Tony Smith (Speaker) Share this | Link to this | Hansard source

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

The Government's failures on healthcare.

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

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

Mark Butler (Hindmarsh, Australian Labor Party, Deputy Manager of Opposition Business in the House of Representatives) Share this | Link to this | Hansard source

The most reliable truism of modern Australian politics over the last 50 years is this: the Liberal Party have never supported Medicare. They have never supported the concept of comprehensive, universal health insurance. They were at least very clear about that for decades, because, for decades, they tried to kill it. The godfather of the modern Liberal Party, John Howard, the former Prime Minister, was especially clear about this. He used phrase after phrase to reinforce the depth of his opposition not just to Medibank, and then to Medicare, but to the concept of universal health insurance in its broader sense. He described the Hawke government's achievement of introducing Medicare as a 'total disaster'. He said it was a 'nightmare'. He said Medicare was 'one of the great failures of the Hawke government'. Back in 1987, as the Leader of the Opposition, John Howard vowed that he would never stab Medicare in the back; he said he would 'stab it in the stomach'.

After the 1993 election, when the Liberal Party lost another election on the platform of abolishing Medicare, they finally hoisted the white flag against the total abolition of Medicare. But let's be clear: they have never embraced the idea of comprehensive universal health insurance. Instead, what they've done for the last 25 years is what John Howard promised never to do. They've spent 25 years stabbing Medicare in the back because they've not been able to abolish it. In their hearts and actions, their only concession to Medicare is as a safety net, not a system of comprehensive universal health insurance. Yet again, they're playing from the playbook of the Republican Party in the US, reluctantly agreeing to a safety net of government funded insurance for low-income households and pensioners but insisting that the middle class pay their own way. Under the rubric of freedom, they're insisting that the middle class pay not only the Medicare levy and their private health insurance but also, increasingly, gap fees.

This government has spent eight long years hacking away at the system of universal comprehensive health insurance, which is one of the shining jewels of Australian politics from the last five decades and one of the proudest legacies of the Labor Party. Memorably, their first attempt to hack away at it was the GP tax in the 2014 budget. They couldn't pass that, so instead they took it out on the doctors, who were, along with the Labor Party, one of the many groups that opposed the GP tax. They punished them directly, and indirectly punished patients, by freezing MBS rebates for years and years. Their budget papers made no secret of the fact that the four-year freeze on MBS rebates, which was introduced in 2014-15, was a direct result of their inability to pass a GP co-payment through the parliament. Four years later, after four years of freezing the indexation of MBS, the Treasurer, now the Prime Minister, added another two years to freeze the MBS rebates.

Government Member:

A government member interjecting—

Mark Butler (Hindmarsh, Australian Labor Party, Deputy Manager of Opposition Business in the House of Representatives) Share this | Link to this | Hansard source

I hear the interjection from across the table.

A government member interjecting—

You whispered it! It was another play from the Republican playbook. Like they do with so many things—the treatment of women, universal health insurance—they pulled out the equivalence chapter. They said the Labor Party started it. One of the great falsehoods of the last decade is that the Labor Party froze the indexation of the MBS system in the way that those opposite have done. It is quite clear that the realignment of MBS indexation in 2013 to the beginning of the financial year, which is when every other health program is indexed, was not a freezing. It is quite clear from the budget papers in 2013—page 177—that, under a Labor government, the next indexation of the MBS system was to be 1 July 2014. Unfortunately, we didn't bank on those opposite getting hold of the Treasury bench and freezing those indexations for year upon year. Those years of real cuts to Medicare funding have seen gap fees skyrocket.

In question time, the minister said—quite falsely, I think—that 86 per cent of patients are getting bulk-billed. He said there had been a six per cent increase in patients, when he knows that the 86 per cent for bulk-billing is about consults. It's not about patients, and it reflects the fact that older Australians go to the GP far more often. The government doesn't release the number of patients who get bulk-billed against the number of patients who actually pay gap fees, but the Australian Institute of Health and Welfare estimates that one in three patients who go to a GP has to pay a co-payment. Those are working families. That is the middle class of Australia. Those Australians have seen their gap fees, in the face of indexation being frozen by this government, skyrocket. They've skyrocketed by one-third for visits to GPs and by fully one-half for visits to specialists. On average, one in three patients is paying $10 more for every GP visit than they were paying when this government came to power and $30 more for a visit to a specialist. On average, if you are seeing a GP seven times a year—as most patients do—and a specialist once a year, this government has lumped a $100 Medicare tax on you over the last eight years. It's all a product of the Medicare cut through the freeze on indexation for year upon year.

Remarkably, under this minister the average gap to see a GP now, for the standard level-B consult, is actually more than the Medicare rebate. The gap was supposed to be a small contribution by the patient. But, under this government and under this minister, the average gap now is actually more than the government contributes to the cost of going to a GP. You pay your Medicare levy. You pay your private health insurance. And now, under this government, middle-class Australia—working families—are funding the majority of a standard level-B consult. That's the contribution to primary care and Medicare under this government.

The concern we have about the latest MBS changes is that they continue this pattern of behaviour that will increase patient costs. They add surgery to GP consults and specialist consults that have seen gap fees and copayments go up. Now, we're not opposed to a review of the MBS to ensure that items in the MBS reflect contemporary practice. It's a sound idea. But, like so much about this government, it's been utterly bungled in its implementation, just like the 2018 changes to spinal surgery that were an earlier tranche of the MBS review. It was sound in approach, properly updating the MBS items associated with spinal surgery to reflect contemporary surgical practice. But, according to the AMA:

Patients were left out of pocket, spinal surgeries were delayed, and doctors couldn't provide patients with informed financial consent about potential gap fees.

And with the latest tranche—more complex, more broad—we are seeing history repeating.

The minister tried to say there shouldn't be any increase in gap fees as a result of these 900 changes, but the Grattan Institute has said:

This will almost inevitably mean that patients will face increased out-of-pocket costs.

Mr Hunt interjecting—

I hear the minister scoffing at the Grattan Institute's analysis, but the AMA also said that that's guaranteed, that patients will see increased costs.

As I said, a review of the MBS is a sound idea. But increased gap fees as a result of these changes that the AMA says are guaranteed are no accident. Just like low wages, they are a deliberate policy feature of this government. They are a deliberate design feature of their approach to public health care, because they have never, ever accepted the concept of comprehensive and universal health insurance. The minister says, 'Trust us.' The minister says, 'There's no reason that patient costs should rise.' But that has been the story of this government for eight years: patients having to put their hand in their pocket to go to the GP, patients having to put their hand in their pocket to go to a specialist and now patients having to put their hand in their pocket to have life-changing surgery. Well, when the minister says, 'Trust us,' I say to Australians: you should never trust the Liberal Party on Medicare.

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

I'm actually delighted to take this matter of public importance regarding health care, because it's quite extraordinary that the member opposite has given a speech and not cited a single example—not one example. And there's a reason for that: there's none he can stand by. During question time today they alluded to a hip arthroscopy. This was referring to femoroacetabular impingement. In other words, they tried to cite a particular example which isn't even on Medicare. If I may, the Medical Services Advisory Committee found that the use of therapeutic hip arthroscopy and the management of FAI was poorly supported by evidence and varied greatly in clinical practice; therefore, this procedure has never attracted public funding and has never been listed on the MBS.

That was the one example from those opposite—something that wasn't on the MBS. They've been caught out in a 'Mediscare' again. But this time it's so obvious, it's so early, it's so ill-thought-through that it's simply embarrassing. This is possibly the lamest MPI I have seen in almost 20 years in this place. So, with great respect, I'm sorry to have to say that to the member opposite, who is generally a very nice fellow and whom I quite like. Having said that, to cite something that isn't supported and was picked out for being misused and inappropriately co-claimed—I'd be very keen to understand whether or not they think inappropriate practices is something that they support, as found by the medical experts, not just once but five years ago. But there has been no change in that period of time.

Let me now step back and talk about where we are as a country. This last year has seen the greatest positive transformation of Medicare since Medicare's formation. There was the creation of telehealth, which has seen over 60 million consultations occur. There was a massive investment, all up, of $6 billion in this budget. There was the increase of the total funding for Medicare from $19 billion when Labor was last in power to $30 billion, $31 billion, $32 billion and $33 billion over the forward estimates. That is real increase—already a 58 per cent increase but growing significantly further over the course of the coming budget.

In particular, we've also seen a $711 million investment in new items just in this budget. If they were to stop that, then I would be very surprised. I'm going to run through what some of those things are. That $711 million investment includes, as I mentioned earlier, $288 million for antidepression therapy. For the first time, repetitive transcranial magnetic stimulation, rTMS, has been included on the Medicare scheme. That's a fundamental change in depression treatment. It puts Australia near the forefront of the world in terms of this treatment. It's about mental health. Sadly, that compares—and this is something that I hadn't previously brought up until very recently—with what happened under Labor when they were in government. What we saw in particular in their time and on their watch was a slashing of mental health funding under Medicare. In the 2011-12 federal budget, the then government and the then mental health minister, who is now the shadow minister for health, announced a $580 million cut to mental health services under Medicare. This included a reduction in the number of Medicare sessions available under Better Access from 18 to 10 per year.

Mr Deputy Speaker, you may be aware that in the October budget we doubled the number of Better Access services available from 10 to 20. We were undoing what Labor did. We were undoing the damage that they had done. Let me be clear: they cut the number of mental health sessions from 18 to 10; we doubled them from 10 to 20. At the same time, they also slashed the rebates for the preparation of mental health treatment plans for general practitioners by $580 million. But it is very important that we understand this is not our assessment. This comes from the 2011-12 budget paper, pages 229 and 230:

The Government will revise the number of allied health treatment services available to patients under the Better Access initiative.

…   …   …

The new arrangements will ensure that the Better Access initiative is more efficient and better targeted by limiting the number of services that patients with mild or moderate mental illness can receive …

I've talked a lot about what they've done in pausing PBS medicines, but perhaps it might be time to talk a whole lot more about what they've done in slashing mental health services. Just to repeat, on page 229 of the 2011 Budget Paper No. 2, it says:

The new arrangements will ensure that the Better Access initiative is more efficient and better targeted by limiting the number of services that patients with mild or moderate mental illness can receive …

That's what they actually did.

In this budget alone, we added $711 million. We put in place $288 million for direct mental health services. Last budget, we doubled the number of mental health services under the Better Access scheme, but we also added another $111 million for creating a new item for patients and carers of young people with mental health conditions to be able to participate in Better Access schemes. Last budget we added to the Better Access scheme. This budget we added to the Better Access scheme under Medicare. When they were in power, they slashed it by $588 million. That is a genuine cause for shame. But it's more than that. They've done it not just once or twice; they've done it on a number of occasions. I made reference before to an article by the member for Ballarat, when she was the shadow minister. I believe it was 16 April 2015 when she wrote very proudly in an article in the Guardian:

As a result of Labor's review process—

this is Labor's Medicare review process—

testing is now refined to better target patients who really do need a Vitamin D test. Combined with another move to split Folate and Vitamin B12 testing, close to $1 billion in savings are being realised over the next five years on just two MBS items—

Medicare Benefits Schedule items. So they took a billion out there and they took $580 million out of Medicare Better Access services for mental health, and we've put in $6 billion in this budget. So, seriously, this is going to be a long week for Labor if they want to run with this through the House, because I look forward to responding time and again with the actual facts.

Then, in terms of what we've been able to do in the course of this budget, the other items which they seem to complain about include an increase in the fee for the revision of a knee replacement, from $2,330 to $2,645; an increase in services for osteotomy of the tibia, from $850 to $956; an increase for coronary artery bypass grafting surgery, of 50 per cent; an increase for complex aortic procedures of $500 to $1,000; and an increase for operations on the spleen, a splenectomy during a distal pancreatectomy, from $1,231 to $1,617. There are many, many examples of those. If they wish to block them, good luck, but they would be denying support to patients. I would also note that the AMA have set out in writing, in a joint release with the government, their support for the actions that we have taken.

Not only can we compare all of this we have done on Medicare in increasing support for mental health, increasing access for new items and creating telehealth; we have increased bulk billing from 82 per cent on Labor's watch for the equivalent period, year to date, to 88.7 per cent. And what is bulk billing? It means that you are able to go to the doctor without having to pay. That's an increase of 6.7 per cent. That's what's happening across the country. And these figures are on the same basis as the figures Labor used when they were in office. That's a 6.7 per cent increase in terms of those who can visit the doctor without having to pay. That's real. That's significant. That's important. That's reducing pressure.

At the same time, we've also slashed in half the price rises that were occurring in private health insurance under Labor. We believe in the public health system. We also believe in the private health system. We believe that's what sets Australia apart and we also believe that is what has allowed Australia to have a partnership which has protected Australians during COVID. I am proud of what this government has done and I condemn what the previous government did. (Time expired)

Ged Kearney (Cooper, Australian Labor Party, Shadow Assistant Minister for Health and Ageing) Share this | Link to this | Hansard source

I am a nurse. I maintain my registration proudly, albeit non-practising, because, once a nurse, always a nurse. I'm a proud member of the Australian Nursing and Midwifery Federation. I was the federal secretary of that great union, which is the largest in the country. It has just over 300,000 members. I worked the vast majority of my nursing life in the public health system, and as a trade unionist I fought hard to save Medicare. I saw firsthand the benefits of the universal health system that we have in Australia—a universal health system with Medicare at its heart. Australians love Medicare and they know the Liberals don't.

Back in the seventies, Liberal members voted over and over against the introduction of Medibank, as it was in the beginning, as introduced by Gough Whitlam. They argued it was a totalitarian measure designed to destroy the people's health and, at the same time, curiously, argued it was socialised medicine. Gough won out in the end. But then Malcolm Fraser, as we heard the shadow minister for health explain, spent eight years as Prime Minister white-anting it to the extent that they attempted to abolish it in 1981. Bob Hawke came to power in 1983, and he virtually had to start all over again with our Medicare. Howard hated it, as we heard before, and Tony Abbott established the disastrously insidious Commission of Audit, which convinced him to introduce a co-payment for Medicare. The people of Australia told him, straight up, what they thought about that. Then Malcolm Turnbull set up a privatisation committee to, pretty much, examine how best to privatise the public health system and Medicare. Again, that went down well with the people of Australia—not!

They have persistently run down the administration of Medicare with cuts to the Public Service, the very people who help our community access it. They kept rebates frozen for years, undermining bulk-billing, and now they have undermined the provision of services with unexplained changes to the MBS. That, without any doubt, will drive up gap fees and out-of-pocket expenses. You can't trust the coalition with Medicare and public health services.

I received an email from a constituent this week. She is 37 years old. She wrote: 'Ged, I am writing to you because I am very concerned about the media reports of changes to Medicare rebates. I don't have some groundbreaking tear-inducing personal story to support my concerns, but I have had a number of minor surgeries in my lifetime, which I've been able to afford through a combination of Medicare, private health insurance and family support.' She continued: 'I'm worried at the 'death by a thousand cuts' approach to universal health care. I have major worries about the slide towards an American inspired private, horrendously expensive and inequitable approach to health care.' She wrote: 'I see this as another way that inequality is becoming entrenched in Australian communities, with the people proposing and supporting such changes coming from economic positions of great advantage and who will never feel the true impact of a high medical bill.' She finished by saying: 'Ged, I hope that you are working hard in Canberra to ensure that younger Australians, such as myself, don't continue to have the rug pulled out from under them as they grow older, pulled out by a generation of people who are undermining Australian values of equity, compassion and universal access to health care.' I couldn't have said it any better myself. She is just one of the vast majority of Australians who care deeply about the universal health system and are troubled by cuts.

Another example of the government running down our health system is the disaster that is aged care. The royal commission found that aged care—the responsibility of the federal government—was suffering from deep neglect. Much has been said in this House and beyond about the complete disregard and bungling of the aged-care system by this government. It is a system neglected. The pandemic gorged open cracks, creating a cavernous disaster when the COVID pandemic raged through our communities. A bungling attitude and incompetence continued with the vaccination rollout—again, the sole responsibility of the federal government.

Politics is a game of tricks to those on the other side. They say: 'Who can we trick with our smirks and our slogans? Who can we ignore with diversions and big photo opportunities? How many health workers can we make believe we care about them with crumbs and small handouts and weaselly worded legislation that takes away rights and services?' They on that side are about tricks. Labor knows that politics is about priorities, and we have Medicare and the public health system at our heart. (Time expired)

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

I was very pleased to be asked to talk on this MPI. I now understand how John McEnroe felt when he questioned the umpire and said, 'You cannot be serious!' The opposition, in choosing to argue that we are failing in the health portfolio, seriously, must have been blind, deaf and not watching or reading anything for the last six or seven years. We have had the biggest increase in the health budget in the history of this nation.

Look at what we did in the COVID situation. The health outcomes we have delivered in public health, controlling the pandemic in this country, are unbelievable compared to other nations around the world. A few stand out. There is the reform in telehealth, specifically triggered by COVID. That will be a long-lasting reform, although we have extended the special COVID provisions until December 2021. We have organised the private hospital sector's capacity to increase the amount of personal protective equipment. There is the ventilator building project. There is money on vaccine research and subsidies for state governments so they can do all this testing for COVID. There's the mental health support for COVID. Beyond Blue is available 24/7 because of the COVID response. We know that people being isolated raises mental health issues. We've funded extra support mechanisms to get out to remote Australia for Indigenous testing and vaccination. We've initiated electronic prescribing. These are all great reforms that will have long-lasting benefits for Australian health consumers.

The last couple of budgets have covered so many things in health that there is no way I can cover them all, but I'll just cherrypick a few of them: the initiatives in women's health; the extra funding for Jean Hailes to deliver its services online; the initiatives for endometriosis and pelvic pain, and for preventing premature labour, keeping children in the womb longer so that you don't have the risk of premature birth. Look at what we've done with the PBS—the dollars tell you the story—and compare it with what the last Labor health minister did, admitting that they were going to save money by delaying listings. In 2012-13 there was an $8.74 billion spend in the Pharmaceutical Benefits Scheme. By the end of this four-year cycle, it will be up to $11.221 billion. In 2012-13 it took an average of 312 days to list a drug on the Pharmaceutical Benefits Scheme. In 2019-20 it's down to 166 days. That's almost a 50 per cent reduction in the time it takes to get an appropriate proven, safe and cost-effective new drug onto the Pharmaceutical Benefits Scheme.

In 2012-13 the Medicare spend was $19.47 billion. By the end of this four-year budgetary cycle, that will be up to $33½ billion. We've had the Medicare Benefits Schedule review. We've been reviewing all the subspecialties and getting rid of old, superfluous MBS item numbers and practices that aren't justified and putting in new ones. Mental health issues are a scar on Australian life. There's been an increase in mental health issues for young and old. We have announced more headspace centres. We have initiated the Head to Health centres for people older than the headspace age. We have 10 new headspace centres and five satellite services being upgraded. We've put funding into dealing with eating disorders. We've put funding into advanced biological drugs for cancer and other chronic bone marrow disorders. The list goes on. The one thing you wouldn't choose to criticise the coalition government on is health. No-one is perfect, but the health portfolio—in my time in this parliament—has seen the most incredible period of extra funding. All the things that were always missing seem to have been picked up and supported, and this last budget confirms that.

Libby Coker (Corangamite, Australian Labor Party) Share this | Link to this | Hansard source

Scott Morrison has launched the biggest attack on Medicare in decades. It is an attack that will be rammed through without any consultation with the sector or engagement with Australians who love Medicare and rely on it. It's hardly surprising. This kind of behaviour is in the government's DNA. In the case of the current health minister, it was outlined in his maiden speech to parliament back in 2002. Twenty years ago, the health minister stood in this place and foreshadowed his vision for Australia's much-loved public healthcare system. He hoped our system would look more like the US healthcare system, a system that is expensive and fails its most vulnerable. It may have taken the health minister 20 years, but it looks like he's finally one step closer to achieving his vision, a vision that would destroy universal health care, health care that is affordable for everyone—the Medicare system that Labor created, an amazing legacy and one that we will continue to fight for.

Under the cover of the Victorian coronavirus outbreak, the Prime Minister and the health minister have sneakily announced that there will be almost 1,000 changes to the Medicare Benefits Schedule. Imagine that. There is a once-in-a-century pandemic, and the government decides to make cuts to our healthcare system. What an extraordinary ambush of people who are already suffering. These last-minute changes, which come into effect in just under three weeks time, will result in many having their life-changing surgeries cancelled with little notice. Others are anxious they will face huge bills they were not expecting. One in six items on the MBS are being changed.

And it's not just Labor that are raising concerns about these changes and the increases to gap fees and out-of-pocket expenses. The Australian Medical Association has warned the Morrison government about the rushed nature of these changes, the lack of consultation and the fact that they cannot be implemented without a significant disruption to the provision of health care for countless Australians. The Grattan Institute has urged the government to defer the changes to allow adequate time for consultation.

What those opposite are doing to Medicare is symbolic of how they're dealing with the health system in general. Time and time again this government produces significant policy changes with little consultation and attempts to ram the changes through. We have seen it with the NDIS and their plan to introduce independent assessments. It's a pattern of behaviour that is often about slashing funding, and it increases anxiety and uncertainty in the process. You just can't trust the coalition when it comes to health care and aged care.

The people in my electorate of Corangamite know this. They're feeling the burden of this government's failures. Out-of-pocket costs for a GP visit in Corangamite have soared by 34 per cent since the Abbott-Turnbull-Morrison government came into power eight years ago. Corangamite residents also have to hand over more per visit to a specialist, with costs rising up to 64 per cent. Just last week I spoke to Tony. Tony lives on the Surf Coast in my electorate. He has type 1 diabetes and he's extremely distressed about the state of our healthcare system and the increasing out-of-pocket costs taking place under this government. His condition means he requires regular check-ups and management. Higher out-of-pocket fees mean he's paying more for health care. Tony's confused about how this government can expect working families to make ends meet under the rising costs. In his own words, he has said: 'I'm not sure how the Prime Minister, the Treasurer and the health minister expect working families to make ends meet. One of the most concerning things about our situation is we are still some of the lucky ones, and we know how hard it is for people doing it tough out there.'

The fact is that, under the eight years of this tired old government, the cost of seeing a doctor has gone up and the wait times are longer. It's not good enough. Everyone knows that when you attack Medicare you attack people and you attack their health. Medicare is one of Australia's greatest achievements. It was built by Labor, and I will always fight to protect it. In contrast, cutting Medicare and dismantling it is in the Liberals' DNA. You cannot trust the Liberals with Medicare.

Gladys Liu (Chisholm, Liberal Party) Share this | Link to this | Hansard source

The Morrison government has been at the helm of Australia's leadership while going through the most significant health crisis we have seen in modern history. Many countries have taken a big hit throughout this crisis. They have suffered major casualties and seen their healthcare systems fail. It is with pride that I can say that, with the Morrison government steering the ship that is Australia, we have avoided the treacherous waters that many other countries have strayed into.

While we have managed the COVID-19 health crisis with aplomb, health was always a priority for this government prior to the pandemic. The Morrison government has always recognised the importance of ensuring Australians have access to mental health resources and support. Our government is leading the way on mental health reform by investing a record $2.3 billion in the National Mental Health and Suicide Prevention Plan. Based on the principles of prevention, compassion and care, the plan will invest $1.3 billion in high-quality and person-centred treatment, including $820.1 million for a national network of mental health centres for adults, youth and children through the Head to Health and headspace programs. For a long time Australians were so focused on their physical health that they didn't recognise the effect mental health could have on their quality of life. Under the Morrison government this has changed for the better. We care for the mental health of Australians, and we are making significant and meaningful reform to improve the mental health of all Australians.

Our healthcare system is envied across the world. We have an efficient and effective public health system that works for Australians and caters for all. It does not just reduce the cost of seeing a doctor or getting necessary surgery. It also includes the Pharmaceutical Benefits Scheme, a scheme that sees the government heavily subsidise life-saving medication for those in need. Astoundingly, since 2013 the Australian government has approved more than 2,677 new or amended medicine listings on the PBS for an overall investment by the government of $13.2 billion. This represents an average of around 30 listings or amendments per month, or one a day. I say it's an investment because that's exactly what it is. Unlike the Labor Party, the Morrison government sees these new listings as an investment in Australians. The Australian people deserve it and the Morrison government will, as it always has, deliver on its promises to the public.

By comparison, Labor stopped listing medicines in 2011. In the 2011-12 portfolio budget statements, it explained that the listing of some medicines would be deferred until fiscal circumstances permitted. On 25 February 2011 Labor announced the unprecedented deferral of the listing of a number of medicines under the PBS, including medications for the treatment of schizophrenia and the treatment of endometriosis. This tells me that they care little for the mentally ill and the women of this country. Labor could not manage the economy and chose to compromise on the health—

Llew O'Brien (Wide Bay, National Party) Share this | Link to this | Hansard source

The member for Macarthur on a point of order?

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

I totally object to that description.

Llew O'Brien (Wide Bay, National Party) Share this | Link to this | Hansard source

What's your point of order, Member for Macarthur?

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

On the truth, the relevance of what she's—

Llew O'Brien (Wide Bay, National Party) Share this | Link to this | Hansard source

That's not a point of order. The member is being relevant to the topic. As you well know, the chair doesn't adjudicate the truth of these things.

Gladys Liu (Chisholm, Liberal Party) Share this | Link to this | Hansard source

Labor could not manage the economy and chose to compromise on the health of the most exposed and most vulnerable. This was a callous and horrific act by the— (Time expired)

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

First of all, I would like to object very strongly to the description by the member for Chisholm of our side being uncaring to the most disadvantaged. In fact, exactly the opposite is true.

Government Member:

A government member interjecting—

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

We did not stop listing medicines. That isn't true, it is a lie and it has no basis in fact.

A government member interjecting—

Llew O'Brien (Wide Bay, National Party) Share this | Link to this | Hansard source

The member will stop interjecting.

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

Some medicines were deferred, but we continued to list medications.

I rise to speak on this matter of public importance on the government's failures on health care, and I thank the member for Hindmarsh for bringing it. I want members to think about two things: universality and equity. People have forgotten, but the Whitlam government introduced Medibank because the commonest cause of bankruptcy in Australia in the 1960s and 1970s was health costs. Medibank was destroyed by the Fraser government, because they didn't care about the health of the most disadvantaged people in Australia. Subsequently, the Hawke Labor government reintroduced Medicare. I started my private practice in the same week that Medicare became available for all Australians. For the first time, it allowed people access to high-quality medical care in an equitable way, so that people in the most disadvantaged areas could access health care. There was a pay-off in that for the doctors: by bulk-billing people, they didn't have to chase bad debts. So they agreed to have a fee, which at that stage was 85 per cent of the scheduled fee, repaid to them through Medicare payments and to forgo the 15 per cent, which was assumed to be a cost of having to collect bad debts et cetera. Subsequently, Medicare has continued to be attacked by the Liberal-National government whenever they are in power. This government is really just par for the course for Liberal governments.

We know there are huge inequities in health care in Australia. For example, life expectancy at birth for the average Australian born in metropolitan Sydney is 82 to 84 years. In rural areas, it's 78 to 80 years, a significant difference in life expectancy. Yet the National Party and the Liberal Party have done very little to try to change this. We know that health care is worse in outer metropolitan areas. Access to general practitioners has become almost impossible for many low-income Australians in outer metropolitan areas. I have approached the Minister for Health and Aged Care on several occasions with supporting letters from general practices in my electorate of Macarthur and in other electorates such as Chifley, Werriwa and Macquarie—the outer metropolitan areas—saying they cannot attract general practitioners because of the changes that this government has made to District of Workforce Shortage qualifications. They can't attract general practitioners. I've had patients and their parents approach me saying they couldn't get access to general practitioners. They were having to use their local hospital as their GP because they couldn't get in to see local doctors. This government and this health minister have done nothing about it. He sent a motherhood letter back to me and to those practices, without any active change.

We know also about this latest Medicare review. It was necessary and has been six years in the making. It was headed by some really good people, like Professor Bruce Robinson and Professor Michael Besser, people of my acquaintance. They are really very smart academics and very smart doctors who've done their best to provide a review. Yet there's been no public discussion about these changes. There has been very little information released even to medical practitioners. As the only medical practitioner in this House with an active Medicare provider number, I've seen very little information about the new changes. There's been no public discussion, and virtually every group that I speak to, from the AMA to the College of Physicians to the College of Surgeons, feels that gap costs are going to be increasing for people to access high-level medical care. This is a disgrace. It's inequitable and it's unfair, at a time when in the last week we have seen published the highest incomes by profession in Australia, where five out of the top six were all medical, with surgeons earning on average $410,000. And I can tell you that, with most surgeons I know, if they're only earning $410,000 they're not really trying. So that has been published, and yet we're going to tell the average Australian that they have to pay more to see their doctor. It is a disgrace. This is the destruction of Medicare by stealth, and there needs to be adequate public discussion of those changes.

John Alexander (Bennelong, Liberal Party) Share this | Link to this | Hansard source

I would like to acknowledge the contribution of the member for Macarthur in reminding us of the history and the noteworthy origins of Medicare. And thank you to the opposition for bringing forward this debate today. On this side of the House, we are always happy to talk about health care.

If ever we needed any more signs of our healthcare successes, we should just look overseas. While Australians go about their lives in relative normalcy, around the world hospitals are clogged, morgues are overloaded and families are grieving. Meanwhile, Australia has had no deaths this year and only a few hundred locally acquired cases. While our hearts go out to those in Melbourne right now, I have confidence that these quick circuit-breaker lockdowns will ensure that life will return to normal sooner than if the disease had been allowed to run rampant. While much of the praise for the handling of this pandemic can go to the states, the federal government has been supporting their efforts in providing healthcare packages to ensure Australians have had the support they've needed.

In the 2021-22 budget, the Australian government provided a further $1.7 billion to extend our COVID-19 health response package and a further $1.9 million to provide vaccine purchases and rollouts. These measures bring the total health-related COVID expenditure to over $25 billion. One of the secrets to our successes locally has been the testing numbers. Of the 19 million COVID tests taken locally, eight million were funded by this government at a cost of $650 million. We've also extended the operation of Medicare COVID-19 pathology test items until 31 December 2021, and we're working with states to respond quickly whenever COVID rears its ugly head.

On 13 March 2020 the Australian government and all state and territory governments signed the National Partnership on COVID-19 Response. As part of the partnership, the government will provide a 50 per cent contribution to the costs incurred by state and territory governments, public health and hospital systems in responding to the COVID-19 outbreak. As of 7 June 2021, the government have provided $5.8 billion to states and territories under this partnership. I could talk for more than five minutes about the success of this government's response to COVID, which have kept us amongst the best performing nations as others have succumbed to devastating outbreaks and a tragic loss of life, but I'd also like to speak of the Pharmaceutical Benefits Scheme. While we face a pandemic now, one day hopefully soon we will be back to normal, and it is important to know that Australians can rely on this government to give them access to the health care and medicines they need to live and thrive.

Since 2013 the Australian government has approved more than 2,677 new or amended medicine listings on the PBS at an overall investment by the government of $13.2 billion. This represents an average of around 30 listings or amendments per month. That is about one every single day. The PBS gives life-saving medicines to Australians at hugely reduced prices. Many medicines would cost hundreds of thousands of dollars per year and be out of the reach of many, but, through the PBS, they will pay $41.30 or $6.60 per script, and 91 per cent of PBS scripts each year, 186 million, are dispensed to concession card holders. Many patients pay no more than $6.60 per script. And 37 million scripts are free of charge because patients have reached their safety net. Equally important, the PBS ensures that the pharmaceutical companies receive fair prices for their medicines, ensuring these drugs are still made available to Australians and future life saving treatments will be available here when they have been proven to work.

We are proud to say that we have a policy to list all positive recommendations on the PBS and we are doing it quicker than ever before. Back in 2012, it took 312 days for an item recommended for listing to actually be listed. Under this government, that is now down to 166 days, ensuring Australians get medicines they need sooner. Many pharmaceutical companies are based in Bennelong and I would love to list all of their recent additions to the PBS that are based locally but, unfortunately, the companies are too innovative and the government far— (Time expired)

Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

The Liberals last week launched the biggest attack on Medicare in decades. While the nation has been focused on the government's vaccine rollout failures and quarantine failures, the Liberals have snuck out almost 1,000 changes to the Medicare Benefits Schedule. The result of these changes is Australians paying more for essential health care and surgeries, with higher out-of-pocket costs. We know these changes are bad news, because the Prime Minister was nowhere to be seen when they were quietly announced. If these changes had been good news you can bet your bottom dollar the Prime Minister would have been there for the photo op, wearing a fake doctor's gown and a fake stethoscope. But there was no photo op, because not even the Prime Minister's private army of media operatives could spin this assault on Medicare into a good-news story.

Labor gave Australia Medicare; the Liberals gave Australia robodebt. Labor builds; the Liberals cut. Over the past eight years of this Liberal government we've seen a radical assault on Australia's treasured institutions, like Medicare. And while today it is Medicare, there's also the ABC, the arts sector, public schools, TAFE and universities—institutions and the essence of our culture, a culture that values fairness and mateship ahead of selfishness and a winner-takes-all attitude. These things are under assault from the Liberals and their radical reimagining of Australia. The Liberals will not be happy until Australia looks like a version of America, with everything privatised: a culture of low wages and servitude.

That is not the vision Labor has for Australia. Labor will protect the institutions, the culture and the way of life that has made Australia the envy of the world. One of those institutions that we will protect—a pillar of our national identity—is universal health care. We know the Liberals have always hated Medicare. They have never supported it. They went to four elections promising to get rid of it. They went quiet on it for 10 years. Then they floated a $5 GP tax. Then they cut $1.7 billion from Medicare and proposed a $7 GP tax, and they sought to privatise Medicare services. Then they cut $1 billion from Medicare. Then they cut bulk-billing in suburban communities. And now they've rushed in these sneaky changes, which cut funding for surgeries and increase out-of-pocket costs.

The fact is that no-one can explain how this enormous change to the Medicare Benefits Schedule, affecting 900 of 5,700 items, will actually work on the ground. And it was publicly announced with just three weeks notice. You'd give more notice when you left a job. Regardless of what you think of the changes, they are absolutely massive. It illustrates the incompetence of this government that they introduced these changes with less than one month's notice. Australians now face the prospect of already scheduled life-changing surgeries no longer being covered by Medicare, requiring them to pay thousands of dollars extra or to cancel their surgeries and go back on the queue for a surgery that is listed.

There has been no opportunity for Australians to discuss these matters with their doctors. No warning has been given that the changes were on the way. The AMA warned the government about rushing this. But, true to form, this arrogant government did not listen. The government has refused to guarantee that patient costs will not rise. Under this government, gap fees for GP visits have already increased by about $10 a visit and for specialist visits $30 a visit. In my electorate, GP clinics are telling healthcare card holders aged between 16 and 65 that they will no longer be bulk-billed and will face a $20-per-visit up-front cost.

That's not the way Medicare is supposed to work. Every year Australians are paying, on average, $90 a year in medical gap fees. Under the Liberals, those fees are going one way—and that's up. In the eight years that the Liberals have been in government, the cost of seeing a doctor in Tasmania has risen by 35 per cent. Cutting and gutting Medicare is in the Liberals' DNA. They've never supported it. For decades now they've been slicing and dicing Medicare, killing it by 1,000 cuts. In regional Australia it's on its deathbed already, a cruel betrayal of regional Australia by a government that purports to represent regional Australia. Labor built Medicare, and only a Labor government will protect it. (Time expired)

Garth Hamilton (Groom, Liberal National Party) Share this | Link to this | Hansard source

The Morrison government's commitment to health care in this country is rock solid. As part of the 2021-22 budget the Morrison government is investing $125.7 billion over the next four years into Medicare, an increase of over $6 billion from last year's budget. We support health care in this country and we put our money where our mouth is. We've heard Labor's scare tactics claiming to the contrary, and their claims are simply not true. They were not true in the past, and they are not true now. These changes we are making to rebates are based on the best medical advice, best medical practice, reflecting changes in modern medicine and expanding access to procedures and policies which did not previously attract rebates.

Throughout the pandemic this government has taken the exact same approach, we can all agree, to great success in Australia of following the best medical advice. As the Deputy Prime Minister tried to say today, there is no other country in the world you would rather be in than Australia. It is performing very, very well and it's thanks to the great work of the Australian people that we have done so. This government will continue to take the best medical advice. This means that when you present to a hospital, under these changes, you will have greater access to rebates for the procedures you need. We are increasing funding where it is needed and we do so following the best medical advice. This is especially true for residents in my electorate who might need orthopaedic treatment. We've added 162 new items and amended 280 items that needed updating to better reflect contemporary clinical practice; 137 items have been superseded where services have been consolidated; and nine items have been deleted, services considered now to be obsolete. All of this has happened in consultation with the relevant peak bodies following the best medical advice and is being progressively introduced. So this government's credentials on protecting and improving healthcare, protecting and improving Medicare are not in doubt.

But I'd like to see some scrutiny in the provision of health services in my region of Groom. In media reports just last week—in the Chronicle and on the local television—it was revealed the Toowoomba Hospital experienced three code yellows in eight days. This is not an unusual experience, unfortunately; it is, though, quite a dramatic one for our region, for those in need of care. This is the hospital that, earlier today in question time, I heard member for Oxley and other members opposite suggest was ready to bear the weight of a 1,000 person quarantine facility. This same hospital, three times in the last week, was above capacity. A code yellow declaration is a significant emergency when a hospital is above capacity and is unable to meet public demand. In these situations where there's a high level of demand for beds, the great health staff in Toowoomba are asked to focus on clinical priorities and discharge patients as quickly as possible. This is an extremely stressful situation for these hardworking health workers, and they should not be placed in this situation. They should have the tools they need to deliver the job they do.

The member for Toowoomba North, Trevor Watts, has been strongly advocating for a new hospital to meet this demand. He's been doing it for a long time. He is not new to this; he is true to this. He has been sticking to this for a long time because he knows this is what we need. He tells me the situation is so bad that minor surgery is now being sent to Brisbane because our facilities are at breaking point. This is the hospital that those opposite want to put a 1,000 person quarantine facility through. With one in nine people returning with a positive test, this is the hospital they want to put that through. This is not good enough for a regional centre.

The premier needs to make our new hospital the highest priority because the needs of our community are only increasing. I would point to the growth of Highfields, the region that has expanded incredibly over the last decade to 15 years and is now a city in itself bigger than Dalby. What was once just an outpost on the side of Toowoomba is now a significant city all of its own. It relies on Toowoomba Hospital as well. The new hospital is going to cost somewhere around $2 billion. That report, the full plans, business case were presented last year. It is nearly 12 months since they were delivered and presented. Two billion dollars is what we need to upgrade the Toowoomba Hospital. Today in the budget announcement, we got $4.9 million. We need $2 billion; we got 4.9. That's not good enough.

Llew O'Brien (Wide Bay, National Party) Share this | Link to this | Hansard source

Order. The discussion has concluded.