Monday, 22 February 2010
Fairer Private Health Insurance Incentives (Medicare Levy Surcharge) Bill 2009 [No. 2]; Fairer Private Health Insurance Incentives (Medicare Levy Surcharge — Fringe Benefits) Bill 2009 [No. 2]
Exactly, surprise, surprise! We have no way of knowing how the $145 million was calculated. Our calculations are unable to come up with the same amount of money. It is also important to point out that those 130,000 people that do not take out private health insurance—those unpredictable 130,000 people who make a conscious decision not to take out private health insurance—were apparently not included, as I said earlier, in the modelling.
However, that rubbery $145 million over four years, we believe, needs to be invested in mental health programs and we are suggesting some very concrete proposals, such as the Communities of Youth. Thirty million dollars per annum should be invested in the program that was proposed by the National Health and Hospitals Reform Commission. We are proposing that further money be invested in Headspace. This is an excellent program that has been running now for some time. It is desperately underfunded and needs to be expanded to the areas that it does not cover at the present time. That service has been highly praised and delivers much-needed services to young people.
The third area we believe needs to be invested in is other early intervention services, again recommended by the National Health and Hospitals Reform Commission. We believe further investment in early psychosis prevention and intervention services would provide an excellent way to help those suffering from mental illness. Also, and importantly, we believe we need to be investing in a suicide hospital discharge and treatment program. This is an area that is underfunded, and that has been highlighted in the media recently. Investing in these programs is a way the government can prove that they are genuine about their desire to increase the surcharge to raise funds. Those funds are supposed to be directed to public health. This is a concrete way those funds can be directed to public health. We believe it is a fair way to ensure that services are genuinely delivered for improving the public health system in an area that is much needed, the area of mental health.
We still have concerns around the increase in the surcharge. We believe that the government has not justified increasing the surcharge—other than to keep people in private health insurance. We do not believe that is an appropriate measure to keep people in private health insurance. We do not believe it is the government’s role to keep people in private health insurance. The government should be investing those resources in places other than private health insurance rebates. It should be directing all of that money to the public health system. We do not believe that the private health insurance sector is delivering good health outcomes for our community. We believe, as I said, that it would be better if the government focused more on the reform of the public health system.
We have a number of problems with the government’s arguments and we are extremely concerned that the modelling around the impact of the measures on the public health sector is not conclusive. In particular, the modelling around the Medicare levy surcharge is incomplete. The government says so itself because it cannot model the people who do not take out private health insurance. We do not believe that the purchase of private health insurance is an objective, rational or measurable act. It is highly subjective, and evidence given to several Senate Community Affairs Committee inquiries by people like Dr Tim Woodruff from the Doctors Reform Society and Ian McAuley from the Centre for Policy Development has shown that cost, as a premium or as a tax incentive or disincentive, is rated lower than perceptions of security and safety. In other words, the basic premise the government is using to do its modelling is flawed. This simply means that the removal of the surcharge would have less of an impact on people’s choices about private health insurance than their age, their general health and their perception of risk and security in general and in relation to their health and wellbeing. In other words, the foundation on which the government is making its decisions is flawed.
The Greens have concerns with the government’s Fairer Private Health Insurance Incentives (Medicare Levy Surcharge) Bill 2009 [No. 2] because it is a ‘stick’ to compel people into taking out private health insurance—forcing people who are not on high incomes into purchasing a market product which is expensive and over which the government has no legislative control. And the Medicare levy surcharge also unfairly penalises people who make a conscientious choice about private health insurance.
However, the Greens do believe that any funds raised from the Medicare levy surcharge should be directed towards mental health programs. We believe it is a worthwhile investment and would deliver real outcomes. We believe they are outcomes that not only are essential to our community but also would be supported by people who are essentially what we call ‘conscientious objectors’ to private health insurance.
According to Dr Lesley Russell from the Menzies Centre for Health Policy, the increase in the Medicare levy surcharge suggests we are moving towards a new policy with regard to the role of the private system in health care. The increased surcharge imposed on high earners seems to indicate that the government expects or at least requires these people to have—if not to use—private health insurance cover. We agree with Dr Russell’s observations that it is a confused approach from a policy perspective. It would appear that the case for budget savings has won out over the drive for better health policy.
This is the bottom line here. In this case we do not believe it is about delivering better health outcomes; it is about trying to appease the private health insurance industry—arguing that means testing the rebate is not going to have such an impact on private health insurers because the government is raising the Medicare levy surcharge, thus forcing people into private health insurance. We believe the government is taking two contrary positions. On the one hand it is means testing the rebate; on the other hand it is saying to insurers, ‘It’s okay. We are going to slug the higher earners who do not have private health insurance and try to force them into taking your product, which we actually do not really like.’ But the government is going to do that to appease the private health insurers, to make them feel better so that they will not oppose the means testing of the rebate. The government has taken two contrary positions. This is confused policymaking. At its heart it is not delivering good health outcomes. That is the concern for the Greens. The government needs to be more upfront about what its position is. It needs to be more upfront about investing the funds from the surcharge into real policy outcomes, and it needs to present its modelling on how it came to its figures for the surcharge. The modelling has not been presented to us. We could not get it through the chamber or through estimates. We do not believe the figures. The government seems to have plucked them out of the air. The modelling does not include the 130,000 people who do not have private health insurance.
At the end of the motion, add:
and the Senate calls on the Government to invest the full amount raised by the Medicare Levy Surcharge (approximately $145 million over 4 years) into mental health programs:
- Communities of Youth, Mental Health ($30m p.a.) proposed by National Health and Hospitals Reform Commission (NHHRC);
- Headspace (30 new services at $1m p.a. or $30m);
- Early psychosis prevention and intervention services ($26m p.a.); and
- Lifeline suicide hospital discharge and treatment plan ($15.39m as a total package over three years) and a new Lifeline freecall number ($17.5m p.a.).