House debates

Monday, 19 June 2017


Medicare Guarantee Bill 2017, Medicare Guarantee (Consequential Amendments) Bill 2017; Second Reading

3:27 pm

Photo of Bert Van ManenBert Van Manen (Forde, Liberal Party) Share this | | Hansard source

I rise to speak on the Medicare Guarantee Bill 2017 and the Medicare Guarantee (Consequential Amendments) Bill 2017. I made some comments prior to question time and I will follow-on from those. It is a pleasure to stand in this House and speak about this government's commitment to ensuring we have a robust and well-funded health system. While those opposite can postulate and bemoan about any strategy they had not thought of first, it is this government that is actually working hard to deliver on a result that is fair, reasonable and constructive for Australia's future health needs. The opposition will say and do anything to distract us from what we are really trying to achieve here. But while they are concerned about serving themselves and their own selfish ideals on this issue, it is this government that is working to guarantee Medicare and to guarantee families in this nation that they and their children's healthcare needs will be supported now and into the future. What is important here is the word 'guarantee' in the title of this bill. It is not a wish, it is not a maybe or some fanciful strategy that we have seen from those opposite many times over the years. It is a concrete arrangement between this government and the Australian people that will work to ensure that our nation is moving into a future of affordable health care for all. We know that this issue is of vital importance to many Australians.

In my electorate of Forde, the issue of quality health care and its importance to our nation and communities is raised with me on a regular basis. My constituents are passionate about making sure that our government defends their ability to receive affordable health care. This bill establishes the Medicare Guarantee Fund to secure the ongoing funding of the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme from 1 July this year. The proceeds from the Medicare levy—that is the portion set aside that will contribute to our fully funding the NDIS, another important decision by this government—along with additional contributions from income tax revenue will be paid into this fund to meet the costs of the MBS and PBS. These amounts are held in the fund for the sole purpose of funding these two. In the next financial year, an estimated $33.8 billion will be credited to the fund, with the Medicare levy contributing about $12.1 billion.

Importantly, this fund provides transparency around the actual costs of running the MBS and the PBS, showing once again this government's commitment to affordable health care for all Australians and that they can rely on this government to provide it. The ring fencing of the revenue in the Medicare Guarantee Fund will increase the public visibility of the costs of the MBS and the PBS, along with the revenue generated by the Medicare levy and the additional revenue necessary to meet these costs. It proves that this government is holding itself accountable for this fund and its success. We and those opposite know that this plan is responsible. It is affordable and practical for this nation and its healthcare future. When this government commits to a plan, it will deliver on it. We are not wasting time and we are not hiding behind grubby scare campaigns like those perpetuated on the Australian people last year. We do not want to trample over our most needy to gain political ground. We know that there is no time to be wasted on this issue.

Australians need affordable and practical assistance with their healthcare needs, and they will get it now through this government. This is a peace of mind strategy for our country, and it is this government that is providing it. We are making sure that all Australians can be assured that Medicare is not only here to stay but will be strengthened into the future. We want to give people the confidence to go to the doctor without the financial burden and the confidence to have children and grow our nation's population. We want to give them the confidence to speak openly and honestly with their GPs and specialists about vital healthcare needs. This is what we want to see for the Australian people.

Importantly, if the Australian people know that those basic services are provided in our community then it gives a level of confidence, for them personally and for their families. We want to see an Australia that is a vibrant, healthy nation, prepared to meet the challenges that we face globally. This bill is about protecting an essential service, so that the many Australians who rely on it and this government's funding of it have the security and peace of mind that it is there for future generations. I commend this bill to the House.

3:32 pm

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

I rise to join my colleague the shadow Treasurer in speaking on the Medicare Guarantee Bill 2017 and the Medicare Guarantee (Consequential Amendments) Bill 2017. This is, quite frankly, an insult to the Australian people. It is an insult because the government, at the same time as we debate these bills, continues to inflict savage cuts which make it harder for Australians to access the health care they need. Only this government would have the audacity to introduce a so-called Medicare guarantee while continuing to rip billions of dollars out of Medicare services.

Let us be clear about what is in front of us. This is a transparent attempt to pretend to care about Medicare, without actually addressing the damage that the government's policies have done and will continue to do to our healthcare system. In fact, only a government that cannot trust itself with Medicare, that knows it has a political problem with Medicare, would seek to introduce this sort of bill. Guaranteeing Medicare would have meant dropping the freeze on the Medicare Benefits Schedule immediately and entirely in the last budget. Guaranteeing Medicare would have meant properly investing in our public hospitals. This government has done neither.

Instead, they have introduced this bill in a farcical attempt to distract from the damage they have done to Medicare. The Medicare Guarantee Fund is not a guarantee. There is nothing in this bill to stop the government from making further cuts to Medicare or to the PBS. In fact, it looks like the government, in its attempt, has been constantly saying Medicare is not sustainable. They have created this bill, this fund, to show and shine transparency on Medicare, and this is their next step in continuing the campaign against Medicare by saying Medicare is not sustainable.

While this bill creates two special accounts used to channel funding through to Medicare benefits and the PBS, this is essentially what actually happens now under the special appropriations in the Health Insurance Act 1973 and the National Health Act 1953. For the purposes of budget mechanics there is absolutely no difference with this current scheme. Stakeholders have quickly called this out for exactly what it is—a meaningless stunt. The former secretary of the health department, Stephen Duckett, says the fund is 'an accounting trick' that

…provides no guarantee of policy stability, no guarantee of additional funding, and no guarantee that a future budget will not tear into the Medicare fabric … .

In fact, the finance minister has admitted that it is not a guarantee; that it is actually about visibility and confidence in Medicare, not a guarantee of Medicare at all.

Bizarrely, this fund does not include public hospital funding, which is a fundamental part of Medicare—our universal public health scheme. Medicare includes: the Medicare Benefit Schedule, our commitment to pharmaceuticals and to universal access of public hospitals. It shows how little this government understands Medicare that it has not included public hospital funding in this guarantee. By leaving out public hospital funding, even the government is conceding that our public hospitals face a future of uncertainty and cuts under their watch and that this government no longer considers them as part of Medicare.

It is no wonder that this government is trying to use the bill to distract from its health cuts. They have an appalling record when it comes to Medicare. The track record includes: repeatedly attempting to introduce a GP tax, only to ram it through by stealth through a six-year freeze to the Medicare Benefit Schedule; attempting to slash Medicare Safety Nets, the extra assistance relied on by Australians with high medical bills; fighting to hike the cost of life-saving medicines for every Australian; attempting to abolish a program which provides dental care for low-income children; slashing basic dental support to Australia's most vulnerable adults, putting further pressure on public dental waiting lists; ripping almost $1 billion out of preventative health, ending successful programs including those which teach children in kindergartens and schools about healthy eating; and, of course, more recently cutting the capital fund that allows public hospitals and others to upgrade their cancer diagnostic and treatment equipment. The list goes on.

The impact of those appalling decisions is that patients have been paying more and our health system has been dragged backwards. This bill does absolutely nothing to guarantee that a future Turnbull government will not continue to wreak damage on Medicare. The bill does nothing to address the fact that our public hospitals are in crisis under this government. Elective surgery waiting times are now the worst they have ever been since records began to be kept in 2001. Patients presenting to emergency departments who require urgent medical attention are being left in emergency departments for longer. In the last financial year only 67 per cent of emergency department patients classified as urgent were seen within the recommended 30 minutes. What has this government done? It has cut the extra funding going to public hospitals from the Commonwealth to improve elective surgery and emergency department wait times. I know the members opposite do not care about people waiting in public hospitals but, critically, we do know that public hospital capacity is not keeping pace with population growth and it is not increasing to meet the growing demand for services. And yet the government's budget has done absolutely nothing to address the crisis in our hospitals—nothing for elective surgery, nothing for straining emergency departments. Not only that, but the government in the budget has changed the funding formula for 2021, meaning that public hospital funding from 2021 will revert to the levels set in the disastrous 2014 budget without a new agreement. The government has a problem here—either it has a big black hole when it comes to public hospital funding or it has an unfunded liability if it intends to increase public hospital funding in 2021.

The fact is that Medicare is under as much threat under this government as it has ever been. The damage done by the Prime Minister's freeze will continue to rip $2.2 billion out of Medicare, out of those patient rebates over the next four years alone. That is $2.2 billion in patient rebates that should have been going to ensuring that people in our communities have the care they need through general practice and specialist appointments.

Frankly, it beggars belief that almost a year after the election, Australians are still bearing the brunt of health cuts that millions of them voted against. And it beggars belief that the government's budget will keep many of these in place well beyond the next election. The GP freeze will not be fully lifted until 2020, including items such as pregnancy support, counselling, GP mental health plans, family counselling help and items when a patient is at imminent risk of death. That is not what a Medicare guarantee looks like; that is what a government desperately seeking to distract from its cuts looks like.

I have a particular question that I would like the Treasurer to respond to when he returns to speak in summing up this bill. I want to ask a particular question about section 15 of the Medicare Guarantee Bill. Section 15 states that 'surplus amounts in the Medicare Guarantee Fund (Health) Special Account' will be transferred to the general consolidated revenue fund. That seems to mean that, if the appropriation for these bill is surplus to what is required to fund Medicare, that money will go back into the contingency reserve fund. What if the reason that it is surplus is that this government has made cuts to the Medicare Benefits Schedule or it has taken drugs off the Pharmaceutical Benefits Schedule?

What this bill in fact does is guarantee that none of that money will stay in health; it will go back into consolidated revenue. So it in fact does the opposite of what a good health minister would be seeking to do, and that is guarantee that that funding that is appropriated for health purposes stays within our healthcare system. That is the problem with section 15. I ask the Treasurer when he comes to sum up on this bill to actually respond to that problem. If surplus funds are moved back into consolidated revenue rather than being reinvested back into Medicare, it will show that, it does not matter how much money is put into the Medicare Guarantee Fund Special Account, the government can get away at any point with cutting it. If they reduce the Medicare Benefits Schedule at all and less money is required for the appropriation of Medicare, that money will not stay in health. This bill actually locks that position in.

Only Labor can be trusted to fight for Medicare. Only Labor can be trusted to protect Medicare. That is exactly what we are doing. We will be introducing amendments to this bill that will properly protect the future of Medicare. These amendments will mean that the bill cannot be considered until funding to support universal access for public hospital treatment is included in the Medicare Guarantee Fund. As I have noted, it beggars belief that funding for public hospitals—a core pillar of Medicare—has been left out of this fund. The amendments will guarantee immediate and annual indexation of Medicare rebates that have been frozen by this government, including GP rebates, rebates for specialist consultations and procedures, allied health services and those diagnostic imaging services unfrozen in the budget in the 2019-2020 financial year. Every day the government's Medicare freeze remains in place is another day that Australians are paying more for their health care.

Finally, given that we know that this government cannot be trusted with anything on health, the amendments I will move will mean that the bill cannot be considered until there is a guarantee that savings from the Medicare Benefits Schedule Review and agreements with stakeholders, including those savings from the deal with Medicines Australia that we want to see used to fund new drugs, can be reinvested in Medicare and not used as an excuse to further cut and undermine Medicare. This government is hell-bent on gutting Medicare through any means possible.

At the last election, Labor committed to reinvesting every single dollar of savings found through the ongoing Medicare Benefits Schedule Review back into Medicare and new innovations in our Medicare benefits system. The government has not made the same undertaking, and we know that it will cut into Medicare if it can get away with it. If the government votes against any of these amendments, it will be more confirmation that, when it comes to health, its budget is a complete and utter sham. With a disastrous record on cuts to health and Medicare, we know the government can never be trusted to do the right thing.

Medicare will never be guaranteed while this government continues to rip millions of dollars out of it. Medicare will never be guaranteed while the government fails to properly fund our public hospitals and to seriously address elective surgery queues and emergency department waiting times. Medicare will never be guaranteed while the Medicare freeze remains on GP items, specialist items and allied health items, in some cases until 2020. The plain truth is that Medicare will never be guaranteed under this government, and this bill does not change a thing. Therefore I move the following amendment:

That all the words after "That" be omitted with a view to substituting the following words:

"consideration of the bill and related bills be deferred until the Minister amends them to include actual guarantees for the future of Medicare, specifically amendments that:

(1) set out the purpose of Medicare, namely to provide a universal public health insurance scheme that provides access to medical, pharmaceutical and public hospital services based on clinical need, not capacity to pay;

(2) include funding to support universal access to public hospital treatment, along with medical and pharmaceutical benefits, in the purpose;

(3) guarantee immediate and annual indexation of Medicare rebates that have been frozen by this Government;

(4) guarantee proper Commonwealth investment in public hospitals, so that all Australians can access acute care without financial or other barriers; and

(5) guarantee that savings from the Medicare Benefits Schedule Review and agreements with stakeholders will be reinvested in Medicare, and not used as an excuse for further cuts".

This amendment is what a real guarantee for Medicare actually looks like, not a pretend guarantee to try and get yourself out of a political problem. We know that is what the government is attempting to do with these bills. We know that the government is basically creating an accounting trick—creating two new funds to replace the purpose of two existing pieces of legislation. We see that in the consequential amendments bill. This bill does absolutely nothing to stop the sort of havoc that we have seen a Liberal-National Party government wreak on our Medicare system: cuts to GP services and the undervaluing of general practice in our communities; the undervaluing of specialists and the important services that are provided by them; cuts to patient rebates; and cuts to child dental services. Only Labor guarantees Medicare. Only Labor will protect Medicare. I hope the Liberal Party finally sees some sense and supports the amendment circulated in our name.

Photo of Mark CoultonMark Coulton (Parkes, Deputy-Speaker) Share this | | Hansard source

Is the amendment seconded?

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

I second the amendment and reserve my right to speak.

Photo of Mark CoultonMark Coulton (Parkes, Deputy-Speaker) Share this | | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Ballarat has moved as an amendment that all words after 'That' be omitted with a view to substituting other words. The question now is that the amendment be agreed to.

3:48 pm

Photo of Luke HowarthLuke Howarth (Petrie, Liberal Party) Share this | | Hansard source

It is interesting to sit here and hear the member for Ballarat continue on her scare campaign from the 2016 election—because that is exactly what just happened here. That is exactly what we heard from the shadow minister, because the statistics prove very different to what she is saying. And statistics do not lie. That is one thing that you are always taught. If you look at the stats, they are true.

The older you get, the more clear it becomes that good health is every Australian's most valuable asset. It is one of those 'money cannot buy it' things. That is what they say, but it is true. When you do not have your health, you have nothing else. While we cannot guarantee that every Australian will be blessed with perfect health, investment in preventive health, health management and treatment ensures you are in the best health you can be. That is why this government is committed to safeguarding Australians' ongoing access to Medicare. While I cannot guarantee every one of us will be forever in tiptop perfect health, I can guarantee that, as a result of the coalition government's resolve, our health system will be.

Australians can have great faith in the fact that Medicare is not only here to stay but will be further bolstered by a $10 billion package that supports our health system so that it may in turn best support Australians and their families. The 2017-18 budget delivers on the coalition government's plan to make the world's best health system even better, so that every Australian has access to the best doctors, nurses, hospitals and medicines.

Funding for our outstanding public hospital system will increase by $2.8 billion this financial year, despite what the member for Ballarat says, and Medicare funding will increase by $2.4 billion over the next four years. This funding injection includes a $1 billion commitment to our doctors and their patients to restore indexation of the Medicare rebate—cut by Labor, by the way—commencing with GP bulk-billing arrangements starting on 1 July. We have joined with Medicines Australia to ensure access to important treatment, by reducing the costs of medicines by $1.8 billion over the next five years. In addition, with heart disease being Australia's No. 1 killer, we are giving new hope to 60,000 patients at risk of chronic heart failure, who will benefit from the listing of new drugs at a cost of more than $510 million.

I am proud to be part of the government that is securing the future of Australians and their families through our commitment to Medicare and the establishment of the Medicare Guarantee Fund. The fund sees proceeds drawn from the Medicare levy, minus the portion set aside for the National Disability Insurance Scheme, and an additional contribution from income tax revenue, with the sole purpose being funding the MBS and the PBS. The fund will ensure transparency, visibility and sustainability of the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, guaranteeing Australians access to these services and affordable medicines long term.

The coalition government understand the value of an effective, efficient health system and what that means to Australians and people in my electorate of Petrie. We are unwavering in our commitment to tangible measures that use taxpayers' money wisely to improve the health and lives of Australians. It is sad that the same cannot be said about those opposite. They see Medicare as a political tool to manipulate for their own gain. I am just saying that we all remember 'Mediscare' in the 2016 federal election. The opposition are not interested in guaranteeing Medicare; their primary focus is guaranteeing their own jobs, and if that comes at the expense of the health of Australians, well their actions suggest an attitude of: 'Oh, well, so be it.'

For those actually interested in the facts about the federal government and our position on Medicare, it is good to know that we are investing record levels of funding into Medicare, and this continues to grow each and every year—each and every year it goes up. We are investing more than $22 billion into Medicare, and this will increase to nearly $26 billion in 2019-20. We have an economic plan that underpins our ability to fund better health care for Australians and their families. Our plan is sensible and sound and it drives jobs and growth, which means that we can fund Medicare into the future and guarantee Australians access to health care.

Medicare is a core coalition government priority, despite what those opposite say. In fact, during the election campaign the Prime Minister made a commitment that every element of Medicare currently delivered by government would continue to be delivered by government. Already we are seeing Australians getting more benefit from Medicare than ever before. Bulk-billing rates are the highest they have ever been. Let me repeat that again: bulk-billing rates are the highest they have ever been—not this year or next year; right now they are the highest they have ever been. It is over 85 per cent, compared to an average of 79 per cent under the member for Ballarat and those opposite. Last financial year there were roughly 17 million more bulk-billed GP attendances than in Labor's last full year in office in 2012-13. More people than ever before are seeing a GP without having to pay anything.

It was great to have the minister in my electorate just this month, when we spoke with local doctors and pharmacists who are particularly welcoming of our Health Care Homes policy. The policy gives GPs and their team flexibility to coordinate, manage and support patients with chronic illness with the aim of keeping them healthier at home and out of hospital. Five sites in Petrie will take place in the Health Care Homes trail: Lakelands Medical Centre, Moreton Aboriginal and Torres Strait Islander Community Health Service, Redcliffe Peninsula 7 Day Medical Centre, The Bay Family Medical Centre and, lastly, Redcliffe GP Super Clinic—which, when I was elected, was still shut; the doors were closed, and there was not a doctor in the place. After all that they said about Redcliffe GP Super Clinics, we finally got it open, and there are doctors practising there. The Redcliffe GP Super Clinic will now take part in the Health Care homes trial. It is a great win for the people of Petrie and a great win for all Australians.

It is no accident at all that Australia rates among the 10 healthiest nations in the world. We boast a robust agricultural sector, an environment which supports the plentiful production of fresh food and we get out and about—we exercise. We have a great nation, a wonderful nation, to get out and about in, and we are active. Importantly, our government is committed to the people it represents. We are definitely committed 100 per cent to the people we represent. Unlike Labor, the coalition governs for all Australians, even if they did not vote for us. We are not lining the pockets of unions.

Mr Tim Wilson interjecting

We are not being held to ransom by a third party, Member for Goldstein, and we are not playing politics with issues like the NDIS and school funding that we have clearly see this week from those opposite. We are focused on outcomes, as opposed to the opposition. We take seriously the health of Australians and their families. Australians place great faith in the range of essential services available to them, and they can be confident that the coalition government will deliver.

3:57 pm

Photo of Terri ButlerTerri Butler (Griffith, Australian Labor Party) Share this | | Hansard source

I rise to speak to the Medicare Guarantee Bill 2017, and to say that it is pretty clearly nothing more than a fig leaf. We have already had the government in here today with their bank levy legislation, which is a fig leaf to protect them from exposure in terms of their work to support the banks and protect the banks from a royal commission. Now, we see this fig-leaf legislation, which is all about protecting them from criticism in relation to their woeful record on Australian public health and Medicare. This bill is an attempt to set up a special account for a so-called Medicare guarantee. But the only way to guarantee and protect Medicare is to end the government's freeze on the Medicare Benefits Schedule, to stop this government from continuing to attack Medicare and public health in this country and, ultimately, to throw this mob out because, frankly, all they have ever done in government is to attack public health care in this country. And their record on private health is not that much better.

The idea of having a special account for Medicare is, of course, an illusion because the Constitution says that there is one account, and it is called the consolidated revenue. This idea of having a special account is really just a bit of creative accounting. It is a bit of trickery from the government to make it appear as though they are taking action on Medicare, while, at the same time, we are still seeing the consequences of freeze on the MBS. What has that meant? It has meant the equivalent of the GP co-payment. They could not get a GP co-payment through the front door, so it is a GP co-payment through the backdoor. And people are paying for it. Households are paying for it. These are the very same households that are suffering from low wages growth, that are suffering from high housing costs and that are suffering from high energy costs because, under this government, wholesale energy prices have doubled. Under this government, wholesale energy prices have doubled and there are flow-on effects for households. Those very same households are suffering the consequences of this government's freeze on the MBS, and why? Because those costs are being passed on to healthcare consumers or, as I like to call them, people. People are paying the costs of this government's MBS freeze and their attempts to pretend as though they are defending public health are falling flat.

No-one believes a word this Prime Minister and this government have to say when it comes to health care in this country. He can complain all he likes about how it is unfair that he is being called out for his attacks on public health. He can stand up at the dispatch box and complain about his perceived victimisation—'Oh, it's not fair; Labor called us out on our public health policies.' We did call the government out at the last election and we will continue to call the government out throughout this term of opposition because, in fact, the only party that has ever defended Medicare in this country is the party that created Medicare—the Australian Labor Party. Bill Hayden, Bob Hawke—the Hawke-Keating years were the years under which Medicare was solidified. Before that, of course, Gough Whitlam had introduced public health insurance. But, unfortunately, what happened? The Liberals, when they replaced Mr Whitlam's government, came in and got rid of the equivalent of Medicare at the time. So it took a Labor government to bring Medicare back. It was greatly sad that there could have been a longer period of time that we had Medicare in this country, but for the Liberal Party.

I think they learnt the lesson of what happened with then Prime Minister Fraser's decision to axe universal health care and Prime Minister Hawke's decision to bring it back. I think they learnt a lesson from that. But, unfortunately, the Liberals learnt the wrong lesson. They did not learn the lesson that they should defend public health care. They learnt the lesson that they should appear to defend public health care. And that is what this is. It is the appearance of defending public health care while, at the same time, taking an axe to it. But people are not stupid. My constituents are not stupid. They know what is going on here. They know that when you start cutting funds—the cuts to pathology, for example—or when you start freezing the Medicare Benefit Schedule, and you freeze it for years and years, the consequences are consequences for them. They know that when there are attempts to put up the price of medicine over and above CPI the consequences are felt by them. And they know that a bill like this is nothing but an attempt to pretend otherwise.

The GP bulk-billing rate in my electorate of Griffith is 68.1 per cent. That is a woeful rate. In fact, we are 141 out of 150 electorates in our ranking in terms of our GP bulk-billing rate. The overall rate is even lower—66.8 per cent. What this means is that up to eight per cent of people will delay and put off going to see the doctor. In an electorate the size of mine, that is up to 13,000 people. That is absolutely reckless. The last thing this country needs or wants is having people not going off to the GP when they should be. Early diagnosis matters. Early treatment matters. This government, instead of this ridiculous idea of running up this pretend protection of Medicare, should actually stand up for people and fix bulk-billing rates, not be sitting around saying, 'Let's brainstorm ways that we can make it appear as though we are defending Medicare. Let's come up with ideas to pretend that we are doing something about Medicare.' Instead of doing that, just fix bulk-billing rates. Get rid of your Medicare Benefit Schedule freeze—not the pretend getting rid of it that you announced in the budget but actually move to get rid of the freeze. Stop trying to introduce a co-payment by stealth. People understand what you are doing, and they are not going to stand for it.

As I said, this is a government that is really not much better on private health than it is on public health. In fact, in my electorate the estimates from the private health association are that more than 60 per cent of people are covered by private health insurance. Yet, private health insurance has been 18 per cent higher under the Liberals. What is the Liberal government doing in relation to these issues? I wrote to the health minister on the day that he became the health minister—the day that he was sworn in as the health minister for this country. I said to him: 'Health Minister, we have these bulk billing problems in my electorate and we have concerns about private health insurance costs.' But this Liberal government has done nothing about those costs—absolutely nothing. All they have done is sit around brainstorming trickery to try to pull the wool over the eyes of the Australian people, because they know how deeply unpopular it is when Liberal governments like Mr Fraser's, like Mr Abbott's and now like Mr Turnbull's take the axe to public health in this country.

Universal health care is something that Australians are rightly proud of. We are rightly proud of the fact that we live in a country where we believe in universal health care, where we do not support the American path of private insurance and insurance being contingent on whether you have got the sort of job that offers the right sort of health plan. We have not accepted that American path of health care costing tens of thousands of dollars. We believe in public health care in this country. We believe in universal health care. It is something that Labor introduced. It is something that Labor has defended for decades, and it is something that the Liberals have opposed for decades. The only difference between now and the 1970s is that they are a bit less honest about it—they are just a little bit less forthright than they have been in the past in relation to their hatred of universal health care.

They cannot stand it. They think it is socialism. They think it is too much state interference in the market. That is what the people sitting over there think about our universal healthcare system. They would love to hollow it out. They would love to reduce the amount of public funding that is going into public health care in this country, and the reason they want to do that is that they have a fundamental ideological objection to public health care and to universal health care.

This bill really bells the cat on that. This idea of creating a special account is an attempt to pretend that some action is being taken is just deeply embarrassing for the government. I think the health minister is an intelligent man. This should be beneath him, and yet this is the sort of thing that is being trotted out for the attention of this parliament to try to help the government deal with its perceived political problem in relation to how on the nose it is when it comes to universal health care and Medicare in this country.

But, as I said, there is a pretty simple way that the government can actually deal with that political problem–that is just to stop taking the axe to public health care. It is a pretty simple thing: if you do not want people to be unhappy with you for cutting public funding to health care, then stop cutting public funding health care. It is as simple as that.

The finance minister has defended this bill by saying, 'Oh look, the thing about having this special account is, if a future government touches it, people will know about it.' That is a pretty frank admission from the finance minister that the Liberals will continue to seek to touch public health care, that they will continue to seek to do that.

In contrast, the shadow minister for health has made very clear our view on this bill. In fact, she spoke in this debate incredibly well—I think most people in this chamber would agree; certainly, people on this side of the House would agree—about our concerns about what this government is doing to public health care. She does not agree with the finance minister. What she has said is that this is some trickery. This is an accounting mechanism. This is not something that in any way provides any real protection to public health care. And how can it?

As I said at the outset, the Constitution makes really clear: there is one fund. It is the Consolidated Revenue Fund. This is not some special source of revenue for Medicare. This is not some special source of guarantee funding as someone might ordinarily understand the word 'guarantee'. This is not a guarantee at all in fact. It is not anything other than a fund being described as a Medicare guarantee fund with a view to trying to persuade the people of Australia that they do not need to be worried about the Liberals when it comes to public health care.

But they do. The people of Australia do need to be worried about the Liberal Party of Australia when it comes to the protection of our universal healthcare system. As I said, whether it is cuts to pathology funding, freezes to the MBS, increases in the price of medicines or cuts to public funding going to the states for the hospital system, this Liberal government has a woeful track record when it comes to public health care in this country.

Trickery is not going to help with that. People are alert to what is happening and what the Liberal Party is trying to do. People know that simply describing something as a special account does not provide it with any measure of protection whatsoever, with any additional protection from attacks by the Liberal government on public health care. The best way to protect public health care is to vote for a party that actually believes in public health care, that has a fundamental values-based commitment to saying that every person in this country—no matter their circumstances, no matter their background—should have the right to health care. That is what we believe and that is why we have been the party of universal health care.

We do not believe that your access to health care should be dependent on your credit card. We believe it that should be dependent on your Medicare card. If you want to have a party that will actually stand up for Medicare—not with trickery, not with accounting moves, not with attempts to pretend to be doing something when you are not really, but genuinely stand up for public health care, genuinely stand up for the appropriate levels of funding for public health care rather than seeking to cut public health care—then there is really only one choice and that is to vote Labor. The Liberal Party of Australia, whether they are led by Malcolm Turnbull, whether they are led by Tony Abbott, whether they are led by Peter Dutton, will never stand up for public health care in this country, and they certainly will never do it to the same extent that the Australian Labor Party will.

Medicare is an important legacy of past Labor governments, and it now falls to the Labor members of this place to stand up at this time to defend Medicare from the Liberal Party and from the conservative attacks on universal health care. My colleagues and I have been standing up on this issue to call on the Liberals to stop attacking Medicare, to reverse their freezes to the MBS, to genuinely stand for better bulk-billing rates across the Australian population and to genuinely stand up for people like the people in my electorate, who, as I say, have an incredibly low rate of bulk-billing, and GP bulk-billing specifically. Labor and each member on this side of this House every day fights to support Medicare, our universal public health care system and access to health care for everybody, dependent on your Medicare card, not on your credit card. The question for every single member opposite, whether it is the member for Bonner, the member for Forde, the member for Capricornia, the member for Dawson or the member for Leichhardt, is: what are you going to do? Whether it is the member for Petrie, whether it is the member for— (Time expired)

4:12 pm

Photo of Susan TemplemanSusan Templeman (Macquarie, Australian Labor Party) Share this | | Hansard source

When you are trying to convince the general public that you have suddenly found a heart and a brain, it is not surprising that there is some attempt to duplicate your opponent's policies and, of course, that is what we saw in the budget and that is what we are seeing in this legislation—a pale imitation of a genuine commitment to Medicare. You know it is merely an attempted imitation when, rather than taking steps to show a commitment to something, the best you can do is bring on a bill that says you have a commitment to it—and that is what we have here. Instead of doing all the things they could have done to show that the right to universal health care is a top priority, they have opted for words. Clearly, they do not realise that actions speak louder than words and, in this case, the actions tell us plenty about the commitment to Medicare.

Let us look at the actions, or the lack of action. If they really wanted to protect Medicare, they would have dropped their freeze on Medicare services entirely. If they really wanted to protect Medicare, they would have properly invested in public hospitals. They did neither and, in fact, have outsourced where they can and have explored ways to reduce the federal commitment to hospital funding.

This bill is a case of 'perhaps, if I say it often enough, people will believe me.' But let us look at the facts about the basic tenets of Medicare. The first is that universal access should be available both in and out of hospital but, also, that the health services we access to prevent an expensive hospital visit, like seeing a GP or getting a blood test or scan, should be available. The last budget locked in a $2.2 billion reduction in funding to GPs, specialists and allied health services like physiotherapy. Far from lifting the freeze on indexation of payments for visits to these health professionals, in order to keep pace with the rising costs, the government is only spending $9 million next financial year to ease the freeze. That represents 1.2 per cent of the funding that has been missing. We also know that the freeze will not be lifted for many items until 2020—not this year, not next year, not the year after, but the year after that. The government will gradually lift the Medicare rebate freeze, starting this year with bulk-billing incentives for GP consultations, then other GP and specialist consultations in 2018, specialist procedures in 2019, and finally targeted diagnostic imaging services in 2020. But there are some hidden extras that will stay frozen for another three years, among them consultations for mental health plans. Federal health minister Greg Hunt says he wants to focus on mental health—Deputy Speaker, my message to the minister is that if you delay the lifting of the freeze on mental health plans, that is a very poor way to show your commitment. The visit to a GP is often the first port of call for people with a mental illness, and a GP has to identify not only what is going on but what the best way forward might be, so to keep this rebate on hold is a real betrayal of individuals with a mental health issue, and a betrayal of their families. Also on the list of items which will stay frozen are chronic disease assessments—assessing people who are at risk of heart disease or diabetes—and pregnancy support services. The official Medicare data shows the list of items where the freeze is not lifted until 1 July 2020, and that those items were used 23 million times last year—that is, in the last financial year those same services were used 23 million times. This is not a small number of items. Many are things that we want people to use a GP for—to reduce the incidence of hospital admissions—because this means that people are managing their health issues. We also know that for diagnostic imaging—scans, X-rays—only seven per cent of these items will have their rebates indexed. As the Diagnostic Imaging Association has said, the government has broken its promise. Too bad if you are pregnant and need an ultrasound; if you have a brain tumour and need an MRI; or if you require a PET scan to assess the extent of your cancer; or if you need any one of hundreds of other vital radiology services—there is no relief. That hardly sounds like something that guarantees Medicare.

To those on the other side, Deputy Speaker, it may not be a big deal to put your hand in your pocket to pay an ever-increasing gap. It is incredible that so many GPs in my electorate have held off passing through the increase to patients, but it just goes to show the incredible commitment that they have to their communities. It has been cost-shifting on a massive scale. I know it is wearing down the energies of some very long-serving and very hardworking GPs in my community. The gaps on many other services really hurt. New South Wales AMA president, Brad Frankum, says the 'small and incremental' increases to the Medicare bulk-billing incentive and Medicare rebate are not enough. He says:

At this rate it will be many years before patients see an appreciable difference in out-of-pocket costs. This is a crushing blow for general practice in NSW and continues to be an ongoing problem for specialists and the patients who need their care in this state.

So much for a commitment to Medicare.

Let us look now at hospitals. Anyone who has had the misfortune to be in hospital in recent times will tell you stories of a staff and a system under pressure, and I have certainly seen that firsthand. I think we forget the massive reduction in health spending that has occurred. In spite of the amazing efforts of the people who work in our public hospitals, things are tough. The Gillard government tried to move to a long-term funding arrangement where the Commonwealth took on a specific share of the growth in hospital costs, initially set at 45 per cent and due to rise to 50 per cent from 1 July this year. In opposition, then leader Mr Tony Abbott endorsed this approach. The election policy of the coalition made this commitment:

Our public hospital system needs certainty.

…   …   

A Coalition government will support the transition to the Commonwealth providing 50 per cent growth funding of the efficient price of hospital services as proposed—

But only the coalition will deliver, they claimed. They certainly have not delivered on this one. The 2014 budget led to a backflip on this commitment, one of many broken promises. This was actually the second time a Liberal government had reneged on a Commonwealth-state hospital deal. The first one of these occurred in 1976, just one year after Medibank, the precursor to Medicare, was introduced. Then, a Liberal government had promised—prior to an election—to maintain the hospital funding scheme. But then they ignored the promise. The Australian Financial Review editorial on the topic was headed 'Mr Fraser's Shabby Renege'.

Forty years later, we have renege No. 2. The 2014 budget created a fiscal cliff for the states from 1 July this year by replacing a 45 per cent cost-sharing scheme with indexation unrelated to either actual hospital cost movements or increases in hospital demand. The deal done last year followed a concerted campaign by the states and territories to oppose those 2014-15 budget changes, supported by the Australian Medical Association, the Australian Healthcare and Hospitals Association, consumer health groups and other stakeholders. The amount of funding still falls short of what is needed. The AMA described it as 'an inadequate short-term public hospital funding down payment to appease desperate states and territories ahead of the federal election', which they said, 'will not be sufficient to meet current and future demand'. The AHHA described the agreement as a 'partial turnaround from the $57 billion cuts to health funding imposed in the 2014 budget.' So it is not a great history.

Recent Treasury figures show the Commonwealth savings from cutting funding to the states for hospitals and schools will escalate rapidly, rising from $1 billion in 2017-18 to $3 billion in 2018-19 and $7 billion the following year. By 2020-21, it will be $10 billion. This needs to be seen in the context of a system that is meant to keep people well and help them recover when they are ill. The New South Wales government's own report says that its health system faces a massive drain on resources from an ageing population, general population growth, the burden of chronic diseases and the cost of new healthcare technologies. The latest Intergenerational report states that health services are headed for a fiscal cliff when Commonwealth government funding drops off steeply after 2020.

Emergency department presentations hit record levels in New South Wales in 2016 and elective surgery wait lists have climbed to an unprecedented nearly 75,000 patients. Our smaller hospitals at Windsor and Katoomba face ongoing challenges to meet demand, while our major hospital, Nepean Hospital, is dramatically understaffed and underfunded. You might not believe what my constituents tell me—many of whom work in the hospital system—but the former president of the AMA put it this way:

Public hospital funding is about to become the single biggest challenge facing State and Territory finances—and the dire consequences are already starting to show.

Bed number ratios have deteriorated.

Waiting times are largely static, with only very minor improvement. Emergency Department (ED) waiting times have worsened.

Elective surgery waiting times and treatment targets are largely unchanged.

These are the sorts of assessments that show us that there are problems.

I think it is worth commenting on the staff who are having to cope in these circumstances. The hardworking doctors and nurses and the other healthcare practitioners who work in public hospitals are still managing to provide a world-class hospital system. They tell me that that is because they are so committed to their patients. It is not because the system is making it easy. We need to start to support these doctors, nurses and other healthcare providers before it simply gets too much for them.

All of this is happening in an environment where we could be making improvements. But before us we have a bill that does absolutely nothing to make things better. I believe that Australians aspire to live in a country where your postcode does not determine your health outcomes. I think that is what we all want. We know that it is not the case yet, but we also know that we currently do a better job here than the United States—but for how much longer? The Australian Institute of Health and Welfare reveal that patients living in higher socio-economic areas have significantly lower waiting times than those living in lower socio-economic areas. One example from their recent report was that an Australian classified as living in the lower socio-economic area will have to wait more than twice as long for a cataract extraction compared to someone from the highest socio-economic tier. So one person waits 63 day and the other 137 days—two months versus more than four months.

Inequality of incomes is at a near-75-year high. The three richest Australians own more than the million poorest put together. The consequences of economic inequality show most painfully in health—when people have to choose between having a meal and visiting a doctor. We have to ensure that access to quality health care is protected, but this so-called guarantee does nothing to enshrine that. This bill is simply a decoy, a mask for what we know the coalition would really like to do if they could get away with it. They must cry for the era of Malcolm Fraser, when you could just get rid of universal access to the health system. 'What a bother,' they must say, that not only does the pesky Labor Party seem to keep bringing it back but people actually want it. If anything showed the true intentions harboured by those opposite, it was the revelation only a couple of months ago of the secret hospital task force to cut public funding and abolish the private health insurance rebate and their actions in selling off the $220 million contract to Telstra Health for the national bowel cancer and cervical screening programs. That shows what they would do if they had the chance. We know there is potential that other cancer screening registries, such as breast screening, might also be contracted out sometime in the future.

Let's look at what protections this bill does provide. Sadly, there are none. The finance minister himself admitted at Senate estimates:

If any government were to decide to touch it, obviously there would be immediate visibility of that and all of the related consequences that come with it.

Great. If they touched it, we would see it, not that we could do anything about it. The community could just watch it happening. The bill merely allocates the revenue from their planned increase to the Medicare levy, after using some of it for the NDIS, into a separate fund. For a start, if the NDIS were in such dire need of funds, how can there be any left over from the Medicare levy increase that they are pushing? But that is another issue. Apparently, there will be some left over, and then it will be topped up with an additional contribution from income tax revenue to cover the projected Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. But the fund does not include the Commonwealth's contribution to public hospital funding. That is not part of it. Using the word 'guarantee' linked with the word 'Medicare' might be a good PR exercise, but this bill gives absolutely no assurance of secure funding for hospitals, absolutely no assurance that Medicare rebates to doctors and allied health professionals will be secured and absolutely no assurance that the needs of Australians accessing health services will be secure. In other words, it is a total waste of this parliament's time.

4:27 pm

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

I rise to speak today on an issue that has been at the heart of my career since I left school in 1971. I admit my bias quite freely. I became a medical student in 1972 and saw the devastation that medical costs could cause families, sometimes resulting in bankruptcy. It was not until the start of Medibank, our first universal healthcare scheme, introduced by the Whitlam Labor government, that we saw people being able to afford proper health care in Australia. There was enormous opposition from the Liberal Party and also, I must admit, from some in my own profession. Unfortunately, Medibank was emasculated by the Fraser government and it was not until it was reintroduced in the name of Medicare by the Hawke-Keating government that things started to improve. Slowly, however, the conservative parties have undermined our universal healthcare system to the point where Medicare is more a healthcare cost subsidy scheme than a universal healthcare insurance scheme. I am getting a little ahead of myself. At least you know the context from where I come.

I came to parliament after last year's election and one of the first issues to come into the House was the legislation that enabled the selloff of the Australian bowel cancer registry to Telstra Health. This was apparently already agreed to by the government. There was very little debate or public scrutiny. I do not think there are many people in this parliament who appreciate just how important and seminal to our healthcare system this was. In the rapidly approaching the future, our health data will be the most important determinant of our health outcomes. This will include genetic information, which will determine treatments, disease risks and preventative strategies, as well as indicating which drug treatments are better for the individual.

This was a very underhanded way of undermining a system that could have easily been kept within the Medicare system. The beginnings of this health data collection has now, without proper community scrutiny, been sold off to private enterprise. This is a very bad result and it is a very bad result for our healthcare future. I do not think it is something that this government understands. In fact, I do not think health care is anything that this government understands. Once sold off, this registry will be very difficult to get back into the public system. It will also mean that future health data will be easily sold off into the private system, and this has the potential to be absolutely disastrous to our public healthcare system looking forward.

One might easily be forgiven for treating any guarantee given by this government with a huge amount of scepticism. As the American baseballer and coach Yogi Berra

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

Order. Will the member be seated. I call the Leader of the House.

4:31 pm

Photo of Christopher PyneChristopher Pyne (Sturt, Liberal Party, Leader of the House) Share this | | Hansard source

I apologise to the member for Macarthur. I would not normally wish to cut off an esteemed member of the House, but, in the interest of us not sitting here on Friday, we need to get the Medicare Guarantee Bill 2017 into the Senate. As a consequence, I therefore move the motion be put.

Photo of Tony SmithTony Smith (Speaker) Share this | | Hansard source

The question is that the motion be put.

4:42 pm

Photo of Tony SmithTony Smith (Speaker) Share this | | Hansard source

The question is that the amendment be agreed to.

4:48 pm

Photo of Tony SmithTony Smith (Speaker) Share this | | Hansard source

The question now is that this bill be read a second time.

Question agreed to.

Bill read a second time.