Mr MURPHY (9:16 PM) —I support the government's Taxation Laws Amendment (Medicare Levy and Medicare Levy Surcharge) Bill 2002. This legislation increases the Medicare levy low income thresholds for individuals, married couples and sole parents in line with movements in the CPI. Whilst this measure may protect low income earners from paying a Medicare levy it is very sad that, as far as health care is concerned, this bill represents the maximum commitment low and middle income Australians can expect from the Howard government. We hear every day in this House that the health policies of the Howard government are hurting Australian families and older Australians who rely on and deserve a decent public health system.

The government's mismanagement has led to decreasing rates of bulk-billing by Medicare doctors, increasing premiums and excess costs for private health insurance and increasing copayments for medicines. It is for that reason that, whilst supporting the bill here this evening, I strongly support the amendment moved by the member for Perth, who made a very erudite contribution to the debate prior to the dinner adjournment. The amendment reads:

(1) notes that the Government's overall approach to Medicare has seen the regrettable position where General Practitioner bulk billing usage has declined to only 74%;

(2) notes that the average extra cost to a patient for a non bulk billing GP visit is now $12;

(3) notes that those who can afford private health insurance have been subject recently to substantial increases in premiums, on average $150 extra per year;

(4) notes that pensioners and concession card holders and those families under financial pressures will suffer further as a result of the Government's latest budget measures, in particular the proposed 30% increase in payments for essential medicines; and

(5) calls on the Government to recognise the Australian community's belief in and support of bulk billing and Medicare and to accept that the Government must match that community commitment in its health policies”.

The government's failure to respond to the deteriorating crisis over medical indemnity insurance—the subject of today's, unfortunately aborted, matter of public importance debate—is only one-half of the health emergency facing Australia. The other half, as you know, is the alarming decline in bulk-billing by both general practitioners and specialists. Since the election of the Howard government, the number of GP services bulk-billed has declined by five million a year. When you consider that the average cost of a visit to a GP who does not bulk-bill is $12, it means that Australians are paying $60 million more each year for doctor visits. This is on top of the $500 million extra that Australians are paying for increases in health insurance premiums and in addition to the $300 million that Australians will pay if the Treasurer's proposal for increased PBS copayments goes through the Senate. Who will pay for all this? We know that it will be those who can least afford it—the most vulnerable members of our community: the frail, the aged, the sick and the elderly.

Bulk-billing is fundamental to our Medicare system. As more and more doctors stop bulk-billing, health care becomes expensive and out of reach for low and middle income families. This moves Australia closer to a USA-style health system where your credit card will replace your Medicare card when you need treatment, and health care will become the reserve of the wealthy and the privileged. There is little doubt that the government's ideological opposition to Medicare—well hidden when they came to office in 1996—is now obvious as Medicare is left to deteriorate. The President of the Australian Medical Association, Dr Kerryn Phelps, was correct in her rebuke of the government when she said:

The decline in bulk-billing is a result of a lack of commitment to public health in Australia. When the Howard government came to office in 1996 the rate of GP bulk-billing was over 80 per cent. Bulk-billing rates are now the lowest in a decade and the health minister's response is, in effect, to say, `So what?' If that is her attitude, the minister needs to explain just how long the government is willing to allow the system to decline before paying appropriate attention to it. The victims of the government's arrogance are the dedicated medical professionals—who will be left with the impossible choice of undercharging for their services in an environment of skyrocketing medical indemnity insurance fees—and their patients, who will be forced to continually pay more or, as it is increasingly the case, will be put in the terrible situation of not being able to find the specialist they need at a price they can afford.

Doctors who subsidise Medicare by continuing to bulk-bill receive their Medicare Benefits Schedule—MBS—rate of $24.45, when the AMA recommendation is that they charge between $48 and $50 for a standard consultation. In not recognising the inadequacy of the Medicare Benefits Schedule, the government is forcing doctors to stop bulk-billing. The problem for doctors and all Australians can only get worse when you consider the additional crisis in medical indemnity insurance caused by the collapse of United Medical Protection. This is summarised in a report in today's Australian newspaper by specialist medical practitioner, Michael Gliksman, who writes:

Last week, an endocrine specialist, who lives in my electorate, spoke to me about the difficulty he is having during the current crisis. He has written me a letter today, fortuitously; I received it only this evening. In part, it states:

I emphasise that this specialist made it quite clear to me that there has to be a bipartisan approach to this. He works extremely hard in his practice, and the overheads—with the long hours that he works as an endocrine surgeon—are such that his taxable income is $120,000. For someone in such a specialised area, that is not a lot of money for the overheads that he has to bear. He is quite concerned because, at the moment, he is being sued and it looks like he might have to bear costs in the order of $60,000, $80,000 or possibly even $100,000. Like most of us, he has a mortgage, a wife and children to support. It is a very serious issue. He is just one of the innocent victims of the government's failure to keep watch on the insurance industry.

In relation to insurance in this country, I accept that it will require a bipartisan approach if we are to resolve the problems. There are a lot of very nervous people out there at the moment, particularly specialists like the endocrine surgeon that I am talking about tonight, because they are not sure that they can actually stay in practice. I had a call from another doctor who, fortuitously for him, is turning 65 years of age in the near future. He has indicated to me that he will turn it up because he cannot afford to pay the $35,000 premium, with the concomitant risks, because he does not know what will happen after 1 July. That is pretty disturbing. For all of us here, the two things that concern people, when you talk to them before you get elected to the House of Representatives, is that they want a good health system and a good education system; they certainly do not want to feel that they will not be covered. In the case of doctors, they are being crippled by this uncertainty over the collapse of UMP.

One of the many constructive suggestions my constituent makes is that indemnity costs should be shared across medical professionals. He says:

That is just part of the letter that that specialist has written to me this evening.

In the case of my constituent, the government needs to provide a written assurance of indemnity for his previously indemnified case, including continuity with the current subcontracted solicitor. He needs United Medical Protection or other substantial organisations to continue seamless cover in New South Wales. Finally, he needs certainty and quality of support with a Treasury managed fund, not just lip-service to risk management programs. That is just one example.

While the Howard government seems intent on undermining the fundamental and equitable nature of Medicare and while it continues to have no constructive response to the medical indemnity crisis, many more doctors and patients will suffer the consequences. That is why I come back to the very erudite contribution that the shadow minister for health made when he moved his amendment prior to the suspension of the sitting. As the member for Perth mentioned, the legislation ensures that the threshold levels at which people are required to pay the Medicare levy and the Medicare levy surcharge are increased in line with the CPI but elsewhere the health policies of the government are slugging Australian families. He talked about decreasing rates of bulk-billing by Medicare doctors when the government has been responsible for increasing premiums and excess costs for private health insurance and increasing copayments and safety nets for medicines.

In short, as the member for Perth, Mr Stephen Smith, pointed out in relation to his amendment on bulk-billing, bulk-billing rates are now the lowest in a decade. When the government came to office, the rate of bulk-billing was over 80 per cent; it has now fallen to 75 per cent. There are over 100 million GP services a year. That means that on the Prime Minister's watch the number of GP services bulk-billed has declined by five million per year, and the average cost of a visit to a GP who does not bulk-bill is a scandalous $12. That means that Australian families are paying $60 million more each year for doctor visits. That is on top of the half a billion dollars extra that Australians are paying for increases in private health insurance premiums and it is additional to the $300 million that Australian families will pay if the Howard government's proposals for increased PBS copayments go through the Senate, as I mentioned earlier. Moreover, the heaviest hits are taken by those who can least afford them—the most vulnerable members of the community.

During the election campaign the Prime Minister promised that his government policies would `lead to reduced premiums for health insurance'. Ha-ha! He also claimed that the coalition would make private health insurance more affordable and attractive to consumers. We know that that has fallen down like a pack of cards. As the member for Perth said, given the outcomes of those promises in an area this government supports, we can only wonder where we are headed with its paltry support for the Medicare program.

For us on this side of the House, bulk-billing is an essential part of Medicare and we will be the last people standing—I will be standing right behind the shadow minister for health, the member for Perth, Stephen Smith—if the government attempts to crucify or remove bulk-billing. We introduced the relative values study to help resolve doctors' grievances about Medicare rebates, and the government has chosen not to go down that route. It seems intent on undermining the fundamental and equitable nature of Medicare. We will fight this to the last gasp. Medicare is here to stay. Labor were responsible for introducing it and the government seems to be doing what the Prime Minister indicated in 1987 he would do— that is, tear it apart. As I recall the member for Perth saying before the suspension of the sitting, we will defend Medicare and we will preserve bulk-billing. I commend to the House the amendment moved by the member for Perth and I hope that the government accepts it.