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Monday, 16 June 2003
Page: 16476


Ms WORTH (Parliamentary Secretary to the Minister for Health and Ageing) (8:27 PM) —in reply—I would like to thank honourable members who have contributed to the debate on this very important piece of legislation, the Health Legislation Amendment (Medicare and Private Health Insurance) Bill 2003. As the debate proceeded, I became very interested in the selective memories of members of the opposition. They can remember every single statement that the Prime Minister ever made about Medicare during the 1980s, but they appear completely incapable of remembering elementary design features of the Medicare system that they created in 1984 and ran until 1996.

The most outstanding memory lapse relates to the ability of doctors to bulk-bill or not as they see fit and to charge what they wish if they decide not to bulk-bill. That was a fundamental characteristic of the system announced by the then health minister in 1983, Neal Blewett. It remained a characteristic of Medicare from 1984 to 1996 under the Labor government. It has remained a characteristic of Medicare since then, and it will remain a characteristic of Medicare under the bill we are debating tonight. Yet those opposite appear to be suggesting that there will be some sort of inflationary impact from the changes contained in this bill, and this impact will arise because doctors will be able to decide whether to bulk-bill or not and will be able to charge what they wish if they decide not to bulk-bill. The opposition even quoted Professor John Deeble as claiming that this legislation will leave doctors free to charge whatever they like. Let me say again: that is exactly what doctors can do now and it is exactly what they have been able to do for the last 19 years. The fact is that this bill and the other elements of the Fairer Medicare package create an incentive for doctors to bulk-bill concession card holders.

The opposition referred to a quote from a general practice manager who has said that the benefit of the Howard government's Fairer Medicare package is that it will allow doctors to offset the cost of bulk-billing concessional patients by charging other patients more. Wrong. The entire premise of this opinion—that there is a cost to bulk-billing concessional patients—is wrong. The heart of the government's package is that the vast majority of general practitioners will be financially better off—I repeat, financially better off. There is no reason for doctors to charge any more than they do now, because they will be financially better off.

There is no disincentive for doctors to bulk-bill others. They will receive exactly what they receive under the current arrangements if they decide to bulk-bill. The vast majority of doctors will be better off if they decide to bulk-bill all concession card holders and continue with their present billing arrangements for other people. The opposition made much of the suggestion that this bill created a financial incentive for general practitioners to bulk-bill card holders by allowing them to bill other people more. Yet that is exactly what doctors have been able to do for the last 19 years. That is why the government has not made any assessment of the inflationary impact of this legislation. The bill does not create any incentives for doctors to raise their charges and, if there is no incentive for behavioural change, it is ridiculous to assess the impact of behavioural change.

The opposition also condemned the proposed private health insurance safety net as the thin edge of the wedge. It always sounds so impressive condemning something that is the `thin edge of the wedge'. The problem with this particular condemnation is that it is not clear what the thick edge of the wedge is supposed to be about. The fact is that some 30,000 people or families who are not concession card holders pay more than $1,000 in out-of-pocket costs for medical services annually—in fact, they pay an average of over $2,500. The proposed private health insurance safety net will allow any Australian family that can afford a modest premium, estimated to be $1 a week, to insure against unexpected but potentially crippling costs for out-of-hospital expenses.

It is in relation to the proposed concessional safety net that the opposition really reveals its lack of understanding of the current system. The opposition seems to imply that this safety net was not required because of the two existing safety nets. The first is the current Medicare safety net, covering the difference between the 85 per cent rebate and the schedule fee once the difference exceeds $319 in a year. The second is the income tax medical expenses rebate, covering 20c in the dollar for costs in excess of $1,500 in a financial year. The fact is that what we are proposing is far more comprehensive. It covers the difference between what the doctor charges and the 85 per cent Medicare rebate, and it covers 80 per cent of expenses over $500 rather than 20 per cent of expenses over $1,500. I believe most concession card holders would prefer access to a safety net covering 80 per cent of the costs over $500, to one covering 20 per cent of costs over $1,500.

The opposition have also made much of the coincidence that the savings against the forward estimates flowing from the changed indexation arrangements from hospital funding grants are very similar to the proposed increases in spending under the Fairer Medicare package. They conveniently overlook the fact that the government has committed to increasing spending on hospital grants by $10 billion, or 17 per cent in real terms, over the next five years—and this in an environment where public hospital admissions are flat and private hospital admissions are booming as a result of the success of the government's private health insurance policies.

Before I leave the opposition's contribution to the debate, I will turn to the amendment proposed by the former shadow minister for health on the motion that the bill be read a second time. The first proposition is that the bill and the Fairer Medicare package will create a two-tiered system under which Australian families will pay more for a visit to the doctor. Leaving aside the confusion between opposition members, as one member accused the government of fostering a three-tiered society, let me point out that concession card holders and their families are Australian families as well, and we are going to make it easier for these families to visit a doctor by encouraging doctors to bulk-bill them. As Professor Deborah Saltman from the University of Sydney so succinctly said to me last Friday, `We don't have a two-tiered system; we have a multitiered system, and we always have had.'

The second proposition is that the bill will result in bulk-billing only for pensioners and concession card holders. There is absolutely nothing in the bill or the package that will stop doctors bulk-billing anyone they wish to. In fact, by paying them more to bulk-bill concession card holders, doctors will be more easily able to afford to bulk-bill other people. The third proposition is that it will be easier for doctors to stop bulk-billing or raise their charges if they have already stopped bulk-billing. The fact is that this legislation, together with the other elements of the package, makes Medicare fairer. It creates incentives for doctors to bulk-bill people likely to be in the greatest financial need, and it targets those incentives to the locations where people are least likely to be bulk-billed under the current arrangements. It puts in place a greatly enhanced level of protection against high cumulative out-of-pocket costs for people on limited incomes, and it allows any family that can afford $1 a week to buy insurance against the out-of-pocket costs of catastrophic illness, where many services may be delivered out of hospital.

The fact is that the government are prepared to improve Medicare to make it more equitable and more relevant. We are prepared to invest money in the health care sector to create a balance between private and public care, between acute and out-of-hospital care and between care and prevention. By contrast, the opposition's plan simply to increase the Medicare rebate across the board would do nothing to redress the inequities between metropolitan and rural areas, nothing to ensure the affordability for concession card holders and nothing to help other people guard against the unexpected costs of catastrophic illness.

The member for Newcastle earlier this evening displayed the opposition's ignorance on the issue of Medicare rebates. Her comments that GPs have not had an increase in their Medicare rebate for seven years not only are wrong but give me the opportunity to highlight the performance of this government compared with that of the previous Labor government. Under the coalition government, the Medicare rebate for a standard consultation has increased by over 20 per cent. By contrast, under Labor's last six years in government the standard consultation increased by less than nine per cent. In addition, GPs receive an average of $18,000 per year in incentive payments to deliver quality programs such as the asthma 3+ visit program. Taking this into account, overall GP remunerations have increased by 30 per cent in the last six years. This government is very committed to a fairer Medicare system, and this legislation is central to that commitment.


Mr Snowdon —Not even you believe that!


Ms Macklin —Come off it, Trish!


Ms WORTH —Despite what the very newly announced shadow minister says—who seems to have a very heavy workload at the moment, and I sympathise with her in that respect—I certainly believe what I am saying. This government, and this parliamentary secretary, believe that we will have a fairer Medicare system. It is a very big commitment that the government is making. I commend the bill to the House.


The DEPUTY SPEAKER (Mr Jenkins)—The original question was that this bill be now read a second time. To this the honourable member for Perth has moved as an amendment that all words after `that' be omitted with a view to substituting other words. The question now is that the words proposed to be omitted stand part of the question.

Question put.