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Thursday, 2 December 2004
Page: 121


Senator FORSHAW (5:09 PM) —It is not my intention to speak for long in this debate on the Health Insurance Amendment (100% Medicare Rebate and Other Measures) Bill 2004 today. Firstly, as has been made clear, the opposition is supporting the thrust of this bill. Secondly, my colleagues, particularly Senator McLucas and Senator Bishop, have outlined in some detail a range of issues that relate to the whole question of this government's approach to Medicare over a number of years since it has been in government. I cannot let the opportunity pass, Madam Acting Deputy President Moore, without saying a few words. In this chamber I like you have taken an interest in those issues and, as a member of the Senate Select Committee on Medicare, we had the opportunity to hear first-hand from people right across the community—practitioners, the specialist services, members of the community, health interest groups and a range of others—about the problems they saw with the government's approach to Medicare.

However, I must first respond to what has just been put by Senator Nettle on behalf of the Greens. There was an invitation there to join the Greens—I can tell you that is something I will not be doing—but also there was a criticism of the Labor Party for having put a position during the election campaign when we released our policy of increasing the Medicare rebate to 100 per cent of the schedule fee where doctors bulk-billed and that we are now supporting this measure of the government to extend the impact of the increase for the rebate of the schedule fee to 100 per cent for both patients who are bulk-billed and patients who pay up-front and then claim the rebate back from Medicare. Senator Nettle had a bit of a go at us for doing that, and then right at the end she said the Greens are actually supporting the bill. I continue to be amazed sometimes at the contortions that the Greens go through.

This bill does not address the fundamental problems that now exist with Medicare in respect of bulk-billing. This bill, as we know, increases the rebate to 100 per cent of the schedule fee for GP services. That amounts to $4.60 on a standard GP consultation. But this bill does not do anything to increase the level of bulk-billing, and that is something that we have been talking about for a number of years as we have seen the rates of bulk-billing decline across this country, particularly in rural and regional areas. You can go to towns in all states where there is no doctor who bulk-bills, and I have been to places where doctors do not bulk-bill anyone, not even pensioners or concession card holders. I know of situations on the North Coast of New South Wales where concession card holders, health care card holders and pensioners may have to travel 50 or 60 kilometres to one of the major cities like Coffs Harbour, Grafton, Taree or Lismore to see if they can get a bulk-billing doctor.

This measure, whilst it is welcome in the sense that it will increase the amount of rebate for a doctor who is bulk-billing a patient and so the doctor will get some increase in his or her return, means that a patient who pays up-front when they go to the Medicare office to claim their rebate will also get an increase on what they are getting now. It does not do anything more. It does not encourage doctors to increase the number of patients that they might bulk-bill, and it is certainly not going to encourage a doctor who does not bulk-bill to suddenly start bulk-billing. Why would you if you were a GP who is currently charging $50 up-front for a standard consultation? If you bulk-billed you would get $25 back. Many of the doctors have said that is not a sufficient return today, so they will not bulk-bill. They will charge the $50 up-front and allow the patient to claim the rebate. If the difference is that a rebate of $25.60 will go to $30 or thereabouts, how many doctors are going to say, `Yes, for that extra $5 I am suddenly going to change the whole nature of my practice and bulk-bill'? They are just not going to do it.

As you know, Madam Acting Deputy President Moore, as a member of the Senate Select Committee on Medicare, the legitimate complaint of GPs is that they have to charge fees commensurate to their practice costs, which have increased dramatically in recent years. There are a whole lot of reasons for that, technology being one, compliance costs being another. But the schedule fee has not kept pace with GPs' costs. It just has not, and we know that. That is the major problem in this whole debate. GPs believe—and I agree with them—that the schedule fee is well below what they charge. This proposal does nothing about that. We had a policy we put to the people which would have increased doctors' incomes, particularly in areas where the rate of bulk-billing is low. Our policy would have increased doctors' incomes by substantial amounts per year—in excess of $25,000 in some cases.



Senator FORSHAW —Senator McGauran says he does not remember them. Senator McGauran, you obviously have not been paying attention. We had that policy and your party attacked us for it. We were trying to help GPs—small business men. We were trying to help these doctors and your party rejected our ideas.


Senator McGauran —Why don't you help the patients?


Senator FORSHAW —That would have helped the patients, Senator McGauran, because the patients would have been more likely to have been bulk-billed under those arrangements than they will be under these arrangements. This policy, this proposal, is not going to do anything to increase rates of bulk-billing.

Another problem is that it does not do anything at all about specialist fees. We know that specialists by and large do not bulk-bill at all—or, if they do, they only bulk-bill concession card or health card holders—and the fees that specialists charge are obviously much, much higher. This is one of the major reasons why the government brought in its scheme to cover out-of-pocket costs. There has been nothing done by this government to try and assist people to be bulk-billed by specialists. It has just been ignored.

In an excellent speech by Senator Allison, where she went through some of the details of earlier proposals to reform Medicare or to supposedly improve Medicare or, as it was said at the time, to make it fairer, she referred to the proposal to allow the private health insurance industry to provide gap insurance for out-of-pocket hospital costs. That proposal just did not fly. Everyone rejected that, except the private health companies of course, and we saw the demise of Senator Patterson as the minister. She lost her portfolio and it has now gone to Mr Abbott.

The approach of this government all along has been to try and wean people away from Medicare by propping up private health insurance. They make no bones about that. What they do, however, is try and say that they are really defenders of Medicare. It is all on the record. I have said it many times and so have many others. The government and this Prime Minister have had an ideological obsession with opposing Medicare since it was introduced by the Hawke government. They have tried every way possible to undermine it, to even abolish it. They said they would get rid of it. The only time they have ever been honest about Medicare was when Mr Howard said to the Australian public, `We will get rid of Medicare,' and the coalition did not win that election in 1993, or earlier elections either. You got beaten because the people were never going to cop it. So you knew that in order to crawl your way back into office you had to put Medicare in the bottom drawer and say, `We actually support Medicare,' and now that you are in office you have done very little to sustain it. I am afraid that under this government, whilst you continue to just put forward these little measures—this one of course will be of benefit to some—at the end of the day the commitment is not really there. I will be looking with interest to see what happens to doctors charges and fees over the next 12 months.

What will happen, I predict, is that a lot of this increase in the rebate will not ultimately be passed on to the patient. They will ultimately just be met with higher fees. We have already been put on notice again by the private health insurance industry. Despite the 30 per cent rebate, despite the proposal by this government to increase the level of that rebate for older Australians, they are queuing up again to ask for more increases in premiums—another five, six or seven per cent. They have got their hand out every year. Thank God that the National Party are not in there, because they would probably be doing what they are doing in a few other areas. They would be just throwing the money back at them. I conclude with those remarks. We are supporting the bill, but this government cannot hold its head high at all when it comes to supporting Medicare.