Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Link to this | Hansard source

I move:

That the Senate take note of the answers given by the Assistant Minister for Health (Senator Nash) to questions without notice asked by Senators Peris and McLucas today relating to copayments for medical services.

During the election campaign we heard that there were going to be no changes to Medicare, there were going to be no new taxes. The budget has put an absolute lie to those commitments made by the now Prime Minister during their campaign. Today's question time has confirmed that there are changes to Medicare and there are new taxes that will be imposed on the Australian people.

The chorus of opposition grows to this budget, particularly the health budget. We have had the Rural Doctors Association expressing concerns about what this budget will do to the health of regional, rural and remote Australians, particularly Indigenous Australians.

Today we have seen Associate Professor Brian Owler take what one would think is an unusual action to get his voice heard and that is to write an opinion piece in today's Age. It is an unusual action. I do not speak for Associate Professor Brian Owler, but it must mean that he is finding it difficult to have the views of the AMA heard by this government. It was interesting to note during question time Senator Abetz refer to the AMA as an 'interest group'. I am sure they will be pleased to know that that is the respect that Senator Abetz has for the leading medical organisation in this country. In the article Associate Professor Owler concludes by saying:

The co-payment is unfair and unnecessary. Ideology has pushed this proposal too far. It is poor health policy. The Prime Minister should step in and scrap this policy. If not, it deserves to fail in the Senate.

You could not be clearer, Associate Professor Owler: you do not think a lot of this co-payment. He says it is unfair. That is right—it is a tax on the poor and sick in our country, on the elderly and children, those who use our health system the most. Associate Professor Owler references a patient on warfarin. This issue was also raised with me by a pathology nurse when I was running a street stall recently. She said, 'Patients often have to go daily to have warfarin blood tests, to test whether or not their blood is suitable to take warfarin.'

Associate Professor Owler also says that not all of these patients will be under the cap of 10 co-payments for concession patients. He concludes:

That will mean hundreds of dollars in co-payments.

We also noted his comments that the co-payment will mean that, with regard to a preventative health approach, the use of GPs in particular, people will not go to the doctor in order to achieve good health. He references a woman with a lump in her breast that will mean, on his reckoning, at least $63 for an early detection event. He concludes:

The effects of delayed diagnosis are expensive and often tragic.

This is what the president of the AMA is telling this government. The co-payment is also unfair to doctors, particularly GPs. The budget in fact has turned the principle of bulk-billing on its head. If a doctor bulk-bills now, they will be penalised. They will lose $5 in the Medicare rebate. They will also lose the bulk-billing incentive that is currently provided. This particularly affects pathology and diagnostic imaging, because the bulk-billing incentive applies to all their patients, not just the people who are on the concession payment.

In my final comments I want to go to Professor Owler predicting in his article that Senator Nash would resort to claiming that the health budget is unsustainable. We heard that all through estimates and we heard it today. He says:

The health budget is not out of control. As a proportion of GDP, Australia’s healthcare spending has remained constant. In 2011 it was 8.93 per cent compared to the OECD average— (Time expired)

Cory Bernardi (SA, Liberal Party) Share this | Link to this | Hansard source

I heard Senator McLucas say 'What a shame,' and I say what a shame it is for the Australian people that we had to sit through that empty rhetoric from Senator McLucas. This is a shadow minister, apparently, who has got a long history in this place and on medical issues, and the best that the shadow minister could do was launch an appeal to authority, one individual who has an opinion, and refer to them and say, 'That must be the definitive outcome.'

It is a flawed logic, because there is none of the detail that is necessary in order to put forward a policy. We know where Senator McLucas has done her research: it is in the media. That is where all good research is done by the opposition, apparently. They cannot think for themselves. They cannot draw the conclusion that they supported a Medicare co-payment in a previous incarnation of the Labor government and now they do not. Like all snake-oil salesmen, those who peddle miraculous cures as they tour around the country, they say, 'Trust us. We'll give you the solution to your problems.' But, like all snake-oil salesmen, they are peddling falsehoods, they are peddling fraud.

A great example of that was when Senator McLucas said, 'If you go to the doctor now, you're not going to be able to be bulk-billed.' What a crock! What an absolute load of codswallop, because there have been no changes to the Medicare payment, no changes to Medicare, that have passed through this chamber, so there is no way that there is any change to the current system. But Senator McLucas, for the benefit of the cameras and the Australian people, hammed it up and peddled her alarmist falsehoods and snake oil—the balm that is going to cure everything—in this chamber.

If someone is prepared to peddle that sort of nonsense, the sort of nonsense that they use to cover up their six years of dysfunctional and hopeless government—the deception of the Australian people—and if they are prepared to do it now in opposition, they are simply not worthy of being considered as an alternative government.

Let me remind you, Mr Deputy President, that serious measures need to be taken to redress a structural imbalance. The structural imbalance in the budget is the fact that the Labor Party ran up about $300 billion worth of debt in six years. They had us on course to have $667 billion worth of debt had they been re-elected. What do we have to show for it? We have nothing.

Eric Abetz (Tasmania, Liberal Party, Minister for Employment) Share this | Link to this | Hansard source

Pink batts and burnt houses.

Cory Bernardi (SA, Liberal Party) Share this | Link to this | Hansard source

That is right—thank you, Senator Abetz—I beg your pardon: we have burnt houses. We had porous borders. We had multibillion dollar school hall budget blow-outs. We had a range of dysfunction. We had $900 cheques sent to people who lived overseas or sent to those who lived on in eternal heaven—dead people received $900 cheques from the people opposite.

This is an appalling act of hypocrisy from the people opposite, the previous government members, to say that they will not support measures that are intended to rejig our budget to put Australia back on a sustainable fiscal path. It is the ultimate betrayal of the Australian people. It is the same sort of rhetoric in which they maintained, as we heard from Senator Cash, that nothing could be done to stop the people smugglers; nothing could be done to stop the illegal boats from coming here; and nothing could be done to stop the people drowning at sea.

You know what? Nothing could be done, because they were not prepared to do anything. They were the laziest bunch, the most hypocritical bunch of government members, that we have ever seen in the history of this country and now they stand up in sanctimonious piety and say, 'It's not our fault. We haven't done anything.' You have come up short for the Australian people. You have come up short in government and you are coming up even shorter in opposition.

What you have done for this country is reduce politics to a laughing stock. You have reduced it to a joke, because no-one believes anything you say anymore.

Senator Carol Brown interjecting—

I notice that Senator Carol Brown is being very vocal over there, but not once during the term of the previous government did she have anything to say about stopping the boats and how important it was. She didn't say anything about the debt and deficit. The only thing that Senator Carol Brown had to say was how bad Senator Polley was while she was trying to get rid of her during preselection.

Alan Ferguson (SA, Deputy-President) Share this | Link to this | Hansard source

You wish to raise a point of order. It will be a debating point, I am sure, but do you want to raise a point of order, Senator Carol Brown?

Carol Brown (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Families and Payments) Share this | Link to this | Hansard source

I ask that Senator Bernardi withdraw that last statement, because it is not true.

Alan Ferguson (SA, Deputy-President) Share this | Link to this | Hansard source

It is a debating point, Senator Carol Brown. Order! There is no point of order.

Nova Peris (NT, Australian Labor Party) Share this | Link to this | Hansard source

I rise to take note of the Abbott government's new proposed GP tax. This tax is a broken promise. It breaks the promise made by Mr Abbott that there will be no new taxes and it breaks the promise made by Mr Abbott to lower to cost of living. It is much worse than just broken promises. This new tax will have an adverse effect on the health of Australians.

The Prime Minister also promised to be the Prime Minister for Indigenous Australians. He promised to keep working to close the gap. This new tax will widen the gap. This tax is not credible right across Australia, but I strongly believe that those who will be affected the most are Indigenous Australians, particularly in the Northern Territory.

Aboriginal people in the Northern Territory already have the worst health outcomes in Australia. This tax will mean that fewer Aboriginal people will go to a GP. This will lead to worse health outcomes and it will end up being more expensive if people go to a hospital, not to a GP.

A research paper recently undertaken by the Centre for Remote Health in the Northern Territory was recently published in the Medical Journal of Australia. The paper was titled The cost-effectiveness of primary care for Indigenous Australians with diabetes living in remote Northern Territory communities. The paper found that not only do the low rates of primary health care resulted in higher rates of hospitalisation, higher mortality rates and lower life expectancy, but it also costs more. The paper concluded that there are significant cost savings and better health outcomes for patients with diabetes when access to primary care is improved. While the paper was specific to diabetes, its findings apply to all chronic conditions.

In remote areas, it is logistically not possible to charge the tax. In a remote community, the health clinic is the only option. They cannot go to hospital. If a child who has been injured is taken to the clinic, you cannot ask them for $7 to be stitched up. If a woman has been a victim of domestic violence, how do you charge them before treating the injuries? If people are charged, they will not go and that means their health will get worse. It will cost a lot more than $7 if they have to go to hospital because they did not see a doctor. As a result of this, the Aboriginal Medical Services have said that they have no choice but to absorb the tax, costing them millions a year. What that will mean is that they will have no choice but to cut preventative programs and awareness programs like nutrition programs, programs that reduce smoking, programs to warn women about the dangers of drinking whilst pregnant. These preventative and awareness programs are the most important if we are to achieve long-term gains in improving the health outcomes for Aboriginal Australians. Cancelling this program is exactly the opposite of what we should be doing to close the gap on Aboriginal life expectancy.

The president of the AMA supports this view that prevention is far better than the cure and that preventive health is far more cost-effective. In fact, just today, the Professor Brian Owler, the President of Australian Medical Association, stated:

Anyone working in health understands the basic premise that prevention is not only better than the cure, but it also makes economic sense. Diagnosing and managing chronic disease properly in general practice keeps patients out of more expensive hospital care. People with chronic diseases are very much affected by the co-payment. This proposal poses a financial barrier for vaccinations and other preventative healthcare measures and chronic disease management.

The recent COAG Reform Council report showed that, among the more disadvantaged in society, 12 per cent of people defer or do not see their GP due to cost. It will significantly increase with a co-payment.

To my disbelief, I also found out that the tax was introduced without any modelling. There was no analysis as to how it would impact on Closing the Gap targets. In fact, the associate professor also said that that was one of the main reasons that the AMA's response to this proposal is a lack of evidence. He stated that

Modern medicine is evidence-based. We are trained not to accept blind assertions, opinions or ideology in determining the best treatment without supporting evidence.

For the government to be introducing any major health policy without assessing the impact of a Closing the Gap target is dismissive of Closing the Gap. If I can just reiterate what my colleague quoted earlier from Professor Brian Owler:

The co-payment is unfair and unnecessary. Ideology has pushed this proposal too far. It is poor health policy. The Prime Minister should step in and scrap this policy. If not, it deserves to fail in the Senate.

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

I would like to begin by supporting the Assistant Minister for Health's assertion that the AMA is an interest group. It is very much an interest group. In fact, it is, perhaps, one of the most effective GPs' unions that is to be seen around. They are doing a bit more lobbying. It is a shame, of course, that they have the support of the opposition in the guise of Senator McLucas and even more so from the other place, with Ms Jenny Macklin spreading untruths, distortions and fear amongst the Australian population with regard to the budget measures taken by this government. We had to—because of the economic mess that we have been left. As Senator Bernardi said earlier, there is currently no co-payment for GPs. There will not be a co-payment for GPs until July next year. So spreading rumours about hypothetical cases and fear is ridiculous. It is unfair to the Australian population. I would also like to quote from Professor Brian Owler's piece today. He said:

It is impractical to collect co-payments in this [aged care] setting, particularly from patients with dementia. It is only likely to drive GPs out of this area.

What a demeaning, hypocritical, patronising statement! Since when do people with dementia automatically qualify as terribly impoverished and therefore not able to pay a GP co-payment? People with dementia certainly deserve our support and help. But that does not mean that they cannot afford to pay a fee.

I would suggest that if Professor Owler does not know how to go about charging someone with a mental health condition, he could talk to any psychologist or psychiatrist in Australia, who every day face that issue of how you go about recouping a fee for service from someone with a mental health problem. We can come up with every scenario you like. It becomes a little bit like the black knight performance that we got from Senator Doug Cameron during Senate estimates recently, where he started out wanting to know what would happen to 50-year-old woman facing domestic violence if she left home? When the Department of Human Services satisfactorily answered that and pointed out the number of supplements that were available to assist someone like that, he wanted to move the goal posts about his hypothetical person who was going to suffer dire consequences under this government. So it is crazy and dishonest of the opposition to continue with this line of 'Lets see how much we can scare them out there.' If people using Warfarin do not have their blood tests done, they are in great danger of serious consequences. Why would this opposition spend their time trying to frighten people out of going to a doctor for service when they will not have to pay the GP co-payment by trying to come up with worst-case scenarios one after the other?

As the Assistant Minister for Health has already pointed out, excellent work is being done and there has been some fantastic support given in rural and remote health and in Aboriginal and Torres Strait Islander health. There is no need for people to be frightened of the consequences of a GP co-payment. They certainly do not need to be concerned about those consequences right now because they are not happening right now, despite the opposition's best efforts to scare people into thinking that the co-payment is occurring right now. We need to look at the fact that the Assistant Minister for Health was one of the strongest proponents of an inquiry into the needs of rural and remote health services. She understands providing support to people who are marginalised—people in remote Australia, people requiring extra services—extraordinarily well. When she calls the AMA an interest group, she is simply speaking the truth. They are an interest group and to suggest that they are a disinterested group in medical terms is ridiculous. (Time expired)

Mehmet Tillem (Victoria, Australian Labor Party) Share this | Link to this | Hansard source

I am shocked. This is astonishing. I wish to speak to the motion concerning the answer given by the Assistant Minister for Health. Today we have seen the government embark on a policy that is scaring Australians. Costs for medical care will go up and the fear is so great that those people who are sick—the elderly, the young, the unemployed—will not be able to afford health care in this country. The government wants to change the Medicare care to a credit card. We have a system which provides for everyone, which looks after those who cannot afford it, but this government is going to rip the heart out of universal health care, rip the heart out of affordable medication and put the burden back on those who are sick. Make no mistake: this is a tax on being sick and unwell.

Doctors are reporting that patients are cancelling appointments or not turning up because they fear they cannot afford it. This is not a scare campaign; this is what is going to happen. A media report today says that the AMA considers this an ill-though-out policy. The AMA is an interest group and their interest is in health care. The Hippocratic oath says first do no harm but that is what this government are doing. They are causing harm to the average Australian who is sick and unwell. Those who want preventative medication or health care are not going to be able to get it. It is not just about paying $7 when you go to see your GP; it is about the payment required for diagnostics, for blood services, for scans. These services are not cheap. The costs will mount. Before you get an MRI done you will have to pay up front. The rebate is being reduced, it is reported.

Senator Boyce talked about a scare campaign. No-one needs to run a scare campaign because every Australian is afraid of what is going to happen to health care in this country. It is astonishing that the assistant minister got up in the Senate and did not answer a single question concerning what those in the community are saying about their fears and their concerns. Day after day we ask questions of the assistant minister and we get no answers. We have had floundering responses about irrelevant things.

Some interesting stats were released in relation to people in rural and regional Australia, as well as those of a lower socioeconomic background. The COAG report has found that close to 16 per cent of Australians do not have their prescriptions filled because they cannot afford them. There is a delay because they fear the costs, that they are unable to pay from medications. This, compounded with what is going to be an additional burden, is what is scaring the Australian community.

We will see, with the increase in medical costs, that more and more Australians will rock up to emergency wards in hospitals and this will no doubt put a massive strain on our hospitals. I am not sure that this is something the government has considered or even modelled. By cutting access to front-line health care through locals and GPs we are increasing the burden on the hospital system. I am yet to hear the Assistant Minister for Health address that issue. My fear is that the damage that will be done to Medicare by this government will be irreversible. I will argue the case in this place for as long as I can.

Question agreed to.