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Thursday, 11 March 2004
Page: 21345


Senator CHERRY (10:56 AM) —I want to take issue with something Senator Nettle said. She was quoting Malcolm Farr in this morning's Daily Telegraph, who said that if you elect an Independent senator you are going to do really well based on this deal. I have to commend Senator Harradine on the exceptionally good deal that Tasmania has got, but I disagree with the view that Queensland is getting a very good deal out of this package, because it is not.

The minister's press release makes it clear that the new bulk-billing incentive of $7.50 per consultation will be available for RRMA 3 to 7. That excludes towns with a population of greater than 100,000 people. In my state of Queensland, that excludes Brisbane, the Gold Coast, the Sunshine Coast and Townsville. I have just come from a radio interview with Peter Lindsay, the federal member for Herbert. Apparently, he is marching straight into Brendan Nelson's office as we speak to ask why Townsville is not included in the bulk-billing incentive scheme. That is very interesting because Townsville's bulk-billing rate in 2003 for the federal seat of Herbert was 61 per cent. The bulk-billing rate for Cairns was 75.9 per cent. The bulk-billing rate for Mackay was 63.6 per cent. We now have the anomaly that Townsville, which has a lower bulk-billing rate than Cairns and Mackay, is going to get a lower incentive for its doctors to bulk-bill. What is going to happen in Townsville? Townsville's bulk-billing rate is going to fall further.

In the metropolitan areas of Brisbane, in the southern part of Queensland, we have seen the biggest fall in bulk-billing rates for any part of Australia. Let me read through some of them—particularly for the benefit of the Liberal members in the other chamber—because they are all marginal Liberal seats. In Dickson the bulk-billing rate has fallen by 30 per cent in the last three years and now sits at 48 per cent. In Petrie it has fallen by 30 per cent and now sits at 57 per cent. In Griffith it has fallen by 28 per cent. In Fisher, up on the Sunshine Coast, it has fallen by 27 per cent. In Fairfax, also up on the Sunshine Coast, it is down 22 per cent. In Ryan, the electorate where I live, it is down by 25 per cent to 49 per cent.

This package and the concessions negotiated overnight do nothing for metropolitan Brisbane. They do nothing for the Sunshine Coast. It might surprise senators to know that the Sunshine Coast is a socioeconomically poor part of Queensland, because so many lower income people and unemployed people live there. This package and the concessions do nothing for that area, which has had one of the biggest falls in bulk-billing rates in Australia. The package does nothing for Newcastle—which, whilst not in my state, I visit regularly—where there have been some of the biggest falls in bulk-billing rates in Australia. In the electorate of Shortland the bulk-billing rate has fallen from 76 per cent to 51 per cent in the last three years—a fall of 24.5 per cent. But these areas are excluded from the extra bulk-billing concession. This package provides a concession to a lot of places that do not need it.

Senator Campbell talked about the bulk-billing rate in regional Western Australia. He might be interested to know that in 2003 the bulk-billing rate in the seat of Pearce was around 70 per cent and in Kalgoorlie it was 61.3 per cent. However, the bulk-billing rate in Canning, which is in a metropolitan area, was 54.2 per cent. Now, 54.2 per cent is a lot lower than 70 per cent or 61.3 per cent; but Canning's residents are not getting an extra concession out of this deal—they are screwed. In my state, Brisbane, the Sunshine Coast, the Gold Coast and Townsville—the poor, struggling federal member who represents Townsville is likely to become the ex-federal member soon—are screwed as well. I disagree strongly with Senator Nettle's view that Queensland has done well out of this. We have had the biggest fall in bulk-billing rates of any state in Australia over the last three years, yet we are being comprehensively screwed in this package.

There is not a single new concession in this package, negotiated overnight, to actually fix the bulk-billing rate in Queensland. All we will have to rely on is the $5 in the original MedicarePlus package which was to go to the bulk-billing of children, pensioners and concession card holders. That means doctors will simply stop bulk-billing other patients. The maximum bulk-billing rate in Queensland—assuming all of those patients are bulk-billed—is probably about 60 per cent, which is lower than the 67 per cent bulk-billing rate that we have now. That really worries me because there are an awful lot of families in my home town of Brisbane who are not going to be able to afford to pay the gap fees. This is rapidly becoming more prevalent across the Brisbane metropolitan area. It is quite clear that the concessions negotiated overnight are not going to do enough to bring those bulk-billing rates back up.

I am very disappointed in this deal. There were apparently two packages in the health minister's in-tray last week: there was one from the Democrats and there was one from the Independents. The Democrats' package, replicating an element of Labor Party policy, would have provided a bulk-billing incentive to every doctor who reached an agreed target—we were looking at a target of around the 75 per cent or 80 per cent mark. It would have ensured that those doctors doing the right thing, regardless of where they were, actually had an incentive to bulk-bill. The government would have been saying to doctors: `It's not just the worthy poor that are worthy of a concession. If you do the right thing and are universal in your bulk-billing approach, then we'll look after you.' That would have provided a much stronger floor to the bulk-billing rates in Australia than only providing extra incentives to bulk-bill concession card holders, under 16-year-olds and pensioners. It certainly would have provided a much stronger floor in the areas where the bulk-billing concessions are needed rather than simply giving it to country areas. I will be interested to see how Senator Harris defends carving out the Gold Coast, the Sunshine Coast, Townsville and Brisbane from the bulk-billing concession he has negotiated. The alternative package in the health minister's in-tray would not have carved out those areas.

I want to deal with the anomaly of Hobart. I commend Senator Harradine on his negotiation skills, because the bulk-billing rates in Hobart are 51.5 per cent for Franklin and 47.4 per cent for Denison. It is the only one of the RRMA 2 towns in Australia included in the bulk-billing concession package. But if you go to a town we all know very well, a town called Canberra, you find that the bulk-billing rate is 35 per cent in Bob McMullan's Fraser electorate. Tony Abbott argues that Hobart needs an incentive because its bulk-billing rates are so low, so why doesn't that apply to Canberra as well? Importantly, why doesn't it apply to Newcastle, where the bulk-billing rates in Shortland, Hunter and Paterson are similar to the bulk-billing rates in Hobart? Why doesn't it apply to those areas in Brisbane, such as the electorate of Dixon—based on the Pine River shire on the northern side of Brisbane—which have a bulk-billing rate of less than 50 per cent? Why doesn't it apply to those areas of suburban Adelaide, such as the federal electorates of Boothby, Mayo and Sturt, which have bulk-billing rates similar to or lower than those of Hobart? I am disappointed in Senator Lees. She usually does her homework, but in this particular case she has forgotten to do her homework on her own backyard of suburban Adelaide.

These are the sorts of issues that the chamber needs to tease out in this debate. The Hobart anomaly is going to be something that we will all have to look at because the justification given by the health minister for the Hobart anomaly does not stack up when you look at the bulk-billing rates. This debate should be about the universality of Medicare, as Senator Evans and the Democrats have always said in this debate; it should be about making sure that Medicare provides a universal safety net for all Australians who need access to health care. It should not be about dividing the population into the worthy poor and the rest. Yet this package—the bulk-billing incentives which are being negotiated and the two-tier safety net which we now debating—actually does that. If we had a decent safety net, if we had a decent incentive program on bulk-billing rates, the safety net would not be as necessary as it is. That is the argument that has been put by the public health alliance around Australia for a very long time. But in this package the safety net will become more and more necessary because bulk-billing rates will continue to fall. The 30 per cent fall in suburban Brisbane will accelerate over the next year or two because there is not enough in this package to encourage doctors in Brisbane to bulk-bill—in fact, there is no extra incentive to bulk-bill. As a result, we will put more pressure on the safety net. The two-tier approach will undermine the universality of Medicare, which has been a cornerstone of our health policy in this country for 20 years.

I am very disappointed with this deal. I thought that, given the Senate committee report and all the evidence that was available to the rest of the crossbench, the government and the Independents would understand these arguments. Unfortunately, with the exception of Senator Harradine, who has done very well for Tasmania, we have a package which leaves metropolitan Australia and the large towns of the Sunshine Coast, the Gold Coast, Townsville, Wollongong, Newcastle, Canberra and Geelong comprehensively screwed. It is very unfortunate and very disappointing. This package is going to put back Medicare and it will probably be the most retrogressive step in Medicare's 20-year history.