Mr ADAMS (5:15 PM) —The Health Legislation Amendment (Health Care Agreements) Bill 1998 deals with the new health care agreement between the Commonwealth and the states and territories, and will apply from 1 July 1998. It is a bit hollow, really, when the whole system seems to be under threat, first by the federal government and then by the states.

The original scheme was introduced in 1984 and brought Australia a new and national health care funding scheme. This was a system that provided universal access for all Australian residents to free or subsidised medical care and to free hospital treatment in public hospitals, irrespective of age, income or health status. It was a system that everyone could access. It was easy and it was funded from general taxation revenue, plus a levy on the taxable income of those who earned more than a certain basic amount. It has worked well and, since 1984, has enabled people of all ages and social backgrounds to have proper health care without having to pay up-front exorbitant fees, as occurs in some other countries such as the United States.

The only trouble is that it seems that the health share of the budget is dwindling. The government does not want to pay out what it collects through tax for health to the states. They would rather give it to the private insurance companies to back up their dwindling funds as people leave private insurance. Private companies have been shored up by $1.7 billion and this money has been ripped out of the public system with the abolition of the Commonwealth dental program, the $500 million lost from the pharmaceutical benefits fund and the closures of the Medicare offices around the country. Private health insurers are in business. They are in business to make a profit. I would suggest that health care is not something one should be making a profit from. It is the right of all citizens of Australia to have decent, affordable health care.

The conservatives of this country have been keen to get rid of the national scheme to try to move the whole thing back to the private sector. `User pays' is the old catchcry. This has been made only too clear in the latest round of the battle for Medicare. This is Medicare removal by stealth. Little by little, inch by inch the Prime Minister, Mr Howard, is moving to get rid of the scheme that has always been hated—Medicare, the fair way to deliver health to our community. He will deny it. He keeps promising Medicare will stay and then more money is ripped out. He is accusing the states of not maintaining their level of funding to hospitals while the Commonwealth is clearly taking away funds from the agreement. The states are no saints, as far as funding health is concerned, but what incentive is being offered to them to increase funds in the health budget if the government continues along the way it is going? Nice try, Mr Howard, but it will not wash. People are going to see through this little ploy and understand that it is Medicare itself that is under threat.

People are not getting treatment and the waiting lists are long because funding is not getting through to the people who need it. The blame must come back to the Prime Minister. Even the name of the Medicare agreement has changed: this is the Health Legislation Amendment (Health Care Agreements) Bill 1998 . It should be the Medicare agreement bill. Another sleight of hand is being perpetrated.

The amendment raised by the opposition is important because the government is placing Australia's world renowned health scheme in jeopardy by failing to achieve new Medicare agreements with the state and territory governments. It points out that the government is also misrepresenting its offer, which amounts to little more than double counting and putting back health funds that have been cut away in the first two Howard budgets, and, further, that it has failed to adequately consult with the states and territories regarding the provisions of this bill.

Of course, the people who suffer most by this sort of subterfuge are those in the rural and regional areas—families and the elderly, the very people that the Prime Minister is supposedly committed to helping. Country areas are smarting from the closure of 44 Medicare offices. They have suffered the closure of country hospitals and they are also losing the services of their local GPs.

What private companies are given an incentive to help those in the country? None. There is no clamour for the private sector to take up small country hospitals or to provide ongoing services. No, they are just closed and the people are forgotten about. They are saying, `Go into the cities. There are better services there.' But people have become marooned in the country, where there is no public transport and no assistance to get treatment regularly. They cannot move closer because they cannot afford the high housing costs in the cities and public housing is being gradually abolished, despite the fact that there are still long waiting queues—2,000 families last week in Tasmania.

An article in the Launceston Examiner on 24 March, by Alison Andrews, captures the feeling of those on the east coast of Tasmania in my electorate. They are distressed and disappointed by the closure of yet another service in a country town. She writes:

In today's Australia wide health crisis, St Marys must seem to them (State Health Services and Minister) like a tiny irritating pimple on a gigantic pumpkin of finance related hospital problems.

But that does not stop rural centres like St Marys all over Tasmania from feeling they've become invisible.

These people know that they are alive and kicking and trying to make a living for themselves and their families in the bush where they've chosen to live, but they must feel as though they have been punished for choosing fresh air, big backyards and home grown vegetables for their kids instead of living in the city that seem to be the only places where anybody can now afford to maintain services.

Country people on the whole are a self-reliant lot. They've proven that over the years by the hospitals, the churches and community halls they've built, the schools they've maintained and the big annual events like agricultural shows that they run.

They tell their kids that if they create something good, then it's worth fighting for and that hard work and straight talking is what pays off.

So it's bewildering and frustrating for country town people like those at St Marys to be told that something they believed was a necessary part of their lives has gone and no amount of hard work or straight talking will bring it back.

St Marys people built their hospital on land granted by one of the farmers in the district for that purpose and helped furnish and maintain it until it was acquired by the State Government at the start of the 1990s for about $2.

They have said that they are prepared to continue helping to operate a 24 hour a day seven day a week hospital to keep it open. They just cannot afford to do it all themselves. . .

. . . St Marys is not a rich community. Its people have been miners, shopkeepers and millworkers.

They fought their battle to keep their hospital as well as they could and no amount of talk about Tasmania wide and Australia wide health catastrophes will make them feel better now that they've lost.

This community's plea is from their hearts. They have lost their hospital and have been given lesser service in its place. With that they have lost their doctor and have been given a locum to fill his place until some magic state government can recruit someone who is prepared to work hideously long hours in this isolated area. That person probably will not receive any relief if they take up that practice.

Most doctors who work in country areas have come from overseas. Although they do an absolutely tremendous job, they are often forgotten by their own fraternity as well. It makes for a very stressful life, and therefore they have to say, `No, enough is enough,' after a certain period. Without a properly funded Medicare scheme, their job will be much harder.

Members might ask why I keep using St Marys as an example. St Marys is to Tasmania what Tasmania is to the mainland: an irritable pimple on the national stage. Tasmania has a small population but it is widely scattered, as most of its job creating industries are resourced based. St Marys, for example, is coal, timber and farming based. The tax gleaned from these resources is quite considerable, but none of it appears to be being filtered back into this community.

The state government has been insisting on massive cuts to costs in the hospital system. The unions have tried to be as cooperative as possible, but between 4,000 and 4,500 jobs have been lost in the Tasmanian hospital system throughout the last few years. This has probably helped a debt reduction program in the state Treasury, but it has cut the services to near unsustainable levels throughout the state.

Another debt reduction measure that has been undertaken is that all aged care centres have been privatised in Tasmania. Benchmarking has taken place on all the support services, and they have been narrowed down to the minimum cost. But morale is very low because of the difficulties staff are having with such reductions and how much the funding has been cut. Health and Community Services Union members were surveyed, and the biggest concerns they have are job security and also being able to provide a quality service to the people they look after—both now under considerable stress because of the Howard government. So don't try to tell me that the scheme has been wasteful. Don't try to hoodwink the public that they will be getting a better service by cutting funds to Medicare. That is not true.

We have to have an agreement. This one expires on 30 June, and it is vital that it be renewed. Of course, Labor supports that concept. But there has to be some flexibility to allow the states to put their case. There has to be recognition of the cuts that have been made and there has to be additional funding, not just bringing the situation back to the status quo.

There are people out there who need to be assisted. While all the arguments continue to go on, patients are not being treated. Health is a priority for many of my constituents. They have a right to the best possible care, and that will be provided by Medicare. The government must find more money for public hospitals to assist the public hospital system to continue to carry out the work that they are there for.

The Howard government withdrew considerable amounts of money from the hospital system in its first two budgets. Of the $1.7 billion that it gave to the private health insurance system, $800 million came from public hospitals, $400 million from dental services and $500 million from the pharmaceutical benefits fund in the first budget. This government needs to replace that sort of money in the public health system, especially in the public hospital system, so that people can be covered. It needs to live up to its promises to protect Medicare and to put the money into Medicare that it needs to service the people of Australia. I support the amendments moved by the shadow minister.