Ms WORTH (3:58 PM) —The shadow minister for health and member for Dobell (Mr Lee) has once again displayed his ignorance of the way the health system works. He has a lack of understanding of what Labor did over 13 years—or perhaps suitable deafness to that; not just plain misunderstanding but not wanting to know the realities. He continues to allege that this $800 million cut that he constantly refers to is just a cut from health but, of course, it is not that at all; it is the contribution that the states agreed to make when we first came to government to help fill in that horrible $10½ billion deficit. The fact that he can attribute all that to health is beyond my understanding.

He has also made comment about the fact that there are Medicare offices closing around the country. There are, but what the coalition government wants to do is to spend money on providing health care rather than finding ways to be constantly administering it. Now there are 130 Medicare fax change facilities in chemists in rural areas, and we will soon have another 400. That is the way we are doing things: we really want to be sensible and cost effective about the way we are spending our very precious health dollars.

We should very briefly look at Labor's record. We have only been in government for two years, and I am proud of what has been achieved. But Labor cannot be too proud of what happened over those 13 years. The member for Dobell has made much about private health insurance. To be perfectly honest, you would think the only thing to do with health was public hospitals and private health insurance. The health debate is much larger than that. We have to be tackling it in all areas. It is complex and I know it is difficult to get around, but we have to do it. It is important to the people of Australia that we do do it.

In 1983, there were 65 per cent of people covered by private health insurance. That fell by more than 30 per cent during the time there was a Labor government. Labor handed the immunisation program over to the states but failed to monitor it, and never checked on what was going on. In 1996, when we came to government, the immunisation rate among Australian children was 53 per cent. That is well below China, Algeria and Vietnam. The current rate now is still lower than some rates in Aboriginal communities around Australia.

Labor refused to acknowledge our ageing population. I used to say from opposition, `When is it going to be acknowledged? When are we going to be planning for it? When is something going to be done about it?' So this government is facing up to those realities.

Despite the fact that private health insurance figures are not quite what we would like them to be, there are 5.885 million Australians with private health insurance, and they do value that. We have provided incentives of up to $450 per family. This benefits 713,000 families with incomes less than $50,000; half a million couples earning less than $50,000; and another half a million singles earning less than $35,000. Presumably, if there is such a commitment, member for Dobell, when you hope to be health minister—although I think that might never occur; I am quite sure it will not because the Australian people will be much smarter than that—the whole idea is to throw that all away so that private health insurance becomes even more important to the people of Australia.

Last November there was legislation introduced which allows doctors and private hospitals to draw up arrangements ensuring that there is informed financial consent, which puts an end to multiple billing and which addresses the out of pocket expenses. So we are tackling these problems on a number of fronts, not just thinking, `Let's hand another bucket of money to public hospitals.' I think public hospitals are very important. They must be adequately funded. They are a very important part of our health system, but so are the private hospitals. There are empty beds in them now. If there had not been such a disgraceful decline in the private health insurance numbers over 13 years we would not be having to battle with the problems we are now.

But, as I have already said, we cannot just be thinking about what happens in hospitals. We should not be just waiting for people to get sick before we treat them. We should be promoting preventative health measures. We should be looking at early intervention. We should be looking at the whole gamut of the way we ensure Australians get a good health care system and adequate health care. It is still, despite the criticisms that are made of it, one of the best systems, if not the best system, in the world.

That is something we should be trumpeting. It does not mean we do not have change. It does not mean we are not always looking at things that can be done better. There will always be changes. There are scientific advances and more medical research and we are getting the benefits of that. There is telemedicine and there are different ways of doing things. If we stand still and just trumpet public hospitals and that funding them is the only way of looking at health care, then we are closing our eyes to reality.

The government has introduced coordinated care trials to help 1.4 million Australians with asthma; 650,000 Australians with diabetes; and a countless number of Australians who are suffering from chronic pain. These are just some of the examples of looking at the whole gamut, the whole health picture. It should not be forgotten that the 1995-96 figures show that Commonwealth expenditure was $2,300 in health care dollars for every person, or 8.5 per cent of GDP. That does not count any private contributions that are made.

The member for Dobell has mentioned the stand-off now with the states. I would have thought that stand-offs with the states were a fairly regular event when health ministers or premiers come to Canberra. That has been part of the games that one expects to see played. As long as I can remember, I have seen games being played in that respect. I personally think—and I have said it quite publicly—that every one of the premiers who walked out of that meeting was jolly stupid to have done so because they were yet to discuss guns and tax reform, which I would have thought would have been fairly important for them and their own budgets.

But let us look at some of the realities. Victoria, for instance, reduced its spending on health by 23 per cent in 1993-94 and is still spending 18 per cent less in real terms than in 1992-93. Queensland reduced spending by 15 per cent in 1993-94 and did not begin spending more until 1995-96. Western Australia made similar reductions. Tasmania—and the member for Dobell was quick to cite Tasmania—reduced spending by 25 per cent in real terms in 1993-94 and has since reduced it a further five per cent. By contrast, the Commonwealth increased its funding by 13 per cent in 1993-94 and by a further six per cent over the life of the Medicare agreements.

The truth of the matter is that spending on health and spending on public hospitals is very important, but let us have some honesty about it. I have to say, with almost some regret, that I recall my friend and then health minister in South Australia remarking publicly how good it was to have saved $60 million out of health spending. I thought at the time that this was really a bit of a tragedy—and we have been proved to be right. The reductions in South Australia, I hasten to add, have not been anywhere near some of those in other states.

If we were to rely on the previous Labor government's forward estimates, there would be $27.3 billion to be spent over the next five years over the current Medicare agreements. But this government has increased that figure to $30.2 billion—a growth of 15 per cent over five years. In addition to this—and this is what I really think is very important, something we have not seen a lot of in the press—there was to be $83 million available for each one per cent decrease in private health insurance should that occur. However, I am also confident that as some of the incentives and a bit of the hard stick we have taken to the high income earners come into effect we will see private health insurance numbers going up again.

If, by any tragedy, that should not occur, built into these Medicare agreements was $83 million for each one per cent decrease. So for the states to argue that we were letting them down over this has been less than honest. If we were to give the states exactly what they were seeking, this would amount to a 33 per cent increase in Commonwealth funding.

We need some honesty in the health debate rather than just playing politics. So often it is said to me in my own electorate and other institutions and electorates that I visit around the country that ideally health would be removed from being a political debate and it is far too important to people to be a political debate. Unfortunately, while there are such philosophical differences and while the opposition chooses to play politics on this, that is unlikely to occur.

Mr Lee interjecting—

Ms WORTH —The member for Dobell was not listening. The member for Dobell was actually speaking when I was giving the figures and the arguments that the state Premiers had put forward and why they have been wrong.

Mr Bruce Scott —There's $750 million for the veterans.

Ms WORTH —That is right; there is $750 million for veterans. I think it was in the member for Dobell's speech last night that I was reading in Hansard where he was saying that the states did not even know about it. It is the classic example of why they should have hung around to discuss these details. I just reiterate that if the Premiers had stuck around to talk about these things they would have been better informed.

I was about to give some examples of where Labor would rather play politics, and in fact cheat and mislead the Australian people and the Australian electorate, rather than face up to some of these real issues. I offered the member for Dobell a briefing on the therapeutic group premiums. He said he would like that, but perhaps he felt he did not need it. We made sure that every member and senator in the parliament, no matter what their political persuasion, background or loyalty, received this pack of information, which provided accurate information not put together by politicians or bureaucrats but put together by some very key and well-qualified independent medical and scientific experts.

Mr Lee —Any mistakes?

Ms WORTH —I am so pleased the member for Dobell has made this interjection because what we do have here, which I can present today, is a pamphlet that is being distributed around the electorates of Australia, including in South Australia and in my own electorate, headed `Unsafe and unfair'. It refers to medicines on the pharmaceutical benefits scheme. They are `unsafe because patients will be pressured to switch to cheaper, older and less effective drugs.' `Even Mr Howard's own experts have said that some of the cheaper drugs are not as safe.' I would love to use the word that we are not allowed to use, but I will not. I will just say that this is a gross misrepresentation of the truth. There would be many manufacturers of medicines, and good manufacturers at that, who would find that deeply offensive. It does not stand up to any scrutiny.

I can provide the member for Dobell, and anybody else who would like to see it, a list of the medicines that are part of that policy, the dates, for instance, that they were listed on the PBS and the premiums. I could go chapter and verse on this, but I will show it to the member for Dobell afterwards so that he can be better informed and not make statements like this. In fact, I hope he will show leadership and actually ask the Labor Party to cancel this misleading brochure so that they will not be misleading the people of Australia in such an improper and shameful way.

This list shows beyond any doubt at all that it is the medicines that have been most recently, except for one example that I am out on, listed on the PBS that have no or the smallest possible premium. It is other medicines that have been there much longer that have a premium. I challenge the member for Dobell to go away to the Labor Party machine and say, `Look, my integrity is at risk here. I would like you to get this right and stop putting out this stuff because really we are misleading the Australian public and, if we are going to have credibility, we should not be doing that.' The wellbeing and the health care of all Australians is far too important to be doing that.

There are other initiatives that the government has taken—further examples that show we should not just be talking about hospitals and hospital funding. I would rather talk about how we care for people before they get into hospitals. There have been major initiatives for carers, unsung heroes in the Australian population who must be cared for. We have resource centres available for them. We have respite centres available for them.

We have a community education program now funded to $17.25 million over the next three years for a comprehensive community-wide education on drugs and drugs of abuse and rehabilitation. We need young people to be aware of the problems they are letting themselves in for. We have made major inroads into the treatment of mental health and we are taking a national and strategic approach to that. We need young people to know that drugs of abuse as well as harming them will also cause them mental health problems. That is something that we have to be taking a lot of care of. We have embarked on the biggest campaign of all time. (Time expired)