Mr ABBOTT (Minister for Health and Ageing) (3:33 PM) —There is no doubt, as the member for Lalor states, that the bulk-billing rate has declined. There is no doubt at all that the bulk-billing rate has declined over the last four years. But this is no great secret; there has been no cover-up whatsoever. In an article in the Australian this Monday I pointed out, under a photo by-line, that the bulk-billing rate had declined from just under 80 per cent to just under 70 per cent since 1999. My distinguished predecessor and friend Senator Patterson released figures on 7 October, just a month ago, pointing out that the bulk-billing rate on an electorate by electorate basis had fallen to 68.5 per cent. So there is no secret whatsoever about the diminution in bulk-billing rates. It is something that the government have known about and it is something that the public has known about, because the government have published the figures. We have been publishing the figures, we are publishing the figures and we will keep publishing the figures, because this is an open and transparent government and people deserve to know what is really happening to their health system.

There is no secret about the fact that the bulk-billing rate has declined and there is no secret about the reason why the bulk-billing rate has declined. The bulk-billing rate has declined because doctors are exercising the choice that they have always had under this government and the former government to choose whether or not to bulk-bill their patients. Doctors have always had the choice whether or not to bulk-bill their patients. It is a free choice; it is an uncoerced choice. It is a choice which is open to them. It was open to them under the former government; it has been open to them under this government. But it apparently will not be open to them under a future Labor government because it seems, from listening to the member for Lalor, that the Labor Party now believes in coercion of the medical profession—a form of medical conscription.

Just to make it very clear, let me read for the member for Lalor's benefit from Labor's new health plan. This was the new health plan, put into place by the former Labor government in 1983, on which Medicare was based. Labor's new health plan said:

That is one way doctors can behave. There is another way doctors can behave, and again I will quote from Labor's document:

Today, doctors are doing what they have been doing since 1984—since the birth of Medicare. I also want to read what the political architect of Medicare, Neal Blewett, said. He put it well:

It was never the intention of the Labor Party when it was in government, when it was responsible, to make bulk-billing compulsory. It was always intended that bulk-billing should be available, but it was never intended that it should be compulsory. I want to make it very clear that as far as this government is concerned bulk-billing is important. Bulk-billing should be available, but bulk-billing should not be—and never will be, as far as this government is concerned—compulsory.

Members opposite are suggesting that falls in the bulk-billing rate mean the death of Medicare. Medicare is not about universal bulk-billing. If it was about universal bulk-billing, it would never have got off the ground, and it would have been a failure since 1983. But, no, Medicare is not about universal bulk-billing; Medicare is about a universal safety net to guarantee that all Australians have affordable access to high-quality health care. Far from the death of Medicare, thanks to the policies of this government, Medicare is alive and well and getting better all the time.

I want to put the bulk-billing issue into context and point out again to the member for Lalor and other members opposite that, sure, the bulk-billing rate has dropped to 68½ per cent but, even at that rate, it is still higher than the bulk-billing rate for the life of the Hawke-Keating government. Over the life of this government, the bulk-billing rate has been 77 per cent, compared to just 74 per cent over the last seven years of the life of the Hawke-Keating government. This government does want the bulk-billing rate to improve. This government does want to enhance the opportunities for people to be bulk-billed. Let me make it very clear to the member for Lalor and other members opposite: in the A Fairer Medicare package the government tried to make it more worth while for doctors to bulk-bill. We tried to provide greater incentives—more money in the pockets of doctors who bulk-bill. Not only that but through the A Fairer Medicare package we tried to ensure that there would be more doctors in our system. That means more competition and it means more pressure on doctors to deliver good quality services to their patients for the lowest possible price—and, obviously, the lowest possible price is free because the services are bulk-billed.

This government wants to enhance the availability of bulk-billing. We have tried to do it through the measures announced in the A Fairer Medicare package. As members opposite well know, this government is now in the business of revising, refining and improving the A Fairer Medicare package, and improve it we will. We accept that, because not all doctors will choose to bulk-bill, there is always going to be the risk that some people will find themselves with significant out-of-pocket medical expenses. This was the case under the former government; this has been the case under this government. But this government is trying to introduce a new measure that will strengthen Medicare and make the Medicare safety net stronger than ever to try to limit the ability of the Australian people to suffer extensive out-of-pocket expenses if they do not have access to doctors who are bulk-billing.

It is a fact that right now there are some 50,000 concession card holders who have more than $500 a year in out-of-pocket medical expenses. It is a fact that there are some 30,000 families who have out-of-pocket medical expenses of more than $1,000 a year. These families deserve a safety net. These families deserve to know that their government and their country will look after them. That is precisely what we were trying to do through the A Fairer Medicare package, and it is precisely this safety net which will be improved and extended in the measures that the government will shortly be announcing.

I want to make it very clear that this government is on about a better, stronger Medicare. There were four elements to the A Fairer Medicare package: greater convenience for patients; more doctors and nurses in the system; enhanced access to bulk-billing; and, finally, a stronger safety net. There was a lot in the A Fairer Medicare package that was good, but we are going to improve it. We will announce those improvements soon. I am confident that all Australians of goodwill, when they see those improvements, will say that this is a government which believes in Medicare and that the Medicare system is safe with the Howard government. This government has a good record when it comes to the health of the Australian people. This is a government which believes in spending everything which is necessary to deliver to the Australian people affordable, high-quality health care. We have not just talked about it; we have paid for it. This government has spent more and more every year, in absolute and relative terms, to improve the health of the Australian people.

Since 1996, the percentage of the federal budget devoted to health spending has increased from 14 per cent to 18 per cent—14 per cent of the federal budget was spent on Medicare under the former government and 18 per cent of the federal budget is spent on Medicare and Medicare related activities under this government. The percentage of Australia's GDP constituted by federal health spending has increased dramatically under this government. In 1996, federal health spending was just 3.7 per cent of Australia's GDP; today it is 4.3 per cent of Australia's GDP. At the same time as the total health spending of Australians, both collectively and individually, has increased from 8.6 per cent to 9.3 per cent and at the same time as there has been this very significant increase in spending from the federal coalition government, the state governments—mostly state Labor governments—have been lagging behind and failing to pull their weight. The percentage of Australia's GDP spent by the states on health has increased from two per cent of GDP to just 2.1 per cent. If there is any level of government that is failing to provide the Australian people with the health care they need and deserve, it is, I am afraid to say, the states. I do not want to get into a sterile state-bashing exercise; I want to work constructively with the states. On the basis of the meetings that I have already had with three state Labor health ministers, I believe that that is precisely what the federal government can do.

Never let it be said by anyone that this is a government which is niggardly with the health of the Australian people. Never let it be said by anyone that this is a government which will not spend what is necessary to guarantee the health of the Australian people. The federal government now spends $35 billion to promote the health of Australians. Of the $67 billion a year which Australians are spending on health, $35 billion—well over 50 per cent—comes from the federal government, and it is going up all the time. This year we are spending $8.6 billion on Medicare rebates, up 43 per cent since 1996. We are spending $7.5 billion on public hospitals, up 60 per cent since 1996. Under the new health care agreement recently signed between the states and my distinguished predecessor, there will be a real increase of 17 per cent in federal funding to public hospitals. We are spending $5.1 billion on the Pharmaceutical Benefits Scheme, and that is up a massive 113 per cent since 1996, and we are spending $5.3 billion on nursing homes and hostels, again up a massive 75 per cent since 1996. This government will spend what it needs to spend to protect, to defend and, where possible, to extend the Medicare system because this government believes in Medicare. Medicare is safe and well under this government. Because we have a Medicare system in good shape, the health of the Australian public is improving all the time.

There are problems with our health system. There are always going to be problems with our health system. A system as large and as complex as the Australian health system is always going to have some problems. The important thing is not that we should never have a problem, but that when problems arise we move swiftly, decisively and effectively to address them and that we spend the money that needs to be spent to fix the problems in our health system. That is what we are doing and that is why the Medicare system is in good hands under the Howard government.