Mr BOWEN (7:24 PM) —The Health Insurance Amendment (Medicare Safety-nets) Bill 2005 implements the recently announced cutback to the Medicare safety net. The bill increases the lower threshold from $300 to $500 and the higher threshold from $700 to $1,000. These threshold changes will come into effect on 1 January 2006. Indexation of the thresholds will recommence on 1 January 2007. As the honourable member for Richmond said, this bill represents a major backdown on behalf of the government. It shows the arrogance of a government out of touch with the needs of the average Australian. The government cannot claim that this was not a core promise. They spent $20 million advertising the Medicare safety net in the lead-up to the election campaign—not $20 million of Liberal Party money but $20 million of Australian taxpayers’ money. We all remember the ads; it is impossible to forget them. They were on the television every time you turned it on. The advertisements for the Medicare safety net coincided—conveniently for the government—with the lead-up to a federal election. This was not a non-core promise, as the Prime Minister so famously said; this was in every sense of the word a core part of the government’s re-election campaign, a core part of their mandate and a core part of what indicates their arrogance and out-of-touch approach to policy making in this country.

In the interests of government accountability, on 8 December last year I asked a question on notice in this House of the Minister for Health and Ageing about the take-up rate of the Medicare safety net in my electorate of Prospect during 2004. I expected a seemingly straightforward answer, in which the Health Insurance Commission would pass on to the minister the data it collects by electorate. However, it was not until 13 July this year that the minister tabled his answer with the Table Office—that is, 217 days or a tick over seven months since the question first appeared on the Notice Paper and six weeks after I asked the Speaker to write to the minister regarding the outstanding question. On any independent examination of the facts you would conclude that, at the very least, this response was tardy and, at the most, that it was appalling and done with an arrogance and contempt for the people of Prospect. What did the government have to hide? Why wouldn’t the minister answer a simple question about the Medicare safety net? Clearly this government is extraordinarily embarrassed about its backdown, and this minister in particular is embarrassed.

Perhaps it is not fair of me to make a judgment on the minister’s performance simply based on one question. But a cursory glance at the Notice Paper reveals that the members for Lowe and Scullin, too, have every reason to be disappointed in the minister, because they have unanswered questions on the Notice Paper dating back to November 17 and 18 respectively—that is, over 10 months and still counting. What is more interesting is that the question by the member for Lowe to the minister focuses on the Strengthening Medicare campaign which, as I mentioned before, trumpeted the Medicare safety net policy in the lead-up to the last election. It is with the slightest bit of irony that the minister now comes into this parliament to legislate his embarrassing backflip on what was a ‘rock solid, ironclad commitment’ while flouting the provision of ministerial accountability and the standing orders to avoid answering questions on the same policy. What a disgraceful performance.

This is a matter of integrity and it is a matter of trust. It is worth while to detain the House for a few moments to examine this matter of trust. When interviewed on 6 September, the minister for health said:

When asked about the blow-out, on 11 September he said:

In April this year, when the Prime Minister announced the backflip, the member for Warringah, the Minister for Health and Ageing, said he was contemplating resigning. He was given ample opportunity to go, but he did not. He could have made something out of this for his own political career. He could have said: ‘I am a man of integrity. I agree with the government’s decision. I agree that they have to be economically responsible but I went out and gave a rock solid, ironclad commitment. I said that I absolutely guaranteed that. And, as a man of integrity, I have to submit my resignation.’ He would have come away from that with his reputation enhanced in the community. Even I, as a detractor of the minister for health, would have said: ‘At least he stands for something. He stands for the principle of standing by your word. At least he is willing to sacrifice his political career for the sake of integrity.’ But clearly he has shown that he is not.

Tony Harris, who is a former New South Wales Auditor-General and a regular critic of the New South Wales Labor government—no friend of the Labor Party is Mr Harris—had this to say about Mr Abbott’s backflip:

I could not agree more with Mr Harris. It is an appropriate summary of the situation we are confronted with when we are considering and voting on this legislation. We have heard plenty about the mandate theory from the government. They are very quick to point to their mandate when they choose to legislate things like industrial relations legislation and the sale of Telstra. They say that they should not be impeded in the other place in implementing their election promises. But when it comes to the Medicare safety net, a very simple election promise repeated several times by the minister and by the Prime Minister, they do not want to hear anything about the mandate theory of politics or about the great breach of faith with the electorate that this bill represents.

The minister’s record is now clear for all to see: breaking solemn and explicit election promises and failing in his duty to this parliament in not answering simple questions on the Medicare safety net but at the same time using this parliament to legislate this backflip. The Parliamentary Secretary to the Minister for Health and Ageing was quoted on 17 April, when the government was in damage control over this policy reversal. He said:

in the cost of the Medicare safety net—

At the same time, the minister was doing the rounds of the press gallery saying:

Even then, when the minister knew that, he was going around saying, ‘I give an ironclad guarantee.’ The minister was found out during the estimates process in the other place, which showed that the minister was briefed by the Department of Finance and Administration and by other bureaucrats that the cost of this program had massively blown out and would be unsustainable in the longer term.

When he was asked about it in this place in question time, he showed the most arrogant disregard for this place that I think I have seen from a minister in my time here. When he was asked by the member for Lalor whether he knew about the cost blow-outs, he stood at the dispatch box in this place and said, ‘I’m not going to play your game.’ But this is not a game. This is a democratic process. This is the place where ministers come in and are held accountable. The minister for health refused to answer a very simple question from the member for Lalor about what he knew and when he knew it. He said quite simply, ‘I’m not going to play your game.’ As I say, this is not a game. The minister for health in his normal insensitive manner might think it is a game, but it is not a game. We are talking about the lives and the livelihoods of many thousands of ordinary Australians, and for the minister for health to arrogantly come into this House and contemptuously say, ‘I’m not going to play your game,’ is to me one of the most remarkable examples of arrogance that we could possibly see.

This has been a truly embarrassing saga for the minister and for the government. It is pretty clear that this is a piece of legislation that the coalition are very embarrassed about. Where are all their speakers? Where are they? We have a list of Labor speakers on this bill as long as your arm, and we have seen a paltry number of government speakers. They are not coming into this House to defend the government’s position. They are not coming in to say, ‘I’m proud to speak for a $499 million saving to the budget.’ Where is the bravado of the rejuvenated National Party? Where is Barnaby Rubble? Where is Senator Joyce on this matter, standing up for the interests of country Australia? Where is he coming into parliament saying that this bill has led to the inflation of medical costs in country New South Wales and that the very least the government could do is stand by its election commitment? Senator Joyce is more than happy to parade around the country pretending to represent the interests of country Australia, but on this issue he is silent. I would have thought better of Senator Joyce.

The Medicare safety net policy first came into effect in March 2004. The policy pays a rebate of 80 per cent of the out-of-pocket costs of the Medicare Benefits Schedule services out of hospital for registered participants after a threshold has been reached. The thresholds were set at $300 for concession card holders and $700 for all others. Throughout 2004, a journalistic inquiry highlighted the inflationary effect that the safety net was having on specialists fees, in particular how the safety net was providing obstetricians with an incentive to restructure their fees to shift in-hospital costs to out-of-hospital costs and, therefore, make them eligible for the safety net rebate. This led to Medicare rebates for obstetrics increasing by 62 per cent from the first quarter in 2004 to the same period in 2005 and obstetrics fees increasing by 151.8 per cent for the same period, from March 2004 to March 2005.

Under any objective analysis this is not good public policy. Under any objective analysis this was a quick fix, a bandaid approach, from the government to limp their way through the election, and it was quickly and savagely dumped by the government after the election. The minister for health released electorate by electorate data in September 2004, and the honourable member for Richmond also referred to this. This data revealed that rebates paid under the safety net were heavily skewed towards those in high-income electorates. Similarly, it confirmed that those on lower incomes and with less ability to undertake what some would call discretionary spending on health—I question whether this would be discretionary spending on health, but perhaps it is spending which is not absolutely 100 per cent necessary and is certainly not at the levels undertaken by people at the higher end of the income spectrum—were getting little benefit from the safety net. Not surprisingly, the data showed that the largest number of safety net rebates were paid to those with the highest average incomes, those included in the electorates of the minister for health and the Treasurer.

In terms of the safety net rebate paid out, 10 of the top 11 electorates were Liberal Party electorates and my electorate of Prospect came in 70th. I do not think you could mount the case that people in my electorate are not entitled to the same level of support as people in the electorates of the minister for health and the Treasurer. I do not think you could mount the case that people in the 69 electorates ahead of Prospect are so much less healthy than the people of Prospect that the people of Prospect do not need the support of the Medicare safety net.

The government’s initial cost estimate was $440 million over four years. It is now more than $1 billion. These increases to the safety net thresholds appeared in the 2005-06 budget as a savings measure worth $499 million. This government claimed to be a good economic manager, but this is the mother of all cost blow-outs. If this happened in a state Labor government, the Liberal opposition in any particular state would be wandering around that state saying: ‘These guys need to be thrown out; they are appalling economic managers. They can’t even manage a project like this. It’s blown out by half a billion dollars.’ But of course this government thinks it will get away with it. Despite its promises in the lead-up to the last election to quarantine health spending—not to mention its promises on the Medicare safety net more specifically—the coalition government has broken its covenant with the Australian people in a way which will further alienate the electorate and make the task of rebuilding people’s faith in the political process that much more difficult.

Of course we saw, as I said earlier, the massive advertising campaign at taxpayers’ expense which was undertaken before the last election. That advertising campaign was designed to put people’s minds at rest about the decline in bulk-billing. It is in that context that the coalition government presented MedicarePlus last year. Explanations about the decline of bulk-billing have tended to centre around two views: one focuses on the level of the Medicare rebate to doctors and the other focuses on the geographical distribution of general practitioners. Medical practitioners have argued, particularly through the Australian Medical Association, that GPs are increasingly charging patients more than the Medicare rebate for consultations because the schedule of fees against which that rebate is set does not provide sufficient recompense for those providing the consultations.

While this is no doubt true, the government originally sought to cover the growing amount of out-of-pocket costs experienced by patients by introducing the safety net. The net effect has been an increase in specialist fees, as I said, particularly in the area of obstetrics. Alternatively, Labor’s approach to address the decline in bulk-billing is to provide direct financial incentives to GPs to meet bulk-billing targets and ease the out-of-pocket costs by increasing the rebate of bulk-billed GP consultations to 100 per cent of the scheduled fee.

I would like to deal with the matter of work force shortage, which the government points to as being one of the reasons for the decline in bulk-billing. The federal government has argued that the decline in bulk-billing rates in an area is a consequence of the undersupply of medical practitioners in that area, and it has implemented certain work force strategies like the Outer Metropolitan Registrars Program to address this issue. It is true that the government has done this; it has implemented the Outer Metropolitan Registrars Program, and other programs, to encourage general practitioners into areas which are not well served. However, this scheme does not deal adequately with the disincentives for general practitioners to work in these areas. There are significant difficulties in attracting general practitioners to outer metropolitan areas of Sydney, let alone the bush.

In my electorate, for example, I have been running a campaign for a general practitioner to be based in the rural part of my electorate, Horsley Park. I have written to the Fairfield division of the Royal Australian College of General Practitioners and all the general practitioners in the electorate, advertising the benefits of moving their practice to Horsley Park. I am also posting community ads in the September editions of the Australian Medical Association’s NSW Doctor and the Royal Australian College of General Practitioners’ Australian Family Physician. One general practitioner has replied to my letter, saying he would like to open a surgery in Horsley Park but the $30,000 Commonwealth government grant would do little to cover the $100,000 cost of opening a new surgery.

That is as it may be, but the other point I want to make is that the federal government provides incentives for existing GPs to relocate their practice from one part of this country to another, but it provides no incentives for new general practitioners—be they overseas doctors or young GPs just out of training—to establish new surgeries in areas of need. If we have got a situation where a new GP, fresh out of hospital training, is willing to go into an area to open a general practice, they should be able to receive similar incentives to general practitioners who are closing down one practice and opening another.

This bill represents a massive breach of faith with the Australian people on the part of this government. It represents an act of arrogance which this government has become famous for. It represents a break of an election promise, which this government set the tone for very early in its administration. It was in 1996 that the Prime Minister said, ‘We have kept all our core promises.’ He was wrong then, but he is even more wrong now. The government has abandoned this promise, which in any sense of the word was a ‘core’ promise. It was ‘an ironclad commitment’, ‘a rock solid guarantee’.

The minister, as I said, would have massively increased his reputation with the Australian population if he had done the right thing and come into this House and resigned. He has not done that. This government has shown its hallmark symbols of arrogance in its approach to this issue. But, more importantly and more sadly, it has shown just how out of touch it is with the needs of the average working Australian when it comes to health care in this country.