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Wednesday, 28 May 2003
Page: 15159

Mr SNOWDON (11:17 AM) —I am pleased to be able to participate in this debate. At a later point, I will make some observations about the contribution from the member for Macquarie, particularly as it relates to the question of the impact of private health insurance, on access to public hospitals and the supposition that the increase in private health insurance would put downward pressure on public hospitals. This is clearly not the case in my electorate or in the Northern Territory generally. I am surprised that we have these very generalised assertions being made by members of the government about the supposed impacts of government policy on health services to Australians.

The Health Care (Appropriation) Amendment Bill 2003 amends the Health Care Appropriation Act 1998. The amendments will allow the Commonwealth to discharge its financial responsibilities under the Australian health care agreements under which the Commonwealth provides financial assistance to the states and territories for the provision of public hospitals. The bill extends the period of operation of the act for a second five-year period, enabling the Commonwealth to negotiate a new agreement with the states and territories. The bill also makes technical amendments to the act. But, as others before me have pointed out, the bill cuts $1 billion from Commonwealth-state health care agreements, and I think there are significant issues that need to be confronted by the government in relation to this.

The current health care system—or, at least as it was; built by the Hawke government initially and followed on by the Keating government—is still one of the best systems in the world. It provides comparatively inexpensive health care to all Australians—well, not to all Australians, as I will point out shortly. It recognises the fact that every Australian has the right to adequate health care services, regardless of their medical need or personal wealth. It should, but it does not. It is clear that the Howard government is intent on destroying the current arrangements in favour of those where access to health care is determined by an individual's personal wealth, creating a two-tiered system where there is top-quality care for those who can afford it and a substandard service for those who cannot. This just gives weight to the proposition that the Prime Minister has been advocating since the 1980s that bulk-billing should be restricted to the disadvantaged and doctors should be free to charge everyone else whatever the market will bear. However, it does not have to be like this; it does not have to be the way the government proposes. First-class health care is possible for all. In fact, I believe it is a citizenship right that we should all expect to have provided for us.

Commonwealth-state agreements on health funding have been in place for the last 20 years. They are the primary method through which states and territories are funded to administer the public health system, including public hospitals, mental and public health and also palliative care. These Commonwealth-state health care agreements are the cornerstone of the health care system, but this government seems bent on destroying it. As I have said, this year's budget figures demonstrate very clearly that the government is planning to slash $1 billion over four years from these agreements—and $1 billion over four years is a significant amount of money. In practical terms, it will mean fewer nurses, fewer operations and longer waiting lists for elective surgery. It will mean that, if states and territories want to maintain the same level of public health services that they currently provide, they will have to find the money from their own resources.

I have heard members opposite railing against state and territory governments for expressing their concern about these arrangements being proposed by the government, which say that they should be able to fund it from their own resources. Let me make a couple of observations about the propositions which have been put by the government. Firstly, I speak particularly of my electorate of Lingiari which, for the benefit of those who might be listening to this debate, comprises 1.34 million square kilometres—all of the Northern Territory except Darwin and Palmerston. There is no private hospital in the electorate of Lingiari. In fact, to my knowledge—apart from Cairns, Townsville, Mackay, perhaps one other venue on the central coast of Queensland and, I think, Kalgoorlie—there is not a private hospital anywhere in Northern Australia or in the remote part of Australia. If you live outside a major metropolitan area you will not have access to private health care in terms of a private hospital.

What does this mean? It means clearly that every citizen in those communities is dependent on public hospitals. Yet it is an issue for these citizens because, as for other Australians under this government, they are required to take out private health insurance. If they do not take out private health insurance and their income is above a certain level then they pay an extra one per cent for the Medicare levy to compensate for the fact that they do not take out private health insurance. But what benefit do they get? In effect, they are subsidising the private health systems of the major metropolitan centres and they are getting nothing in return. They are being hit with the situation where they do not have access to private hospitals, despite the claims which are being made by members opposite. What are the magnificent benefits that these Australians receive by being compelled to take out private health insurance? In my electorate it is nil. They know each week, fortnight or month when they receive their pay packet and they see the deductions which are taken out for private health insurance or for the Medicare levy that they are supporting someone else's health. They are supporting the top end of town—the people who live in Rose Bay and, I might say, the people who live in the northern suburbs of Canberra. Yet these citizens are required to pay this contribution.

The government will say that they can attend their general practitioner, which they would do. But in the whole of the Northern Territory there is only one GP who bulk-bills and who will accept new patients into their practice. There are two other practices which bulk-bill, as I understand it, in the whole of the Northern Territory. In the town that I live in—Alice Springs—there is not one. What do we have for it? We have proposals by this government to cut $1 billion from the public hospital system; and, in the case of the Northern Territory, after the sleight of hand accounting tricks are teased out, there is significantly less money than in the previous agreement with the Commonwealth. The Commonwealth is offering the Northern Territory $16 million less over the next few years.

Let me go back to the issue of private practitioners. In the community in which I live, practices charge upfront fees of anywhere between $40 and $60. There is a practice in Alice Springs where GPs charge $60. The market will bear it because the government has failed the Australians who live in this community in the provision of health care and access to bulk-billing. Remember, if they pay the 60 bucks, these Australians are paying an extra $35 on top of the rebate to attend a doctor. Their choice is to go to the public hospital. We are seeing that Australians who cannot afford to pay the $35 to this practice or to other practices who charge similar rates are forced into the public hospital system, even though they are also required to take out private health insurance. The benefit they get from this government for that is a reduction in the expenditure for public hospitals in the Northern Territory of $16 million. Is this fair?

You are a reasonable man, Mr Deputy Speaker Scott. I know the community in which you live. You will have the same problem that I have. This is a problem that is across Northern Australia, yet this government refuses to acknowledge its responsibilities to these Australians and dresses up these proposals for changes to Medicare in the budget proposals by saying that somehow or another doctors will be attracted to take up bulk-billing. I am prepared to wager that it is unlikely any practitioner in Central Australia will sign up for the proposals put forward by the government in relation to the budget measures. We will still be left in a position where people in Central Australia and, indeed, the whole of the Northern Territory—except for those people who have access to clinics, which are Aboriginal health services—will not have access to bulk-billing services.

If you have been listening to the debate, Mr Deputy Speaker—I am sure you have been—you will have heard the government tell us that we should be pleased with the benefits that we are to receive as a result of these changes brought about by the budget. There is no way that these budget proposals are either fair or reasonable for the people of the Northern Territory. Whilst it is okay for members opposite to rail against state and territory governments for objecting to the government's proposals and to say to them that they should take up the slack, out of their own resources, this fails to take account of not only the level of reliance on the public health system by people living in remote Australia but also the narrow taxation base.

Where is the Northern Territory to get the revenue to compensate for the shortfall as a result of the reductions in funding from the Commonwealth? Eighty per cent of the Northern Territory's budget revenue comes from Commonwealth sources. So what magic pudding are they supposed to use to deliver to the Northern Territory community additional health care expenditure to fund public health? Where is this magic pudding to come from? It is worth while knowing that, by comparison, other states and territories rely on the Commonwealth for about 40 per cent of their revenue. That is a significant difference. Leaving aside the logic of the position which the government adopts in relation to people living in remote Australia in particular, its argument in relation to where state and territory governments should get additional funds from fails to comprehend—certainly in the case of the Northern Territory—their ability to raise additional revenues to meet the shortfalls as a result of the Commonwealth-state agreements.

This matter is of great concern to the people in my communities. They are very concerned about the failure of this government in terms of health care. I can recall when there were a number of bulk-billing practices in the electorate. But now I understand that, for some, there is no choice in the matter: costs have increased to the extent where many practices can no longer afford to bulk-bill. Others have made a commercial decision and are charging $60 for a consultation. That is not a health decision, it is a commercial decision. What it means is exactly what the government intends: those people who can afford to pay the $60 will get health care, those who cannot will go to the public hospital. I do not think that that is a fair or reasonable ask of the citizens of the Northern Territory or of the Northern Territory government, because of the failure of this government to come to terms with its responsibilities.

When we are having this debate in the community, as we will, I know what will happen. The community is going to say, as they should, `The doctors that we get service from, the medical practitioners we visit—whatever they might charge—do a very good job.' But the bottom line is that, in the provision of medical services in Central Australia and in the Northern Territory generally, in terms of private health and private practitioners, there is no competition. As a result, we are seeing people pay $60 a consultation to visit a private practitioner. This is not fair, nor is it reasonable. What it shows very clearly is what the Americanisation of the Australian health care system will bring to Australians. They will be forced to pay what the market will bear, not what they ought to pay. The government has a responsibility here. Every Australian pays 1½ per cent of their income as tax for a Medicare levy. Those who do not buy private health insurance and whose income is above a certain level pay an extra one per cent. They expect for that decent public health care. They expect for that a Medicare system which works. Instead they get a fraudulent approach by the government which seeks to delude and mislead the Australian community about what they can expect for the provision of medical services in this country.

This whole debate shows how much of a misunderstanding this government has about its responsibilities. As I have already outlined: firstly, the Northern Territory government just does not have the capacity to fill the hole; secondly, Territorians—certainly those who live outside Darwin and Palmerston—do not have access to a private hospital system; and thirdly, we have got one of the poorest communities in Australia. Roughly 43 per cent of the people in my electorate are Indigenous Australians. These are the poorest Australians and the people who most rely on the public hospital system. They have a life expectancy which is very much lower than that of the rest of Australia. What does this agreement do for them? It says, as it does for other Territorians, that you can expect that the services available from the public hospital system will diminish over time because of the failure of the Australian government to provide adequate funds for these purposes to the Northern Territory community. So instead of addressing the terrible and awful health problems of these Australians who require hospital care, the government is making it more difficult. How are we to get better health outcomes for the dollars spent on public hospitals under these arrangements?

Whilst the opposition will be supporting the legislation, I commend to the House the amendments which have been proposed by the opposition, which outline our concerns with the government's health policy failures.