Mr LEE (5:37 PM) —I have been saying for a while now that, as sure as night follows day, if this government is re-elected the member for Bennelong, the Prime Minister of Australia (Mr Howard) will axe Medicare. Tonight the axe hits another part of Medicare.

Mr Bartlett —How can you say that with a straight face?

Mr LEE —The member for Macquarie (Mr Bartlett) interjects and says, `How can you say that?' Tonight an axe wielded with David Foster like power will smash into the trunk of Medicare because in the next 90 minutes we will debate the Health Care (Appropriation) Bill 1998 , a bill which I believe is the beginning of the end of Medicare. It is the beginning of the end of Medicare because this bill means that, for the first time in Australia since Medicare was established, we will not have the five-year Medicare agreements with each of the states—the five-year guarantee that Medicare in public hospitals is there as the safety net for every public patient, wherever they may live, whatever their circumstances.

This is a $29 billion bill which pays for hospital services, and it represents the complete failure of the Howard government to reach Medicare agreements with the states. Apparently the Minister for Health and Family Services (Dr Wooldridge) can negotiate health care agreements with New Zealand and Ireland but cannot negotiate health care agreements with his own Liberal and National party colleagues in the states. He certainly cannot negotiate a Medicare agreement with the state of New South Wales.

The acting minister gave us a 20-line second reading speech for a bill that is to allocate $29 billion to the states. It is clear to anyone that this government does not care about public hospitals; public hospitals that serve two out of three Australians for most surgery and almost every Australian for emergency care. As we pointed out in the last couple of weeks, the budget provided not one extra dollar for public hospitals that was not on the table when the Premiers walked out of the Premiers Conference two months ago. It seems that this government has come to the conclusion that it does not want Medicare agreements. It hates Medicare so much that it cannot even stand to have the name `Medicare' in the title of this legislation. That is why we know that, if this government is re-elected, as sure as night follows day, this mob will axe Medicare. It wants to go to the election without having signed any Medicare agreements, and it wants to have a free hand afterwards. That should send a chill down the spine of every member of this House.

We have had a few indications lately about what the government really thinks about Medicare and public hospitals. On 21 May the Treasurer (Mr Costello) said that he thought people getting treatment in public hospitals was a problem. The Treasurer said that he thought a good public hospital system is some place where people who cannot afford to get medical care should go. That is not what we on this side of the House think of public hospitals. We think public hospitals are the safety net for Australians, no matter what their circumstances. It is the safety net that two-thirds of Australians are placing their faith in.

Mr Bartlett —It was one-third before you guys got into power.

Mr LEE —It is the government of which you are a member that has cut the federal funding for public hospitals by $800 million.

Mr Bartlett —That is rubbish.

Mr LEE —You go and talk to the people at the Blue Mountains hospital or the Nepean hospital or the Hawkesbury River hospital about the pressure that their hospital is under because of the federal cutbacks that your government has made. You come into this House and vote for cuts that have affected the hospitals in your own electorate, and you cannot walk away from your own personal responsibility for supporting these cuts in federal funding for public hospitals. That is why Maggie Deahm will be the next member for Macquarie. She will be re-elected as the member for Macquarie at the next election because you have failed in your responsibility to speak up for your constituents.

Mr DEPUTY SPEAKER (Mr Mossfield) —Order! I ask the member to direct his remarks through the chair.

Mr LEE —We on this side of the House believe that the government has a responsibility to make sure that the public hospital system is looking after those public patients. The Howard government wants to leave the way clear to impose up-front hospital charges at public hospitals if they get re-elected, and this bill allows them to do it. We are not prepared to let that happen, and we do not trust this minister to stop it. We will be moving an amendment to the bill in the consideration in detail stage to ensure that that cannot happen. I am quite happy for copies of that amendment to now be circulated in the chamber. I foreshadow that that amendment will be moved when we get to the consideration in detail stage.

If the government is not prepared to accept the amendment, they will have made it clear that their intention is to allow a re-elected Howard government to introduce compulsory charges for public patients in public hospitals. We know that the Prime Minister, the member for Bennelong, has always hated Medicare. We know it is something that he has always opposed. Let me remind the House of some of his most famous utterances on Medicare:

Medicare has been an unmitigated disaster . . . Radical surgery will be performed on Medicare . . . The second thing we'll do is get rid of the bulk-billing system. It's an absolute rort . . . We'll pull it right apart.

That is what the member for Bennelong said about Medicare.

Mr Truss —Was that 1985?

Mr LEE —It was only two weeks ago that Peter Costello said that he intends to re-engineer the health care system. We have the Prime Minister saying that he wants to pull it right apart—

Mr DEPUTY SPEAKER (Hon. N.M. Dondas) —Order! I would ask the honourable member for Dobell to direct his remarks through the chair, and I would ask the minister not to aggravate the honourable member for Dobell.

Mr LEE —Thank you for your protection, Mr Deputy Speaker. As recently as two weeks ago, we had the Treasurer saying that he would re-engineer the entire health care system. We had the Treasurer saying that he wants to introduce a system of no claim bonuses in private health insurance. In some way he thinks that human being's bodies are the same as motor vehicles. The elderly and the chronically ill are the greatest users of the health care system. They will be the ones hardest hit by the Treasurer's intention to introduce no claim bonuses into private health insurance.

At the end of the day this bill, in allocating $29 billion, is providing inadequate funding for the Australian public hospital system. It is not just the Labor Party that is saying that; the states in their submissions to the Senate inquiry into the Medicare agreement stated that 1.4 million patients are not funded over the five-year agreement of the offer. We have the AMA stating that it is quite clear that there will be a doubling in the waiting lists. Let me remind the House of what the AMA had to say. According to Dr Robert Hodge, one of the AMA's federal councillors:

Public hospital waiting lists will double in a few short years unless the Commonwealth dramatically lifts its funding offer . . .

He further stated:

If no more money is offered, hospital waiting lists will blow out and the quality of care doctors are able to provide will be compromised.

Some 116,000 Australians are on hospital waiting lists—this is likely to double over the next few years unless a better deal is struck.

Consultations with colleagues in all states over the past few weeks has demonstrated a deep and unprecedented level of concern among surgeons working in public hospitals.

People are waiting in corridors to get access to hospital beds, less and less elective surgery is being undertaken and teaching and research is being lost, particularly in out-patient departments.

So it is quite clear that the AMA has very serious concerns about the government's inadequate offer. We have a former leader of the Liberal Party, Dr John Hewson, completely dismissing the government's claims that this offer represents a 15 per cent increase in hospital funding. Dr Hewson was quoted on The World Today on 13 May as saying:

Well it's true, on the numbers there's a 15 per cent increase, but if you allow for things like population, if you allow for the aging of the population, if you allow for the service delivery considerations, that 15 per cent shrinks to 1 per cent, and that is why the states are screaming.

That is why public patients are going to be hurt by this government's inadequate federal funding for public hospitals. On the Face to Face program of 17 May we have the minister for health stating:

If you take age out; if you take population out; if you take any drop in private health insurance out; the increase is 1.5% per year, so that's 7.5% over 5 years . . .

We have the minister for health disputing the Prime Minister's claims that it is a 15 per cent increase. The minister for health pulls the rug out from underneath his own claims that this is a 15 per cent real offer. It is clear that the minister's press secretary winds the minister for health up every day and then sends him out for his doorstops. Is it any wonder that the minister is getting into so much trouble when we have comments such as this one reported by the ABC, who ran a story on Tuesday, 5 May, which stated:

The office of Federal Health Minister Michael Wooldridge now says that Government's patience may run out and it could change its offer of payment.

We have the health minister making it clear that one of the weapons he intends to use to bludgeon the states, to take the axe to Medicare, is to actually cut the amount which is currently out there on offer to each of the states. This is despite the fact that on 23 March the Prime Minister said:

. . . I make it very clear to the patients of Australia and to the public of Australia: you will not suffer because of the petulance of the Premiers—

this is when they walked out. He continued:

Every single dollar contained in the offer that we made will be delivered in full and on time.

The minister for health's press secretary winds him up like a sort of clockwork toy and sends him out. The minister for health and his office is out there saying that the offer to the states is going to be cut because this minister for health has lost patience with the states. So we have the press secretary to the minister for health overruling the Prime Minister's guarantee that every single dollar of the offer would be provided to the states.

One of our concerns is that this very bill does not comply with the Prime Minister's undertakings. We had the Prime Minister stating that every single dollar of that offer would be delivered. This bill does not meet the Prime Minister's offer. The Prime Minister said that the payments to the states would be indexed according to a whole number of factors, including declines in private health insurance. This bill is a lump sum each year. There is no indexation; the offer that the Prime Minister made that every single dollar would be provided to the states in full and on time is not provided for in this piece of legislation.

Someone is misleading the Australian people and someone is misleading the health ministers of each of the states and the territories. We know who that person is: it is the Prime Minister, John Howard, the member for Bennelong, who at the Premiers Conference said that every single dollar would be delivered. But the bill that has been introduced into the House does not comply with the undertaking that the Prime Minister has given.

If you look in detail at the offer, it is ludicrous for the government to claim that there is a massive increase in funding. They have got dodgy figures all through this package. They have double counted the funding for mental health and palliative care; they know that there is $479 million for mental health and palliative care in this offer and they know that this area was not included in the last Medicare agreement. They claim that there is a substantial increase in the new Medicare agreement because they have brought mental health and palliative care funding into the tent. It is a clear demonstration of that old saying that there are lies, damned lies and statistics. This government's claim that there is a 15 per cent real increase in federal funding for public hospitals is worse than a damned lie; it is quite clear that they have doubled counted the funding for mental health and palliative care.

Veterans' Affairs funding has also not been in the Medicare agreements before, and only 45 per cent of veterans currently use public hospitals. We have had the massive cuts to federal funding of public hospitals in the last two budgets—$800 million in 1996 from the forward estimates, and another $400 million from the state health budgets and the abolition of the Commonwealth dental health program. It is very clear that the government has abandoned the Medicare agreements to give it the flexibility to take the axe to Medicare if it is re-elected.

The real concern is that this government's inability to sign agreements with each of the states and territories before 1 July leaves Medicare and the protection for public patients in public hospitals completely at risk. Because there is no binding agreement with the states, there is no certainty whatsoever. The only limit in the bill is in the maximum amount the Commonwealth can pay the states. There is no minimum amount which this minister can provide each of the states and territories under the legislation before the House.

Every year, each of the state health ministers will be at the whim of the federal minister for health. He has already shown he has no intention of keeping the Prime Minister's promise about making sure every dollar is delivered on time. So every year we will get the same round of bickering and acrimonious negotiations, which are not just bad for the public health system but disastrous for planning for public hospitals and a nightmare for patients, who are the ones that really suffer at the end of the day.

This minister has run the length and breadth of the country claiming that this package is about reform in health, but there is no reform in this bill at all. One part of the minister's reform plan was the national development plan. This was supposed to be capital funding for structural reform, but the minister sold out his own plan when he gave Queensland a pre-election bribe and turned this money into recurrent funding—completely contradicting his own guidelines for submission based project funding.

Because this minister has been unable to negotiate, his fancy talk about reform has come to nothing. He cannot bring about change in health unilaterally. The minister should soon start to learn that you can only negotiate these things in a rational and trusting way, not in a way that seeks to bludgeon the states to the negotiating table.

I would now like to turn to the three Medicare principles which have been put into this piece of legislation. They have been rewritten in such a way that a strict literal reading of them would make it impossible for any state to comply with any of them, ever. For example, principle 1 states:

Eligible persons are to be given the choice to receive, free of charge as public patients, health and emergency services of a kind or kinds that are currently, or were historically, provided by hospitals.

What is an example of a service which was never so provided? I would like the minister to tell us when he sums up. Give me an example of some medical service that has never been provided at some stage by hospitals. There is no time limit on this. How far back are we going to go to look at the role of hospitals in each of the states and territories? If you compare it with the previous principle in the former Medicare agreement, it states much more simply:

Eligible persons must be given the choice to receive public hospital services free of charge as public patients.

Turning to the second principle, the minister's new version in the bill states:

Access to such services by public patients free of charge is to be on the basis of clinical need and within a clinically appropriate period.

I do not think anyone has met that particular principle yet. The new version of principle 3 states:

Arrangements are to be in place to ensure equitable access to such services for all eligible persons, regardless of their geographic location.

That is also so wide ranging that I doubt any state health system meets that principle either. Compare that with the old principle 3, which stated as follows:

To the maximum practicable extent, a state will ensure the provision of public hospital services equitably to all eligible persons regardless of their geographic location.

What they have deliberately done is to broaden the principles in such a manner as to make them meaningless. The effect of these new principles is that the minister can choose himself whether or not to pay who he likes and when he likes. This legislation therefore has no meaning whatsoever. It is no guarantee to the states or to the people who are out there working in the public hospital system that federal funding will be maintained. It leaves the way completely open, if this government is re-elected, for the radical surgery that the Prime Minister proposed for Medicare back in 1987.

The old Medicare principles were less general and less open to ministerial fiat and ministerial interpretation. The government has deliberately broadened the principles to such a ridiculous extent that, as I say, they are trying to render them meaningless. Once again, this applies to up-front hospital charges as well and we believe that there is no guar antee whatsoever on that. That is why we will be moving our amendments in the consideration in detail stage, to try to ensure that public patients have a guarantee that they will not be hit by compulsory charges no matter what this government seeks to do.

For those reasons, we believe that this legislation is an outrage. The future of Medicare is to be decided in a 90-minute debate in the House of Representatives, a 90-minute debate that is going to commit the Australian taxpayer to spend $29 billion. For all the people out there who know that their local public hospital is under pressure, this is what this government thinks of you and your local hospital: 90 minutes on a Wednesday night; 90 minutes to allow all of those concerns to be dealt with by the national parliament; 90 minutes to determine whether or not their inadequate and measly $29 billion is going to address the pressures and concerns that are out there due to the crisis in the Australian public hospital system.

Come the next election, members of the government will each individually be held accountable for their neglect of public hospitals, for their attacks on the public hospital system, for their obsession with private health insurance, for wasting $1.7 billion on private health insurance while the public hospital system lurches from crisis to crisis. They are the people who will be held responsible for the fact that the Australian public hospital system is not going to receive the funding that it so desperately needs.