Senate debates

Tuesday, 3 March 2015

Questions without Notice: Take Note of Answers

Health Care

3:04 pm

Photo of Jan McLucasJan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | | Hansard source

I move:

That the Senate take note of the answer given by the Minister for Employment (Senator Abetz) to a question without notice asked by Senator Wong today relating to co-payments for medical services.

Today we saw the next chapter in the saga of dysfunction and chaos that is the Abbott government. What we heard announced this morning by Minister Ley was not designed for the health of our country. It was not designed to improve our health system or to make sure that our doctors are treating patients in a timely way. It was designed for one thing and one thing only. It was designed to save the job of the Prime Minister. Mr Abbott is so desperate to keep his leadership on life support and to save his skin in the next leadership spill that he has made what is, in fact, the fourth policy change in the health financing space since coming into government. This is the only reason Mr Abbott is suggesting changes to the GP tax. He thinks this is the way to keep the support of the backbenchers who are ready—we know from reading the papers—to get rid of him.

Whatever the government tells us today, the truth is that Mr Abbott and this government remain committed to imposing a GP tax on our community. This morning Minister Ley was asked a question—a very similar question to the one Senator Wong asked of Senator Abetz—about whether the policy intent, to impose a GP tax on the Australian community, was a good one. Her words, and I wrote them down myself—I am not reading from a transcript—were, 'The policy intent was and remains a good one.' That makes it very clear. That is a bit different from the answer that Minister Abetz gave to Senator Wong when she asked, 'Does the Prime Minister stand by his claim that his unfair GP tax is "good policy"?' Senator Abetz avoided answering that question, but Minister Ley did answer it. She said, 'The policy intent was and remains a good one.' The Australian people are now warned. We know what is about to happen; we know what is coming down. We know that, one way or another, this Liberal government will impose a payment on Australians attending the doctor. We have heard it called a number of things. It was a 'small co-payment' from some. Then we heard the 'value' description, where we had to put a 'value signal' on going to the doctor

That is gone now today, apparently. But what we have seen is the minister saying that today we will remove the $5 tax on going to the doctor, and we will consult more.

The Senate Select Committee on Health has been consulting too. They have heard that doctors have been spending hours upon hours having to respond to the now four policy positions of this government when it comes to the price of going to the doctor. We have seen the $7 GP tax, we have seen the $20 cut, we have seen the $5 tax and we have seen the four years worth of cuts to Medicare rebates. This has resulted in chaos and dysfunction in the Liberal Party—we have all seen that. But it has also resulted in chaos and dysfunction and work being done in the small businesses that are doctors' surgeries right across this country. We have also seen, though, another impact as well. Not only have we seen doctors having to respond to four different policy positions of the government, we now know that there have been delays in people attending doctors. We know that there have been delays in people undertaking the right level of pathology that their doctors are telling them to do.

We need a policy that has Medicare at its heart. We want a policy that will deliver good quality health outcomes to our community. We want a policy that values the universality of Medicare. We want a policy that Labor will support, and that is a Medicare which is sustainable. It is an absolute furphy to say that Medicare in its current iteration is unsustainable. Rather than quote whole figures, let's start having a look at Medicare expenses as a proportion of GDP. (Time expired)

3:09 pm

Photo of David FawcettDavid Fawcett (SA, Liberal Party) Share this | | Hansard source

I rise to take note of the answer to the question that was asked of Senator Abetz about the Medicare payment, and I am thrilled that the Senate opposite has just highlighted the underlying problem with this whole affair. It is that Labor do not acknowledge that so much of the structural spend that they have put in place over the last six years has put Australia on an unsustainable footing into the future. If you look at the policy intent around the coalition's policy for Medicare it is about sustainability for the long term to make sure that not only we here in this chamber, in our old age, but also our children and their children have a system that will support us.

The narrative that those opposite seek to paint into the Australian community is somehow that coalition senators do not care about Medicare and that the Labor Party is the sole protector of our healthcare system. I want to take you back to the former coalition government under Prime Minister Howard. When we had Prime Ministers Rudd, Gillard and Rudd, their constant refrain and attack was that the coalition was all about cutting funding to health care. I draw the attention of the Senate to the fact sheets that the Museum of Australian Democracy has on different prime ministers. They highlight just a few of the key achievements of those ministers. For Prime Minister John Winston Howard, AC, one of those key achievements was record health funding, which back then was $46.7 billion in 2006-2007. Just in case you think this is some kind of conservative think tank, the four people who were ex-members of parliament on their board included two members of the Labor Party, one Democrat and only one Liberal. So the facts speak for themselves. The coalition actually makes record investments into health care.

Let us contrast that with the ALP when they were in government. Let us go and have a look at the 2012-13 MYEFO and look at the evaluation that was conducted there not by the Liberal Party but by the Australian Primary Health Care Research Institute at the Australian National University, an organisation that is not known for being a strong supporter of the conservative side of politics all the time. What they said was:

The hidden disaster in the 2012-13 MYEFO is the hit (unacknowledged by anyone in the Government) taken by preventive and public health. We know that $ 1.5 billion over four years ($254 million in 2012-13) has been cut from the National Health Reform (NHR) funding.

What we see is absolute hypocrisy here from the members opposite who seek to say that the ALP are the only people who care about health care, whereas the policy intent from the coalition is clearly about making sure that not only do we provide, as we have in the past, record funding but also we provide sustainable funding for the healthcare system for Australia.

Senator O'Neill interjecting

They do not like hearing that, do they? They interject because they do not like to hear it. Anyone who is listening to this broadcast can recognise that senators opposite do not like to hear the facts and so they interject to try and muddy the argument. But let us look at the facts. Medicare has more than doubled in expenditure from around $8 billion to about $20 billion over the past decade, despite the proportion of Medicare spending covered by the Medicare levy falling backwards from about 67 per cent to 54 per cent.

The consultation that is ongoing now is because the government has realised that there is clearly not support in the public and there is clearly not support from members opposite nor from the crossbench to put in place measures to make Medicare sustainable. The consultation that is going ahead now is to work with the AMA and other groups who are stakeholders in the industry to say, 'Where can we make this more efficient?' What I hear is the AMA saying there are savings that can be made, there are efficiencies can be made. But, as Andrew Leigh, the shadow Treasurer, has indicated in the past, one of the viable methods for that, which and he has clearly supported, is the concept of having price signals. The government has accepted that there is no support here for that and we are looking for other savings. But the point is that the policy intent of the coalition in this area is to make sure that Medicare is effective and sustainable into the future, and our track record shows that we have invested heavily in the health of this nation.

3:14 pm

Photo of Anne UrquhartAnne Urquhart (Tasmania, Australian Labor Party) Share this | | Hansard source

Here we are, chaos and dysfunction again.

Photo of Eric AbetzEric Abetz (Tasmania, Liberal Party, Minister for Employment) Share this | | Hansard source

You are not in government, are you?

Photo of Anne UrquhartAnne Urquhart (Tasmania, Australian Labor Party) Share this | | Hansard source

No, your chaos and dysfunction, Senator Abetz. We have seen it now since the budget last year. We saw the government introduce a $7 tax which was toxic. There was no discussion, there was no consultation and it was introduced without any discussion with the medical profession or other groups that were expected to introduce it. Then we saw a backflip in December. We saw the $7 dumped and replaced with a $5 discretionary fee—'to recover income' was the mantra for that. We then saw the $20 tax introduction. But the government said it would continue to stick with its plan to reduce the Medicare rebate that GPs receive for common consultations by $5 from 1 July. So the government is still heading on with this plan to attack the principal primary healthcare funding.

What happened with the $5 was the government gave the doctors a choice—very generous of them. The doctors could either pass the $5 on or they could bill their patients. Now, here we are at the 11th hour when the government knows that it is not a popular policy so they are making another announcement that they are not pursuing it. However, as Senator McLucas has just indicated, the government said that it does remain good policy. If that is what they are saying, what are they going to come up with next? They will push ahead with the planned freeze on indexation for Medicare rebates to 2018.

So what is next? Mr Hockey has been reported as saying the government listened to the medical community and is going to continue to work closely with the medical community. The Rural Doctors Association of Australia has certainly welcomed this latest backflip by the government. But it is also saying that it has major concerns about the government's current commitment to maintain the freeze on the indexation of Medicare rebates paid to patients. So what the RDAA is saying is that this big freeze has the potential to increase costs for patients to a greater extent than the proposed co-payment, with the resultant restriction and difficulties in accessing primary care services. So here we are again with a policy that is designed to attack the primary level of health care. The primary purpose for people to go to the doctor is to try and get their health in order before it gets to a stage when they are really sick. So it is a pity that the government had not bothered to listen before putting of these ill-thought-through policies out into the community.

When the government introduced the $7 co-payment and then dropped it back to the $20 tax and then took it to the $5 payment, I bothered to go out and talk to the doctors. I did a survey amongst all the doctors on the north-west coast and on the west coast of Tasmania. The result was astounding. Close to three-quarters of north coast and west coast doctors believed that bulk-billing would decrease or end completely. The north-west coast and the west coast of Tasmania, as Senator Abetz would know, are home to some of the poorest communities in the country, with 85 per cent of doctors actually bulk-billing. People who live in these areas are very vulnerable to health care costs and hikes.

Labor knows that the government GP tax is bad policy but I wanted to learn exactly what the impact would be from my community and from the GPs who serve in my community. They were the statistics that came back. Some of the doctors told me that the government changes were not only cruel and unfair but were economically reckless because of the attack on the primary health care. Some of the other doctors said that this was a blatant attack on Medicare that makes no financial sense. From the doctors that treat the patients in my area in Tasmania, there is no economic sense to introduce these policies.

Doctors tell me—not me reading it or making it up—that evidence tells us that primary health care is the most efficient part of the system and that when it works properly it stops people ending up in hospital where the burden on the budgetary constraints is far greater. So it is ill thought out, it is ill conceived, it is reckless and it is chaotic.

3:19 pm

Photo of Anne RustonAnne Ruston (SA, Liberal Party) Share this | | Hansard source

I too rise to take note of the question asked by Senator Wong regarding the GP co-payment payment, which has now been abandoned. I must say, having listened to the contributions of Senator McLucas and Senator Urquhart, I am a little confused. When we originally put on the table this co-payment as a method by which we could try and seek to make Medicare more sustainable, there was an absolute total outcry from those opposite. They were absolutely incensed that we should consider bringing in such a policy.

Now today when we have made the decision, for a whole heap of reasons, that we are going to drop this policy, those opposite are belting the hell out of us for dropping it. Those opposite have to have it one way or the other. Do those opposite support us having the GP co-payment or do they support us no longer continuing with the GP co-payment? Because, I have to say, those opposite cannot have it both ways. I am a little disappointed, given the pressure that those opposite put on the government in relation to this particular co-payment, that when we actually did something and reacted to the response that we have had from those opposite and from the community—that the time is not right for this particular measure—that they do not congratulate us for actually listening to the community, for listening to the medical professional and for doing something that is obviously at the current time in the best interests of Australia. I just put that on the table because it does become rather contradictory when a few months ago those opposite were beating us up over a particular policy and then beating up on us for removing that policy.

Today marked a day when the government recognised that Australia was not ready for this particular reform. The government has listened and has realised that this particular policy is unpalatable to the Australian public so therefore the decision has been made not to pursue it. Notwithstanding that, even though we have made the decision not to pursue this particular policy, it still needs to be recognised that Medicare in its current form is not sustainable into the future without some change being made. So it does not matter what we do or how much we carry on, the option that the Labor Party continue to put on the table—the do-nothing option—quite clearly is not an option.

It is necessary that we look at the fact that government expenditure on Medicare has more than doubled over the last decade, from about $8 billion to $20 billion, and that is despite the proportion of Medicare spending covered by the Medicare levy falling backwards from about 67 per cent to 54 per cent over the same period of time. So to suggest that the trajectory of the cost of this particular service, which Australians justifiably take for granted, is not a problem is being extraordinarily naive. The reality is that this is a legacy like many other legacies that have been left to us by those opposite. It tends to make the situation we find ourselves in even more hypocritical.

Amongst all the scaremongering that goes on from those opposite, we do need to seek some alternatives for how we are going to make Medicare sustainable into the future. I for one do not want to continue borrowing money and sticking it on the credit card, because all I am really doing is racking up a debt for my children and their children, and that is not responsible. We certainly would not do it at home. If you decide to buy a car you would not take out a loan in the name of your child, so why on earth would we here think that that is an acceptable way to fund the largesse of our current society and only push the debt repayment of that onto future generations? I do not think borrowing is an acceptable way to do it. The only way we can deal with this is by increasing the level of revenue or decreasing the level of expenditure. For those opposite to sit here and bang on at us about many of the initiatives that we bring into this place to try to get our budget and our debt and deficit situation under control—things like voting against their own savings that they had put into this place before the election—is just unconscionable. They should hang their heads in shame, because they are not doing anything to provide a solution to the problems that this country faces. Today they are just playing politics with issues for the sake of playing politics, with the response that we have seen to the responsible dropping of the GP co-payment, which we quite readily accept did not meet the requirements or the test by the Australian public. I think it is completely irresponsible and to sit here with absolutely no answer is absolutely shameful.

3:24 pm

Photo of Chris KetterChris Ketter (Queensland, Australian Labor Party) Share this | | Hansard source

Another day and another barnacle backflip by this government. Today, we see the latest move by this divided and confused government. After three iterations of the GP co-payment, it still cannot work out what to do. It appears today that Minister Ley has finally decided to talk to some in the medical profession. One wonders whether the government is actually going to be listening to what the medical profession has to say. But it is quite clear to us that the argument about the sustainability of the Medicare system is a furphy. This is an argument that cloaks an ideological obsession which is directed at the universality of Medicare. It is somewhat belatedly that this government is talking to the medical profession. The profession has lambasted the government previously in relation to its proposals and I would put that the only reason this consultation is occurring is because the Prime Minister's job is on the line as we speak.

Why did they not listen to the doctors before? I think it is important to quote from the Senate Select Committee on Health and its first interim report, in December last year, when this question of sustainability was totally discredited by the medical profession. I seek to quote from the report, at paragraph 3.12:

This notion of unsustainability has repeatedly been cited as the rationale for the government's $7 co-payment policy intervention. However, the evidence provided to the committee does not support the government's assertions. For example the AMA's submission states that:

The Government is justifying the health budget measures on the basis that Australia’s health spending is unsustainable. It is not.

      The Government fails to acknowledge that Australia’s nominal GDP continues to grow at rates that are above OECD averages. Australia can afford the health system it currently has.

      Further, a representative from the AMA, Victoria, supported the view that health expenditure is not unsustainable, and he said:

      Whichever set of numbers you want to look at, we can look at the percentage of the Commonwealth budget, in terms of health. We have said that it was 18 per cent and it is down to 16 per cent. On that measure alone it is not unsustainable. If we look at general practice, in this whole co-payment argument general practice has been hit over the head with a very big stick as being to blame for the problem, but nothing could be further from the truth. In fact, general practice is the solution to the problem, not the problem.

      We have heard the health minister say on the one hand that the government has hit the pause button on its GP tax, but remarkably Senator Abetz and Senator Nash told the chamber in question time today that the government has completely dropped the plan altogether, so effectively it has hit the delete button. It cannot even dump a policy properly. The health minister said today that the government has not yet arrived at a final position. What a shambles it is in.

      On top of this latest shift in Medicare policy, the government has a sorry record in health in my home state. This government has no comprehensive rural health policy and has abandoned preventive health in rural and regional communities and sought to axe the Australian National Preventive Health Agency.

      In my remaining few minutes I want to look at my home state of Queensland where the former Premier of Queensland, Mr Campbell Newman, identified that the government had treated Queensland very badly when it came to cuts to health-care funding and the GP tax. He made comments to the effect that you cannot just throw health and education issues on the states and not give them money to deal with the problem. He said, 'The federal government is making the states do the heavy lifting and making the tough decisions in relation to health and education and that they are doing it in a non-transparent and non-upfront way.'

      We have heard the Prime Minister, on 53 occasions, backing the GP tax as good policy and claiming it to be 'The best friend of Medicare we've ever had.' We have had him support the $7 GP tax, the $20 cut, a $5 GP tax and a four-year freeze on indexation.

      Universal health care is being treated as an ideological plaything by this government where a succession of half-baked reforms are trotted out. The Australian public have noticed and they know whatever the latest backflip, pause or about-face is, this government cannot be trusted on Medicare.

      Question agreed to.