Senator BUCKLAND (12:18 PM) —I rise to speak in this debate and join my colleagues in passing comment that the Health Legislation Amendment (Medicare) Bill 2003 before us is ill-conceived by the Howard government and certainly needs defeating. In considering the bill, we need to understand what Medicare is all about. It seems to me that the Howard government has lost sight of the fundamental principle of Medicare when introducing its safety net arrangements.

Medicare is the Commonwealth funded health insurance scheme that provides free or subsidised health care services to the Australian people. It is a universal health insurance scheme—at least it was intended to be—but the safety net arrangements proposed in this legislation take the universality out of it by categorising the population into two distinct groups: the less well-off and the not so well-off perhaps. I suppose there is a third group who are well-off and not too fussed by anything being proposed, but I tend to think they are in the minority. This seems an odd thing to do if the government is serious about maintaining a health insurance scheme whereby all Australians can access affordable health care no matter where they are, where they live or how much they earn. They are eligible for a universal rebate for the services they receive, they are able to benefit from free care in public hospitals and receive subsidised medicines through the PBS. Under this scheme, the very idea of access to affordable health care for all Australians goes out the window; all it does is create a series of winners and losers.

It is not my intention to reiterate and bore the Senate with what has already been said—it has been said very well by my colleagues. I was not part of the committee that inquired into this issue, but I give praise to Senator McLucas and her colleagues—from all sides—for the effort they put in. It is a shame that the government members could not join the majority report. Having not been a part of the committee, I relied heavily on the report and also, more importantly, on the evidence that was given before the committee. Much of it moved me to believe that some of it should be put on the record in this place. Some of the rhetoric does not match the reality of the proposed reforms.

This package does not strengthen Medicare as a universal entitlement; rather, it enhances the safety net provisions for people clocking up medical bills as a result of the chronic underfunding of the federal Medicare Benefits Schedule. It also confirms that the costs of medical practice are outstripping the Australian government's willingness to properly cover a visit to the doctor for everyone. It signals very clearly the government's preference for well-off people to pay more at the point of service, so that a defined group—children under 16 and people with concession cards—may attract an additional $5 per visit Medicare insurance entitlement and thus have a slightly better chance of being bulk-billed. They have a slightly better chance—it is not a guarantee.

There appear to be some major assumptions underpinning the MedicarePlus package. Firstly, there is the assumption that many people will pay more to see a GP. Only concession card holders and young children are the targets for bulk-billing. In other words, the government is content that nearly half of all GP patients will have little hope of being bulk-billed. In the mind of the Australian government, this is obviously acceptable public policy. What I have just said comes from the Catholic Health Australia submission. It is one that I would encourage all members of the Senate to pay attention to, along with all of the other very fine submissions. The reason I think it is important for people like me to rely on the evidence is that the people making these submissions—the welfare groups and the individuals—are the people who are experiencing the difficulties of health care day by day and hour by hour. They experience these difficulties 24 hours a day.

GPs will only be able to sustain bulk-billing at its current rate of remuneration by seeing more patients for shorter consultations. This is another observation from that same submission, and isn't it right? I am a very fortunate person, and so are the members of my family. We rarely need to see a doctor, but that could change at any time. In fact, last year was the first time in four years that I have been to see a doctor. I took sick here in Canberra with the flu because of the weather. I am blessed in that I do not need to continually use the services of a GP. Many times doctors are putting people through as quickly as they can, sometimes simply to maintain some level of service but also to keep the level of income up. I do not know if that is greed based. I do not know if it is because there are so many sick who cannot access doctors, particularly in rural areas, where there are not sufficient doctors. That is not an aspersion on doctors at all. Indeed, I have spoken with many doctors in rural areas who felt this need to push patients through as quickly as they could. It is endemic within our community now that we have insufficient doctors able to continue practising in rural areas. The government should do a lot more about it, rather than just talk about it.

There are people on concession cards who have better means than average working families. The many people who are in the work force and do not have concession cards, but do have families, mortgages and responsibility for someone who suffers an illness, are the ones who will lose out under the proposed legislation before us. They will lose out. They can be earning but they will be no better off than concession card holders or those who fall into the safety net area that the government says will be covered. The committee report found that the key objective of any health safety net is the minimisation of hardship resulting from incurring medical costs. This often involves the identification of those in the community who are economically disadvantaged and/or those who incur above average medical expenses. In assessing the proposed new safety nets, it is important to establish the situation as it presently exists. The rationale behind the current safety net system was explained to the committee by Professor Deeble. Professor Deeble said:

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These are people who are out there every day dealing with the problem we have in our health care system. The report goes on to say:

It does not matter where you go in this report or where you go in the evidence that came before the committee, everyone is saying that what is being proposed in relation to the safety net by this government is not right. It is wrong and it needs to be rethought. As I said earlier, one of the principles of Medicare is equity—something for all Australians. This is another way the government has found to divide the nation into different groupings. On the point of equity the report says:

That was pointed out in the Country Womens Association submission. I will not quote the full text of that but I would encourage senators to read that part of the submission dealing with equity. The Liquor, Hospitality and Miscellaneous Union made a similar case. Again, without going into too much detail of that, reflecting the same view they said:

this time not the working poor but the forgotten Australians—

not those on benefits, but those who are commonly called the working poor. The same problem was gone into in great detail by ACOSS, a respected organisation in many different areas. ACOSS said:

So it goes on. The Geelong and Region Trades and Labour Council made a submission along the same lines as did the Council on the Ageing, which said that illogical differences would emerge:

These are the people who are missed out and suffer from this ill-conceived proposed legislation. Many of the submissions saw this whole proposal as being ill-considered. The Uniting Church called it `illogical and unrealistic'. Catholic Health Australia, which I made reference to earlier on, made the point that there `are people with concession cards who have better means than average working families.' The Doctors Reform Society concluded:

It does not matter who you talk to or where you go, we find real difficulties confronting us with this bill.

There are other parts of this bill that would be worth exploring if time allowed and at some time we may do that. The submission that touched me more than any—and I suppose knowing the author made it seem a little bit closer—was from the St Vincent de Paul Society. On the safety net it reads:

That is, there are 4.6 million people we have missed out. It continues:

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