Senator FORSHAW (9:11 PM) —At the outset of my speech during the second reading debate on the Health Care (Appropriation) Bill 1998 , I pay tribute to the speakers from the opposition in the previous debate. What we have seen this afternoon and this evening is a comprehensive outline of the absolute failure of the Howard-Fischer coalition government to deal with any of the major problems and issues facing the Australian nation today and, further, of its endless list of broken promises. Whether they be in regard to such issues as tax, Telstra or the GST, the record has been laid clear. The public are certainly going to get an opportunity in the near future to exercise their judgment.

One of the critical issues—dare I say, it may even be the most critical issue—facing the people of Australia today is the imminent collapse of the public health system in this country. If that is to be its fate—and God help us that it isn't—then it will be squarely on the shoulders of the current government, the current Prime Minister (Mr Howard) and the current Minister for Health and Family Services (Dr Wooldridge).

There is no doubt about it: the public health system in this country is in crisis. Those are not just my words. Do not just take the word of the opposition, even though we always speak the truth. Do not just believe me; believe the words of every one of your coalition premiers around the country. Believe the words of every one of the state and territory health ministers around the country, all of whom, with the exception of now two states—might I say proudly, given the recent success of the Labor Party in Queensland—have Liberal premiers. They have condemned this government for its record on health. Further, they have pointed to the crisis that now exists in the health system.

The people will get the chance to make their judgment on this government and, when they do, they will remember the solemn promise of John Howard, the current Prime Minister, prior to the last election. He stood up and solemnly promised, with his hand on his heart, that he would not abolish, destroy or undermine Medicare. We know why he made that promise. We know that he never believed it, because John Howard has been on the record for years—I might say, in living memory—as being opposed to Medicare and wanting to abolish it.

However, prior to the last federal election, he went before the public and promised to maintain Medicare. He knew he had to do that because he knew that the Australian electorate would never accept as a government any party that sought to abolish or dismantle Medicare. Medicare is one of the inherent parts of our great social system in this country. John Howard finally recognised that because, when those opposite tried to abolish it when they went to the people in 1993, the people said, `No thanks. We want Medicare and we don't want you and a GST.' On the last occasion, of course, he promised to maintain Medicare, but the government have done anything but.

Let us look briefly at what the government have done to the public hospital system in the 2½ short years they have been in office. I remind the Senate and the people of Australia that it was a Labor government back in the mid-1970s that established Medicare, then known as Medibank. It was Malcolm Fraser, as Prime Minister, and John Howard as Treasurer in the Fraser government, that abolished Medibank. It was not until 1983 that Medicare was restored under a Labor government. When we came to office in 1983, over two million Australians were uninsured. That was the legacy of the Fraser-Howard years—two million Australians without health insurance.

The Minister for Aboriginal and Torres Strait Islander Affairs (Senator Herron), who is in the chamber, may get up again this evening and tell us about the declining levels of health insurance and what happened under the Labor government when it was in power for 13 years. Let us go back to the beginning of our period of office in 1983. We remember that two million Australians had no private health insurance coverage at all. There was no national universal scheme of health insurance for them. We established Medicare to protect ordinary working Australians and their families, to give them a guaranteed access to the best quality care in public hospitals that you can get anywhere in the world. That is still the case. Australia is the only country where people are guaranteed access to top quality medical and hospital care free of charge.

But this government, notwithstanding its solemn promise by the Prime Minister, has systematically tried to undermine our public health system. Over the last 12 months or so we have seen this disgraceful circus, if you like, of the Minister for Health and Family Services sitting down, supposedly, to negotiate with the states. But he has never set out to negotiate with the states on Medicare. He put an offer on the table and for months refused to revise it, notwithstanding the genuine arguments that were put by all the states and territories.

I remind the Senate that of all those states and territories only one of them was a Labor state, and that was New South Wales. Dr Wooldridge's own coalition colleagues in the states, those that are in charge of managing the hospital system and delivering health services, were telling this government that its proposals on new Medicare agreements were totally inadequate. But Dr Wooldridge refused to listen. He treated the state health ministers essentially as if they were irrelevant. He said it was a take it or leave it offer.

Eventually, at the Premiers Conference this year, there was the unique situation—it had never occurred in the history of this country—of all the state premiers walking out because of the Prime Minister's refusal to sit down and genuinely negotiate on the Medicare agreements. The Prime Minister dismissed that as a little sideshow walkout. It was not that; it was a genuine demonstration by all the state premiers and territory leaders that they did not accept this government's record on health and they wanted a proper opportunity to sit down and negotiate.

Still today, with one day left of the current five-year Medicare agreements before they expire on 30 June, we have the situation where all the states and the Northern Territory—with the exception of the ACT and Queensland—have still not signed the proposed Medicare agreements. I have made a mistake and should correct the record. They are not to be called Medicare agreements any more. This government proposes to change the name to health care agreements. Maybe I am cynical and should not read too much into that, but it is an interesting observation, is it not? They are changing what for years have been called the Medicare agreements to the proposed health care agreements with the states.

As I have said, all the states—except Queensland and the ACT—are still refusing to sign the proposed agreements. We know why the ACT and Queensland signed. The then coalition leaders in the ACT and Queensland were coming up to an election and they hurriedly signed the agreements. They were bought off with the bribe of some extra funds if they signed. I am sure the new Queensland Labor government will be in there reiterating the point properly on behalf of the Queensland people, not like the previous Premier, Mr Borbidge, who thumped the table and said he was going to stand up for the rights of Queenslanders for a decent health system and then crawled off and signed an agreement as quickly as he could because he was a little concerned about his election. It did not help him.

The states are still making it very clear to the government that this current offer is inadequate. Let me just go to what the states are saying, because it is important to have this on the record. This is an issue notwithstanding the fact that this legislation will be passed tonight because we as an opposition—despite all of our concerns with the current situation and with the current impasse in the negotiations—are not prepared to see funding denied to the states from tomorrow onwards to be able to continue to operate their public health systems. This is what the Hon. Kevin Prince, the Western Australian Minister for Health said when he gave evidence to the Senate Community Affairs Legislation Committee. When talking about the negotiations with the Commonwealth he stated:

As far as the Medicare funding offer is concerned, the joint bid by the states is well justified. The current offer—as my colleague Mr Knowles has said—

Mr Knowles being the Victorian health minister—

is vastly inadequate for a whole series of reasons. And some of the claims that have been made about the offer are, frankly, misleading. What Mr Knowles has not discussed is how the Commonwealth offer would impact differently on different states. Under the most generous interpretation of the offer that was put on the table on 19 December last year, which has been reiterated this year, my state will actually receive $149 million less in hospital funding grants over the next five years than if the current Medicare agreement between the Commonwealth and Western Australia continued. There is no way that I can agree to that; it is simply not possible. One hundred and forty-nine million dollars less is not on when we have—and everybody knows that we have—this huge increase in demand that is trending upwards.

If I can also quote what Peter McKay, the Tasmanian Minister for Community and Health Services, stated:

We find the current Medicare negotiations frustrating. I think probably best described as belittling. I think that the operation, as Dr Refshauge was saying, of the press media release type negotiation is astounding. I never cease to be amazed about how they can utilise this one-off funding of $120 million to try and get us to sign up to an agreement that would devastate our hospital system over the new five year agreement. It depends on which press release you read from the Commonwealth as to whether it is $4 million or $9 million. Today it was $9 million from Dr Wooldridge as far as what the state was entitled to. Not long ago it was only $4 million, so it has changed a little bit in that time. But that relates to something like about nine days of operation for our hospitals. Our hospitals cost around about $350 million to run acute care in Tasmania so it is roughly $1 million a day. He—

that is, Dr Wooldridge—

is trying to make us sign up to an agreement that gives us nine days of paradise and five years of absolute bloody hell. I really think that I am not that encouraged to sign.

To summarise, Mr Knowles stated to the inquiry:

Further consultation is required between the Commonwealth and the states to develop a partnership approach to delivery of health care and to agree on the appropriate way to embody that approach in the legislation and agreement.

So what has happened? We have a situation, as I just outlined, where the states are vehemently opposed to the current Commonwealth offer. It is not only grossly inadequate in funding terms but there is also a whole range of other issues that still have to be resolved, including the final terms of the agreement.

It is clear that, notwithstanding the threats from the Prime Minister and the current minister for health and the attempted bribes to get them to sign early, the states are not going to be swayed. So we reach a position tomorrow where the current five-year Medicare agreements expire. That is an intolerable position. We also have a situation where the government, because of its own inadequacies in terms of managing its program through this place, is here tonight endeavouring to have this legislation carried by the parliament.

While we in the opposition do not oppose passage of the Health Care (Appropriation) Bill 1998 , we do have some concerns with it. Because of the impasse where there are no Medicare agreements renegotiated, there is still a necessity for the Commonwealth to appropriate money so that it can legally pay the states to continue to be able to fund the public health system—that is what this legislation sets out to do. Whilst we are very concerned that the legislation is being put through the parliament without the accompanying agreements having been signed off, we nevertheless cannot stand by and see the states being denied funds from tomorrow onwards.

I will quickly deal with some of the opposition's concerns with the legislation. Firstly, clause 4(3) of the bill notes that the total amount paid by way of financial assistance under this section, which concerns the grants to the states, must not exceed an amount of $29,655,056,000. One of the concerns we have—and I would be interested to hear the minister deal with this in his concluding remarks—is that the Prime Minister has promised the states that, for every one per cent fall in the level of private health insurance coverage within a state, their funding under the proposed health care agreements under this legislation would be increased accordingly so that a state would not suffer a disadvantage financially by virtue of a drop in the level of private health insurance. We have a major concern that, because the amount prescribed in this bill to be appropriated is capped at that level, it does not allow for any adjustment in the level of payments for the states if there is a further drop in private health insurance coverage. Given the way this government's private health insurance rebate scheme is going, one can only anticipate a further drop in the level of private health insurance coverage.

Another point that we wish to raise is with respect to the definitions in the Medicare principles. The changes that are noted in this legislation compared with the existing principles are indeed of major concern and, again, I would invite the minister to respond to these concerns in his reply. The current Medicare principle 1 states:

Eligible persons must be given the choice to receive public hospital services free of charge as public patients.

That has been changed in this bill to read:

Eligible persons are to be given the choice to receive, free of charge as public patients, health and emergency services of a kind or kinds that are currently, or were historically, provided by hospitals.

There is no definition of what is meant by `services of a kind or kinds that are currently, or were historically, provided by hospitals'. In fact, we cannot think of anything that would not come into that definition, but we would appreciate some clarification. Interpreted strictly and literally, that principle, and indeed the next two principles which I will come to in a moment, could well mean that no state would ever be able to fully comply with these principles because of the sheer impossibility of the literal interpretation. Under this bill, the minister has full discretion as to whether to pay funds to a state or not.

In principle 2 there is a change such as to refer to what is called a clinically appropriate period—that is, that access to services must be available within a clinically appropriate period. That could almost be one that could be an impossible definition to meet. Thirdly, there is a reference in principle 3 whereby equitable access has to be available to all eligible persons regardless of their geographic location. Again, one can consider that that may have put undue burdens on the state public health system. (Time expired)