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Tuesday, 29 October 1996
Page: 6036


Mr HOLLIS(8.20 p.m.) —I rise to speak tonight on the National Health (Budget Measures) Amendment Bill 1996 with no great feeling of pleasure. Indeed, I believe this bill is typical of so much of the change that this government has attempted to sneak in through the back door because it knows, as we on this side of the House know, and as the community are now discovering, these measures are penny pinching at its meanest and most devastating. In particular, I join my colleagues in opposing the increases to the pharmaceutical benefits scheme co-payments. This bill under discussion raises a concessional co-payment for medication under the pharmaceutical benefits scheme for health care cardholders from $2.70 to $3.20 and for general patients from $17.40 to $20.

As my colleague the honourable member for Hunter (Mr Fitzgibbon) alluded, these increases of 50c and $2.60 no doubt seem meagre, minor and insignificant to members sitting on the other side of the House. No doubt when their mind is heavy with the weighty problems of which of their tens of thousands of dollars in shares they are going to sell, no doubt when they are wading their way through the enormous number of pages in their share portfolio, no doubt when they are spending hours trying to collate the family fortune in shares held by their close relatives, no doubt when they are frantically trying to find answers to the questions quite rightly raised by this side of the House, no doubt when they are trying to cover up from the public eye the enormous wealth that sits in the share portfolios of so many of their members, which quite clearly indicates how removed those on that side of the House are from average Australians, that 50c and $2.60 would seem like change that they could lose out of their pocket and not even realise.

In an earlier debate today, I heard the honourable member for Bradfield (Dr Nelson) claim—indeed, he repeated it in later debate on this bill—that when he was campaigning in the Lindsay by-election, two nameless pensioners—I actually suspect they might be Mr and Mrs Wright; and we know all about them—came to up him and said that they did not mind paying the extra 50c or an extra couple of dollars. I spent some time in the Lindsay area in the lead-up to the by-election and certainly no pensioners said that to me. All I can say is that the pensioners the honourable member for Bradfield met when he was campaigning on the streets of Penrith were very different from the pensioners I met and most certainly were very different from the pensioners at Oak Flats, Port Kembla, Dapto, Warilla and Albion Park in my electorate.

When I talked about people not missing 50c or $2.60 from their pockets, this is most certainly not the case for many people out there in our community struggling on day-to-day budgets to cover their normal living costs and to maintain their families. Our constituents on pensions and low incomes must be very worried, sitting on their lounges tonight watching on their televisions the pitiful and, no doubt to them, incomprehensible debates over hundreds of thousands of dollars of shares held by the wealthy gentry on the other side of the chamber. The comparison is stark, and a disgrace to the government.

In June this year, a local community health group in my electorate held a public meeting which a member of my staff attended—I was actually here in Canberra. The meeting was called to gather views from the public about the impact the operation of the pharmaceutical benefits scheme had on individuals and families. The group was particularly interested to hear from pensioners and low income families. The meeting was very well attended and many issues were raised by the people present which were forwarded to the National Health Consumer Forum.

Let me tell you one story raised at that meeting. This story was related by a mother with three asthmatic children who graphically detailed for the group the daily struggle faced by her family in meeting their health care costs. Unlike the Minister for Employment, Education, Training and Youth Affairs (Senator Vanstone), in Throsby we do not need to invent families to make our point. We do not have to have a Mr and Mrs Wright. We have the families there. They are constantly at our door with true stories of the daily impact this government, in its zealous drive to squeeze the underprivileged, is having on them.

Her husband, luckily for the family, has a full-time job, but it is very low paying. She had been working to help the family budget meet the many demands a young family faces today. However, the youngest child is not only an asthmatic but also suffers from attention deficit disorder. In order to look after this child, she had to leave employment. They are not, however, eligible for disability support for this child.

This particular mother painted a clear picture of day-to-day life for her family in trying to provide the medication needed for her children. The woman knows what `shares' mean. To her it means her children regularly having to share inhalers until they can get enough money to buy another one. The family also struggles to provide swimming sessions for the children in an attempt to prevent serious occurrences of asthma. They must always have double medication for the two oldest children because one inhaler must be left at the school. The youngest child uses a special spacer to help inhalation. This costs extra. The mother told of her despair and anger at the children when the spacer was accidentally broken—an overreaction caused by the financial stress of providing in these circumstances.

It is often these additional costs that are not part of the standard calculation of health care costs that create added burdens for families and individuals with chronic illnesses. The costs of other treatments such as medical tests, aids and appliances, nutritional supplements, and preventive treatment all add to the stress on their budget. And probably most pitifully, this mother told, in some embarrassment, of the birthday presents for the children she had requested from the grandparents this year. The birthday presents were dust mite covers for their beds. It is quite clear from this example that families in these circumstances are already being denied the maximum opportunity to deal in the most effective and efficient manner with chronic illnesses.

This family's circumstances are not unusual. This is a real dilemma facing families on low incomes every day of every week for the whole year. An extra $2.60 for each medication for them is a significant problem. When you recognise that usually they are purchasing three or more scripts at a time, the amount of money is compounded. If more than one family member is affected by the illness, then stretching the budget can become an impossible task.

Other families at the meeting told of having to make decisions, when given scripts by doctors, whether or not to have them filled. Chemists also made submissions to the health group indicating that often patients would come into pharmacies and ask the chemist which of the scripts they could do without because they could not afford them all. And this in the lucky country!

Individuals also told of extremely dangerous decisions they were forced into making—including taking out-of-date medicines that were left over from previous illnesses; self-medication with over-the-counter medicines, such as pain relief tablets and supermarket cough and flu medications; using medicines prescribed for other family members or friends that the untrained relative, friend or ill person determined would be appropriate; or—most worrisome of all—not taking any medication at all.

People on low incomes who are not entitled to a health care card and who have chronic medical conditions are particularly vulnerable and unprotected because they have little discretionary disposable income. They are concerned about the impact the cost of medication has on their weekly budget rather than the annual costs of their medication. An illness can throw them into financial difficulty for many months after recovery, or they can decide not to seek medical help at all.

For many consumers, the costs of pharmaceuticals are already a considerable barrier to access to appropriate and efficient health care and quality use of medicine when they face these unexpected out-of-pocket expenses. This situation is already forcing many people in our communities to treat their health care as an option rather than as a basic necessity.

I notice that the budget portfolio statement for the Department of Health and Family Services states:

Saving will accrue from concessional patients meeting a higher proportion of the total cost of pharmaceutical benefits scheme drugs plus a disincentive from the price increase to reduce unnecessary drug use.

The audacity of the underlying assumption that the disadvantaged in our community are consuming drugs like biscuits and that we can force them to reduce consumption through prices fails to recognise that the consumer does not, and should not, have the responsibility for determining what medications they will take. The same document makes the same spurious claim in its explanation about the increased co-payment for general patients. It states that an intended impact is to create a `disincentive arising from the increased cost for the acquisition of unnecessary scripts'.

If the government believes there is a problem with oversupply of scripts, then this should be addressed through the doctor and not through the patient. The reality is, how ever, that this bill is all about cost cutting and nothing about health protection.

Regularly I speak to the people in the Throsby electorate on these issues and regularly I am horrified by the decisions that families are being forced to make on their health. Often I am told that people delay going to doctors for unreasonable amounts of time because co-payments are a problem. People tell me about hunting around the house, in kids' money boxes and so forth, to find enough money to buy the medicines prescribed. Often when families are sick, such as during flu outbreaks, the parents will buy their children's medications and not their own.

The results of these sorts of decisions have far-reaching impacts on the education performance of children, on the work productiveness of parents, on the spread of illness and, not least, on the quality of life for these families. Indeed, the $488 million estimated to be saved by these measures will be more than lost in the impacts outlined. This is a measure that takes the easy, visible saving and ignores the far more significant and insidious cost to our society and economy in the long run.

I do not apologise for portraying a grim and dramatic picture tonight on this issue, because the increases that are outlined in this bill will cause a grim and dramatic decrease in the health and wellbeing of many people. I can well believe that this would be incomprehensible to the share-endowed people on the government benches. I can well believe that the idea of having to scrape together small change to buy medicines would be incomprehensible to them. I can also well believe that making decisions about buying, sharing or doing without medicines is incomprehensible for them. They are, after all, seriously preoccupied with determining the best time to sell hundreds of thousands of dollars of shares. I can well believe all of this. It makes the petty, mean-minded and arrogant decisions of this bill all the more shameful for this government.

Several weeks ago I said in this House that it was interesting to hear government members, especially new government members, come into this chamber and try to defend the indefensible. This could have been one of the most indefensible actions in the budget program. The honourable member for Gilmore (Mrs Gash)—a new member—said in her speech during the appropriation debate and has said many times in her electorate that no-one is disadvantaged by this budget. I am waiting until the pensioners from Kiama, the pensioners from Nowra and the pensioners from around the bay beat their way into the honourable member for Gilmore's office and explain to her how they are very much disadvantaged by these government measures with the additional payments that they will have to make. I guess the honourable member for Gilmore will make her usual response and accuse me and other opposition members of scaremongering.

Many of those on the other side of the House who are smugly relying on keeping the mainstream middle income earners on side to protect their seats will want to start feeling some anxiety about this bill also. Average income earners are no more happy about these proposals than the lower income earners. It was pointed out to me by a Throsby family on a reasonably comfortable income—I have a few of those in my electorate—that these changes, while not causing them the agonising choices facing low income families and pensioners, will certainly impact on them and cause resentment against this government.

A parent who visits a doctor with a child can reasonably expect now to be close to $50 out of pocket after the experience. Firstly, they face the Medicare co-payment at the doctor's surgery. Most commonly, they receive at least two scripts for a sick child and, therefore, face paying another $40 minimum at the chemist. This is a direct out-of-pocket increase of $5.20 for this family. I hope that, each time they reach into their pockets to pay it, they remember the lies and the empty promises that the government made about `looking after' mainstream Australia.

For a party that campaigned on being family friendly, this government has the strangest idea of friendliness that I have ever observed. Forcing families, and especially the most vulnerable on low incomes or income support, to make the sorts of decisions that this bill will force them into is reprehensible and shows the family friendly promises for the shallow and meaningless tripe that they are.

The government should drop the changes proposed in this bill immediately. It is completely unacceptable to make budget savings based on decreasing support for families and pensioners in ensuring their health and wellbeing. Health is not an area where decisions are made purely as a goods or service purchaser where a decision to forgo the purchase is a viable option. If this government, in its remoteness from the real lives of average Australians, pursues this type of agenda on health then it has proven itself the enemy of families throughout Australia. This will not be forgotten by those families.

In conclusion, as the member for Bradfield is so keen about the Mr and Mrs Wright that he met on the streets of Penrith when he was campaigning, I would invite him to come with me and address the Dapto senior citizens who meet on the last Thursday of the month—if he does not want to come to Dapto then come to the Oak Flats senior citizens, the Albion Park senior citizens, the Warilla senior citizens or the Shellharbour senior citizens—and explain to them why they are going to have to pay this extra money and see if he gets the same reception. That is, if the pensioners there turn cartwheels up and down Wentworth Street, Port Kembla, because they enjoy having to pay extra money. I do not know if the pensioners were turning cartwheels up and down the main street of Penrith, but he indicated that they were quite happy to pay that extra amount to the government.

The member for Bradfield did not name them, but I suspect they are Mr and Mrs Wright. However, I can assure him that he will not find a Mr and Mrs Wright in my electorate. He will find very concerned pensioners. They are very concerned about where they are going to find the funds to meet the impost of this cruel and heartless government and, when they are ill, what part of their meagre allowances they will have to go without to meet this increased cost.