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Thursday, 21 June 2018
Page: 40


Senator O'NEILL (New South Wales) (13:21): I rise to make a contribution to the debate on the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018. Labor is the party of Medicare. We invented it and we will always protect it. It's our universal public health insurance scheme. It's the heart and soul of our healthcare system, and it's the envy of many other countries around the world. It ensures Australians can access life-saving treatment when they need it without worry. More than 20 million of us access Medicare services every year, including GP visits, vital tests and scans and hospital treatments. Without a doubt, it's one of the most important programs the Commonwealth government delivers. It's fundamental, not just to our health system but to our economy and to our society. That's not to say it's perfect, but, of course, with a program this size there will always be problems and there will always be improvements that can be made.

Labor is always up for sensible improvements. This government bill implements a 2017 budget measure to improve the Medicare Benefits Schedule compliance and debt recovery practices, and it will result in an estimated combined saving over the forward estimates of $103 million. That money should, of course, be reinvested straight back into Medicare in a transparent way, rather than returned to the budget bottom line, but that is an issue I will return to later. This bill amends three acts, the Health Insurance Act 1973, the Dental Benefits Act 2008 and the National Health Act 1953. These technical changes will, hopefully, enable improved compliance by better targeting unusual business billing and improving the consistency of administrative arrangements.

I want to say at the outset that the vast majority of medical and allied health professionals that bill Medicare for services to their patients do the right thing. But we also know that there are increasingly commercial interests at play in some areas, so compliance is something we have to improve. Only 40 per cent of Medicare debts are currently recovered, meaning there's over $50 million in outstanding debt. There's obviously a need for some action in this space. These changes clarify that the Professional Services Review, which investigates Medicare and PBS compliance concerns, has jurisdiction over corporate medical practices that contract health providers as well as practices that employ providers, and the providers themselves. It introduces compulsory offsetting and garnishee provisions for providers who do not voluntarily agree to repayment plans within 90 days. At present, these providers are still able to claim full Medicare benefits even when they owe significant debts. Where a compliance debt is issued, both the employer and the contracted provider will be responsible for part of the debt, reflecting their shared responsibility for accurate billing.

This bill also makes record-keeping requirements consistent across different health professions. In particular, allied health providers will be required to keep copies of referrals for two years, just like doctors. Pharmacists will be required to produce prescriptions to justify queried claims, and dentists and pharmacists will face the same administrative penalties on unpaid debts as do other Medicare providers. Further detail will be set out in regulations, and the new arrangements will start on 1 July 2019. But, for now, I can say Labor will support this bill.

Like I said, we are always willing to support sensible improvements to Medicare. What we don't support is this government's overall approach to Medicare. It took two Labor governments more than two decades to shape and embed the Medicare that we know today. Many Australians today take Medicare for granted, as if it was always there. It's great that they have that attitude. That is exactly as it should be. Australians should be able to rely on Medicare whenever they need it, without worrying and without a second thought. But let's never forget that the conservatives opposed Medicare every step of the way. Labor had to fight hard to set it up, and we continue to fight hard to protect it.

We know that you cannot trust the conservatives with Medicare. They drone on constantly about their rock-solid commitment to it, but we know the truth. They have revealed it over decades. They hate it. They have tried to take it out many times. They want to dismantle it. They just don't believe in universal health care as Labor do. They dream of and implement wherever they can mechanisms to echo the American health system, where it's every man, woman and child for themselves, where people increasingly have to rely on private means to access basic health care, where people die or suffer for years because they cannot afford to see a doctor or go to a hospital and where you have to get out your credit card, rather than your Medicare card, when you visit the doctor. That's the Americanised model that the Liberal-National Party seek to inflict on this country. Hating Medicare is in their DNA. They might behave themselves for a while, because they know how much the Australian people value Medicare. Australia certainly sent that message out loud and clear at the last election when the government was plotting to outsource parts of Medicare to the private sector. Labor, of course, staunchly and vehemently opposed that move.

In the two years since that election, the government's been very busy trying to rewrite that history, pretending that it didn't happen, pretending that Labor made up its efforts to outsource parts of Medicare to the private sector. But that is a reality. It's a historical reality that the government will pretend didn't actually happen. Its defence is utter nonsense. This government was actively planning to outsource the Medicare payment system to a corporate player—one of the four big banks, perhaps, or maybe a private health fund? If we'd let them get away with it, it would have been the beginning of the end for Medicare as we know it. The government dropped its plan because Labor's tireless efforts to highlight the damage that it would have done to our health system pulled them back from the brink of implementation. It was because the Australian people agreed it was a terrible plan and punished this government for it. Eventually, as we all know, the Liberals, true to their DNA, will have another crack at Medicare. They'll come up with another scheme to undermine it, weaken it or to sell off parts of Medicare.

They've got so much form with their attacks on Medicare, over so many periods of their government. Remember, on the arrival of Mr Abbott, their first effort at the $7 co-payment. That was just a few years ago. That was an unprecedented attack on the universality and the accessibility of Medicare. It was effectively an attempt to end bulk-billing. Then too, it was Labor, it was the parliament and it was the Australian people who ultimately stopped the government going down that dark road. As is so often the case, we helped save the government from itself. The plan that they were attempting to implement revealed what's really in their hearts: to attack Medicare at every opportunity.

When they couldn't get their $7 co-payment through the parliament, they went for an alternative strategy: a freeze on indexation, which impacts every single doctor delivering health care in this country today. That freeze was implemented by this government on the fees that doctors receive and health professionals receive for the services that they provide. That freeze stuck while all the other costs of running a small business—that is what our doctors do; they have costs such as electricity and all of those costs that are attached with running a business, all with rising rents—all continued to rise. The freeze that this government implemented is still in place today. Again, under intense pressure from Labor, from doctors pushing and from the public pushing, Minister Hunt was forced to announce a fall in the freeze as recently as May 2016; but he still hasn't actually lifted a single element of it. Some elements will finally come off on 1 July, delivering GPs a paltry 55c increase in their rebate. It won't put a dent in soaring out-of-pocket costs in the health sector.

While the government continues to try to tell the Australian people that they love Medicare, other elements of the freeze that they have underway will remain in place until 2020. That's six years of slugging doctors and ultimately patients with that cost, simply because they want to access the healthcare system. The rebate freeze has saved this government billions of dollars, and they're banking the savings right now. Those are billions of dollars that should have gone to providing health care for Australians, but this government took those billions out. Meanwhile, we know that the latest Medicare data shows that the cost of seeing both your GP and your specialist is at a record high, and that is directly attributable to these Liberal cuts. The gap has expanded for Australians who simply need to get to a doctor, get seen and hopefully get well. For those who find themselves unwell and who have to go to a specialist, the cost of getting to a specialist has just grown and grown. The Liberal freeze is a key reason for that increasing gap.

The first three months of 2018 are pretty instructive. Australians paid an average out-of-pocket fee of $38.44 to see a GP. It is up to nearly $47 in some states and territories. The national figure has risen nearly $4 from $34.53 at the end of 2017. Out-of-pocket fees to see specialists have soared even higher. They were up to an average of $87.62 in the March quarter. That's up from $71.75 in the last three months of 2017, up nearly $16 in a quarter. In some jurisdictions the average out-of-pocket cost of seeing a specialist has now soared to well above $90. That's far, far too high. I can tell you that from doorknocking in the seat of Robertson, where we have a fantastic candidate, Anne Charlton. We were out doorknocking in Wamberal, right near Terrigal, and we were meeting great Australians who've served this country in many ways across the years. I remember an encounter that Anne and I had with a woman who said she'd been able to manage her health care very well for all of her life but was at a point, for the first time in her life, where she was simply unable, despite owning her own home and having had financial stability all of her life, to access health services. That was on the watch of this government and its action around Medicare. So every time those opposite say, 'Nothing to see here; we support Medicare,' remember the facts: an attempt at a $7 co-payment and a freeze that's still in place.

Ninety dollars in out-of-pocket costs to see a specialist is far too high. Meanwhile, the government is out there trying to trumpet a static GP bulk-billing rate as some kind of great achievement. How out of touch can you get? The Australian people are far too smart to fall for the kind of spin that this government is trying on them. They know that the cost of going to the doctor has risen. People feel it in their pocket every time they have to go to the doctor. What about families with children? I've got three. It was always: one would get an ear infection, the second would get one and then the third one, and it would all be one day after the other. For families, multiple visits to doctors in the course of one week are common. The cost of that—the out-of-pocket cost—has expanded under the watch of this government.

The Australian people will not fall for any of the nonsense that's promulgated by this government about their love for Medicare. Sadly, the consequences of five years of Liberal-National Party government under Mr Abbott and Mr Turnbull, both of them, are that Australians now are delaying going to their doctor. They are delaying going to their doctor simply because they can't afford it. The freeze has had a terrible impact on the health and wellbeing of this nation. Official Bureau of Statistics figures show that one million Australians delay or avoid seeing their GP each year due to cost, with another 1.7 million Australians skipping specialist appointments. About the same number don't fill a prescription because of cost. Older Australians fare the worst, with one in eight telling a Commonwealth fund that they've got problems getting health care because of cost. Only patients in the US, obviously no role model when it comes to universal care, fare worse than older Australians.

There have always been challenges to Medicare's universality, such as difficulty in accessing services for Aboriginal and Torres Strait Islanders, as well as the challenges—very big challenges—for people in regional, rural and remote Australia, but in recent years out-of-pocket costs have become a very significant barrier to access. Medicare statistics show that 10 years ago Australians paid an average out-of-pocket fee of $21 to see a GP. Increased in line with inflation today, that cost would be around $26. The same is true for specialists. Ten years ago Australians paid about $44, equivalent to around $54 now. But the problem is that the costs under the Liberal-National government are much, much higher than that. The Liberals make a laughable claim that Medicare has never been stronger than it is now, on their watch. What a load of rot! Whether it's making Medicare more expensive, cutting public hospitals or putting health insurance profits before patients, the conservatives can never be trusted on health.

At the last round of Senate estimates, officials said the government's latest budget was trying to bend the curve of Medicare—bend the curve of Medicare, right? That means basically they're trying to cut. That was what we found out at Senate estimates in this building just a few weeks ago. The government wants to bend Medicare, all right; they want to bend it till it breaks.

In stark contrast, the Leader of the Opposition in his budget reply speech in May announced the first round of Labor's new investments in Medicare, and it's a significant investment in MRI machines, which are so vital for the diagnosis of complex medical illnesses. Unlike other services, MRI scans only get the Medicare rebate if they're performed on an eligible machine. The licence system is anachronistic. It worked pretty well until 2013, given that the last Labor government granted 238 licences. Unfortunately, the current government has totally neglected MRIs, granting only four licences. There were 238 MRI licences from Labor and four licences in the five years that they've been in government. This is a woeful record and it goes again to the facts about this government, their attitude to Medicare and their cavalier attitude to the health and wellbeing of Australians. Access to Medicare MRIs is very patchy, and many Australians travelling long distances experience significant wait times to access an eligible machine. It's too long to have to wait.

This government's assurances about health are worthless. While there's $190 million in savings from the MBS review in the 2018 budget, there's just $25 million in new MBS listings, which means another net cut to Medicare. They are taking money out of the health budget hand over fist. They cut Medicare. They cut hospitals. They do everything they can to prop up the private insurers. Labor will have much more to say about this government's treatment of Australians' health in times to come.