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Wednesday, 28 May 2003
Page: 15180


Mr BILLSON (12:55 PM) —Today should be a celebration. We are seeing the three key legs of a strong, sturdy and robust health system celebrated today with a further interjection of federal funds. The health system is strong in Australia. It is stronger because of the Howard government. Today we are discussing the Health Care (Appropriation) Amendment bill 2003, which will inject more of the nation's taxpayer funds into the public hospital system. This is one of the three legs of the Commonwealth's approach to make sure that our nation's hospitals and the care that is available to our citizens is affordable, appropriate and of an outstanding quality, and that people get the service that they are looking for, because people's wellbeing is central to their happiness. It is pleasing to rise today to support what the Commonwealth is doing.

As I said, it is a three-pronged approach. The first leg, which is the centrepiece of this bill today, is further growth in the Commonwealth's direct contribution to public hospitals. The Commonwealth has been contributing more and more money over time. Its share of the funding towards state public hospitals has grown in the last few years from around 43 per cent to 48 per cent and it is terrific that today we see a further injection. So that is one central part of it.

The second leg is trying to encourage the states and territories to match the Commonwealth's performance. You would have thought that that is not an unreasonable expectation as these are, at the end of the day, public health facilities which are owned, operated and managed by state and territory governments. It is not unreasonable that they match the rate of growth that the Commonwealth is putting into those facilities, but apparently the cabal of Labor premiers—operating as the nearest thing we have to organised crime in this country—has come together and said, `We are not going to do this. We are not going to support the Commonwealth's efforts to strengthen public hospitals.' That is the second leg of that very robust and sturdy stool.

The third leg is trying to make sure that the balance between public and private hospitals continues to be supported. It can simply be described as a load sharing initiative. We know that if people are prepared to invest some of their own funds into their health through the private health system that, where they make those contributions to their own health, some encouragement from the Commonwealth is appropriate. Why? Because they are making an investment which is relieving pressure on the public health system and will actually drive the Commonwealth and state dollar further for the public hospitals.

So those are the three legs of that robust, strong and hopefully strengthening hospital system that we will have as a Commonwealth over the next five years. But what is new and different about this proposal we are discussing today? It is not really that new. What is continuing is that there is more Commonwealth money. There is a proposition, which could be made possible through this legislation we are discussing today, to provide even more money to the states and territories for running the hospital system. You would have thought that that would be welcomed. I certainly welcome it and I think all Australian taxpayers welcome it, but apparently the states and territories do not.

We have before us the bill that provides for how funding will be made available when the current health care agreement expires on 30 June—not long from now. The Prime Minister wrote to all the premiers and chief ministers in late April outlining the Commonwealth's funding offer. There are some new elements that accompany that funding offer; not only is there more money going in but there is a call to those state and territory leaders and the governments that they represent to match the performance of the Commonwealth. Those new things are an independent verification of the details of public hospital funding.

One of the great mysteries of Commonwealth-state relations—and I have had particular insight into this through the unmet needs work that I was involved with in support of the disability sector a number of years ago—concerns the fact that everyone says, `We need more money.' Everyone wanted more money under the Commonwealth-state disability agreement. The only thing you could not find out was what the states were actually doing. You could not find out what their effort was; you could not find out whether pledges of lifting their game actually amounted to anything. Sadly, in terms of the unmet needs for the Commonwealth-state disability agreement, we still do not know to this day. Why? Because the states and territories collect data differently. They rebadge programs—they describe something as an apple one year and as a piece of fruit the next—and there are a bunch of other activities. You have no idea what is going on; all you know is that the states and territories want more money and, boy, can they spend it.

Here is an example where the Commonwealth is expected by the states and territories not only to clearly articulate its funding contributions but to outline them for the next five years as well. That is five years in advance. Fortunately we have sound economic managers leading the Commonwealth government. The states and territories are demanding to know what it is that the Commonwealth will provide—and this bill actually responds to that demand—for the next five years. But what do we get from the states? We do not even know what they spent last year, and there is mystery, great confusion and doubt about the years prior to that.

What this piece of legislation seeks to implement as a complementary measure, with bucket loads of extra money, is a mutual commitment to public hospitals, because we do not have that now. We do not have a mutual commitment to public hospitals. We have the Commonwealth leading the way, writing bigger cheques, driving change and improving services, while the states complain and moan. They come out together and sing from the same page of the same hymn book—`We need more money; we need more money'—without ever answering the questions: what are you guys doing; what is your effort to ensure that the public hospital system is delivering better outcomes for Australians? We do not know, and that is one of the reasons why the Labor Party seems to oppose what is being put forward in this measure. We want the states to commit to specific levels of funding over the next five years. Surely that is not too much to ask. Surely, if they demand that of the Commonwealth, the states and territories should at least walk their own talk and give the Australian community an understanding of what their effort will be over the next five years.

What about some really novel ideas, like committing to a reporting system so that Australians and people living in different parts of the country can understand what is going on with our hospital system? You would have thought that that was pretty basic stuff and that, for the billions of dollars that go into public hospitals, you would at least have some reporting framework so that we could all measure which states and territories are serious about public hospitals, which ones are actually doing what they say they will do and which ones are just fudging the numbers and trying to deceive the taxpayers and the electors of their particular jurisdiction.

We also want the states and territories to recommit to the Medicare principles. You have heard about how the Commonwealth is prepared to continually put more money into the Medicare system, expand the range of services that are available, provide new MBS schedule fees for longer consultations for chronic illness, and manage people's wellness as well as respond to their illness. That is what is going through the Commonwealth: making sure that Medicare is relevant and responsive to the health needs of Australia. And what do we run up against? Initially the Labor Party were saying: `Just leave it the way it is. Don't touch it. You can't possibly touch Medicare.' Yet then you have members opposite from the ALP deriding the performance of Medicare. So what have we got? Juxtaposed against each other are the Labor Party saying, `Don't touch Medicare; it is a sacred cow,' and then coming in here and complaining about what it is delivering. What has the Commonwealth done? What has the Howard government done? It has looked at the reasons Medicare is not meeting some people's expectations and where it can be enhanced.

You would have thought, from the arguments being put, that bulk-billing rates are testament to all things virtuous about Medicare. They never have been; they never were when Medicare was introduced. This is all some latter-day conversion by the ALP to be critical about a program that has been strengthened and enhanced under the Howard government. It is not just about the fees that are paid, either. You heard the previous speaker talk about schedule fees being the only game in town with Medicare and how the Labor Party will put in all this extra money should they come to government. Let us think about it: in the electorate that I represent, bulk-billing rates are below 50 per cent. Isn't that interesting: in the area that I represent—the Greater Frankston and Mornington Peninsula area—they are below 50 per cent. But if you are on the North Shore of Sydney—a far healthier socioeconomic group than my community—you are 65 per cent more likely to get a bulk-billing consultation. What does that tell you? Are bulk-billing rates reflected in the socioeconomic wellbeing of a community? Clearly not. There is something else going on, and that is an issue about the work force.

In some of the university courses for medicine this year, none of the graduates are going into general practice; they are all going off into other specialisations. Why? Because they do not think that general practice is attractive. The task before this government, in terms of ensuring that Medicare is as strong and healthy as it can be, is to get the skills of the doctors in the places where they are needed. You do not do that by saying to doctors, `We're going to pay you less for your skills.' In the Labor Party proposal, they are saying, `We'd like you to bulk-bill and we're going to make sure that, if you're in the city, you bulk-bill 80 per cent of your patients.' That has a direct implication for the doctor—for the doctor's decision to practise in that area and for the doctor's decision about how they price their skills and about the relationship they have with their patients.

The great irony is that no-one in the Labor Party, I am sure, believes that they could possibly deliver the outcome they are talking about. When you look at the billing practices of doctors—that is, the decisions they make about the price at which they provide services to their patients—the kinds of increases in Medicare rebates that the Labor Party are talking about do not go anywhere near what the actual behaviour is at the moment. It is a smoke and mirrors policy; it means nothing, and it is more of what the Labor Party does in the health sector. Contrast that with what the government has been doing, and contrast that with the offer that is on the table for the public hospital system.

A major feature of the agreement is that we want the states and territories to match the Commonwealth's rate of growth year by year if they are to receive all the funds that are on the table. The idea is a simple one. This offer is for a 17½ per cent real increase in Commonwealth funding contributions. If the states and territories are for real, the offer is: `There are the funds; you match that effort. If you're as committed to public hospitals as the Commonwealth, walk the talk. Match the effort of the Commonwealth, and the funds will be there.' That is what this is about. For states that do not decide to match the Commonwealth's rate of growth, the amount that they are eligible for will be 96 per cent of the funding that is being made available. The message there is simple: if the states and territories are not for real about their public hospitals, the Commonwealth's contribution is reduced. It will still be growing, just not at as fast a rate.

So the measure before the parliament today on divvying up $42,000 million in funding—the $42 billion the Commonwealth is providing to the states and territories over the five-year life of this agreement—says, `If you want all of it, states and territories, match the Commonwealth's performance.' In my home state of Victoria, that represents $10.1 billion over five years to run the state government's hospitals. That is a handsome sum of money. That is a $2.4 billion increase on what is on the table now.

It is hard to compare that with what the state government has actually done over the life of the current health care agreement because nobody knows. No-one can nail that information down. What we do know, though, is that certain undertakings that the state government gave under the current health care agreement it has not fulfilled. Under the health care agreement that expires on 30 June, the Commonwealth government provided $7.7 billion to the state of Victoria, and in return the state of Victoria did not deliver on its commitments. It did not uphold the agreed number of hospital services, a benchmarked rate for hospital services based on the population of Victoria. It did not uphold that part of the agreement. It certainly did not uphold an undertaking to reduce elective surgery waiting times. They actually increased. They increased in 1999-2001 by 10 per cent. This is further evidence that the Commonwealth is for real but the state is not. If the state of Victoria and the Bracks government choose not to sign the agreement, they will place at risk $832 million of funding. If they are not as committed to public hospitals as the Commonwealth, the price is $832 million of funding.

You would understand, Mr Deputy Speaker, that it is very hard to believe what the Bracks government say. After the Scoresby Freeway bypass, after the backflip on tolls, after all the taxes going up and after their decision on Point Nepean, it is very hard to believe anything they say, but they tend to say that hospitals are important. That is their defence for blowing the legacy that the Kennett government left them. Here is a chance to perform and to see whether they are all windbags or whether they are genuinely committed to the public hospital system. I have to say that the early evidence is not encouraging; it is actually very discouraging. In the lead-up to the last state election we had the parliamentary secretary for health in the electorate of Dunkley promising a $20 million nonacute service hospital in Mornington. That was the headline in the Mornington Peninsula Leader: `ALP's $20 million carrot'. It is actually the ALP's $20 million deception. They just keep racking them up.

This project was promised by the parliamentary secretary, Matt Viney, who said, `The funding for the project will start in the 2003-04 state budget.' This was not a long time ago, this was not ancient history; this election was only a handful of months ago. At that time the $20 million promise was written up in the Mornington Peninsula Leader. It said that the Bracks government had thrown a powerful last-minute election sweetener to peninsula voters with the promise of a $20 million, 60-bed public nursing home and hospital nonacute service. I will not go into the rest of the details. It was a $20 million sweetener. We know it was bunkum; it was a bribe, it was deception. What is in the state budget recently announced by the Bracks government? What is on the health service and hospital waiting list? This $20 million project. What could possibly have changed in that handful of months? Nothing had changed. We know that the ALP will say anything in the lead-up to an election and hope to bribe people into voting for them. The people in the peninsula and the southern area of my electorate have been deceived. Is there any sign of that project in the 2003-04 budget? No, there is nothing. Is there any sign of it in the 2004-05 budget? No. In 2005-06? No. In 2006-07? No. In none of the out years in the budget that has been delivered by the Bracks government just weeks ago is this promise, this carrot—this $20 million bribe to vote for Labor—of the Mornington hospital nonacute facility for subacute rehabilitation. Is it anywhere? No.

So when the Commonwealth is putting $42,000 million on the table in the hope that the state and territory governments will be vaguely interested in living up to their rhetoric, you can understand why it is reasonable to ask for a framework of accountability that goes with that money. Where is the state and territory contribution? How much will it be? Will they report on these service requirements that they have failed to live up to in the last cycle of this Australian health care agreement? That is a perfectly reasonable thing to ask for. Why? Because they have failed in the past. In the last few months they have deceived people again and they have no hesitation in deceiving the Commonwealth and the taxpayers of Australia about the funding that is made available.

Let me go a bit further in looking at the current health care agreement that expires in a few short weeks. In that agreement you would be aware, Mr Deputy Speaker, that there is a clause to do with an increase in the private health insurance participation rate, supported by the 30 per cent rebate that the Labor Party so detests. It says that if the natural consequence of transferring some demand from public hospitals to private hospitals materialised there would be an opportunity to recover $2.5 billion of Commonwealth funding. What happened? Australians wanting to invest in their own health and wellbeing have taken up private health insurance in numbers that exceeded the signposts in the current health care agreement, enabling the Commonwealth to recover $2.5 billion of Commonwealth funding. Did the Commonwealth recover that money? No. It was perfectly entitled to under an agreement signed with the states and territories, but it has not recovered that $2.5 billion. That is another windfall to the states and territories in terms of funding for public hospitals.

So the states and territories complain about the conditions that come with $42,000 million of Commonwealth funding. I say to the states and territories, `If it was up to me, I would have gone further.' For that money you would expect a reasonable distribution of services. We know that, in the area of home and community care in the state of Victoria, if you happen to be an ageing person in need of home based care you are worth far more in the eyes of the Bracks government in the inner metro area, where the Labor Party dominate in terms of parliamentary representation, than you are out in my area. Why is that? We have been battling it for years. They are really happy to look after their crowd in inner Melbourne while services are stretched in the outer metro areas.

The same happens in accident and emergency areas. The last time I spoke on the health care agreement I highlighted how the block funding allocation, with some discounted weighting for different types of patient categories, determines the amount of funding that goes to accident and emergency facilities around Victoria. The sad news is that, if you need an accident and emergency visit, you are far better off being in inner Melbourne because that is where the bucks go. The accident and emergency facilities in the outer metropolitan areas of Victoria—where they deal with more acute, increasingly complex, life-threatening cases—are underfunded. Under this agreement, where we have some conditions relating to the funding, we could have gone further. I look forward to seeing whether the states and territories live up to—(Time expired)