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

This is not my first speech. I rise to speak on the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025. I welcome the bipartisan approach taken by the coalition in restoring integrity and maintaining the sustainability of Medicare. As you know, Acting Deputy President O'Neill, Medicare is our most important safety net. It doesn't matter how many zeros you have in your bank account or what your postcode is—once you have a health scare, it tends to level the field.

All Australians, irrespective of their background, require a strong health system that can catch them in their moment of need, and I know that acutely. I have looked after thousands of patients in my near 30-year career, from all backgrounds—rich, poor and everything in between—and a public health system is the cornerstone of our health system. Yes, 55 per cent of Australians now have private health insurance, but the private health system tends to be a high throughput system, which tends to look after slightly lower acuity patients. If you have serious health problems, you will need the public system because that's where the complex medicine occurs.

I am also aware of reports—and I was distressed by them—in the media of a spate of allegations regarding Medicare fraud. It actually made me quite angry because I know, overwhelmingly, the workforce in this sector is there to do the right thing. They are individuals who have committed their lives to delivering high-quality care to the highest ethical standard, as the Australian people would expect. Our nurses, doctors, allied health professionals, social workers, physios, occupational therapists and support staff—who run hospitals and ferry patients from A to B, carting them around in their gowns—are the people who hold up the sky, as far as our health system goes. So, when we have a small group who are using Medicare as a piggy bank—an ATM, effectively—it casts a shadow over the whole system and raises question marks in the minds of Australians.

This legislation was born out of a review led by Dr Pradeep Philip. It was initiated by the health minister, who pulled an emergency handbrake and basically brought together a team of people to scrutinise, in a rapid-review-type fashion, what was going on. Hence a whole range of amendments have been brought into place to essentially grant the Commonwealth greater powers to investigate, to gather evidence and then, of course, to prosecute. So I would caution any bad actors out there that we are watching you. This legislation will now pass thanks to the bipartisan approach in this chamber.

Medicare was, I would argue, the centrepiece program that we took to the Australian people at the last election. There is the reason the Prime Minister was holding up his Medicare card every five minutes; Australians realise that Medicare is one of the most important social, health and, I would argue, economic programs that we have in this country. It is the ultimate safety net. Medicare is now 40 years old. It was introduced by the great Bob Hawke in 1984, when I first came to Australia. I remember Bob Hawke. He was a figure writ large in my memory. He is one of the reasons why I sit on this side of the chamber, but of course Medicare is the other reason.

Medicare, however, was in trouble when we came to government. Bulk-billing rates at the start of 2022 were described to be in freefall. That's not our language; that was the descriptor used by the president of the College of GPs, who is not known to use hyperbole or to exaggerate. In fact, at the start of 2022, the College of GPs issued a circular to their members to start increasing their out-of-pocket fees because general practice was on a precipice of viability. Hence we pulled an emergency handbrake the following year in our budget, putting in around $6 billion into the system in order to triple the bulk-billing incentive for the biggest users of Medicare, who are pensioners, concession card holders and, of course, children. This patient group is around 11 million Australians. They constitute 40 per cent of patients who use general practice, and they use around 60 per cent of GP visits, so it made sense to target this group.

We learnt a lot from that process. What we actually saw was an uplift in bulk-billing rates in a year's time. Bulk-billing rates, a year after that policy was instituted, actually lifted 2.1 per cent. It doesn't sound like much, but it translates to 103,000 additional bulk-billed visits per week. That happened pretty quickly because those general practices did their math and realised that if they bulk-billed these patients, they were going to get an incentive and make more money, and that would enhance their viability.

But the interesting thing was that the uplift was greatest in our regional communities, which is just the best news ever. For too long, we have had this health-wealth divide in our country based on postcode, where the regions have always suffered on just about every metric, whether it be health or economic—the two are tied. To see an uplift of nearly six per cent in Tasmania—I have worked in the Burnie hospital and I have worked in regional Tasmania—is fantastic. To see an uplift of four per cent in regional Queensland—I have worked in Rockhampton and Gladstone—was also great. To see an eight per cent increase in Bendigo, regional Victoria, was astonishing. And that was just with one year, so we will be watching closely to see what happens to bulk-bill rates.

Having achieved some success—I don't want to overstate it; these are green shoots of recovery in Medicare, and it's about arresting and then reversing that decline, that freefall, in Medicare bulk-billing—we have now gone further. We have decided to take this thinking, the idea of an incentive to encourage GPs to bulk bill more, and slap more incentives on top incentives to the tune of $8½ billion. That's a lot of money. That's a big down payment into Medicare. That is going to flush through the system on 1 November when that triggers. That is in response to the $8.3 billion that was ripped out of Medicare a decade ago by the then coalition when they froze Medicare rebates for at least six years.

We didn't just cook up this idea. We sought advice; in fact, this idea came from the AMA. The AMA have, for a long time, been advocating for a substantial injection into Medicare. We designed it in this way in order to get the outcome we want, which is to lift bulk-billing rates and to give Australians what they want, which is the ability to see a bulk-billing doctor again. That's what they want. We weren't ever going to just tip more money into the rebates. I'm not convinced that supporting ever-increasing rebates will actually deliver the outcome we want. Rebates can keep rising, but so can out-of-pocket expenses; there is no ceiling on the two. They tend to correlate; they tend to travel together in parallel. What we're trying to do is forcibly bring down the out-of-pocket expenses and lift rebates at the same time. That's what this policy is designed to do.

Our modelling suggests that, in five years time, in 2030, nine out of 10 GP visits will be bulk-billed. I'm aware that there was recently a report suggesting that a quarter of GP practices will not be adopting this. Well, I say to those GP practices that competition is a consumer's best friend. When you are surrounded by three in four general practices that will likely adopt this, you risk oblivion, basically. Your patients will vote with their feet. They will vote with their feet.

We will be looking forward to rolling this out. I think Australians absolutely understood what this meant for them at the last election. This is ultimately about frontloading this health system—finally. As a person who spent way too much time in big hospitals, all I did was catch disasters and emergencies at the bottom of the cliff. That was my day from morning till evening, on call, seven days a week. This was my life. We need to frontload our primary health system in order to prevent patients from becoming sicker and sicker and then ending up in hospital.

There are other measures around strengthening Medicare that will also do that. One is cheaper medicines. It doesn't get talked about enough. Cheaper medicines are incredibly important for patients with chronic disease. One in two Australians has a chronic disease—that's 50 per cent of the population—everything from heart disease to hypertension, diabetes, hyperlipidaemia and a range of other rare diseases that affect a large proportion of our population. These require medications that they will be taking chronically for years—not weeks, years—and it costs money. So what did we do when we came to government? The general script was around $42. We slashed that to $31—the biggest cut in the PBS in about 20 years. We've gone further at this election by cutting that to $25, which will start on 1 January.

Now, that's good news for the three million Australian women who are aged between 45 and 64—like me, my vintage—who are struggling with perimenopause and menopausal symptoms. We are the sandwich generation of Australian women. We've been caught between raising children and dealing with aged parents. The last thing we need is another whammy—the triple whammy of dealing with the symptoms of menopause and perimenopause—when we're trying to balance so much else in our lives and maintain our physical health, which is not easy when you enter your 50s. What we have done with menopause has been an absolute game changer for women. By listing a whole range of medications, we have dropped the price of these from private scripts costing between $55 and $60 a month to now $31 and then, from January of next year, to $25. Drugs like Prometrium, EstroGel and EstroGel Pro are used by millions and millions of Australian women, but, for a long time, there has been a health-wealth gap where only women like me who have the means can afford these drugs. Now we will democratise these medications for millions and millions of Australian women. Go and have a conversation with your GP, please.

We're also ensuring that the endometriosis clinics—there are 22, and we're going to increase that to 33—will have the expertise in-house to provide information and look after women my age who are dealing with menopause. So not only will these clinics be able to manage endometriosis, which is an incurable chronic disease; they will also be able to provide advice on pelvic pain and menopause, effectively becoming hubs for women's health. For too long in our health system that's been the province of specialist hospitals in major cities, and that information has been siloed; it has not diffused out into the community. This will change that.

We've also instituted a new rebate for menopause, making it cheaper for women to actually go and see their GP and have a longer discussion on menopause treatments. We also realise that GPs do not have the necessary training, and hence we will be working with the relevant colleges to develop what are called living guidelines on how to deliver best practice care. These living guidelines are effectively a road map for medical practitioners. They are extremely important. They are evidence based, and, because they are living, they will evolve as the evidence changes with time—as new medications, for example, come online. I'd like to give a shout out to Senator Marielle Smith and colleagues in this chamber for their work in the Senate on the menopause inquiry.