Michelle Ananda-Rajah (Victoria, Australian Labor Party) Share this | Hansard source

This is not my first speech. The May 2025 election was a resounding endorsement of this Labor government's overwhelmingly positive agenda put forward to the Australian people, and conversely it was an emphatic rejection of the poverty of ideas and relentless negativity peddled by the so-called alternative government. Our principal offering—I would say it was the centrepiece of that offering—to the Australian people in this historic election was around Medicare. I sit on this side of the house because of Medicare. Medicare is a proud Labor legacy. It was introduced in 1984, which, incidentally, is the same year that I immigrated to Australia as a child. Is there a coincidence? Maybe. I remember as a child watching Bob Hawke on TV. I grew up to become a doctor, and, before I entered parliament in 2022 in the other place, I served for 26 years in our public hospital system right around the country. I have worked in regional communities and I have worked in big city hospitals—those hospitals that suck patients up from everywhere. If it takes a village to raise a child, then it takes a city to treat a patient. That's what these places are like. And underpinning all of that is Medicare.

But, over the 26 years I worked, I saw increasingly worse outcomes in patients. I saw far too many patients with severe chronic diseases, like diabetes that led to blindness, like kidney disease and serial amputations. I saw patients with advanced heart failure who were literally drowning on dry land. I treated patients with severe mental health illnesses and suicidality in young people who had no business being in a major hospital. I also managed drug and alcohol dependency, perhaps the most stigmatised part of mental health, and one that we need to shine a light on in this parliament and destigmatise. I dealt with homelessness every single day. I kept patients in hospital just so that they could have a feed, a wash and a bed, and so that they didn't feel threatened on the streets.

There wasn't a week that went by in that nearly 30-year career when I didn't make a cancer diagnosis. How easy do you think it is to tell a woman my age and who has children my children's age that the pain in her hip is actually due to a cancer deposit and I don't know where the primary is? I saw a Jewish Orthodox patient and I was told, 'Michelle, she's got cancer in her skull and we don't know where it's come from.' I went to the bedside and I examined her. I exposed her breasts, and I could see the lump on her breast. I could see the lump. Why is it that this even happened? You don't think gender bias is real in the health system? You can't tell me that when patients present with advanced cancer they haven't seen a healthcare professional sometime in the last five years, two years, one year. What was going on? There are blind spots in our health system. I was literally the ambulance at the bottom of that cliff. In this place we, this Labor government, become the menders of the fence at that top of the cliff, and the name of that fence—say it with feeling—is Medicare.

This is why we are strengthening Medicare, committing $8½ billion to finally deliver what Australians want, which is to see a bulk-billed doctor again. That's what it's about. We believe that nine out of 10 GP visits in the next five years will be bulk-billed. Now, there are detractors among us who say it's never going to happen. In fact, there was a report yesterday in one of the broadsheets that said only three in four GPs are going to bulk bill, meaning one in four aren't. Well, I say to those one in four who aren't that three in four is pretty good. I'll take that. I guarantee you your patients will vote with their feet. Australians are not stupid. They get it. There are plenty of great doctors in this country. Do your homework. I say to those clinics who are considering this: do your math. The incentive is huge.

It restores what the AMA actually asked for when the coalition, a decade ago, froze rebates in general practice, and this is why we now have seen what has been described as a freefall in bulk-billing. I don't use that language casually. That language was actually put by the president of the college of GPs. She said in 2022, when we came to power, that bulk-billing was in freefall. That's why we pulled an emergency handbrake. We tripled the bulk-billing incentive. I can see today the gallery is full of the people who this incentive was designed to help—pensioners, concession card holders and children under the age of 16. What did we find? We found an uplift in bulk-billing. It's effectively restored bulk-billing to this group. Now nine out of 10, or 11 million, Australians in that category are receiving bulk-billed care. That happened because of one well-designed incentive. Now imagine us rolling that out for every single Australian.

I challenge anyone who tells me that this is not going to work. I know for a fact that when I visited a GP practice—one of the few GP practices in Warrnambool in western Victoria—they were genuinely surprised about this. They didn't really know the detail, but it means that their consults will go from being about $40, rebated, to $80, rebated. That means that, across the thousands and thousands of patients they see, they're going to get more money and they can then employ more doctors or nurses and so on. It's a game changer. It's also not lost on me that Warrnambool is in the seat of Wannon, an electorate which is held by a Liberal member. Those communities need Labor governments.

A year on from the tripling of the bulk-billing incentive, we saw a rise in bulk-billing of two per cent. It doesn't sound like much. It translates to around 100,000 additional bulk-billed visits per week. But here's the thing: the national average was two per cent one year on, but the effect in regional communities was way outsized. For example, in regional Tasmania the rate went up 5.7 per cent; in regional Queensland it was four per cent; and in parts of regional Victoria, principally Bendigo, bulk-billing went up eight per cent. I pay tribute to the member for Bendigo, Lisa Chesters, who did a lot of work promoting this policy.

What if you are too unwell for your GP but you're not unwell enough for an emergency department? Where do you go? We have recognised that we need a halfway house for people with non-life-threatening injuries to attend. They may have a sprain or sporting injuries, are perhaps running a fever, have gastro or a cough and cold. Maybe the child's got a rash. Where do you go? You don't want to spend half a day in an emergency department, right? That's why we rolled out 50 urgent care clinics when we first came to power, but then we decided we'd go further and roll out 87. In fact, we overdelivered. These are open from early till late, they are walk-in—you do not need an appointment—and all you need is your Medicare card. It's hard to believe, but you do not need your credit card. Put it away.

Interestingly, here we are—two years on, we have hit a new milestone. One and a half million Australians have used these clinics. They have been a roaring success. A third of patients who attend these clinics are, in fact, children aged less than 15. Imagine that. We have had no problem recruiting GPs. They're local GPs, and they have flocked to this clinic model. But we're not stopping there. We are going to be rolling out another 50, taking this up to 137. It means that nine in 10 Australians—can you imagine that, in this huge continent land of ours?—will be within a 20-minute drive of an urgent care clinic. This is a game changer. Victoria will get 12 urgent care clinics, including one in my former seat of Higgins, and, to those of you who say it's too wealthy an electorate, it actually has the lowest rate of bulk-billing in Victoria. It will be going into east Stonnington, which is now in the seat of Chisholm. It is a new element in our repertoire—I welcome it—somewhere in between primary care, which is still the backbone of the healthcare system, and hospital care. We also know that it saves money.

You can't be serious about strengthening Medicare without addressing women's health. Women make up over half the population, right? But our problems have been shrouded in stigma and in secrecy for too long. I don't think that when I went through med school we ever talked about periods, pelvic pain, endometriosis, menopause or contraception. It was really something seen as being in the too-hard basket and that we will have specialists deal with. The problems have come home to roost. Women consume 60 per cent of all health services, but they face a range of barriers, from cost to institutional bias. It is baked into the walls of our hospitals and our health system. This Labor government, which is a female-dominant government, is levelling the playing field. We committed nearly $1 billion to women's health in the last election.

I want to focus on a few key areas. One is contraception. Around two-thirds of all Australian women of childbearing age use contraception. Traditionally this has been the oral contraceptive pill—that is what has been around for decades, since the sixties—and condoms. But we listed for the first time in 30 years—can you believe it took 30 years for this to happen?—new oral contraceptives on the PBS, bringing their costs down to currently $31, but from 1 January next year all general scripts will go down to $25, saving Australians more money.

But here's the thing. The oral contraceptive is old tech. There are newer contraceptive devices around now—IUDs and birth-control implants, like the Implanon. These are called LARCs—long-acting reversible contraception. They have a much, much lower failure rate. In a perfect setting, the oral contraceptive will be 99 per cent effective. That's pretty good. But we don't live in a perfect world. In the real world, it's about 91 per cent. Why? Because it is user dependent, which means that it's prone to error. People forget. Things happen. You might be on meds that interact with the oral contraceptive. You might not absorb it if you have diarrhoea or something like that. So I would urge Australians to look seriously at and have conversations with their GPs about the LARCs, the long-acting reversible contraceptives. We have put these on the PBS. Now Australian women can go and have that discussion and save approximately $400, or maybe more, in out-of-pocket costs. It's a game changer.

In Australia, only one in 10 women use LARCs, whereas in Sweden it is one in three. Get this: the less effective use of contraception, meaning our overreliance on the pill, has led to a high unintended pregnancy rate in Australia. It is estimated to be around 40 per cent, and it's much higher in rural areas. What are the consequences of that? When you have an unintended pregnancy, it leads to a few things. It's stressful. If you want to have a termination, it is medical or surgical. We all know the problems with accessing surgical abortions in this country. It's really, really hard. So why have this problem in the first place? Please, women of Australia, go and have this conversation with your GPs.

We do know that there are barriers to care and that many GPs do not know how to insert these devices. We are working on that, with $25 million going towards centres of excellence around the country to train up our workforce—not just GPs but nurse practitioners. Again, we have untethered them from GPs so that they can work to full scope of practice. That's what this means. It means women providing care to women anywhere in the country. It is the most highly effective care, and it has taken a Labor government to deliver that.

I could keep going, because I love this stuff, but I might need to leave this for another day. I was going to talk about menopause. I will park that for another day. I was going to talk about endometriosis, but time is short. I am just so proud to be part of a government that has pulled back the veil on some of the problems in health that have been in the too-hard basket. We understand that this is going to be a long road of reform. But Labor created Medicare. Labor will always defend Medicare.