Senator LEES (1:47 PM) —Today I want to stress my disappointment in the section of the budget that covers health spending, that deals with the health of Australians. It is not just what is there; it is also what was left out and what has not been done. This government prides itself on its supposed ability to manage finances, yet it has failed to tackle the waste entrenched in the way we deliver our health services and has committed us to wasting billions more of our scarce resources.

After many weeks of speculation, leaks and more leaks, the government announced last night in the budget that it will indeed demand that consumers pay the price for its own poor health policy decisions. The government has announced that consumers of medications will pay for its priorities in other areas. Those on low incomes—in other words, those with a health care card—will be forced to pay $4.60 for each script. Everyone else will face a minimum of $28.60.

Eighty per cent of prescription drugs are purchased by health care card holders. These are the sickest and poorest people in our community. The Democrats do not accept that the sickest people should be punished simply because the government will not make fairer and more constructive changes. For some in the non-card holder category, the rise in the price of a script of a few dollars will not be a problem; they will shrug it off perhaps as an annoyance but it will not be a financial worry. For many, however, particularly families on low incomes who just missed out on the card, the extra cost will mean running up a debt with their chemist, waiting until pay day before a script is filled or simply not having the script filled at all.

The government's response to the rising costs of the PBS is naive and short sighted. It is under the mistaken impression that what they have done by hiking up the cost of scripts will save money. In fact, as research has shown us here and overseas, it will be more expensive for the system as a whole. Patients who stop taking medication because they can no longer afford it or simply do not get scripts filled will end up in our public hospital system—the most expensive part of the health sector. But that does not really matter to the Commonwealth as the states pay for that. So here we have yet another example of cost shifting, this time from the Commonwealth to the states and territories.

There are so many more sensible, more sustainable, more equitable ways of reining in health care costs, but the government simply does not want to see sense on the issue. It is trapped by ideology on the private health insurance rebate, and it is trapped by its preference for short-term quick fixes for the PBS. It would rather increase payments for medication to save $300 million in the next financial year than do what is fair and means test the private health insurance rebate to save over $1 billion.

To justify health cuts, we are fed the argument that we need money for border protection, but I argue that is just a furphy. This government's border protection policy will cost about $600 million in this financial year. Even if the large majority of Australians accept this as justifiable expenditure, it is nothing compared to the $2½ billion the government is wasting every year to prop up the private health insurance industry.

The private health insurance rebate is recognised by virtually every health economist in this country as being a crazy, inequitable and unsustainable health policy. I will not go into the details today of what we could actually do in our public system if we had that much money, or at least if we capped and means tested it, which would free up about $1 billion to $1½ billion. I will say this: the government owes an explanation to all low and middle income earners now worrying about how they are going to afford their next script. They deserve an explanation as to why people on over $200,000 are still going to get their gym shoes subsidised.

I want to focus today on making some recommendations to the government on how to contain the cost of the PBS without punishing the sick and without sacrificing patient care. It is not the answer to do as the government has done and subject doctors to even more red tape and more restrictions on prescribing. Instead, the government should relieve the pressure on GPs by placing restrictions on the marketing of new products by drug companies. The government has to crack down on pharmaceutical companies, and not increase the price of drugs for consumers. We have proposed an eight-week ban on the advertising of newly listed drugs, which will give the doctors the opportunity to access the information that they need and read it. That information should come from the National Prescribing Service. Or we can simply have a system where we have eight weeks between when a drug is approved and when it is actually listed.

We would also strongly recommend a total ban on the representatives of drug companies visiting doctors' surgeries and handing out free products, promotional materials, invitations to functions et cetera. Many individual doctors have complained to me about this. The Australian Divisions of General Practice, which now represents over 90 per cent of Australia's GPs, is also calling for changes. A press release from the Divisions of General Practice early this week stated:

Some may argue that it is unfair to restrict drug companies' access to doctors but I ask: is it fair to increase the price of medications for pensioners? The government has flagged programs to provide information to doctors on new and revised PBS listed medicines but it has left it up to the drug companies to do this. Why? Surely we should have the National Prescribing Service delivering the appropriate unbiased information. I also strongly recommend that the government's PBS review look into the concept of the `lifestyle script', used in Europe, which gives alternatives to just prescribing a drug. It offers advice on lifestyle issues such as diet, exercise et cetera.

The budget's increased copayment for PBS drugs is a knee-jerk reaction to a problem created by this government's own decisions and mismanagement. Last year's price blow-out was due to just two popular drugs: in one case because the government failed to ensure that there was a price-volume agreement, and in the other because extensive advertising resulted in soaring demand for the product. To conclude my brief comments on the PBS, I make one more suggestion about how to contain costs, and that is by putting more resources into services such as physiotherapy and psychology. If these services are not available, doctors are often forced to prescribe.

I turn to other issues. We welcome the additional access to oncology services in regional areas and also the money allocated for arthritis and macular degeneration. I have major concerns with the inadequate amount of money for Aboriginal health. We will not see the much needed boost in the health status of indigenous Australians with so little funding. I had hoped the government would use this budget to address a number of serious medical work force shortages—in particular, the shortage of GPs and nurses. There have been a few positives, particularly for aged care nurses, but much more needs to be done. In South Australia, just as one example, we have a shortage now of at least 500 nurses, and nationally the shortage runs into thousands. The worse the shortage becomes, the more pressure on the nurses in the system and the more likely that they will leave. I will not pre-empt any findings of our nursing inquiry but I must stress here that the Commonwealth has to take a lead in resolving this problem. From my reading of the budget papers, there are incentives for some 250 aged care nurses for rural Australia, but the universities get absolutely no funding for this.

Also, nowhere in the budget papers is there any extra funding for our universities to train more GPs. It is not a solution to simply pay doctors a little more if they will go to outer metropolitan or rural areas. We need more doctors. That is what the Access Economics report said recently. They estimate that the shortage is about 1,000 to 2,000 a year. They are looking at a shortfall of as many as 10,500 GPs by 2020 if the current trends continue. There was an enormous amount the government should and could have done in the budget to address that. Instead, we have a couple of bandaids that are not a long-term solution.

We need some government initiated research into a range of issues impacting on GP services. This includes work force distribution, remuneration, placement of GPs from other countries, working patterns of recent graduates and the ageing of the medical work force, particularly in rural Australia. In South Australia, with a nursing shortage of some 500, the GP shortage just in Adelaide is 60 full-time positions. We cannot continue to judge the number of doctors Australia needs on old-fashioned assumptions that most doctors are men and are happy to work 70 hours a week and more and be on call beyond that. As the Access Economics survey showed, female GPs are not prepared to even work the average. Many of them, with family responsibilities, are looking at trade-offs. Given that 57 per cent of our medical students are now female and that that figure is rising, the hours worked by doctors in the system must be given serious consideration. Overall, I stress that I am very disappointed in the government's health budget. The rhetoric about looking towards the future and preparing us for a health system that is sustainable in the long-term is a nonsense when you read the detail.