Mr LEE (4:27 PM) —After that, is it any wonder the Australian people have so many concerns about the changes that this government is making in all sorts of social policy areas? It is quite clear that the legislation which is before the House at the moment, the Health Legislation Amendment (Health Care Agreements) Bill 1998 , is an attempt by this government to go one step forward with its ideological agenda for funding for the Australian public hospital system.

Before I address the detail of the bill, it is quite clear that the government's agenda on health care fits in with its broader agenda in social policy right across the broad spectrum. The government is seeking to cut back federal funding for the public hospital system. It is quite consistent in its cutbacks to federal funding for employment programs. We have the fiasco of the federal government cutting back federal funding for skillshare centres in the same way that it is cutting back federal funding for the public hospital system. In the Aged Care Amendment Bill that has just been debated, the government is cutting back federal funding for aged care for older Australians. My colleague the member for Werriwa (Mr Latham) has on many occasions outlined the government's agenda for cutting back federal funding for the public education system right around Australia.

In health, the government is not only attempting to cut back federal funding for the public hospital system but also squeezing the GP rebate, making it harder for ordinary GPs to continue to bulk-bill. As each day passes and this government squeezes that GP rebate, there is extra pressure on doctors to switch from bulk-billing to charging up-front fees. The government's cutbacks in federal funding subsidise the cost of essential medicines for ordinary Australians.

This piece of legislation is to provide a legislative underpinning for the next five-year Medicare agreements, those Medicare agreements between the Commonwealth and the state and territory governments to cover public hospital funding. The first thing we notice about this bill is that this government hates Medicare so much it cannot even stand to have the word `Medicare' in the name of the agreements. The government, of course, has had a long-term agenda to try to undermine Medicare by stealth. As one of the most petty examples of this government's hatred of Medicare, it has renamed the agreements. Instead of being `Medicare agreements' they are now `health care agreements'. There is nothing wrong with the description `health care agreements', but it is just another example of this government's pettiness and the lengths to which it will go to do all it can to distance itself from Medicare. Medicare was one of the greatest achievements of the Hawke Labor government and re-established universal health insurance, which was put in place by the Whitlam Labor government and was one of the great achievements of that short period of government. This government so hates Medicare, it so hates universal health insurance, that it cannot even bear to have the word `Medicare' in the title of the federal-state agreement that provides the funds for our public hospital system.

The intention of this bill is to provide the Commonwealth with the power to enter those arrangements with the states. It outlines the principles and mechanisms which must be adhered to in order for the state and territory governments to continue to receive the funding. The federal funding for the public hospital system is an essential feature of Australia's Medicare system. The current arrangements will expire on 30 June 1998 and it is vital that these funding agreements are renewed. Labor supports the main elements of this bill which provide those essential legislative underpinnings of any new agreement.

Unfortunately, this government has placed at risk the achievement of new agreements. As we saw last week, every Premier and every Chief Minister, bar Kate Carnell from the ACT, walked out of the Premiers Conference over the meanness of the federal government's offer. We had the Prime Minister (Mr Howard) claiming that he said to the states that he was willing to continue talking to them but he was not willing to increase the financial offer to the states. He dismissed the states' walkout as childish because they were not prepared to continue talking to him. Mr Deputy Speaker, you can imagine if you were trying to sell your house to someone and they said that they were willing to enter into genuine negotiations as to what that price will be, but the person who was negotiating with you to buy your house said to you, `I am willing to keep talking to you but I am not willing to increase my financial offer.' There would not be much point in continuing any financial negotiations on that basis, but that is what this government and this Prime Minister and the Minister for Health and Family Services, the member for Chisholm (Dr Wooldridge), said to the states last Friday: we are willing to keep talking to you about the level of funding to our state public hospital system as long as there is no expectation that you will get an extra cent from the federal government to make the public hospital system work better.

Mr Fitzgibbon —Talk until you get the election out of the way.

Mr LEE —As my colleague the member for Hunter points out, this is purely a desperate attempt by this government to try to get the states and the territories to sign the Medicare agreements—a title by which we on this side of the House will continue to call the Medicare agreements. It is a desperate attempt by this government to have the Medicare agreements resolved before this government seeks to go to the people for the next election.

One of the crucial problems that this government is going to have to face is that during the short time it has been in office this minister and this Prime Minister have presided over a reduction in the federal funding for our public hospital system—a public hospital system that is already starting to feel the effects of federal and state cutbacks over the last few years. The states will not accept the Commonwealth's offer for one simple reason: all it does is try to put back the money that the Howard government has slashed from health spending in its first two budgets. We have the Prime Minister claiming that the Commonwealth is offering an extra $2.9 billion over five years, yet when you go to the detail of the Commonwealth's offer it is quite clear that the Prime Minister is simply putting back the money that he slashed from public hospitals over the last two years. For example, $479 million of the Commonwealth's offer is for mental health and palliative care services. This is not new money; it is nothing more than agreeing to fund the existing services. These vital existing services are simply getting a continuation of funding, yet the Prime Minister claims that this is an increase of $479 million. It is just a con.

The rest of the offer does little more than restore funding which was cut in the Prime Minister's first budget in August 1996. It was a budget that slashed $800 million from the public hospital system, a budget that was probably the worst federal budget for the public hospital system in decades and a budget that meant that not only was $800 million slashed from the public hospital system but we had $400 million taken from the Commonwealth dental health program. So it is hardly surprising that the five conservative Premiers and the Northern Territory Chief Minister treated the Prime Minister and his health funding offer with the contempt that they deserved last Friday. Is it any wonder that they are determined to keep the pressure on this government to increase federal funding for our public hospital system.

Last Friday we had the Prime Minister claiming that the public hospital system is ticking over well and that there is no need for the federal government to increase its funding for our public hospital system. Today we have had a former Australian of the Year, Dr John Yu, and the former head of Westmead's new children's hospital in Sydney make the following comments. I quote Dr John Yu:

I am not sure how well briefed the Prime Minister is. I am certainly disappointed that Dr Wooldridge does not have a better understanding of what is happening.

Dr Yu went on to say:

Public hospitals deserve a better deal. There is really a crisis in the public hospital system. We are faced with the denial of treatment for things many of us would believe were the right of any Australian.

Hear, hear! That is what doctors right across Australia are saying today. They are saying that our public hospital system is in crisis because federal and state governments have not put in the additional money that our public hospital system needs.

If you talk to doctors who work for the Tasmanian public hospital system, they will tell you that there is a desperate need for additional funding in that state's public hospital system. I suspect the member for Bradfield (Dr Nelson) would have a better understanding than the minister for health, Dr Wooldridge, as to the serious nature of the crisis in our public hospital system. The minister for health must be the only doctor in Australia who thinks that our public hospital system has too much money. He is the only doctor in Australia who does not believe that federal and state governments, Liberal and Labor, should be putting more money into our public hospital system to make sure that ordinary Australians have a chance to receive the medical care that they need.

Let me give you a few examples from right across the country. In the Northern Territory, we have reports of a woman spending a night on a recliner chair after having surgery, because of inadequate funding for public hospitals in the Northern Territory. In Queensland, we have doctors misleading patients on the length of public hospital waiting lists in order to trick them into paying for private hospital treatment, because of the inadequate funding for public hospitals in Queensland. In Tasmania, there is no surgery after 5 p.m., even if you have already had the pre-operative medication, because of the inadequate federal funding for public hospitals in Tasmania.

In South Australia, we have a dying man who waits 24 hours in accident and emergency before he gets a bed, because of inadequate federal funding for South Australia's public hospital system. In Western Australia, the home state of the Leader of the Opposition (Mr Beazley), we have an 82-year-old woman with a fractured arm and a grazed eye who is turned away from regional hospitals because of the inadequate federal funding for her state's public hospital system.

Here in the ACT, where the Chief Minister has taken her 30 pieces of silver and signed up for a health care agreement that she knows will not provide enough federal funding for her public hospital system, we have the Canberra Hospital emergency department unable to cope with a 12 per cent increase in demand. In Victoria, one in two Victorians have lost faith in the public hospital system's ability to cope and think that resources are stretched too far to meet demand. That is the view of ordinary Victorians, because of inadequate federal funding for the Victorian public hospital system.

We have also had Dr John Yu's comments about the serious crisis facing the public hospital system in New South Wales. That is not because of any reductions in funding to the New South Wales hospital system by the Carr Labor government; in fact, under Dr Andrew Refshauge, the state minister for health, there has been a substantial increase in the state commitment to that state's public hospital system.

Mr Truss —Even you cannot believe that.

Mr LEE —I challenge the Minister for Customs and Consumer Affairs to get the figures. In fact, I will give the minister for customs a guarantee that I will send him a letter later today comparing the performance of the New South Wales Labor government with that of the Queensland coalition government on the level of increase in the state contributions to the public hospital system in New South Wales. I am sure he could learn something. Perhaps he could encourage his state to emulate the performance of the New South Wales government in state effort.

Despite the New South Wales government's efforts, they are still being hit by this government's unilateral federal funding cuts to public hospitals in New South Wales. So, despite the increased state funding effort in New South Wales, the federal funding cuts mean that they are even further behind the eight ball because of this government's dramatic cuts in federal funding for public hospitals right across the system.

One of our concerns is that the Prime Minister claims he has no extra money for public hospitals. He cannot increase the offer. Our criticism is that, before the last election, this government argued that the centrepiece of its health policy was one simple solution to every problem in Australia's health care system. The Prime Minister said before the last election that he would subsidise private health insurance to make health insurance cheaper. That would increase the membership of private health funds, and he said that would take the pressure off public hospitals. That was this Prime Minister's promise, in opposition, to address the crisis in our public hospitals.

What have we seen in the two years that the member for Bennelong has been the Prime Minister of Australia? Health insurance premiums are dearer, not cheaper. Health insurance premium increases have swallowed up the benefit of the tax rebate that this government has put in place. We have seen membership decline, not increase. If you look at this table, you will be distressed to see that the percentage of Australians who have private health insurance has continued to fall, despite the government spending $1.7 billion of taxpayers' money on the tax rebate. The announcement was back here at the start of this graph—on the left hand side—and it is almost a straight line. In fact it was a straight line almost going back into the days when the Labor government was in power. Yes, there was a fall in private health insurance coverage during the Labor years. It was a straight line during our days and it is a straight line today. The big difference is that this government has spent $1.7 billion on the health insurance tax rebate, and it is still a straight line.

Jeff Kennett was the first to recognise this. He said that the rebate was money down the drain. Richard Court said it was a dud. Your own Industry Commission inquiry said it was money that was not being spent efficiently to take the pressure off public hospitals. People like Keith Woollard of the AMA—which is not exactly a sub-branch of the Labor Party—are saying that if only you had spent that same amount of money directly on patient care you could have done something about the crisis in public hospitals. You could have done something about the cases that Dr John Yu raised this morning. If you had spent that same amount of money directly on patient care, we could certainly have assured the states last Friday that they would have had an extra $1.7 billion towards the federal-state agreement that has been wasted because of this government's failure to address the crisis in our public hospital system.

One of the other concerns we have is that, once again, with this legislation and this negotiating process we have an example of a minister for health who does not know what is going on or is unable to ensure that proper processes are followed. The legislation that is before the House today was not seen by the states until it was introduced into this House 13 days ago. Certainly the states tell us that they were not consulted. I challenge the Minister for Health and Family Services to dispute that if that is not the case, but the feedback that we get from Labor and Liberal state governments is that there was little consultation with the states about the content of this agreement, and there has been inadequate information provided to the states about what the Prime Minister's current offer is.

I will give you a good example. The Prime Minister and the minister for health were claiming yesterday that there was to be, under this agreement, an extra $750 million going into the state health system because of a new offer to transfer responsibility for veterans hospital services. The only information the states were given as part of that process was this piece of paper—a piece of paper which has less than a dozen words on it and less than 16 numbers. Less than a dozen words and less than 16 numbers, and that is meant to be how this minister and this government make a detailed offer to the states to give them an extra $750 million to look after veterans. How would you expect any state government to be able to make any sensible decision about whether veterans would get a fair deal from a dozen words and 16 numbers? A lot of the numbers are small numbers, too, so the states have every right to ask whether or not veterans would be worse off if they were to accept that particular element of this government's offer.

This is not the only situation where we have a stalemate between the federal government and the states on negotiations in this portfolio. We are still waiting for the conclusion of all the federal-state and federal-territory public health outcome funding agreements and the Aboriginal health framework agreements. The government is in just as much trouble in the negotiations over the Commonwealth-state disability agreements, as my colleague the member for Jagajaga (Ms Macklin) knows only too well—not to mention the Commonwealth-state housing agreements.

Two years ago they said that they would fix up the problem with cost shifting in the health care system. They were going to be the glory days. They were going to give the states control of the pharmaceutical benefits system. Do you remember that one? We were going to have eight pharmaceutical benefits systems right around the country. Different drugs would have been available to different people, depending on where they lived. If, like my father, you lived in Boundary Road at Tweed Heads, under Dr Wooldridge's proposed system you could get access to certain drugs on one side of Boundary Road, in New South Wales, and on the other side, living in Queensland, you could get access to different drugs. Is it any wonder that they dropped that scheme pretty quickly?

They were going to hand the pharmaceutical scheme over to the states. They were going to hand over HACC and all the aged care and community services to the states. There was even talk about the federal government opting out of the provision of public hospital funding, transferring all that responsibility to the states. What has happened to all that? How long is it since we have had a COAG meeting? It is probably no surprise that the Prime Minister is afraid to call a COAG meeting when he has as much trouble as he had last Friday in even holding a Premiers Conference.

Do you remember COAG? That was the regular meeting every six months when the heads of government would sit down and try to work out ways to make federalism work more smoothly, to get a better division of the responsibilities between the federal government and the states. This Prime Minister is too afraid and too timid to even call the Premiers and the Chief Ministers together to try to make any progress on these issues.

At the end of the day, the Premiers and Chief Ministers woke up to what this was all about. This was all about getting the states to do this government's dirty work. It was about getting the states to cut back the services available to ordinary Australians under the home and community care program. It was about getting the states to do this government's dirty work in cutting back access to essential medicines. It was about getting the states to do this government's dirty work in cutting back the public funding to our public hospital system.

One of the basic problems is that this Prime Minister is obsessed with private health insurance. One of the consequences of his obsession with private health insurance is that he is providing inadequate attention to the public hospital system. Whether or not we have private health insurance, if we are really sick we will be turning up at the public hospital system to make sure that we or our families are looked after.

It is this government's attempts to cut federal funding for public hospitals, for dental services and for pharmaceuticals that generated the $1.7 billion pot of gold that was used to subsidise private health insurance. The public health care programs were slashed to provide the tax rebate for private health insurance that has been a complete and utter flop. It has not made health insurance cheaper or attracted people back to private health insurance or taken the pressure off our public hospital systems. It will only be when this Prime Minister faces up to his responsibilities to provide adequate federal funding for our public hospital system that we will address these issues.

We have a certain track record from the Prime Minister on many of these issues. The old John Howard said, `Medicare has been an unmitigated disaster.' He said, `Radical surgery will need to be performed on Medicare.' The old John Howard said, `We'll pull Medicare right apart.' The old John Howard said, `Bulk-billing will be abolished.'

The new John Howard says he loves Medicare but has been forced to close 44 Medicare offices right around Australia. The new John Howard, the member for Bennelong, says he loves Medicare, but he has been forced by budgetary problems to squeeze the GP rebate that every day is forcing more and more GPs to switch from bulk-billing to charging up-front fees. The new John Howard says he loves Medicare, but he has been forced to slash federal funding to our public hospital system by $800 million. He claims that he loves Medicare, but he is going to do all he can to make sure that there is insufficient federal funding provided to the states and territories under the next Medicare agreement. Is it any wonder that Labor and Liberal Premiers and the Chief Minister of the Northern Territory left the room? Because this government is not prepared to meet its particular responsibilities, they walked out, after the shortest Premiers Conference in Australia's history.

This Health Legislation Amendment (Health Care Agreements) Bill 1998 will sink or swim, it will either deliver or fail to deliver to Australia's public hospital system, depending on how much money this government provides to the public hospital system. That figure will not be put into this legislation. That figure will depend on whether or not the federal government reaches agreements with the states and territories.

Labor accepts that this legislation has to pass, to make sure that, if there is an agreement finally negotiated, it is underpinned by legislation. That is why we are not going to oppose this legislation. Our great concern is that, because of the meanness of the offer and the incompetence of this minister and this government, today it looks like there will be no agreement between the Commonwealth and the states. One of our concerns is this: what is going to be the consequence if we get to 30 June and there is no agreement signed with Premiers such as Jeff Kennett and Rob Borbidge?

Mr Truss —Keep paying the money.

Mr LEE —The Minister for Customs and Consumer Affairs interjects across the table and says he will keep paying the money. The difficulty he faces is that, if there is no agreement signed with Jeff Kennett and the other states, then there is no obligation for those states to continue to provide public hospital treatment to their citizens free of charge. The agreement is the only thing that stands between conservative state governments and the introduction of new fees for public patients in public hospitals.

Maybe that is the real agenda of this government and this Prime Minister. They have set out, every step of the way, to undermine Medicare by stealth, by closing the Medicare offices, cutting the federal funding for public hospitals, abolishing the Commonwealth dental health program, cutting back access to essential medication and doing all they can to poke the Premiers in the eye and not reach and finalise an agreement with the states before 30 June. Maybe the real agenda of this government and this Prime Minister is to try to let Jeff Kennett, Rob Borbidge and, maybe, Dean Brown or John Olsen, be tempted by the possibility of introducing charges for public hospitals right across Australia.

The only thing that will stop that happening is this Prime Minister putting his name to a deal with the Premiers on another five-year Medicare agreement that prohibits those charges being introduced. You do not stop those charges being introduced by sending them a cheque once every year. Only those Medicare agreements will make sure that does not happen.

The bill is not all bad; in fact, the bill is essential if we are to make sure that there is legislation underpinning the agreement. The bill also allows for the creation of the Office of the Health Care Information Commissioner, which is to be a new cost-shifting policeman—or policewoman, as the case may be. The opposition believes that this initiative can only succeed if it is well resourced and has the support of the states and territories. The opposition welcomes this initiative as it clearly represents an admission that the arbitrary and unfair cost-shifting penalties which were imposed in the first Howard government were both unreasonable and unsustainable.

Under this government and this minister, figures were fiddled so that the only Labor state of the Commonwealth, New South Wales, copped more than half of the arbitrary $75 million a year funding cut for alleged cost shifting. Meanwhile, the mates of the member for Chisholm in Victoria were let off the hook, despite the fact that his own department's analysis showed that Victoria was the worst offender for cost shifting. Let us be honest about cost shifting. There is cost shifting by the states onto the Commonwealth, just as there is cost shifting from the Commonwealth onto the states. For every person who should be in an aged care facility, such as a nursing home, who cannot afford or cannot get admission to a nursing home and who stays in a public hospital, that is cost shifting from the Commonwealth onto the states.

This government's fiasco in aged care funding has meant that the cost shifting from the Commonwealth to the states, because of the aged care backlog, has increased. There is cost shifting at the individual hospital level because many area health boards and many individual hospitals know that the only way they can keep theatres open and nurses employed is to cost shift. But, if that is the only way they are going to keep hospitals open, how do you fix the problem of cost shifting by taking money off public hospitals? That is this government's proposal. They say that the way you fix cost shifting is to give the hospitals even less money to look after public patients. It is certainly to be hoped that the proposed new Health Care Information Commissioner will ensure that this government's attempt to impose those arbitrary cost-shifting penalties on states is treated a bit more dispassionately and does give the states a fairer go.

Whilst having doubts about some of the details of this bill, there can be no doubt that the legislation is needed as the foundation to underpin the new Medicare agreements. Therefore, the opposition is greatly concerned that this legislation has once again been rushed into the parliament at the eleventh hour. As I have said, it is a pretty common problem with this minister. As a result, we are not surprised to see that there is to be a government amendment to this bill, which appeared only a few hours ago. Notwithstanding our dissatisfaction with this minister's—and this government's—handling of the legislation, we recognise the importance of the bill. Therefore, we do not propose to vote against the legislation in the House.

However, we do propose to have this legislation referred to a Senate committee. We think that a Senate committee will have the ability to try to ensure that the legislation is examined very thoroughly—hopefully in a speedy and efficient manner. It will of course make sure that one of the most important federal-state agreements for the next five years is examined thoroughly and expeditiously by a Senate committee. It will give the states and territories an opportunity to have their case heard publicly, to be tested if necessary by government senators with questions. At the very least, it will make sure that this government is kept on its mettle on all of these issues.

We will also be seeking to move an amendment to this bill to restore the word `Medicare' in the name because we know how much you hate that word. We are determined to force you to vote here in this House to try to change the name in the bill from `health care agreements' back to `Medicare agreements'. In conclusion, my amendment seeks to ensure that there is a wide-ranging debate during the second reading, but does not seek to have the legislation amended. I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the Bill a second reading, the House is of the opinion that the Government:

(a) is placing Australia's world renowned health system in jeopardy by failing to achieve new Medicare Agreements with State and Territory governments;

(b) is misrepresenting its offer to the States and Territories which amounts to little more than double-counting and putting back health funding which has been cut in the first two Howard budgets; and

(c) has failed to adequately consult with the States and Territories regarding the provisions o this bill".

Mr SPEAKER —Is the amendment seconded?

Mr Melham —I second the amendment and reserve my right to speak.