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Wednesday, 28 May 2003
Page: 15142


Dr EMERSON (10:00 AM) —The Health Care (Appropriation) Amendment Bill 2003 appropriates funds for a new five-year funding offer to the states for public hospitals. But the budget papers confirm that the offer constitutes a withdrawal of $918 million over four years and well over a billion dollars over five years. Some offer! It is an offer to withdraw funds from public hospitals. But we should not be surprised by it, because it is the Liberal way. This is a Liberal government and this budget is definitely the most Liberal budget that has been brought down, because it gives full expression to the Liberal philosophy; that is, those people who do not have the resources to look after themselves—who previously, under Labor governments, have been protected—are now left to fend for themselves. This is a government that does practice social Darwinism—survival of the fittest—in this country.

I see that the shadow minister for workplace relations has just walked into the chamber. Survival of the fittest is expressed right throughout this budget and throughout the legislation that has been brought into this parliament with respect to workplace relations. The government has brought into this parliament legislation that would tear away the basic protections for the lowest paid workers in this country so that they are left to survive if they can, if they are fit enough. If they are not then they do not survive. That is the Liberal way. That is social Darwinism. It is practised day in and day out in this parliament and most recently with this legislation, where the government is making some offer—an offer to withdraw $918 million over four years from our public hospital system.

It is not as if Labor failed to see this coming. Speech after speech was made by Labor MPs when the GST was first being mooted, and when the legislation was finally brought into this parliament, in which we said that it was only a matter of time before the government started trimming back the tied grants to the states. This government's plan was to withdraw funding to the states for the tied grants and say, `You can pay for it yourselves because you have got the revenue from the GST.' We warned about that and, from the very early days, funding for health was treated in that way when the government sought to reduce the value of that funding in real terms by holding it, in dollars of the day, at the same level and allowing inflation to erode it away.

At the time that the GST was introduced, members on the government side conveniently neglected to recognise that untied grants to the states totalling $18 billion were abolished on that same day. The tied grants were maintained, but Labor warned that they would be allowed to erode over time. And that is exactly what is happening here. On such a fundamental issue as the funding of our public hospitals over the next five years, the government is allowing the real value of those payments to be eroded over time such that the impact is a withdrawal, over four years, of $918 million and, over five years, of well in excess of a billion dollars.

The cuts to public hospitals over four years of $918 million almost exactly match the $917 million Medicare package that the government unveiled formally in the budget. A Medicare package? It was a plan to destroy Medicare. That has been the aspiration of this government, not just since the proposal to introduce the GST in the 1998 election but way back in 1987 when John Howard, then the Leader of the Opposition, made very clear to the public what his plans for Medicare were. One thing you have to say about John Howard is that when he has an idea in his mind it tends to stick there and it stays and stays.

I again bring a matter to the attention of my colleague the shadow minister for workplace relations. When John Howard was opposition leader, on the issue of workplace relations, he said, `We will bust the unions. We will fundamentally overturn our system of fair bargaining in this country.' Legislation comes into this parliament almost on a daily basis to do exactly that. Way back then, when he was opposition leader, he was a supporter of the GST. And he got his GST into the parliament courtesy of the Democrats. Way back then, in 1987, the then opposition leader, now Prime Minister of Australia, told the Australian people very clearly, very frankly, what he thought about Medicare and what he planned to do with Medicare if he became Prime Minister after 11 July 1987. His promises were to tear Medicare right apart, to pull Medicare apart and, he said, without wanting to put too much of a pun on it, to take a scalpel to Medicare. He described bulk-billing as a rort. He said he would get rid of bulk-billing for everyone but pensioners. That is exactly what this plan would do. So we should not be surprised that this is the agenda, because it has been John Howard's agenda since at least before the 1987 election.

The current Prime Minister does have a bit of perseverance: he lost that election, but he learned his lesson. He thought, `Well, if I keep saying what I want to do—which is to destroy Medicare, to take a scalpel to Medicare, to tear Medicare right apart, to get rid of bulk-billing for everyone but pensioners—I won't become Prime Minister, because the Australian people don't want that.' They told him that emphatically in 1987 when the then Labor government picked up a total of four new seats, very much because of the now Prime Minister's publicly stated plan to destroy Medicare. So he went underground—very cunning, our Prime Minister. He stopped saying that he was going to destroy Medicare. In fact, as opposition leader going into the 1996 election, he said, `We love Medicare. It is a health system for all, not just a few; Medicare for all, not just a few.' But his mind had never changed. He always had the view that Medicare should be destroyed, because that is the Liberal way.

The way to destroy Medicare without saying you are destroying Medicare is twofold. Firstly, you run down funding for the public hospital system—hence this bill before the parliament today—and, secondly, you preside over a reduction, year in and year out, in bulk-billing. Bulk-billing is the cornerstone of Medicare. If bulk-billing collapses, community support for Medicare will collapse. Then the Prime Minister will be in a position to formally dismantle Medicare, but he would say in those circumstances that it was the will of the people. Very cunningly, he set out from 1996 onwards to ensure that bulk-billing fell consistently, and he succeeded. In each and every year of the present government, under the prime ministership of Mr John Howard, the rate of bulk-billing has fallen, yet in each and every year of the previous Labor government the rate of bulk-billing rose.

The Prime Minister's plan was working. Community support for Medicare—not for the Medicare that Labor created but for the Medicare that the Prime Minister is presiding over—is shaken, because by stealth, year in and year out, he has been destroying Medicare. But this budget brings it all out in the open again. It brings out his long-cherished aspiration to destroy Medicare, because it actually provides funding that would create incentives to bulk-bill only concession card holders, leaving doctors free to apply whatever fee they want to the 14 million other patients in this country. Doctors would be free to charge whatever they believe the market will bear.

There it is, the Liberal philosophy: charge whatever the market will bear. That is what the package does. It provides for patients to walk into their GP's surgery with two cards. One card is the Medicare card. There is a device there, and you swipe the Medicare card. Then there is another device, called an EFTPOS machine. Out comes a credit card, and you swipe that card, because under John Howard's system, unless you are a health card holder, you need two cards: the Medicare card and the credit card. The most important of those two cards, over time, will be the credit card. Why? Because under the system that the government wants to implement doctors can charge whatever they want.

In my electorate of Rankin, doctors who are not bulk-billing tend to charge around $15. But there is no limit on it. If this legislation were ever to get through the Senate, then that $15 would go up and up and up to whatever the market would bear and not according to capacity to pay.


Dr Southcott —Mr Deputy Speaker, I rise on a point of order under standing order 81. We are discussing funding to public hospitals. The member for Rankin appears to be unaware of that. He mentioned the legislation—


The DEPUTY SPEAKER (Mr Jenkins)—I know the honourable member for Rankin is well aware of the need to be relevant. As I understand it, he is aware that he needs to relate his remarks to the bill and to the second reading amendment that is before the chair.


Dr EMERSON —For the benefit of the member for Boothby: there are two components to the destruction of the public health system in this country. The first component is cutting funding to public hospitals through the Health Care (Appropriation) Amendment Bill 2003 which is in front of us here and now. The second component is a reduction in bulk-billing which is in the budget announced by your Prime Minister. It is worth having a good look at it—at the demise of Medicare, the destruction of Medicare, under this government. You would be well advised to have a good look at what the Prime Minister is doing instead of picking up a few speech notes produced by the Prime Minister's office or the health minister's office and coming in here and parroting a whole lot of rubbish about how you are saving Medicare. Make no mistake: this government is destroying Medicare in a two-pronged attack by, firstly, starving public hospitals of funding and, secondly, presiding over the destruction of bulk-billing, the collapse of bulk-billing. There you have it: the destruction of Medicare, with the Prime Minister's plan implemented in full.

The credit card will be more important than the Medicare card, because that up-front fee—of around $15 in my area—will go up and up and up. Since Medicare was first introduced, doctors have never been allowed to bill Medicare as well as charge patients directly for the same service, and that is what has helped to maintain bulk-billing and to keep doctors' fees reasonable. The fact that the government's package includes a new safety net for concession card holders and a new capacity for others to insure privately for medical expenses over $1,000 is a clear admission that costs will rise.

This new capacity to privately insure against doctors' fees is the next step in the Americanisation of our health system. That is where we are headed in this budget, through the appropriations and the measures provided for in relation to Medicare. We are headed straight down the track of the Americanisation of our health system to a situation where those who do not have the capacity to pay are confronted with a second-class health system. This would be a disgrace in Australia. We do have, in Australia, a sense of a fair go. We do have an egalitarian streak. We do have a sense that not every behaviour and every service to every Australian should be based on capacity to pay. We do have a sense in Australia that it should be based on need so that we do not have a two-tier health system in this country, as exists in the United States.

John Howard does want to Americanise the health system in this country. Labor say: `No. We will save Medicare.' Labor built Medicare; only Labor will save Medicare. Labor will not only save Medicare but also improve Medicare. We will lift the Medicare rebate ultimately to 100 per cent of the scheduled fee, thereby providing greater incentives for doctors to bulk-bill. Doctors will receive incentive payments for achieving specific bulk-billing targets. In my area of outer metropolitan Brisbane, the target is 75 per cent and doctors will receive incentives for exceeding that target. Here is a comprehensive plan to save Medicare and to make Medicare even better. We do not and will not accept the government's plan to destroy Medicare through running down funding for our public hospitals and running down rates of bulk-billing.

In my own electorate there is a controversy about the very existence of the one remaining Medicare office. That Medicare office is in Logan Central. I received information that that Medicare office was going to close, and I checked that information by writing to the health minister. The health minister's parliamentary secretary replied, saying in part:

I am further advised that the Woodridge Medicare office does not meet HIC facility standards or locational criteria. The expiry of the lease on the existing premises has provided an opportunity to review the viability of the location of the office. Submissions have been called for from potential lessors in the identified customer catchment area and are currently under consideration.

That says the Medicare office at Woodridge will close. When I revealed the existence of this letter to local federal Liberal members the member for Forde and the member for Fadden, they said, `That is incorrect; the Woodridge Medicare office will remain open.' We checked back with the parliamentary secretary's office, who told us that they would not have said this unless it was authorised by the health minister. We checked with the health minister's office. Weeks and weeks ago we asked the Medicare adviser in the health minister's office to return our phone calls. We are still waiting. Nevertheless, the member for Forde and the member for Fadden are saying: `It's fine. That office will not close.' I have written to them and asked them to confirm in writing that the Woodridge Medicare office will not close. I am awaiting replies to that letter.


Mr McClelland —They've closed one of mine.


Dr EMERSON —They have closed a Medicare office in the electorate of Barton. There is example after example of the destruction of Medicare under this government. There is one point I will concede to the government: under its plan to destroy Medicare there will be no need for a Medicare office, because there will be no refund. There will be no place to go for a refund because you will not need a refund. After you swipe your Medicare card, you will have to pay the balance—the up-front fee. Most visitors to doctors would think, `When I've paid the second amount, I will go and get a refund.' No. There will be no refund. It will be all up front and it will all go up and up. So there will not be any need for a Medicare office under the Liberal plan. Why don't the member for Forde and the member for Fadden come clean, come into the parliament during this debate and confirm that the Woodridge Medicare office indeed will close? Why will it close? Because there is no place for the Woodridge Medicare office under John Howard's plan to destroy Medicare. That is because you will pay up front and it will go up and up, and there will be no refund.

It is a terribly sad day when legislation has been introduced in this parliament to not only cut funding for public hospitals by $918 million but also destroy Medicare. We will fight tooth and nail. We will do everything we can on behalf of struggling Australian families to stop the destruction of Medicare, and when we get into government we will save Medicare. Labor built Medicare and only Labor will save Medicare.