Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health and Medicare) Share this | Link to this | Hansard source

Here we have yet another Liberal bill designed to clear up a mess of the Liberals' own making. You would be forgiven for thinking that's all this government does when it comes to health—clean up messes of its own making. That seems to have been the minister's No. 1 preoccupation over the last 18 months, desperately trying to right some of the egregious wrongs perpetrated by his two Liberal predecessors.

This Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018 amends the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000—I will call it the 'pathology tax act'—to change the frequency of the tax paid by approved pathology collection centres. Presently, each of Australia's roughly 6,000 collection centres pay a tax of $1,000 when they're first approved and then when their approval is renewed each year. Under this bill, collection centres will pay a tax of $2,000 every two years instead of $1,000 every year. There is a big debate to be had about that, apparently. This is intended to reduce regulatory burden for the government and industry while maintaining the revenue raised by the tax. The rate of the tax has not been increased since it was first introduced in 1999, and the government argues there should be no increase in tax at this time, to ensure that smaller providers are not negativity impacted. I note that, in fact, there has been substantial consolidation in pathology over the course of the last few years. Now only three per cent of the pathology industry is made up of smaller pathology providers and, increasingly, they are being swallowed up by the larger pathology providers, and the market has become very, very concentrated.

I have also asked the Department of Health to tell me how much is raised each year by the pathology tax. We think it is around $6 million but it would be good if the minister, in summing up, could actually clarify that. It is a question we did ask of the department. I also ask the Department of Human Services what the cost is of actually administering this taxation system and the value of the reduced regulatory burden to government and industry. I haven't been given any answers to those questions yet and I would expect the minister, in his summation, to be able to do so.

All of that in the bill sounds fair enough. Regulatory burden changes are fairly minor changes, and Labor of course will support the passage of these bills through this place and in the other place. Although I note the fact that the tax has not been increased for some 18 years—it hasn't been indexed, as I understand it—is pretty surprising. It is a very small amount of money paid compared to the profits of the large providers that now dominate this pathology sector.

But let's look at the real reason the government is having to introduce this bill. This is damage control. It's clearing the decks before the next election. I've said it before and I'll say it again: the government has spent the lion's share of its second term in health cleaning up the messes it made in its first, and this bill is a classic example of that.

This issue goes back to 2009, when Labor first introduced bulk-billing incentives for pathology and diagnostic-imaging services. These incentives were an additional payment made to providers who chose to bulk bill their patients in an out-of-hospital setting so patients would not face out-of-pocket costs. It came about at a time when Labor was making sensible savings to pathology rebates, but we wanted to ensure that, at the same time as we were making those savings to be reinvested in health and health areas, those savings did not have an impact on patients. It was a sensible policy, and it worked. By 2014-15, of the 104.3 million pathology services provided out of hospital, almost all of them—98.7 per cent—were done at no cost to the patient. In fact, the percentage of bulk billing actually increased in pathology as a result of the bulk-billing incentive. In diagnostic imaging, it increased by 10 per cent in just six years thanks to those bulk-billing incentives. As Michael Gannon, the now former president of the AMA, said:

At a time when Medicare rebates for pathology and diagnostic imaging services have been frozen for more than a decade, the bulk billing incentives have been vital in ensuring that all patients can have ready access to these services, regardless of their financial circumstances.

So what did the brains trust over on the other side decide to do? What they always do in the Health portfolio: they basically decided that they were going to get rid of this bulk-billing incentive. Not long after the Prime Minister took over the top job, the Liberals delivered their Mid-Year Economic and Fiscal Outlook and, having learnt nothing from the public backlash to their substantial previous health cuts, they decided in MYEFO to go at health again. One of the most significant cuts was to Labor's bulk-billing incentives in a bid to save some $650 million. This was back in the days before the 2016 election, when the Liberals didn't even try to hide their cuts, and there was no commitment to reinvest any of that money in the Health portfolio; rather, the money was going to fund other policy priorities, not in health at all. Frankly, health is always this government's last priority. After all, they'd rather give big business an $80 billion tax cut than properly fund our hospitals.

The announcement came as a shock to many, particularly given that the government's review of Medicare services was still underway at the time—and is still underway to this date—and pathology had not even started to be looked at yet. Why pre-empt such a major review by making such a major change to the Medicare Benefits Schedule in this way? That's the problem with this government. With every measure this government takes, they just use blunt instruments without thinking them through—without consulting or negotiating, they just announce them—and, at the end of the day, it is patients who suffer.

This announcement also pre-empted the expiration of the July 2016 five-year agreement between the pathology sector and government, a document which governed arrangements around Medicare-funded pathology and something the Liberal Party said that it would support. The then Minister for Health, the member for Farrer, argued that bulk-billing incentives for pathology were no longer needed because the sector was naturally very competitive. We on this side knew that these changes would directly hurt patients, forcing out-of-pocket costs even higher. Obviously, the pathologists were always going to pass those costs on to patients. Even worse, it would force some people to delay getting tests, putting their lives at risk. So we did what Labor always does when the Liberals try to cut from our health system: we fought back, vowing to use every mechanism we could to kill off this measure in the Senate. The sector fought back too. Describing it as a co-payment by stealth, the AMA warned that the move would hit the poorest and sickest the hardest. But when has this government ever cared about those people? They only care about the people they want to give an $80 billion tax cut to.

Dr Gannon said the evidence showed that many patients, particularly the sickest and most vulnerable, deferred seeking treatments because of cost, exacerbating their pain and suffering and ultimately adding to the nation's overall health bill. The peak group Pathology Australia warned that not only would bulk-billing rates fall but that some pathology collection centres would be forced to close, including those in rural and regional areas and in hospitals. The sector's Don't Kill Bulk Bill campaign gave us the immortal image of the member for Farrer dressed as Uma Thurman's sword-wielding bride from Quentin Tarantino's film. I thought she pulled that look off quite nicely, but that campaign also delivered a petition of 600,000 signatures, showing once again that the Australian people were deadset against this government's health cuts and that they were just not going to tolerate it.

This campaign clearly gave the Prime Minister quite a fright. The campaign went on for a while, with 600,000 signatures collected across the country, but the next thing you knew was that the Prime Minister was standing up in the first leaders debate with the Leader of the Opposition, suddenly announcing that he'd struck a deal with the pathology sector in a bid to shut them up for the rest of the campaign. That was all that was about. It was a shameless and cynical stunt to get his government through the election. It was the move of a desperate Prime Minister, committed to funding cuts but praying that the Australian people wouldn't find out about them. It was a dodgy deal, probably scrawled on the back of an envelope or napkin somewhere. Pathologists, however, accepted the abolition of bulk-billing incentives in exchange for a government pledge to regulate the rents that pathologists paid GPs to co-locate in their practices. 'Deal done,' the government thought. 'Problem solved. We've got them to be quiet during the election campaign. All good.'

Well, not so fast. We knew, the minute that was announced, that the government had not told the truth. We knew that GPs would be furious about it, many of them having already based their business cases on those rents. The two largest pathology companies attempted to outbid each other, trying to get themselves into collection centres in practices, particularly in areas where lots of pathology treatments were available. They were outbidding each other. They had bid the rents up so high and then complained about them, getting the government to agree, despite the fact that GPs had put their entire business case on the basis of this income—many expanding their practices substantially—and suddenly that was going to be done over. You have to be kidding! We absolutely knew the government had no intention to deliver—nor could it actually deliver—on that promise. GPs were absolutely furious. So in the government's hasty attempt to buy the silence of the pathology sector, it made enemies of the family doctors across the country. Terrific. A genius move.

The government was already at war with GPs after its attempt to increase the $7 co-payment and then freeze the Medicare rebates. At least in that sense the government is consistent. It can't help picking fights with the medical profession. As the AMA pointed out, the rents deal plunged GPs across the country into uncertainty about an important element of their business. Many of the practices that leased space to pathologists are small businesses that negotiated leases in good faith with larger multinational pathology providers. They made business decisions based on projected rental streams, including investment in infrastructure and staffing which helped to keep them viable. The AMA's Michael Gannon said:

GPs are sick of being told by politicians on both sides that they are highly valued, but then hit with Government policy that consistently hurts practice viability.

I doubt that the government truly contemplated the extent of the impact of its election commitment when it was announced. This is, frankly, typical of this government's approach when it comes to health: half-baked ideas and unnecessary cuts followed eventually by the inevitable humiliating backflip. The government capitulated again, using its 2017 budget to break its deal with pathologists to reverse its cuts to bulk-billing. In fact, gallingly, the minister keeps saying, 'We've invested with this new $650 million in pathology and diagnostic imaging.' You've reversed your own cuts—that's what you've done—and ditched the rent regulation plan. As I said, it backflipped on the $650 million of cuts that set off this whole sorry saga in the first place.

This bill is one of a number of policy changes that the government has offered the pathology sector by way, frankly, of a grovelling apology. No stakeholder in health should trust this government when it says that it's doing a deal. That is the lesson that Pathology Australia, the Diagnostic Imaging Association and GPs across the country should read from what we've seen in this bill. When this government does a dodgy deal, it is just that: it is a dodgy deal that it does not honour.

This bill is not about health policy; it is a dispute resolution. As I said at the start of this speech, that is pretty much all you see from this government in health: no vision about the health of this nation; no vision about the development and future needs of the healthcare sector in this nation; and no strategy—just constantly having to clean up mess after mess after mess. While Labor will be supporting this bill, it's important for the record to reflect the real reasons that this bill has in fact been brought before this parliament. I move the second reading amendment that's been circulated in my name:

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

"whilst not declining to give the bill a second reading, the House condemns the Government for its attack on pathology bulk billing and notes its desperate pre-election deal with corporate pathology giants".

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Julie Collins (Franklin, Australian Labor Party, Shadow Minister for Ageing and Mental Health) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

In rising to speak on the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018, I congratulate the member for Ballarat for well summarising our concerns about this legislation. I fully support her amendment and agree with her comments. I rise today to speak on this bill, which we will not be opposing. However, in line with the amendment, it is critical to condemn this government's attack on pathology bulk-billing at the previous election and consequential election deal around rent control that overwhelmingly favoured corporate pathology giants and left the small pathology centres out to dry. This really does demonstrate this government's lack of ability to understand health care in this country.

I started my private practice in 1984, the year that the Hawke Labor government introduced Medicare. My practice was founded on the benefits that Medicare gave to our population in terms of health care. Unfortunately, this government has continued its thousand cuts to the Medicare system. The government rails against Labor's campaign supporting Medicare in the last election, but, really, this is just further evidence of how little this government understands health care in this country and further evidence of its continued attacks on the health care of people who really struggle to meet the current costs of health care in this country.

The government has done many, many things, even in the short two-year period since the 2016 election. One thing that was of grave concern to me was the sell-off of the Australian cancer registry, which this government quite happily did very surreptitiously, without much fanfare at the beginning of our term in parliament. It was a real shame and something that we will, I think, live to rue in the future.

We're constantly talking about cuts and freezes on bulk-billing rates, cuts to hospitals and difficulty accessing specialty health care. That's because this government has a real ideological problem in that it doesn't really understand a fair, accessible and equitable universal healthcare system. There have been many, many things that have demonstrated this in the past and even in the last two years since the 2016 election. In my own electorate, I have seen cuts to our hospital services and cutbacks in our GP after-hours service—in fact, the removal of the GP after-hours service co-located at the main hospital in my electorate, Campbelltown Hospital. That was a real shame for this provider of health care in the Macarthur electorate—and, again, something that happened very surreptitiously.

This government, I repeat, ideologically does not believe in a fair, accessible and equitable health system. In the government's 2015 Mid-Year Economic and Fiscal Outlook, it listed the changes to diagnostic imaging and pathology bulk-billing services incentives and said, 'The savings from this measure will be redirected by the government to repair the budget and fund policy priorities'—again, attacking the healthcare system for other priorities. I'm not sure what policy priorities are more important than providing equitable healthcare services, such as bulk-billed pathology testing, but, after campaigning by Pathologies Australia, the government did not reverse the cuts and instead cut a rent deal that allowed the pathology companies to get cheaper rent for collection centres located in GP clinics. In exchange, these companies would stop campaigning against the coalition, which is a real sign to me that this government is prepared to support its big business mates at the expense of equitable health care.

It is important also to remember that when we talk about pathology companies, we are talking about multibillion-dollar companies that have a monopoly over the sector and have squeezed out smaller independent pathology centres. The government have done very little to look at other alternatives to widen the pathology network but have concentrated on their big business partners. The only reason the government backed down was the fear of these companies campaigning against them and the electoral backlash. In return, these pathology companies agreed, even with the cuts to the bulk-billing incentives remaining, to stop any negative campaigning against the coalition—the coalition protect their big business mates; their big business mates protect the coalition. This is a poor deal for the general public, for the smaller healthcare providers and for the GPs in particular.

What's blatantly clear about the deal is the lack of consideration for the patients or the GPs. In fact, the Department of Health said that there was no evidence that rents pathology companies were being charged were above market value. Many GPs had formed their businesses based on the rents they were going to receive from the pathology companies, but the screws were put on them at the expense of their patients and the GPs to the benefit of the pathology companies. This was a deal the coalition made with the big end of town, with no consideration for the Australian public. This should not be a surprise to any of us, because this government only govern for their mates and not for the general population. We've seen this just recently with the government constantly giving in to the big media players, their mates, against the ABC, and we continue to see the government's persistent attempts to enact tax cuts for big business.

The ABC issue is very important to me because the ABC provides services to all Australians. It provides wonderful access, particularly in rural and remote areas, yet the government is prepared to campaign with thousands and thousands of dollars cut from the ABC budget at the expense of the ABC and to the benefit of the major media players—again, big business benefitting at the expense of ordinary Australians.

Labor fought off the proposed introduction of the GP co-payment. We all remember that from the Abbott government proposal and how pathetic the attacks on equitable health care were. Now we see this government consistently chipping away at funding for hospitals, chipping away at bulk-billing incentives and delaying the lift on the freeze on bulk-billing payments to GPs and others. In fact, the recent budget introduced a miserly increase in GP payments, really quite derisory, and yet they continue to support big business.

What's critical to understand is that this, as I said, is an ideological battle. The coalition just doesn't believe in a fully accessible universal healthcare system. I would like to refer to the recent Four Corners program that looked at access to health care. I have seen evidence of this in this my electorate and, indeed, amongst my own patients. There is now an increase in gap payments required to visit specialists. This really is across the board, but there are some specific procedural specialties that continue to charge increasing gap payments to the point where many people cannot afford access to specialist care. A visit to a specialist cardiologist in my electorate can cost a patient out-of-pocket expenses, over and above the Medicare rebates, of $500 or more, and this has put access to specialist cardiologist services out of the reach of many of the poorest in my community. This is an absolute tragedy. The major hospital in my electorate does not have an easily accessible outpatient clinic for cardiology patients. So, in fact, many elderly people, often on pensions, are being excluded from specialist care. We are seeing an increase in the inequity in health care to the point where we are rapidly developing a two-tiered healthcare system, and this is a great shame. This is not the sort of healthcare system that I was brought up to believe in. I really think that the government should look at itself, look at its policies and see what it's doing to health care in this country.

I said before that we are heading down the path to a two-tiered system, and I want to see some action to ensure that our healthcare system does not rival that of the United States where, effectively, only the wealthy can access quality care. With the government and industry putting profit before patients, I just cannot stress enough how much we are at risk of heading in this direction. This is a philosophical problem that the coalition has; it just does not understand equitable health care. We need to be doing more to make sure that we hold this government to task.

I'm proud to be part of the party that created Medicare. I'm proud that I've been through the introduction of Medibank, introduced by the Whitlam Labor government when I was a medical student. It was really destroyed by the Fraser Liberal government. Medicare was reintroduced by the Hawke government and promoted by the Gillard and Rudd Labor governments, but is now facing a thousand cuts by this Liberal coalition government. I want to ensure equal access to health care for all Australians, not just those who have a credit card and money in the bank. It's really unknown to me why conservative members of this place are intent on attacking this ideal. I thought this was something that everyone in this place supported—equitable access to health care for all Australians—but by the actions of this government, clearly not.

I really think that equitable access to health care has become part of who we are. The general population believe in it; we've seen how they respond when there are attacks on Medicare. We have called out this tirade of attacks time and time again, and yet those opposite continue to chip away and chip away at the fabric of a healthcare system that's provided equitable access to most Australians—nearly all Australians—for over 30 years. Unless we continue to identify and call out the more subtle moves by those opposite to undermine our health system, we'll find ourselves before long adopting this two-tiered system, which they seem to want, without even realising how we got there.

Throughout my professional career, prior to being elected, I witnessed respective Liberal coalition governments trying to eat away at the framework of our universal healthcare system. A change that may lead to different individuals paying different rates for their premiums may not seem that dramatic, and certainly will not have the effect of closing hospitals overnight. However, subtle changes over time, such as these to private health insurance rates, are far more significant than many members can understand. Eroding the level and quality of care all Australians have a right to is not something that we want to see.

The Four Corners program, as I mentioned, released its investigation, stating that out-of-pocket costs are totally out of control. My own profession has some responsibility for this. We are seeing more and more patients having to pay larger and larger out-of-pocket expenses, now to the point where many people cannot afford quality care. It is becoming harder and harder to find a specialist that bulk bills and the costs to patients are constantly increasing. Out-of-pocket costs to patients vary significantly from rural and remote areas to inner city areas to outer suburban areas. Sometimes there are differentials of 100 or 200 per cent between what doctors in the same field charge. Many people in the more disadvantaged areas are, interestingly, often those being asked to pay the larger gap payments. It's a shame that those who are most disadvantaged are being disadvantaged even further by our healthcare system. While the majority of Australians still have access to bulk-billing GPs, it is incredibly hard to find a bulk-billing specialist in the country. And when you do find a specialist that bulk bills, you may be waiting months and months for appointments.

Medicare is founded on the notion of ensuring equality of access to health care for all Australians. I will always call out threats to that when I see them, and I see big threats from this government chipping away at what is equitable care. We need to stop playing games with the healthcare system. We need someone on the government benches to stand up for equal access to health care across the board.

When I'm looking for political causes, I always find following the money interesting. When you look at the share price of some of our biggest pathology companies and healthcare providers, you find that the share price of the biggest provider of pathology services in Australia has increased by 15 per cent in the last 12 months. I think that's a very good sign of what has been happening: big business has been benefitting from the government's policies on health care. It is a real shame that that benefit is at the expense of those most disadvantaged. We need to support our general practitioners, we need to support our most disadvantaged to have access to health care and we need to make access to specialist care much more equitable.

What this government is doing is trying to chip away at a system that has provided wonderful healthcare support for all Australians for over 30 years. The government has been called out time and time again. It is no good their standing up and saying, 'We support Medicare,' when we know they don't. We know they don't support equality and equity of access, and that is a shame. Whilst we support the bill, the amendment is very important and it should be passed. I fully support the shadow health minister. I really despair of what this government is doing to health care and I want it to change.

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

I remind the member for Macarthur that his speech is about the bill and that, if he wants to make electorate statements, there are other opportunities in the House to do that.

Milton Dick (Oxley, Australian Labor Party) Share this | Link to this | Hansard source

I rise to follow on from my colleague the member for Macarthur. I acknowledge his lifetime commitment to health and quality health care for the people of the electorate that he represents and the wider Sydney community. I thank him for his contribution, which covered details of the bill but also came from a very personal point of view, and his great understanding of the health sector. As one of the few GPs to have served in this parliament, he knows what he's talking about. Through you, Mr Deputy Speaker Irons, perhaps I could say to the government that they might start taking lessons from health professionals. They might start taking professional lessons from those who know what they're talking about.

I rise tonight to speak on the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018 and also to strongly support the second reading amendment of the shadow health minister. If there ever were a shining example of the hypocrisy of the government, this is it. Whilst, as we've heard, Labor supports the bill, which will make life easier for approved pathology collection centres, it cannot be lost on the House how this government gives a little with one hand but takes away a lot with the other. It's what they do about properly funding our schools, it's what they do with our hospitals, it's what they do with aged care—as we debated in this place today—and it's what they do with providing affordable and accessible health care for Australians. We, on this side of the chamber, know that, when it comes to dealing with health, health reform and health services in this country, the Turnbull government cannot be trusted. Unfortunately, Pathology Australia found this out the hard way in 2017, when pathologists accepted the abolition of bulk-billing incentives in exchange for reregulation of the rents that pathologists pay GPs to co-locate in their practices, only to have the government break this promise in the second half of 2017. It was promising on one hand while taking away with the other, which is hardly surprising, coming from a party that said there would be no cuts to health, no cuts to education and no cuts to the ABC or SBS, when, in truth, we know those opposite would actually cut the funding from all of the above.

At the time when Pathology Australia launched their Don't Kill Bulk Bill campaign in 2016, Chief Executive Officer Liesel Wett said that the sector had provided savings to the government for many years but could not continue to absorb further cuts and that the proposed unfair cuts would see patients having to pay for services from July. The CEO said at the time:

We want to make sure patients don't miss out on getting their pap smears and their life-saving blood tests, but the proposed $650 million in cuts to pathology and diagnostic imaging simply cannot be absorbed by the sector …

But that's exactly what the government did, and we know that is true to form. Rather than supporting and investing in our healthcare system, all they seem to do is cut. Here we have the national peak body for private pathology in Australia coming to terms with the government for what they thought was an acceptable outcome, only for the government then to pull the rug out from underneath them and renege on the deal. It is little wonder that the people of Australia have lost faith in the government when it can't even stick to the promises it makes with organisations like Pathology Australia, which provides high-quality, affordable, safe and accessible pathology services to all Australians.

As I mentioned at the start, when the government does give a little bit with one hand, they take away a lot with the other. This was easy to see when the government announced its modest Medicare rebate in last year's budget. While they wanted to be rewarded and congratulated on their supposed thaw, the facts told a completely different story. The Medicare rebate thaw did not apply to 93 per cent of scans, including X-rays, MRIs and ultrasounds used to diagnose some of the most common forms of cancer, and was only lifted on 59 of the 891 radiology items listed on the Medicare Benefits Schedule. That's just seven items. While mammograms and a number of CT scans were indexed under the plan, X-rays, MRIs and ultrasounds for such common conditions as brain, lung, breast and ovarian cancers were not. The rebate on common scans for arthritis and nuclear medicine also remained frozen. The government gave a little with one hand and took away an awful lot with the other. Just ask any of the 100,000 Australians who, as we heard today in this chamber, are waiting for an appropriate home care package. There is no Medicare guarantee under this government and there never will be.

It was a former member for Oxley, Bill Hayden, who built and delivered Medicare. The great Bill Hayden first delivered universal health care for this country. In 1973, during his second reading speech on the health insurance bill to introduce Medibank as it was called at the time—and I might add that it was opposed violently by those opposite—Mr Hayden said it was to provide 'the most equitable and efficient means of providing health insurance coverage for all Australians'. It was introduced by Labor and it was opposed by the Liberal Party then. It was not just for the wealthy, not just for the few, but for all Australians.

The contrast with those opposite is a very different story. The cost of going to a GP is up, the cost of private health insurance is going up, the cost of radiology is going up and the cost of seeking specialist medical care is going up. For example, earlier this year when the health minister announced another rise in private health insurance premiums, the health funds would have average weighted increases in premiums of 3.9 per cent from 1 April 2018. Thousands of private health insurance customers have seen their premiums soar well over the 3.9 per cent average increase, with figures showing that more than a dozen policies have jumped by double-digit figures. So we know that the cost of health care under this government is getting harder and harder for people to afford.

Last year, under this government, there was an increase of 4.84 per cent in premiums. The year before, it was 5.59 per cent. In 2015 it was 6.18 per cent and in 2014 it was 6.2 per cent. The costs of health care continue to rise and access to health care continues to be difficult for many Australians. Out-of-pocket costs are soaring, with hospital patients now paying around $300 per service. Not surprisingly, the Private Health Insurance Ombudsman has revealed that there were almost 10,000 complaints in the last year, almost twice as many as in 2013.

In my electorate of Oxley, just over 90,000 people hold private health insurance and they would like to see a better deal than what is being put forward by the government. In contrast, under Bill Shorten, Labor has made the unprecedented decision to cut the price increases of private health insurers at two per cent each year, for two years, delivering premium relief and budget certainty to Australians. Families in my electorate will benefit under a Shorten Labor government. Further, a Shorten Labor government would invest more in every single public hospital in the country, with an extra $2.8 billion in funding for more beds and shorter surgery waiting times.

When it comes to life-saving scans, this side of the chamber will deliver more affordable health care and greater access to it for more communities, by expanding Medicare to subsidise access to diagnostic imaging in areas where there are shortages. This means investing $80 million to boost the number of eligible MRI machines and to approve 20 new licences. That will mean 500,000 more scans funded by Medicare over the course of a first Labor budget.

In closing, it's clear to say that the Australian people do have a choice when it comes to providing affordable and accessible health care. As I said in my opening remarks, whilst we won't be opposing this bill, I do want to place on record that, time and time again, when it comes to health reform and these bills before the parliament, we constantly see the government give a little with one hand but take a lot more with the other hand. I once again say to the government: start listening to the professionals; start listening to the experts. They're the people who are wonderful frontline workers, frontline nurses and all of those great clinicians, particularly in my home state of Queensland, who go beyond the call of duty day in, day out—just like the member for Macarthur did in his professional career before entering public life. This government could take a lesson out of those doctors' books and start listening to the professionals to provide better, more affordable health care for all Australians.

Sharon Bird (Cunningham, Australian Labor Party) Share this | Link to this | Hansard source

I indicate to the House that I rise to support the amendment moved by the shadow minister. The bill before us, of course, is the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018. It's intended to change the frequency of the tax paid by approved pathology collection centres, known as ACCs. At present, each of Australia's 5,500 to 6,000 ACCs pay a tax of $1,000 when approved. That has to be renewed each year. Under this bill, they'll pay a tax of $2,000 every two years instead. The intention of the bill is to reduce the regulatory burden for government and industry and to maintain the revenue raised from the tax.

Of course, as the shadow minister outlined, the bill sits within a range of developments that have occurred since the 2015-16 MYEFO. At that time, the government sought to cut $650 million from Medicare bulk-billing incentives for pathology and diagnostic imaging, including abolishing incentives for pathology. The peak body, Pathology Australia, commenced a serious and major campaign against those cuts. It was called the Don't Kill Bulk Bill campaign. That particular campaign included a petition which attracted over 600,000 signatures. As a result of this campaign, during the 2016 election campaign the government reached a settlement with Pathology Australia. Pathologists accepted the abolition of bulk-billing incentives in exchange for re-regulation of the rents that pathologists pay to GPs to co-locate in their practices. However, GP opposition to the changes forced the government to break that deal in the 2017 budget. This bill is one of a number of policy changes that the government has offered to the pathology sector in return. The amendment moved by the shadow minister reflects the problems that have led to this position, whilst not denying the bill a second reading.

In speaking to this bill and the health insurance industry, I just want to touch on some of the concerns that have been raised by my local constituents. In February this year, I did one of my costs-of-living surveys and had over 1,000 locals respond to that survey. Over 80 per cent of them indicated that they'd had no real increase in their pay or, indeed, had had a reduction in their pay over the last three years; 45 per cent of them said that their doctor and specialist visits put increased pressure on their budgets; 33 per cent said pharmaceuticals put an increased pressure on their family budget; and 67 per cent said that private health insurance costs put increased pressure on the family budget. Of those who responded, over 70 per cent of people said they found it difficult to make their income stretch over their pay week, fortnight or month. Over 70 per cent are struggling with the cost of living, and a significant proportion of those indicated that health costs were an important contributor to that struggle. Over 70 per cent of those who responded felt that private health insurance was not good value. I'll just repeat that: over 70 per cent—over a thousand people, just in my electorate—indicated that they did not feel they were getting good value for money with their private health insurance.

Not only did people respond to the question, but I invited them, in an open section of the survey, to make comments on their experience and why this was an issue for them, and I want to share some of those comments because they go to the very issues in the health insurance debate and the issues that have led to this bill. They reflect very much the experience of locals in this space. I'll just use people's first names, to respect their privacy. The response was enormous. In the surveys I received back, there were almost none where people did not take the opportunity to give me some direct, written feedback on what their experience of health insurance has been. Scott from Bulli said:

I can't see value in it. I feel like it's a scam and gap fees to pay every time.

Nathan from Warrawong said:

Value for money is not good and getting worse.

An anonymous contributor from Coledale said:

We don't have health insurance because we cannot afford it. We just hope we don't get badly sick (e.g. need elective surgery etc) because we are reliant on the public health system. We hope perhaps we can afford insurance when we are older and have a higher income. I am now over 30 and it will cost more and more every year I delay.

Tianbing said:

Too expensive and cannot get much help.

Emma said:

Recent articles stating that's it isn't value for money and I'm probably better of just supporting the public system. Also I don't like the rebate.

Barry from Stanwell Tops said:

Of no benefit as after paying exorbitant fees we still have to pay a $500.00 excess and then pay for each specialist over what is covered by the fund when as a public patient we would not have any of these cost. Does not make any sense to pay to be ripped off?

Natalie from Wollongong said:

The cost for full cover is astronomical, even if you shop around & find one that best suits your needs. I would love to be able to cancel mine, but I have serious health issues that require my hospitalisation multiple times each year.

Ross from Corrimal said:

The cost has risen so far, that with also having to pay for the gap, there is no value for money.

Hayley from East Corrimal said:

We don't see the point in it, we pay way more than what we use for benefits

Maria from Warrawong said:

Don't have it. Cannot afford it

Helen from Farmborough Heights said:

Considering my wife has to have hip replace the specialist gap is$3,150,15. Also had to pay another$400 gap for the anaesthetist plus anything else that might crop up

Stu from Thirroul said:

We can't afford to use the services that we get minor deductions on. Even the out of pocket costs for dentistry is such that we avoid going.

Lois from Austinmer said:

It very expensive , 74 and fear age related illnesses though am presently in good health but require dental and optical which are poorly covered by my private health insurance,

Sue from Woonona said:

We always end up with big gap payments. The rebate on extras like dentist and optical are ridiculous

Janine from Corrimal said:

The only benefit of insurance is for urgent electives i.e. endometriosis, hernias, most other debilitating health issues that are NOT deemed life threatening, but you cannot wait for months / years to be treated. But the out of pocket can break you financially.

Mark from Mt Pleasant said:

The out of pocket expenses for some procedures and the ever rising costs make the products a bad deal.

Alan from Helensburgh said:

Poor value & gap difference far too high on specialists & private hospital.

Mark from Unanderra said:

There is about to be another price hike and we get no value for money. I will change it to necessities only. I pay WAY TOO MUCH for health care. It is very disappointing.

Katherine, from Figtree, says:

It costs our family nearly $300 a month for hospital and extras cover. The extras cover goes towards necessary health care—dentist, optical and physiotherapy—to keep us well and functional. However, the amount paid out by insurers against those premiums is pitiful and often a couple of extra visits to a physio for an injury will be the difference between making it from pay to pay with some money left in the bank and having to use our credit card to cover necessary costs like groceries etc. Since we are generally healthy, we rarely use the hospital cover. However, we are scared to drop the cover because of the penalties imposed both under the tax system and by the Lifetime Health Cover penalty should we want to take up cover later in life.

Private health cover is terrible value for money. We never receive the full amount back for services. We would drop our cover and rely on the public system except that we want choice when we are older. So we are paying now so that, in thirty year's time, should we need specialist care in the private system, we are not penalised for having not held private health insurance across the life span.

Mark says:

We don't have private insurance because it's unaffordable. Also, we don't see any real benefit having it.

Lesley, from Austinmer:

When I retire it will cost $100 per week which is almost half of the pension.

David, from Wollongong:

I am finding that it is too expensive, going up more and more every year but the benefit I get from it is going down and backwards.

Michelle, from Bellambi:

We are considering to cancel the extras and pop the money in the bank instead. We are not getting value for money as the gap on items seems to be getting bigger.

Colin, from Stanwell Tops:

Pay near $4000.00 a year and still have to pay out of pocket. Been paying for 50 years.

This is just a small sample of all of those who replied to my survey.

When we talk about health insurance and the private health insurance system, we have to recognise that, while profits are up each year for the private health insurance industry—the latest official data showing that they were getting $3.7 billion more than they were paying out in benefits—there are many, many people in our community who not only feel that it's not good value for money but also are very frustrated by the fact they feel they can't give it up but they're not getting a fair go under what they get back. As many of those commenters from my survey said, the premiums continue to rise while the benefits don't seem to be improving at all.

I think it is important to acknowledge within this health insurance debate that Labor have made it clear that we want to tackle this problem. It's very important that we realise that this is a real cost-of-living pressure on families. It's no wonder that many of them, as reflected by my constituents, are considering dropping their cover. Indeed, nearly 12,000 people dropped their hospital insurance in the last three months of last year. So it is something that needs serious attention. That is why Labor have said that we will cap premium price increases at two per cent for two years, which will deliver families an average saving of $340, and shift the balance of power back in favour of consumers rather than private insurance companies. As part of that, we will also task the Productivity Commission with a sweeping review to identify long-term, sustainable ways to bring down costs and improve quality.

As we debate this bill today, another in a range of bills dealing with health insurance and the private health insurance industry, I think it is very important to listen to the voices of the people in our community. I'm sure that colleagues, not only on this side but right across the House, will have heard when they talk to their local communities that people are finding carrying the costs of their private health insurance increasingly problematic. They've had stagnant wages and their cost of living keeps going up. When the cost of health is going up as well, as many of those comments I've just read out indicate, people, sadly in some cases, don't follow through on their health purchases—purchasing pharmaceuticals, having pathology tests, going to see the specialists as they are required to do—and that has very serious health implications. Also, there are people who are doing those things and paying those costs and then finding that they don't have money for groceries, or they are putting things on the credit card that they shouldn't be and are getting themselves in more financial difficulty.

I think that it is very, very important that we understand that health insurance—not only in this bill as it affects providers, such as pathology providers, but across the board—has real implications for real families in our communities. Government needs to get serious on getting much more effective action on addressing those costs and the gap between what people are paying and the services that they feel they're reasonably receiving. I commend the amendment moved by the shadow minister. I think it is very pertinent to the health insurance debate that we acknowledge the context within which we debate it tonight.

Julian Hill (Bruce, Australian Labor Party) Share this | Link to this | Hansard source

Deputy Speaker Kevin Andrews, as much as it is always a delight to have you present in the chair, I do confess to a moment of sadness, because I had made a promise to the previous Deputy Speaker who was there, Mr Irons. The promise was that I would spend at least one minute talking about the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018 itself before moving on to the second reading amendment—but I'll still keep the promise.

I think it's fair to say that this is not a riveting bill. You wouldn't classify this as groundbreaking reform that's going to improve the health system in any meaningful way. Indeed, despite the government's claims, I suspect that—when they finally get around to answering some of the questions put to them by the shadow minister, if they can—it's probably not going to do much towards reducing the regulatory burden for government and industry.

The bill amends the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000 to change the frequency of how often people pay this tax. Currently, you pay $1,000 every year if you're a particular kind of pathology business. In a moment of brilliance, the health minister took a bit of time out from yelling at grandmas and came up with the idea that you would pay a tax of $2,000 every two years. It's a little bit less paperwork for the same amount of revenue, so that's pretty good. As I said, it is intended to reduce regulatory burden for government industry while maintaining revenue.

The shadow minister has asked some questions. 'How much do you raise?' Don't know; still waiting for an answer. 'What's the cost to the Department of Human Services for administering this approvals and renewals system?' Don't know; still waiting for an answer. As I said, we're still waiting to hear what the supposed reduction in regulatory burden is actually costed at. That will be of great excitement to the Australian people and the parliament, no doubt.

Having acquitted my promise to the previous Deputy Speaker with honour, I turn now to the second reading amendment, which condemns the government for their attack on pathology and for their desperate pre-election deal with Pathology Australia, which they then shamelessly ratted on. They ran away from it, realising that it was a stupid idea, and then created an even bigger mess when the GPs rounded on them. They thought: 'Panic! Panic! Well, let's rat on that deal and we'll go and make a different mess over here.'

We do need to retrace history. In the 2015-16 mid-year financial update, the government announced out of the blue that they were cutting $650 million from Medicare bulk-billing incentives for pathology and diagnostic imaging, including the incentives for pathology. Now, I was a candidate running for parliament then, and I remember starting to pick this up when I was visiting businesses and talking with local people through the media and in the community. The campaign started by Pathology Australia was called Don't Kill Bulk Bill—straight to the point. They collected a petition with, I think, over 600,000 signatures, such was the of strength of opposition.

But it's important to understand what the incentives for increasing bulk-billing in pathology were. They go back to 2009, actually, when they were introduced by Labor. They were additional payments which were made by providers, who, in response to the payments, then chose to bulk-bill their patients in an out-of-hospital setting so that their patients don't face out-of-pocket costs. It was sensible policy and it actually worked, because, in just six years, diagnostic imaging bulk-billing rates rose 10 per cent thanks to these fairly sensible, well-targeted measures. By 2014-15, there were 114 million pathology services provided out of hospital, and 98 per cent of them were bulk-billed.

Bulk-billing pathology and removing barriers when you need a test are good things for getting tests done quickly. You are not muddling around, waiting for weeks to find $20 or $30 or $50. To many people in this House, that doesn't sound like a lot of money, but I can assure you that, to people in many parts of my community, $20 is an enormous amount of money when you're living hand to mouth. It is important that we don't provide disincentives to people to get tests because the evidence shows—I know the government is quite challenged by the word 'evidence'; think climate change or any manner of things—that it is important that poor and vulnerable people, indeed anyone, are not delayed in getting tests because those delays make them sicker. People are more likely to get sick and develop more serious conditions if they are not diagnosed quickly so that they can be treated properly. This is a false economy because, when people get sicker, they cost the health system more. You'd think that even the boneheads in the government would understand that it is not a good idea to remove incentives, but apparently not. They will remove incentives, which will make people sicker, will delay them getting tests and treatment and will run up the costs to the health system.

Labor ran hard on protecting Medicare at the election. The member for Oxley outlined the history of Medicare through the 1970s and 1980s, and through multiple elections, where we proposed a great public health system for the country so that anyone, regardless of their income or place in society, could access high-quality medical care. They could bulk-bill to see the doctor or pathologist and so on, if that's what they needed. We ran hard on that. We build it, and coalition governments try to cut it. Over the last few decades it's been in the Liberal Party's DNA to oppose universal services every step of the way.

The government then panicked. They did a deal with Pathology Australia, and, just before the election, the pathology sector accepted this deal. The government said: 'We'll abolish these bulk-billing incentives, but we understand that you want bulk-billing, so we'll do something different. We'll re-regulate rents to general practitioners where you are co-located.' In some crazy, silly idea, the health minister—I won't even speculate on it because it's unparliamentary to speculate what might have been going through her brain or body—came up with such a ridiculous proposition without consulting and without understanding that if you squeeze one side of the balloon then the other side is going to bulge out.

The government did a deal to remove the bulk-billing incentives and re-regulate rents with GPs. That didn't go very well, did it? We told the Australian people: 'You should not trust the government on this. You can't trust them on Medicare; you certainly can't trust them on this deal.' The government said that we were lying; we were exaggerating; all of that was not true and of course people could trust the government because the government stick to their word on health and Medicare all the time. What happened? The government won the election. That's right—they fell over the line with 76 seats. Eventually, the Prime Minister got out from under the doona at Point Piper on election night. His wife must have pushed him into the car and said: 'Come on, come on! I know you don't like it but I think you're going to get there; you're going to get 76 seats. You have to man up and face the people.' They won the election. But, as it turned out, they lied. They shamelessly, cynically broke their deal and created a ridiculous mess. They ratted on the deal. What they discovered, of course, was that it was a stupid arrangement. The GPs were now furious because the GPs said: 'We're locked into leases. We have commercial business models in our practice. Government, you can't just come in randomly and re-regulate the rents on which a whole other set of other commercial arrangements rely. That's not very clever. That's not going to have the outcome you want.' So the government ratted on the deal.

This shows that health is always the Liberals' last priority. They talk a big game, but, when push comes to shove, when you have a look at where they put the money and at their record, it is clear that at the end of the day Medicare is just a logo to them. It's a green-and-gold logo. The thing that made the Prime Minister most furious—remember that tantrum that went on for weeks after the election—was that someone had used the Medicare logo. This was the health system, apparently. We had all that debate and an inquiry through the electoral matters committee to try to make it a Commonwealth offence to use the Medicare logo. That is completely missing the point: Medicare is not a logo; it's a public healthcare system that enables people, wherever they are in society, to access quality and affordable health care.

I believe we should be so proud of Medicare, and Australians generally are. We should be so proud, not just that we can see the GP but that, over time, as technology has changed and improved, we've continued with the ethos of a public health system that Labor introduced. They call it 'socialised medicine' in America—shock, horror. They spend a greater percentage of GDP per head of population on health care in America than we do, yet tens of millions of them can't see a doctor. They cannot get treated. That's what privatised medicine looks like. You only have to look to the United States. It's a country that I admire a lot, but we are a better society.

We should be proud of the public healthcare system delivered by Labor and our legacy in creating this incredible asset that Australians love and value. We should be proud of it. It's not perfect. It never will be. Of course it won't be. But this is idiotic meddling, thinking, 'We'll cut the incentives.' They've just been proven, with evidence, to be driving up bulk-billing rates and enabling people to get tests in a timely matter and not pushing up future costs and make people sicker. That's when we should be going, 'That's a good idea.'

As the then head of the AMA, Dr Michael Gannon, said, getting rid of the bulk-billing incentives was a 'co-payment by stealth' and would hit the poorest and the sickest hardest. He went on to say that evidence showed that many patients—again, particularly the sickest and the most vulnerable—defer their treatment, exacerbating the pain and suffering for people in the community and pushing up the cost to the healthcare system. You'd think, as speaker after speaker has said, that the government would listen to the experts, the profession, and also consult with them. If you're going to come up with a stupid pre-election deal that stuffs up one part of the system while thinking you're fixing another, it's not good reform. It's not good policy.

This is important to me. I failed my family destiny to become a doctor or go into the health profession. My father was a specialist, my mother was a nurse and my uncle has two PhDs in nursing. I didn't want to go into medicine, but, surrounded by my family, I was brought up with that ethos that it wasn't just health care and service. My mum did always say: 'Darling, if you go into medicine, be a dermatologist. Don't be an obstetrician like your dad. The phone rings all night. Please don't do that.' But she also told me the family story about his GP practice. He died when I was four, so we hadn't won the Medicare battle with you guys opposite at that time. Apparently he was a great doctor but an awful business person. He never made any money from his GP practice because he felt sorry for his patients because they couldn't afford to pay the bills, so he wouldn't send them the bill. I think mum always maintained that he had to have a few days a week being an obstetrician so he could actually charge people.

Suffice to say this is a another bandaid fix, cleaning up the mess left by the previous health minister. You can only imagine—the mind boggles, doesn't it?—how the current health minister is going to go in and clean up the mess. He's going to say, 'Don't you know who I am? You can all f-off!' and somehow that will fix it.

Ross Hart (Bass, Australian Labor Party) Share this | Link to this | Hansard source

He'll use his swear jar!

Julian Hill (Bruce, Australian Labor Party) Share this | Link to this | Hansard source

He'll use his swear jar. He will be using his swear jar extensively. In summary, the second reading amendment is worth drawing attention to. I'm glad many of my colleagues have chosen to devote some time to it. We already heard the Prime Minister in question time. We pointed out quite honestly, 'You have cut the indexation rate for hospitals from what you promised.' The government went to an election and said, 'We're going to index hospital funding at 50 per cent.' I think it was 50 per cent. Don't quote me on that; I haven't got the figure in front of me. Then they provided a lower indexation rate. They cut the indexation rate. We pointed this out and said, 'You cut the funding,' and they said, 'No, we didn't; we increased the funding.'

We're going to hear a lot of this going into the election, so this is an important matter to remind people about. With all the argy-bargy, with whatever nonsense and false words about committing to increasing funding and doing deals you hear from those opposite, you simply cannot trust them based on their record. They say one thing, they get into office and they do another.

Ross Hart (Bass, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018. This bill amends the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000 to change the frequency of the tax paid by approved pathology collection centres—ACCs. This is an attempt by this government to clean up yet another Liberal mess. Currently, each of the approximately 6,000 ACCs pay a tax of $1,000 when first approved and when its approval is renewed each year. Under this bill, collection centres will instead pay a tax of $2,000 every two years, a move intended to reduce the regulatory burden for both government and industry whilst maintaining the revenue raised by the tax.

The rate of the tax has not been increased since it was first introduced in 1999—nearly 19 years without an increase—which is surprising compared to the profits of the big providers who now dominate this sector. This is a minor change, and Labor will support the passage of the bill. However, as my friend the member for Bruce has just done, we need to examine why this government has put this bill forward.

In 2009, Labor introduced bulk-billing incentives for pathology and diagnostic imaging services. These incentives are an additional payment made to providers who choose to bulk-bill their patients in an out-of-hospital setting so patients do not face out-of-pocket expenses. The policy imperative underpinning this was that you shouldn't put barriers between a patient seeking medical treatment and diagnosis of their condition. It is, or should be, reasonably obvious that significant out-of-pocket expenses operate as a barrier to many people accessing appropriate, timely medical care. This policy meant that of the 114 million pathology services provided out of hospital by 2014-15, over 98 per cent were at no cost to the patient. Unfortunately, it wasn't long before the Liberals were up to their same old tricks. In the 2015-16 MYEFO, the government sought to cut $650 million from the Medicare bulk-billing incentives for pathology and diagnostic imaging, including by abolishing these incentives for pathology. There was no commitment to reinvest the money into health, only a vague statement by the government that the money would be funding other policy priorities.

As to the question of policy priorities, health is clearly not a priority for this government. It hasn't been a priority in the past. In fact, if there was a policy priority, it was towards subverting the issue of public health, including Medicare, until the Liberals belatedly realised that Medicare was really popular with the general population. Inevitably, these costs from abolition of incentives would result in increased charges, which would in turn be passed on to patients, increasing out-of-pocket costs and potentially delaying people's access to critical tests and diagnostic imaging. We on this side of the House fought back, as we always will, against the Liberal cuts to health, and the sector fought back with the memorable Don't Kill Bulk Bill campaign. The campaign was, of course, successful. It was so successful that the Prime Minister took fright and struck a hasty pre-election deal with the sector whereby pathologists accepted the abolition of the bulk-billing incentives in exchange for a government pledge to regulate the rents that pathologists pay GPs to co-locate in their practices. This did nothing to improve the feeling of GPs towards the government after they had already attempted to impose a $7 co-payment and froze the Medicare rebates. This deal with the pathology sector only served to perpetuate uncertainty for GPs about an important element of their business.

As indicated previously, access to diagnostic imaging, including pathology and imaging, is absolutely central to the provision of cheap, effective and timely medical care. Once again, and unsurprisingly, the government has again backflipped on health, not just once, using its 2017 budget to break its deal with the pathologists and ditch the rent regulation plan but twice—secondly on the bulk-billing incentives that they first sought to cut back in 2015-16.

That brings us back to the bill that we have before us today. This bill can be fairly described as damage control—an attempt at an apology to a sector that has suffered under the hands of this government. This bill, again, makes it clear that health is not a priority for this government. We know they would rather give big business an $80 billion tax cut than properly fund health care. All we've seen from them is backflipping and cuts in successive areas of health policy.

Australians need relief from the costs of health care, not increases to their out-of-pocket expenses, especially at a time when they are paying more than ever for private health insurance—another important item in an average family's budget. This is important, whether or not you consider the cost of diagnostic investigation or substantive medical treatments and hospitalisation. In my electorate, the northern Tasmanian health system is already struggling with patient care and access to services. Northern Tasmanian patients are struggling with the fact that it's very rare to find a bulk-billing GP, irrespective of whether pathology tests or imaging are required. On Thursday last week, I raised the importance of properly funding our public health system, particularly for the Launceston General Hospital, the LGH. An estimated 7,092 families in Bass have private health insurance, and every year those people are hit with above-inflation premium price rises that put further strain on their household budgets, even before they are required to pay other out-of-pocket expenses. I know that low-income families who are relying on the public health system find it incredibly difficult to meet out-of-pocket expenses.

Labor is the only party that believe in universal health care and we are absolutely determined to fix our hospitals and facilitate better access to GPs, which includes, of course, access to pathology and diagnostic imaging. The Liberals have cut from Medicare and hospitals every year since the member for Warringah's horror 2014 budget. One of the most significant cuts was the cut to Labor's bulk-billing incentives in a bid to save a total of around $650 million. As I've said previously, their priority is everywhere but health. This is seen every day that they fight to give the big banks and big business billions in tax cuts rather than properly fund health. It's also seen in their language about creating a strong economy in order to pay for Medicare, the Pharmaceutical Benefits Scheme or our public health system. This assumes—in their distorted world—that health and education are not a priority; they are optional—that is, if the economy can afford it.

Like many decisions this government have made since they took office in 2013, the announcement of the axing of the bulk-billing incentive was a shock, especially as their own review of Medicare services was still taking place at that time. Such is the lack of empathy for health and the importance of health care to every Australian that they're prepared to make major changes without the review. Ultimately, it is the patients who are suffering under this government. The Prime Minister has continued the assault, cutting $2.8 billion from hospitals between the next election and 2025. He is giving an $80 billion handout to big businesses and the banks instead of funding health. He's leaving Australians languishing on waiting lists for critical surgeries, such as hip operations, knee replacements and cataract removal, at the same time as he's giving banks, especially the big banks, a $17 billion tax giveaway.

The health of Australians should never take a back seat to a handout for big business. That's why Labor will fight to give Australian patients a fair go, with more funding and better hospitals. Labor will invest an extra $764 million over the forward estimates and $2.814 billion over six years to fix Australia's public hospitals, with funding to be allocated from a better hospitals fund. Labor's plan has been fully costed by the independent Parliamentary Budget Office. The then Minister for Health, the member for Farrer, argued that bulk-billing incentives for pathology were not necessary. She said that this was because the sector was naturally competitive. Again, the government is prepared to force out-of-pocket costs even higher and on to patients, many of whom are having to make a choice and, if they make that choice, they may go without.

The AMA warned that the government's co-payment by stealth would hit the poorest and the sickest the hardest. Did the government care? No, their priorities then and now are with big business and the big banks. In my electorate of Bass, I know that when people are struggling to keep up with the growing cost of living they will prioritise where every dollar goes. Now I fear that, thanks to this government, patients are deferring treatment because of the cost, exacerbating their pain and suffering and ultimately adding to the nation's health bill with much greater acuity on presentation to public hospitals.

Also of concern to me is the change that bulk-billing rates on pathology could have on rural and regional areas like Tasmania. Peak group Pathology Australia has warned that not only would bulk-billing rates fall, but some pathology collection centres may be forced to close. As I said earlier, this is particularly important in northern Tasmania, as we undeniably have a public health system which is under even greater stress. My electorate of Bass shares the northern coastline with the electorate of Braddon, where my friend and colleague Justine Keay is working hard to be re-elected, because she knows that Braddon will be better off under Labor. Tasmanians remember the Liberal promise that there would be no cuts to hospitals in 2013. What they do not know is that the Liberals tore up the intergovernmental agreement which bound the Commonwealth to bear 50 per cent of the increased cost in health.

What have we had since? It's clear that this Prime Minister has just not learnt. The pathology sector's Don't Kill Bulk Bill campaign delivered a petition in 2016 with 600,000 signatures, showing once again that Australian people are deadset against cuts to health. They are simply not going to tolerate it. This campaign reached its target and the PM made a hasty retreat. The PM's dodgy deal asks pathologists to accept the abolition of bulk-billing incentives in exchange for a government pledge to regulate the rents pathologies pay to GPs to co-locate their practices. GPs were furious, they were already upset that the government's attempt to impose a $7 co-payment had been imposed upon them and that they had also frozen their Medicare rebates.

This bill is one of a number of policy changes that the government has offered to the pathology sector, seen by some as part of a two-year apology to the sector for their past sins. This bill is not a health policy. It is conflict resolution writ large. This government has no vision for the future of health care. Its only purpose is cutting services for health and giving those resources away in billions of dollars of tax cuts for big business.

Tony Zappia (Makin, Australian Labor Party, Shadow Assistant Minister for Medicare) Share this | Link to this | Hansard source

The Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018 is another example of the government's shambolic approach to the management of the health portfolio. It is an approach that we can see in so many other areas in the health portfolio, the government flip-flopping from one side to the other and ultimately landing on a position to try to get itself out of the mess. That is exactly what it's doing with respect to pathology fees.

It reminds me very much of the government's approach to the out-of-pocket costs or the co-payments that it wanted to introduce when the coalition took office in 2013. Firstly, it was a $7 co-payment, then a $5 co-payment. Then, if I remember correctly, there was meant to be some $20 cost on GPs. Ultimately, the government landed on just continuing the Medicare rebate freeze from 2014 right through to now, which effectively has caused doctors to apply their own co-payment in order to continue to make their businesses viable.

Not surprisingly, we don't have any government speakers that are prepared to come into the chamber and speak about this legislation. I get that this legislation isn't exactly exciting legislation; it deals with, I guess, an administrative matter when it comes to pathology specimen collection centres and the licence fee they pay to the government each year. Nevertheless, it goes to the heart of our health system, because there are few medical procedures carried out in Australia today, or medical appointments made with GPs and the like, that don't ultimately involve a pathology service of one kind or another, or an MRI service. Without those services, it's obviously very difficult for the doctors to pinpoint what the problem is. So it does go to the heart of the funding and the costs that a patient has to bear every time they go to see a doctor or a specialist.

We saw, with respect to this particular issue, the government first coming out and saying, prior to the 2016-17 election, that they would abolish the bulk-billing incentive payments for pathology services and MRI services. That, of course, created a huge backlash from the pathology industry itself, and quite understandably so, because this is an industry that made it absolutely clear that it was because of those incentive payments that they were able to keep their fees down for the patients. So the government then, in turn, said, 'Okay, we will raise the same revenue by promising that the pathology collectors get lower rents in the premises from which they have their services.' Most of those services are provided from within medical centres—medical centres generally run by a group of GPs. Of course, those GPs rely on the rent space that they get from the pathology collection agency to run their own medical practices. I'm sure that they have factored in the income they would receive from those pathology collection companies that are there as part of their business running costs. So when they protested, and understandably so, the government realised it now had an even bigger fight on its hands because it was fighting with the whole medical profession more broadly. The government had to backtrack, and it did so.

It is now looking at a way of trying to save some dollars in order to ensure that it finds savings in the pathology section of its budget. The reality is that the savings the government will find out of this legislation are minimal. We don't have a problem with the savings themselves on this side of the House. It means that instead of the centres paying their fees once a year, they pay them every second year. I'm not sure why they didn't suggest it be every third year. If it is the case that it saves money to the government in terms of the administrative costs, I'm sure it will also provide some savings to the individual practices or pathology centres that have to make the payments for their ability to continue their business.

However, I do ask this question: it's not clear as to whether the money would go back to a pathology service provider if, for some reason, after having paid for two years in advance, they decide halfway through to cease their business. Whatever the case is, I don't know, but perhaps that is something the government might want to think about. The idea of biannual tax payments is nothing particularly new, and it's nothing that has any particular consequences of concern to us. What does concern me about it is that it is just another example of this government's ad hoc approach to its healthcare responsibilities.

Right now, we're seeing another example of this with the Australian Dental Industry Association. The government has proposed to introduce a new fee for new dental products that are defined as low-risk medical devices. These fees will apply, from my understanding, to products that come from dental suppliers who are generally small business people in this country. Most of them are not big organisations. The fee proposed is $530 for each new low-risk medical device entry on the Australian Register of Therapeutic Goods. Now, $530 doesn't sound like a lot of money, but when you add it up at the end of the year, for many of the small businesses associated with the Australian dental industry, it will amount to anywhere between $4,240 and $13,250, according to the industry itself. When you are starting to talk of amounts between $4,000 and $13,000, it does start to make a difference to small businesses in this country.

The concerning thing about this proposition is that the government is proposing to introduce it, I think, by 1 July, with no public consultation, no business impact analysis and no cost recovery impact statement ever having been carried out with the industry in respect of those new charges. This is all from a government that constantly comes into the chamber and tells us how they are the friends of small business, how they are the ones who will support small business and how they are the ones who are backing small business in this country. I couldn't think of a worse example of small business being betrayed by a government—no consultation, no discussions but, 'We're going to hit you with some new fees'. Clearly it is another example of the chaotic way that this government manages the health portfolio.

In the Australian dental industry, if a new fee is introduced, dentists will have no choice but to pass on those costs to the patient. The patient will ultimately wear the costs, because we don't have a universal dental scheme in Australia. Even with private health insurance in this country, patients inevitably pay considerable out-of-pocket costs with their dental expenses. That brings me to the question of private health insurance more broadly. We know it is becoming more unaffordable for people as each month goes by. We have seen the membership rates for private health insurance falling. Indeed, in country areas, I understand that now only 45.5 per cent even have hospital cover. We have seen increases in the exclusions within those policies and the costs of those policies rise 27 per cent under this government, which adds something like $1,000 a year or thereabouts for most families who have private health insurance. Indeed, the whole concept of private health insurance is becoming so complicated that we now have a website called Health Insurance Comparisons to help people try and decipher which policy they should go for and what it will cover. That's how complicated it has got.

We now also have a health system that, in many parts of the country, is in crisis. We have hospital elective surgery wait times blowing out. Indeed, I recently dealt with a constituent in my office who was looking for elective surgery in South Australia and the response provided to that person was that the person would have to wait years for the procedure required. It's not for me to argue whether or not that procedure was urgent—that's for the doctors—but, when you have to wait years for an elective procedure, there is something wrong with the system.

We know that last year there were 7.8 million presentations to emergency services department of hospitals throughout the country. That's a 16 per cent increase over the previous years. I can only assume that that's not just attributed to the population growth but because more people are presenting to emergency services departments because they cannot afford to go to their normal GP or perhaps their specialist, depending on the issue. Again, that's borne out by the figures as well, as a result of the Medicare freeze. Ten years ago, the average GP out-of-pocket cost was $21. Today the average out-of-pocket cost is $38. For specialists, 10 years ago, it was $44. Today the average out-of-pocket cost for specialists is $88. Those costs demonstrate the shift in how much more people are having to pay to go to their doctors or to their specialists.

Not surprisingly, as a result of those increases in costs, the statistics also bear out another story. In 2016-17, according to the ABS, 1.7 million scripts were not filled by patients because, probably, they couldn't afford it and didn't see it as a priority. And 1.7 million Australians skipped a specialist visit—again, I can only assume—because they couldn't afford it. One million Australians either avoided or delayed a visit to their GP—again, I can only assume—because they couldn't afford it. Not surprisingly, also in 2016-17, 1,830 personal bankruptcies in Australia were attributed to health costs.

I think the statistics paint a very clear picture of the state of the health system in Australia. But no-one paints it more clearly than the new AMA president, elected only a month ago, Dr Tony Bartone, who at the AMA national conference in Canberra, only a month ago, said:

… our health system is ailing.

Public hospital waiting lists continue to blow out.

Private health insurance is becoming increasingly unaffordable for our patients.

The enormous bottlenecks in the training pipeline.

The continuing struggle for some doctors around their own health and wellbeing.

Variable access to care in country towns and rural areas.

General Practice has been systematically starved of funding - tearing at its heart; wearing it down; putting at risk its world class outcomes in primary care, its very survival.

Dr Bartone went on to say:

Our Health Minister needs to understand that the time for rhetoric is over. Our patience is wearing thin.

Those are not my quotes. Those are not Labor's quotes. Those are the quotes directly from the newly-elected president of the Australian Medical Association, who was summing up his perception and how he sees the health system—and, can I say, his perception is shared by people everywhere I go and by everyone I talk to throughout my electorate.

Universal health is being eroded by this government. It's being eroded little by little but, ultimately, the collective efforts or the collective changes that are being made are making a substantial difference, for the worse, to the universal health system that we have in this country—which I believe was a much better system years ago. As the member for Bass quite rightly pointed out, when universal health is undermined, the worst affected are people on low incomes. Sadly, many of the people on low incomes are also in rural, regional and remote Australia, where access to medical services is even more difficult. Again, the statistics show that their health outcomes are much worse than the health outcomes experienced in the rest of the country. Their access to services is much more difficult and, therefore, the prevalence of different illnesses is much higher in regional, rural and remote Australia.

We need to maintain the universal health system we have for all Australians. It was introduced to make sure that every Australian, regardless of income, had access to a good health service—and that's what we will be fighting for between now and the next election.

Greg Hunt (Flinders, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

I thank members for their contributions to the debate on this bill, the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018. This bill amends the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000 to increase flexibility by enabling the tax payable on the grant of an approval of an Approved (specimen) Collection Centre, ACC, to be calculated for approvals granted for periods longer than one year.

The bill will amend tax payable on the grant of an approval of an ACC from $1,000 paid annually to $2,000 paid two yearly. The rate of the tax has not been changed since the act was enacted in 1999. Careful consideration was given for no increase to the tax so as to ensure that smaller ACCs were not negatively impacted.

The changes to the tax and the proposed corresponding amendment to the Health Insurance (Eligible Collection Centres) Approval Principles 2010 to extend approvals from one year to two years will be welcomed by the sector as they assist in reducing operational and administrative burden. There are a number of parallel projects that support the development and implementation of the government's direction for pathology that include administrative changes by automating and streamlining processes to reduce regulatory burden for pathology providers. The department has been engaging with, and will continue to engage with, key stakeholders prior to 1 July 2018 to advise of the amendment to the tax and the extension of the time frame for new and renewed ACC applications, including reaffirming the key elements of the measures announced in the 2017-18 budget.

In summary, this bill will amend the tax payable on the grant of an approval for an ACC from $1,000 annually to $2,000 to be paid two yearly. This amendment is an essential component to the budget measure as part of streamlining processes and reducing the administrative burden for pathology collection centres. I thank all of those involved from Pathology Australia, including the CEO, Liesel Wett, the department and my office. I commend this bill to the House.

Kevin Andrews (Menzies, Liberal Party) Share this | Link to 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 immediate question is that the amendment be agreed to.

Question negatived.

Original question agreed to.

Bill read a second time.