Mr TUCKEY (7:08 PM) —To respond to the member for Lalor's speech, I think she is operating under a number of flawed assumptions. The first is that general practitioners are grasping, greedy individuals and that the reason they might raise their fees has something to do with an increasing cost base. As a former plaintiff lawyer—an ambulance chaser—she would be a contributor to this, because it is well known in this place that one of those substantial cost increases in the conduct of a general practice is the massive increase in professional indemnity insurance fees. These fees have been brought about by the actions of plaintiff lawyers by suing general practitioners for just about anything that can happen, and over periods of up to 24 years.

Somebody practising in the legal profession should understand—and it was understood by the designers of Medicare during a period when I was present in this House—part V, section 51(xxiiiA) of the Australian Constitution, which, in simple terms, prevents a form of civil conscription of medical practitioners. The member for Lalor said in her speech that there was nothing in the Health Insurance Amendment (100% Medicare Rebate and Other Measures) Bill 2004 to virtually force doctors to comply with bulk-billing. No-one knows better than she does that that would be unconstitutional and that no government has had the power to dictate what general practitioners charge.

She suggests that there could be an increase in fees that general practitioners charge, for whatever good reason—and I underline the words `good reason'—when the outcome of this legislation is that the patient will be $4.60 better off or, to use her other example, $1.7 billion better off over four years, because that is the additional money that this government is providing to rebate to patients. It is a patient rebate. If medical practitioners who do not bulk-bill increase their fees, then the patient is still better off by $4.60. To suggest that there is some relationship between that and what the government provides is patently false and typical of the member for Lalor. The first thing we have to understand is that whenever bulk-billing was introduced in its various forms it was always a voluntary scheme.

The member for Lalor cries crocodile tears and talks about people in country areas—of which you, Mr Deputy Speaker Scott, would know something. The only people who ever made a real profit out of bulk-billing, and then went on to buy football teams and things of that nature, were doctors who were in a position to practise in areas of high-density population and who set themselves up in practices where they had all sorts of associated services, such as pathology, x-rays and you name it. That was very profitable for a period.

The member for Lalor asked us to consider history prior to the last election. I would like her to consider back into the early 1980s, when this form of Medicare was created by Minister Blewett and the Hawke government. I would like her to remember that, during that period, they discovered the tiger they had by the tail and set about to reduce the incidence of bulk-billing. One of those policies eventually introduced by the Keating government was a media campaign that we had too many doctors and they were all rushing into the metropolitan areas to bulk-bill and buy football teams. There was a policy decision made, which is a matter of public record, to reduce the intake of medical graduates by 4,500 about 10 years ago—and, surprise surprise, what is now one of the pressures on bulk-billing and on the availability of general practitioners outside of the high-density areas? Whether in the peripheries of the big cities or throughout country areas, what is the other problem? We are short 4,500 doctors who, if it had not been for the initiative of the Hawke and Keating government, would be young undergraduates coming in to the stream 10 years later. We do not hear about that effect on bulk-billing. We do not hear about the competition that that might have brought into the market that would probably have turned more general practitioners to bulk-billing.

So when we look at it we find these various circumstances, but then of course—and it is oft forgotten in history—the Hawke government also decided, for the purpose of reducing bulk-billing, to introduce a copayment. Minister Howe brought in the copayment and it was passed through the parliament. Then Treasurer Keating decided he was going to challenge for the leadership of the Labor Party and, consequently, the prime ministership. What did he do? When he lost the first contest in Caucus, he went off to the left wing and said, `Switch your vote from Hawke to Keating and I will cancel the copayment.' That is the history of the Hawke and Keating governments—underline `governments'—in their management of bulk-billing and the attempts they made to reduce it.

That is the last time we had a Labor government. It is all right to be the smart alec in opposition with all your wonderful schemes—and I wish the member for Lalor had stayed around to be reminded that, while she is criticising the Howard government for spending money, she was the author of Medicare Gold and goodness knows how much that would have cost. Anybody who stands up and proposes something like Medicare Gold has no grounds whatsoever to criticise anybody else in this parliament who suggests some level of expenditure.

The first factor arising from the speech made by the member for Lalor is that one of the causes of increased doctors fees chooses to criticise them and to suggest to this House that, in contravention of the Constitution, this legislation should contain measures to virtually force medical practitioners, and GPs in particular, to enter the bulk-billing system when it is unconstitutional and ignores the cost based variation that occurs throughout Australia in the delivery of medical services. I have already made the point that, in the electorate of O'Connor, there is not one general practitioner who, in my recollection, has ever bulk-billed. That is not because they are greedy, grasping individuals; it is because, given the population density of the areas they service, they could never survive on what various governments have set as the schedule fee, be it 80 per cent or 100 per cent. The point is that they just do not have enough patients but, on the other hand, they provide a magnificent service.

For many years in my electorate it has not been uncommon that not only did doctors not bulk-bill but the community, through their local authority, also has had to provide subsidies—be that a car, premises, residence or sometimes just up-front cash. That was not because the practitioners were greedy, grasping people. Many of them, as time has gone by, have been overseas doctors—yes, I might say the majority. These people have given a wonderful service, but they are entitled to a reasonable living. This bill improves their chances, particularly if they bulk-bill, remembering that, as was admitted by the member for Lalor, the $7.65 and $5.10 bulk-billing incentives also remain.

But let us compare this proposal with what the member for Lalor and her leader took to the last election. It was bulk-billing, bulk-billing, bulk-billing. So, for people living in high-density population areas, a practice can probably economically operate as a 100 per cent bulk-billing practice. But the reality is that, in other areas, were Labor to have been elected on their policies, the people who had no choice about bulk-billing would not have received anything. Irrespective of the somewhat generous proposals that were announced at the time to get people back into bulk-billing, there were two factors that they did not consider. Firstly, some doctors have never bulk-billed and have a philosophical objection to bulk-billing and, if they are the only doctor for 100 kilometres around, there is a fair chance you will go and see them. Secondly, if you are elderly, you have attended the same practice for many years and you have faith and confidence in that practitioner, you are not going to leave.

Where do those people stand? Under the provisions in this bill, they are at least $4.60 better off than they would have been under Labor if no bulk-billing were available. At least, when they make their claim, if they pay up front they will get the additional money—about $30. That is what they will get, whatever the doctor charges. I do not commit the government, but let me say that the schedule fee has risen ever since I have been in this parliament. I have never really investigated the formula or the arrangements but, quite clearly, it does increase and no doubt there are some arrangements associated with that. The member for Lalor just completely ignored that proposition. She suggested that this thing is set in concrete and as the doctors charge more—as they will; as I said, one of the reasons is the cost of their professional indemnity insurance—that is a cut from this $4.60 average. It is not, and that is another thing that must be said about her amendment, which is virtually misleading the House.

She wants to condemn the government for `failing to ensure that any of the $1.7 billion spent will be passed on to patients'. It will all be passed on to patients, whether or not the doctor takes it and bulk-bills and they walk out of the surgery paying nothing. If that is the incentive that pushes a doctor into bulk-billing, the patient is the beneficiary. And, of course, if they are going to a non-bulk-billing doctor because they have no choice, when they get their rebate from Medicare it will be $4.60 higher than it was previously and, what is more, $4.60 higher than in any proposal from the Labor Party during the election.

These are the fundamental issues that we are talking about. It is about time that, when people bring amendments to the House, they are at least based on fact or are otherwise truthful. This amendment is a blatant misleading of the House—unless of course you are in some way numerically challenged. I do not know how many sums you do when you are doing your law course, but it seems to me that there is not much evidence that the member for Lalor carried on with arithmetic. It is clearly and truly an assistance, and it is the only assistance to people in my electorate and people living in the outer suburbs.

This is also about getting a supply of doctors, which this government has set about doing. We have a number of excellent policies that are associated with getting enough medical practitioners into the field. As a deliberate policy decision, the last Labor government—not the Labor opposition that come up with all these miracle cures in the hope that they never have to implement them—reduced the intake of undergraduates in the medical disciplines by 4,500. That pain is just hitting Australia. We all know that the lead time from starting an undergraduate course to becoming an independently practising GP is about 10 years. We have to look at all of these factors. So, whilst it is all right for the Labor Party to say that the system is not working, the fact is that it is fundamentally their system.

Bulk-billing has always been a difficult issue, and it is something that the parliament cannot impose upon these other people. It cannot be done and it will not be done. That is the fundamental issue. I am amazed when I look at this. There are issues that are of considerable importance. The 100 per cent of the schedule fee is not restricted to the much publicised figure of $4.60. That is for a standard consultation of between six and 20 minutes. Were the time to be, for instance, over 40 minutes, the additional payment would be nearly $13, which of course has to be a great help.

It is worth mentioning at this time that, under the Labor government and its Medicare policies, if you lived in the electorate of O'Connor and you had to see a non-bulk-billing doctor and pay cash at the door, when you got your account the only means by which you could get reimbursement was to post off your application form and wait for a cheque in the mail, notwithstanding that you might have a very low net income because you might have two or three kids or be a pensioner—because there was no Medicare office out there, whereas someone in a metropolitan area could virtually go around the corner to get a cash refund. The money was gone and you just did not have it for that period of time. The initiatives that this government took in that regard to deal with this system included electronic transfer into your bank account. More importantly, we put in Medicare Easyclaim. We have also funded a large number of rural transaction centres, where people can get the speediest possible access to a Medicare refund.

Let us hope that, at least in the foreseeable future, with the endorsement of the Australian people, who provided this government with a majority in both houses—remember that was the people's decision—we might be able to introduce legislation, which the Labor Party once cancelled so someone could become Prime Minister, involving a sensible copayment arrangement whereby the medical practitioner can make a charge in his surgery. That of course was something that was deliberately forbidden under the Labor plan—again, to force people into a form of civil conscription that could not be done through legislation. If the doctor's fee is an additional $10, people should have the right to pay the $10 in the surgery and the doctor should be able to claim the full rebate that we are providing. That would be sensible and convenient for people wherever they were. But, of course, the reason that Labor have blindly opposed that simple arrangement is that they are scared stiff that fewer and fewer doctors will operate under their preferred method of bulk-billing.

I congratulate the government for taking this particular measure. It will be infinitely beneficial to my constituents, who were going to get nothing under Labor. They very smartly worked that out, and my Labor opponent's vote went down by two or three per cent, from what was previously a relatively low level. People are not silly. They know the difference. This is good legislation and the appropriate response.