Tuesday, 26 August 2014
I rise today to talk about the battle that is going on around the future of Australia's health system. We are currently involved in a debate about whether our health system is affordable, whether it is sustainable and whether, in fact, we can continue on the trajectory we are on in terms of government spending. Clearly, the Abbott government have put forward a view that the increased expenditure on health has to be reined in. But what is worth reflecting on is the view that most people express when asked, 'What do people want from their governments?' What they say repeatedly is that they want a better health system and they want their taxes to support Medicare and the PBS and to deliver a fair system of health care for those people who need it.
It is worth reflecting on the health system at the moment and where the small increases in spending are occurring. The advances in science and medicine over the past decade have been remarkable and we are now seeing modern medicine treat conditions that, only a few years ago, were thought to be incurable. We have seen remarkable progress on the issue of melanoma, for example, where we are now starting to understand that immune therapies are successful in addressing the issue of sun cancers. Malignant melanoma, in particular, responds to medications that have their origin in immune therapy.
There are a number of other conditions where we have seen remarkable progress, such as the treatment of type 2 diabetes, ulcerative colitis, obstructive airways disease and so on. The small increase that we are seeing in health spending comes about as a result of these breakthroughs in health technologies and people getting access to new life-saving treatments. That is something that we should celebrate. It is something that we should be proud of and it is something that Australians want.
The real issue is whether we should spend government revenue on these measures. In order to answer that, we have to address two fundamental questions. The first is, is it a good thing to rein in spending in health care when the cost of that might mean denying people access to these lifesaving treatments? Should we be decreasing spending rather than increasing it if the cost of that decrease is that people are denied access to medicines? When you look at what we spend on health compared to other OECD countries, you get a picture of health expenditure in Australia ranking quite low down when compared with similar nations. In fact, we are the 10th lowest of the 33 OECD countries when it comes to public spending on health care. The question we should be asking ourselves is, in a rich, prosperous, developed country like Australia, why shouldn't we increase spending on health care; why shouldn't we be increasing access to these treatments that we know will allow people to live longer and healthier lives?
The second question is, if we are to increase health spending, is the level of spending we have at the moment and any potential increase that derives from increased health technologies sustainable? Can we continue that level of spending over the long term? When we look at what Australia has spent on health over the past decade and what projections look like for the next decade, we see a picture of Australia's spending on health as a proportion of GDP being relatively stable. It is just over nine per cent now, having increased by a per cent or so over the previous decade and potentially increasing by another half to one per cent over the next decade. If that spending is efficient, and when you consider that it is much less than that spent by France at 11.6 per cent, Canada at 11.2 per cent and the Netherlands at 11.9 per cent, and similar to the UK—and almost half that of the US—you begin to get a picture of a health system that is not spiralling out of control but is sustainable by world standards.
Yet we hear the claim that spending is spiralling out of control and health care costs are rising in real terms. Of course that is true, but so too are incomes—it is estimated that average weekly earnings will double by 2050—and our economy is growing, making arguments using absolute numbers in health care almost meaningless. That is not to say that we should not examine what are appropriate expenditures in health care and where we can get better efficiencies. No-one is suggesting, even for a moment, that we should not do that. But let us ensure that we have a debate that is grounded in reality and that accepts the facts as they are. When we took evidence at a recent Senate committee hearing we heard from people like Jeff Richardson, who is the professor and foundation director of the Centre for Health Economics at Monash University. He said very clearly that health spending is not unsustainable and that comparison with other countries indicates that we do spend relatively little on health. The evidence from the AMA was similar—we have a health system that is efficient, that does well in terms of providing equitable access to people and that does not need the sort of radical surgery proposed by this government.
We have some big choices to make. The question of whether health spending is sustainable is not a value-free proposition—it is a choice that we need to make. It is sustainable if we choose it to be sustainable. It is sustainable if we choose to raise the revenue to provide the treatment for people as new treatments emerge. It is sustainable if we begin to take on some of the inefficiencies that do exist within the health system, largely at the margins but that are there and that allow us to get better value for money. That is the discussion and that is the debate that we as an Australian community should be having, and we should not be disguising what is going on at the moment, where we have a government that is trying to raise revenue and increase its tax base by raising the cost of health care in Australia—attacking the very system that we most want our governments to provide.
The result of this is not just an attack on fairness and not just an attack on a health system that does provide people with the means of living longer and healthier lives; it is also short-sighted in narrow economic terms. Most of the suggestions that have been put forward by this government will result in long-term economic costs, they will result in huge shifts from the Commonwealth government to state governments through the hospital system and they will mean that people are denied access to essential health care. We have problems when it comes to collecting the data and evidence necessary for us to build on what is already a very efficient health system, and getting a thorough understanding of what drives the cost of health care can be achieved only when we have reliable data. Yet we have heard time and again that the datasets necessary to attack some of the inefficiencies in our health system either are not being collected or are unavailable—or at least are not being made available to the people who need them. It is a problem as simple as an understanding of the linkages between the MBS and the PBS datasets still being unachievable.
Health is too important to be whipping up a scare campaign. We need an honest and open debate about what we want from our governments. We need to ensure that debate happens in health care, and unfortunately that is not what is occurring at the moment.