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Wednesday, 28 May 2003
Page: 15162


Mr RANDALL (11:37 AM) —I am very pleased to speak on the Health Care (Appropriation) Amendment Bill 2003, because at this stage we are going through the Commonwealth-state health care agreements which will be in place for the next five years. It is appropriate that we examine some of the history, the existing situation and the need for such agreements. A previous speaker alluded to the fact that this has been going on for some 20 years. One of the things we will always find out from these Commonwealth-state health care agreements, which are negotiated every five years, is that no-one is ever happy. The states will never be happy, and the Commonwealth will not necessarily be happy with the way the states view them, so, ultimately, we have a Mexican stand-off every five years.

I will give you an example. There may be Labor state governments in every state of Australia at the moment, but when the previous agreement was negotiated in Western Australia there was a coalition government. I recall that the then state health minister, Kevin Prince, was decidedly upset with the deal he believed he was getting from the Commonwealth government. He endeavoured to negotiate with the then federal health minister, Dr Michael Wooldridge, and he also lobbied federal members and senators from Western Australia to try to get a better deal. I believe a better deal was put in place, but it can never be enough. From the states' point of view, they will never ever get enough in these agreements.

An ideological battle goes on in this place between this side of the House and the other side of the House. The other side of the House accused us of trying to run down Medicare and the general health care agreements in this country. That is just not true, and I will demonstrate that shortly. We have a view on this side of the House that the previous Hawke-Keating government tried to run down the private health system in this country. In an endeavour to destroy the private health system, they put obstacles in its way, and the take-up rate of private health insurance in this country plummeted. The then health minister, Senator Richardson—who now works for Channel 9 and would probably agree with this—said that if private health insurance in this country fell below 30 per cent it would be unsustainable. It did fall below 30 per cent under a Labor government and it did become unsustainable. It was not until this government put in place a scheme to give tax relief to those paying for private health care that the uptake rate increased.

There are some very interesting statistics around the country, including from Western Australia, on the uptake of private health care. I hope these figures are right; I find them quite alarming, actually. The opposition spokesman in Western Australia has cited the fact that, on the introduction of the private health care rebate in conjunction with Lifetime Health Cover, the percentage of people signing on to private health care in Western Australia rose from 45 per cent to 62 per cent. That seems a remarkable statistic, but that was the upshot of the relief given by this government through the 30 per cent private health care rebate.

Yet we know from the other side—and this has not been denied—that the Australian Labor Party, if they were to ever have the opportunity to be on this side of the House, would do away with the 30 per cent health care rebate. There can only be one outcome of what Labor are intending to do with Medicare, and that is to get rid of the 30 per cent private health care rebate. Yet people were saying to us all the time, `Why can't we return to the days when those who invested and paid their own hard-earned money towards health care got some sort of tax concession or relief?' That is what we did, and the public health system in this country has received a good deal of relief because of the growth of the private health care sector.

In this new round of agreements, we are endeavouring to inject more funds into the states' agreements, but with some commitments from the state governments. For example, as the member for Boothby has stated, currently the federal government's agreement is for $32 billion and an increase of $10 billion over the next five years—a 17 per cent increase. That is not a decrease. I do not know where the opposition get the information that it is being driven backwards; that is quite spurious. There is going to be—if the states sign on to this agreement—a $10 billion increase. That is the commitment that the federal government has made towards health care in this country.

We do have an unusual situation in that the federal government puts in funds but the states run the system and put in their own funds. It is a bit like the mishmash we have in education, with state governments providing funds for state schools and the federal government providing funds for non-government schools plus some to state schools as well. There is a mishmash of responsibility. In an ideal world, it would probably be better if one of the jurisdictions ran the whole lot. But I cannot see that ever happening.

The health minister in Western Australia is nicknamed `Hamburger' Bob Kucera, for good reasons. I will tell you why. As a former policeman, he was the detective in charge of the Belmont police station when the infamous Mickelbergs were getting the tripe belted out of them. As a detective in the Belmont police station, Bob Kucera's only interest in them while they were getting belted up was to stick his head around the corner and ask whether they wanted some hamburgers from across the road. Did they want pickles or sauce on their hamburgers? That is where he earned his dubious police reputation.

Mr Kucera is also a bit under question here. He has come out and said that he will not accept the new federal-state health agreement. In fact, Mr Kucera said that he would reject the Commonwealth's $4.12 billion offer as a demonstration of his commitment to the principles of Medicare and to attaining a fair deal for Western Australia. He is happy to reject the deal for Western Australia, but the ramifications of that are quite outlandish—and I will give you the dollar figure in a moment. This is what the federal government over the life of this health care agreement wants to do for Western Australia: add an extra $4.12 billion over those five years.

Mr Kucera was caught out. He was asked in the state parliament how much Commonwealth funding provided under the pending health care agreement for 2003-08 was factored into the state health budget. Mr Kucera, the health minister, responded by saying that it was $733.9 million. So here he was in parliament—that is, he was required to not mislead the House and to be honest—saying that that is the figure. If that is the figure, then it is the figure for the first year, 2003-04, of the Commonwealth-state health agreement for Western Australia. If Western Australia agrees to sign and match the rate of growth in Commonwealth funding, the estimated figure for 2003-04 is $734.3 million. So much for his rejection of the package; he has actually factored it into the state budget. On one hand he is saying he is not going to take the money but on the other hand he is saying, `I'll take the money, and to show I'm taking the money I have actually factored it in to this year's state health budget.' You cannot have it both ways.

However, if Mr Kucera wishes to deny Western Australia access to this money and agrees to sign but does not match the Commonwealth rate of growth in funding, over the five-year period of this health care agreement he will deny Western Australians $154 million. In fact, if he does not sign the agreement at all—and he is saying he will not, but as I said he has already put it into the budget—over the five-year period Mr Kucera will deny Western Australians $404 million. How responsible is that? This comes from a minister who does not seem to understand his brief. I will demonstrate that from this point of view. In my electorate of Canning, I have the following general public hospitals: the Armadale-Kelmscott Memorial Hospital, the Murray District Hospital, the Waroona hospital and the Peel Health Campus in Mandurah. I share that large city with the member for Brand, and that hospital is actually in the member for Brand's electorate—but we divide that city almost equally. That is the other major health care provider in that region.

When the state government came to power, Dr Gallop said, `We know the problems with health care in this state and we're going to fix them.' One of the biggest issues in the lead-up to the previous election, and a problem which Dr Gallop said he would fix, was ambulance bypasses. Ambulance bypasses became the largest issue from a health point of view that the then state Labor opposition attacked the then government on, because the number of them had grown. For those who do not know, an ambulance bypass occurs when an ambulance goes to one major hospital, like Royal Perth Hospital, and cannot get in, is told to go to Sir Charles Gairdner Hospital and cannot get in, and does the rounds until it goes to Fremantle Hospital and eventually finds an opportunity for the patient to be taken there.

What has happened since then? Not only has the rate of bypasses increased; they are into a curious little arrangement now called ramping. Ramping, for those who are not aware, is done when the ambulance cannot bypass any hospital because all the emergency departments are full. The ambulance is parked in front of the hospital and the doctors from the emergency department come out and look in the ambulance and ask, `What's the matter with this person?' The doctors examine them there. Because there is no room to park people on trolleys in emergency wards et cetera, people are left in ambulances parked in front of the hospital. This is going on in Western Australia at an increased rate.

The government do not even deny it now. What has Mr Kucera said? He has said: `We think it's a good strategy. We're using it as a strategy.' That is the sort of health care the state government is administering in using our funds. In not signing on to this agreement, Mr Kucera is talking about potentially denying the state $404 million. What sort of health care commitment is that from a state health minister? These are the sorts of people we have to do business with. We are trying to make structural reforms to the Medicare arrangements in this country so people can get a better deal.

My area has a decreasing bulk-billing rate, and I will address that now. The bulk-billing rate, particularly around my electorate office in the Armadale-Kelmscott area, has gone from 69.9 per cent in December 2000 and 68 per cent in 2001 to 59.9 per cent—almost 60 per cent—at the end of December 2002. It is declining. Why is that? The decline in the bulk-billing rate is because there is a lack of doctors. It is not because doctors have an aversion to bulk-billing per se; it is a function of the lack of doctors in any one area. The Armadale-Kelmscott region in my electorate has the lowest ratio of GPs per capita of any outer metro area in Western Australia. I repeat that: it has the lowest bulk-billing rate of any outer urban area of Western Australia. Doctors do not necessarily want to go out into those areas that are a bit tough. If they do and there is not much competition, there is no competitive edge in bulk-billing, as there is in the leafy suburbs of Nedlands or Cottesloe or the inner city suburbs of Perth.

What we are doing? We are giving these GPs in the outer urban areas an opportunity. We are saying: `Look, we know that $25.05 is inadequate. If you will sign on to the new agreement we are offering you, we will pay you extra when you treat concession card holders, pensioners et cetera.' We are also saying to them, `We will not only pay you extra; we will make it easier for those who go to your surgery to claim.' You have heard this many times, but it is worth repeating. At the moment, the poor mother—who may be on a low income—who goes in to the doctor with her two sick kids, after having to get time off school for them and time off work for herself, gets both of them treated, gets the receipts and has to somehow find time to get down to the Medicare facility to claim the rebate. Sometime later she gets the rebate back, but she could have been up to $70 out of pocket.

We are going to make it easier for people. Inside the doctor's surgery we will put in a facility, a bit like an EFTPOS machine, where people can swipe their health care card and they will only pay the difference. They will not be $70 out of pocket; they would be, on average, $12 out of pocket, or $24 for two consultations—but they will not have the mess of claiming and being out of pocket to the extent we have been talking about. This is what we are offering to attract doctors to sign on. It will not only make the system more fluid and workable but encourage more bulk-billing in the outer urban areas, particularly in the areas of need.

What else are we doing in the areas of need? The Serpentine-Jarrahdale Shire Council is in my electorate. It has been identified as an area of need—yet, again, it has been very difficult to attract doctors into that area. The head of the AMA in Western Australia, Dr Pearn-Rowe, made it quite clear yesterday, in an interview with Paul Murray—and I am also aware of this through talking to my colleagues—that in Western Australia we are creating an extra 100 places for medical students at the University of Western Australia and, hopefully, at the new Notre Dame Medical School. This will put more doctors into the area.

We are also bonding doctors into rural and outer urban areas. The people we need to send into these outer urban areas need to be special—they must have an affinity with the people in the region. They get close to the people because it is more rural. An excellent example in my electorate is Dr Peter Wallace, who was named the GP of the year in an Australia-wide competition. He works out of Pinjarra. Dr Peter Wallace should be congratulated because he is a tireless, hardworking doctor and there are not enough Dr Peter Wallaces out there. A special note should be made of him. I will also be awarding him a Centenary Medal shortly. I am going to be very proud to do that on behalf of the people who nominated him and the people of Australia. It is important that we recognise people like Dr Peter Wallace.

It is quite galling when you hear the bleating from the other side on this class warfare stuff. They would like to see a British system where medicine is basically nationalised. When Hillary Clinton came to this country on a visit several years ago she met with Dr Wooldridge. She could not believe Australia could run such an efficient dual system, with both private health care and a public system operating in tandem, that worked so well. We know what happens in America: if you get chronically ill, you basically have to sell your house to pay the medical fees. Australia has a marvellous health care system. If you get knocked down by a car walking out of here today, you will get treatment in an emergency ward of a hospital whether you have money or not.

That is the quality of health care in this country, but it is not sustainable unless there is structural reform. All the independent commentators, like the Paul Kellys of this world, will tell you that unless there is structural reform in Medicare and the health care system in this country it will be unsustainable—just as the PBS is unsustainable without support. What are we getting from the other side? The opposition is obstructing, obfuscating and trying to destroy it for political purposes. This is not an opposition that actually wants the best for the Australian people; this is an opposition that wants to score political points at the cost of the health care of those in this country who most need it. The opposition needs to get on and support the government's initiatives in this area because they will continue to provide the world-class system that Australians are used to and entitled to. (Time expired)