by those opposite with good intentions. But here we are with $650 million in the pockets of multinational, profitable, publicly listed companies who's first priority is to their shareholders, not to the consumers of the services that they provide, which begs the question: what might be the alternatives if that is the way that they want to play cricket?
It is extraordinary to see the Labor Party standing up for big profitable multinationals in favour of consumers. This scare campaign is being run in my electorate and across the state of Tasmania. People coming in to have their pathology tests are being asked to sign a petition to say that an incentive that was put in place of between $1.40 and $3.40, depending on the respective schedule number, is going to require payments after 1 July of $50, $60, $70, $80, $100. This is extraordinary. They could cut their interim dividend for six months that is going to their shareholders—which has gone up by 3.8 per cent I note, and I will be tabling this report—by 0.1 per cent, and they could pay for this incentive payment that was made by those opposite.
My view of the world is that I try to be pragmatic about these things. I do not dispute that what those opposite put in place had good intentions. It was intended to increase the rate of bulk-billing. Guess what has happened? In four years, $650 million later, the rate of bulk-billing for pathology services has gone from 83 per cent to 84 per cent. If that is money well spent, I will give it away. Rather, we could have put the $650 million to the side and said, 'When you show us how you will increase your bulk-billing proportions, we will pay you a bonus.' I reckon I could have lived with that. I reckon the taxpayers of Australia could have lived with that. I think this could have been something that would have been considered. But the fact is that we have paid over $650 million over four years and we have not seen a demonstrable improvement in the rate of bulk-billing.
In my state of Tasmania, I asked this question—and again, I have put consumers first, not profitable multinationals. As a government, and as organisations that are providing these very important pathology services, maybe we should put the whole damn lot out to tender. Maybe we should go to these profitable, publicly listed companies, and maybe we should ask them to put their best foot forward on what they are prepared to provide services for—on the basis of, say, a 95 per cent bulk-billing rate. Maybe that would be an alternative. So I ask the question again of those opposite: do they support consumers, or do they support a scare campaign that is being run by profitable multinational companies whose first priority is to their shareholders, not to the consumers of their services?
What an extraordinary display! To quote Shakespeare, he 'doth protest too much,' quite frankly. Obviously, the member for Lyons is concerned about these cuts in his own electorate and in Tasmania. And so he should be because, with a federal election due in coming weeks, we all recall the current government's promise on the eve of the last federal election of 'no cuts to health.' It is a very definitive statement, I would have thought. Of course, since that time we have seen them tear up the health funding agreement that committed 50 per cent of growth funding for the efficient price of our hospitals. This is already starting to impact in Tasmania, as the additional funding of $300 million for Tasmania's health system that we secured when we were in office—actually when the member for Sydney, who is right here beside me, was the health minister—starts to run out at the end of this June. We have the state government already making significant cuts to the Tasmanian health system in preparation for this. Indeed, the Parliamentary Budget Office has suggested the health funding cuts over the forward estimates to be $1.15 billion, just in Tasmania. For the Royal Hobart Hospital and the southern health services, that means a cut of $600 million—to one hospital in southern Tasmania and its services.
We have even had our state Premier and our state health minister stand up and say that these cuts are disgraceful. They have at least said that. They have not actually argued for much of the money back. I was very disappointed when our Premier came back from his meeting with the Prime Minister and said that he had an additional $54 million from 2017 to 2020—when he has had $1.1 billion taken away. It does not take much to do the maths to say that we are more than just a little bit short. What it has meant in Tasmania is that at the moment we have more than 27,000 Tasmanians currently waiting on outpatients' lists to see a specialist. So they have not yet even progressed to the waiting list for elective surgery; they are still just waiting to see a specialist. There are 27,000 Tasmanians sitting on those lists, and some of them are waiting for a very long time indeed. To see a gastroenterologist, the wait at the moment is 850 days in my home state of Tasmania—to get in to see a specialist in the public health system there is a wait of 850 days. It is not good enough. Those opposite should be ashamed of these cuts. They should be ashamed of the impact they are having right across the country, but particularly in my home state of Tasmania. We all know that the way you keep people out of hospital and off these lists is with preventative and primary health care. That brings us to the important role that GPs play in the health system.
This motion specifically talks about the two attempts by those opposite to introduce a GP tax—a co-payment for people to pay when they go to visit a GP. They finally saw sense after a very long campaign indeed, particularly by GPs and other health professionals around the country, when it became very obvious that this would mean that people would not seek the health support that they need. They would then, further down the system, get sicker and cost all of us more. They decided that they would not do that. But what they have done is freeze the Medicare rebate for seeing a GP. What that will mean is a GP tax by stealth. We are already seeing an impact, in local communities, with people trying to get into GPs. We have already had GP clinics—last time they talked about their GP tax—saying that people rang up and cancelled their appointments because they could not afford to go to the doctor. What we do not want to see in this country is a situation where the health care of Australians is determined by somebody's credit card, not by their Medicare card. We need to make sure that all Australians, no matter where they live, no matter their illnesses, can seek the health care that they need, right across the country.
This motion also goes to the issues that you talked about, in terms of pathology and bulk-billing, and what the member for Lyons got so upset about that I referred to at the beginning. I attend pathology on a regular basis. Every time I go in there, they talk to me about the concerns they have with bulk-billing, the bulk-billing incentive and their patients. The concern is that people will not get—
Government members interjecting—
This topic is very sensitive to everyone in Australia because health is so important to everyone. At some stage, everyone needs to end up in a hospital or at a doctor's surgery, so there is so much emotion attached to an argument about health. We will try and restrict it to the facts. I just want to point out some of the hypocrisy coming towards us from the other side.
First of all, the member for Lyons so elegantly outlined the bulk-billing rebate. At the time that pathologists are running a scare campaign, saying that we are cutting bulk-billing, it is really quite misleading. Bulk-billing itself is not being cut, but the incentive to the pathology company that does not go to the patient is being cut because it did not achieve what it was meant to. It was meant to increase bulk-billing but, over five years, it has hardly budged. That is a figure of $1.40 to $3.40. As was recently tabled, some documents for a publically listed company show a healthy profit margin and an increase in the last six months.
The ability to cherry pick knows no bounds from the other side. They miss the big picture. In a health budget, it is not just a pathology bulk-billing incentive that counts, it is things like drugs. Look at all of the new hepatitis C drugs that are available for patients, courtesy of sound financial management. Look at all of the new cancer drugs, look at all of the biologicals that are coming on-stream. People forget about the Pharmaceutical Benefits Scheme. That has to be paid by something. Everyone on the other side seems to cherry pick any remote linguistic twist to put the word 'cut' on the table—whereas health funding has gone up to record levels under this coalition government.
State funding agreements for hospitals have gone up over the forward estimates, in the next couple years, to the tune of several more billion. That is not a reduction. That is also part of the health budget. Look at what we have been doing with the Primary Health Networks. Primary Health Networks were very dysfunctional. There was the odd one that was really delivering some runs, but it has been restructured and they have clear KPIs, and they have a clear target of what to do. They are not going to just duplicate existing general practice services or providers—whether they are public hospitals or private practitioners—they have to meet targets.
There are our initiatives in chronic disease management. Chronic disease costs so much to the health budget. It is the old adage that 15 per cent of the patients cause 85 per cent of the costs. That is the nature of it. Most of the health spending that all we Australians receive comes at the tail end of our life. If most of us remain healthy, that is the logical conclusion. The chronic diseases—those recurrent spending ones such as kidney failure, diabetes, heart disease, vascular disease or chronic lung disease—are a real burden on an individual's life, but economically they are the best areas to target for savings and efficiencies. By having a healthcare home, rather than having patients shop around to wherever it is convenient at the time, you will get all your chronic disease cases focused into one practice. That will mean that 65,000 patients, in a trial across 200 medical practices, will get a system in place that works for the patient and also for the economic bottom line.
This criticism about so-called rebates was really meant to be about incentive payments. I notice that the member for Sydney is here to debate this topic, but when she was the Minister for Health she introduced an MBS freeze. The member for Ballarat actually belled the cat on Sky News on 22 February 2015. She said: 'The Opposition would be kidding itself if it didn't recognise there are challenges. There is no area in the budget that is going to be exempt.' We are already on the front foot in addressing this. That is why the Medicare Benefits Schedule Review is under way. Look at what we have announced in the Health portfolio with the Child and Adult Public Dental Scheme. That is an increase—up to $2.1 billion to provide infrastructure in public hospitals in regional and remote Australia, and to deliver what the previous schemes have not delivered.
Whilst a rather animated attack by the member for Lyne—in a very selective way—on one multinational corporation was made in this place rather than in the House, when word drifts back to the Free Enterprise Foundation and Senator Sinodinos, I have a feeling he will be getting a phone call about that outburst. It was against one corporation alone, for reasons that we can see in this debate. Yes, indeed, the attack by the current government on universal health care in this country is manifest and is broad. It has ranged through co-payments and across the $650 million in cuts to Medicare rebates for pathology and diagnostic imaging. It has involved the abandonment of the National Partnership Agreement on Preventive Health and abolishing the Australian National Preventive Health Agency. Another aspect has been the abolition of the Health and Hospitals Fund, cutting $1 billion. If it has been manifest and broad, then the results have already been manifest and broad as well.
The degree of opposition to this is, indeed, across the spectrum. We have seen a situation where, already, with regard to patients, more than one in seven healthcare fund members used their cover to pay a medical gap last year, which was up from almost one in 10 at the same time last year. A Sydney University analysis has estimated that the Medicare rebate freeze will cost the average full-time GP $9,600 a year from July, rising to $29,500 by 2017. As I say, this is a credible Sydney University analysis. This equates to a 7.1 per cent cut in real terms. Assuming this cut is passed onto non-concessional patients, each visit would cost around $8 more. We have seen a need for doctors to charge patients an extra $2.74 to cover costs from this year, rising to $8 per visit by 2017-18.
Whilst those opposite are making a rather novel attack on pathologists, we note that they are campaigning against government cuts to bulk billing incentives that could see a blood test cost $20 from 1 July. Nearly half a million patients in this country have so far signed a petition. Last week, the industry released a report which showed how it saved the government $2.4 billion last year by providing free tests. The Ernst & Young report shows Australian pathology costs $381 million less than in the USA and $45 million less than in Canada.
Radiologists have produced an analysis that shows cancer patients face gap payments of up to $800 a year for scans when Medicare rebates are slashed from July. The ADIA figures suggest general bulk-billed patients could face up-front costs of up to $101 for an X-ray and $532 for an MRI, and there would still be out-of-pocket expenses of $62 to $172 for MRI patients. Dentists are fighting cuts to the child dental scheme that will see three million Australian children denied access to $1,000 worth of government funded dental care from their family dentist. Instead they will be thrust into the public dental care scheme, where they will queue for up to three years to get treated. The Oral Health Alliance—once again, those opposite will say they are interested parties, that doctors and dentists are all self-interested bludgers on the system; that is the kind of line those opposite are coming out with about the Australian medical fraternity—has calculated that the cuts mean people will get one dental treatment every 17 years or else receive $40 per year for their care. They have publicly labelled the government's new Child and Adult Public Dental Scheme as nothing but smoke and mirrors.
In an article in The Sydney Morning Herald on 17 February, two organisations hit by the pathology cuts said that the publicity around the costs alone had already begun to discourage patients from getting tests. The article said:
This trend, and the effect of cuts to fees for Vitamin D tests, which were implemented in 2014, were a drag of interim profits, announced by both companies on Wednesday.
But those opposite will say: 'They're multinationals. It's all lies. It's all false. It's all fabricated.' That is despite the fact that this is supported by disinterested medical research units.
Other federal cuts in last year's MYEFO are also specifically hitting people who otherwise would not access health care. The ABC reported in March this year that the Haymarket Foundation Clinic, a health clinic for Sydney's homeless, has lost annual federal funding of $900,000 and will be closing after more than 40 years of operation. They are not too wealthy, they are not pathologists and radiologists; they are people doing this out of a commitment to the patients. The clinic is staffed by doctors, nurses, welfare workers and a psychologist. The clinic is expected to close its doors shortly.
What an interesting motion from the member for Newcastle! It was laid on very thick—so thick that if you put on your garden you could watch the veggies grow by the minute. The motion is full of Labor headquarters messaging. We understand that in this business there is a relative amount of spin—I accept that—but this is not spin; this is pure deceit. We are talking about a range of activities. There are eight or 10 points to this motion. Let us begin where the previous speaker left off: the MBS rebate pause. Who introduced the pause? It was the Labor Party.
Ms Plibersek interjecting—
The member for Sydney over there tries to interject, but let me read what you said—
I acknowledge that. Thank you. When Labor introduced this measure that they are now arguing against, the then health minister, the member for Sydney—listen carefully—said this: 'Doctors earn enough money to bear the Federal Government's controversial freeze on MBS rebates.' The previous speaker said that we are the ones who have something against doctors, dentists and specialists because they earn too much.
Let me remind you, this is what she also said: 'I understand that GPs have all sorts of expenses running their surgeries and employing staff and so on, but the average billing from Medicare is more than $350,000 a year.' In other words—
The reality here is that the MBS rebate pause was put in place by the previous government under the direction of the member that sits in this chamber now, the member for Sydney. Do not come in here with your crocodile tears today, because it is just not going to wash.
Let's talk about pathology and radiation. What a tremendous contribution by my fellow Tasmanian the member for Lyons! He got it spot on. What happened? The previous Rudd government said, 'We'd like to increase the number of people who are being bulk-billed'—which was about 86 per cent at the time. They committed, rounded up, $600 million for an incentive of between $1.40 and $3.40 to try to encourage everyone in that space, but we know that about 80 per cent of the business in that space was taken up by two major companies.
So we go from talking about removing an incentive that has only increased by one per cent to these companies now saying, 'Whoa! We'll have to charge $30, $40, $50, $60, $100.' What the hell is that all about? $1.40 to $3.40 is being proposed to be taken away because the incentive that you put in did not work, and we have multinational companies actually saying, 'That's going to cost us $30, $40, $50 to $100.' How does that work? I do not know where that works. I am going to leave that. You can run the 'don't kill bulk-bill' campaign all you like, but the reality is you are supporting a strategy that basically puts very good profits into the hands of very big companies. Do they do a good job? I am sure they do. I agree with the member for Lyons; maybe it is time that we put this service out to tender. Maybe that is what we should be doing. I think the member for Lyons is spot on.
Let us talk about another one of these areas in the member for Newcastle's motion: the child dental and adult dental health scheme. What is really interesting here is that we heard a lot a minute ago about health and about how everyone should be treated equally—that it should not be about your postcode and your credit card. What did the previous government do? One: they put in place a scheme in which only a third of the eligible children have been treated. What an absolute joke.
Opposition members interjecting—
It is like everything you do—it is never project managed and it never delivers. What did you say? You said that the child dental benefits schedule was just like Medicare except that it was means tested. Does this mean that Labor has a secret plan to means test Medicare? Well, we know that they love a good means test. Just look at the private health industry rebates.
At the end of the day, this motion that is before us today is just full of error, it is full of incomplete ideology, it is full of deceit. It is a deceitful motion. Everything that is going on around this is full of deceit, and the people are much smarter than that.