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Wednesday, 28 May 2003
Page: 15185


Mr FITZGIBBON (1:15 PM) —The member for Dunkley reminds us, once again, in terms of this debate, that the current Commonwealth government's approach to all of these matters, where there are jurisdictional questions, is to set themselves into a position to simply blame the states. When everything goes wrong in health care, in education or in any sector you care to think about, the current Howard government's strategy is to simply set the states up so that they take the blame for many of these issues.

What has been very sad about this debate is the extent to which people have been prepared to deceive their electorates. Someone sitting at home, listening to this debate on the radio, must be thinking, `My goodness, this is a complex debate,' and wondering how it is that members from different sides of the chamber could have such different perspectives on what this bill means in terms of recurrent funding to the states for public hospitals. This is not a complex debate. This is a bill that simply gives the legislative underpinning for Commonwealth grants to the states for the running of their public hospitals. The critical question is whether the Commonwealth is going to be giving sufficient money to the states over the next five years to run those hospitals and to maintain universal access to those hospitals or, indeed, whether it is going to be giving insufficient money.

Someone sitting at home, if they had Budget Paper No. 2, would find it very difficult to learn any more about those questions by looking at the paper. They pick up Budget Paper No. 2 and they see that in the forward years the Commonwealth is cutting funding to public hospitals—in 2003-04 by $108 million, in 2004-05 by $172 million, and so on; in total $918 million over five years. If they look a bit further down, the government's spiel is that they are increasingly funding by 17 per cent over that same period. Surely, that would cause the person sitting at home to scratch their head. How could the government be claiming to increase funding by 17 per cent when their own budget document shows that they are cutting it by $917 million? The answer is pretty simple: all things are relative in life.

That budget paper is telling us that the government proposes to spend much less on public hospitals over the next five years than it had originally proposed to spend. In other words, it is proposing to increase funding but by nowhere near as much as it had originally proposed. The person sitting at home might think, `At least they're increasing it. This sounds like a good proposition. Maybe they're increasing it by less than we would have liked, but surely they are increasing it and that is a good thing.' That naturally depends upon the increasing demands on the public hospital system and whether that increasing funding will keep pace with that increasing demand.

With the ever-spiralling downward rates of bulk-billing in this country, of course demands on our public hospital system over the next five years are going to dramatically increase. The question of course becomes whether this additional funding is anywhere near sufficient to meet that additional burden. I suspect it is not and I think, with a close look at the propositions put in the budget, that most people at home in their lounge rooms would reach that very same conclusion.

This will have a significant impact on our public hospital system. It is time the government got serious about sufficiently funding growth in the system, but also doing something about the downward spiral in bulk-billing in this country. I have had a close look at the government's most recent package for Medicare and I think it is a disgrace. As so many in this House have said before me, Labor has always been the great builder of these schemes that provide universal access, and each time we do so the coalition government comes along and tears it apart. Whitlam did it in the seventies and Fraser tore it apart; Bob Hawke did it in the early eighties and the coalition government in this country is doing all it can to tear it apart once again.

This time they are doing it through the back door. We all recall the current Prime Minister making it very clear to the nation throughout the early nineties that he was opposed to Medicare, he wanted to dismantle it and he did not believe it to be fair. But he changed his tune just prior to the 1996 election, realising at last that to go into an election promising to dismantle Medicare was political death. So he deceived the Australian electorate; he promised that Medicare would remain and that it would remain strong, and yet over the course of the last seven years we have seen the slow but very deliberate and very effective dismantling of that system. We have seen it in the freezing of Medicare rebates, we have seen it in the cutback to university places for doctors and now we are seeing it again with the decision to produce what is effectively a two-tiered system.

Yes, it is a system that strives to take care of pensioners and those with concession cards, but it is also a system that sends a very clear message to GPs in this country that they have the imprimatur of the government to do away with bulk-billing for lower income families. The government is now saying that Medicare is a system for those with health care cards and those on benefits and pensions but it is not a system to provide universal access for lower to middle income families. I think that is a very great shame, and it marks the beginning of the end of the universal system we have enjoyed for so many years.

I want to spend a bit of time speaking about the GP situation in my electorate generally but I will start with Cessnock. The Cessnock local government area has a resident to doctor ratio of about 2½ thousand to one. I think the state average is about 1,200 residents for each doctor. In the Cessnock local government area, we are talking about not only the affordability of health care but also access to health care. In Cessnock at the moment it is very difficult to get access to a GP, particularly if you are not on the books of a current GP. Our GP numbers continue to decline. We have had some temporary relief, because we have had an influx of temporary overseas trained doctors and we have had, very fortuitously, a number of postgraduate students taking up temporary practice with other GPs in the local community. So there has been some temporary relief, but the structural problems remain—and will remain with us until the government gets serious about addressing these problems in rural and regional Australia.

The government has a number of programs designed to both attract and retain GPs in country areas. Unfortunately for the Cessnock local government area, the RAMA classification excludes us from many of those incentive programs. I have had discussions with the minister's office and department on this issue. I will acknowledge that the minister's office has been listening to our concerns and has made some commitment to looking at the situation to see whether or not we can provide Cessnock with access to some of those programs. It advises that changing the RAMA classification system is all too difficult because, once you change the boundaries onward another step, that provides anomalies elsewhere. I have been prepared to accept that on the condition that the minister's department is able to be somewhat creative in terms of extending some of those provisions to the Cessnock local government area.

I am very pleased with Labor's plan for Medicare. I have done the sums on the government's proposal, and I can assure the House that an extra $2.95 will not cause one additional doctor in the Cessnock LGA to bulk-bill. Not one doctor will decide to change their practice as a result of a lousy $2.95—and, of course, I do not need to repeat that this will do nothing for lower to middle income families in my electorate. By contrast, Labor's plan will encourage more doctors to bulk-bill. I have done the numbers, and any GP in the Cessnock area who embraces Labor's target for bulk-billing would indeed increase their income. At the same time, that would mean that there would be greater access to bulk-billing services for Cessnock families. That would be the case when you combine the reward for the target and the increased Medicare rebate they would get for each of those bulk-billing services. If additional money can be earned at the same time as being able to provide additional bulk-billing services, doctors might be more prepared to come to Cessnock.

It has always intrigued me that doctors are not flocking to Cessnock. It is a beautiful part of the world. It has as its heart wine country—Australia's premium wine growing area—and it is within a two-hour drive, if not less, from Sydney. It is a perfect part of the world and it is a beautiful community, but for some reason doctors do not seem to be prepared to come to Cessnock. I suspect that that is largely because the pressures are too great, as doctor numbers are too small. Doctors do not want to come to Cessnock to lock themselves into a 20-hour day, 365 days a year—they are looking for an easier lifestyle than that. Doctors in Cessnock are also expected to make a commitment to the public hospital system and to be on a roster. Of course, the fewer doctors there are, the more difficult, onerous and burdensome that roster is—and, again, there is a downward spiral.

So it is a good thing that Labor's package will encourage doctors to come to Cessnock, because that is at the heart of the bulk-billing issue. We can provide doctors with all the incentives we like to bulk-bill; the fact is that the taxpayer cannot afford to be giving sufficient money to doctors running bulk-billing services—nor should we be excessively subsidising doctors so that they bulk-bill. We need to increase doctor numbers in country areas. At the end of the day, bulk-billing rates are a function of competition or the number of doctors you have in your local area. In places like the Prime Minister's electorate, and indeed the electorate of the member for Werriwa, where you have a doctor on almost every corner, you have strong competition and a very strong incentive to bulk-bill. If I remember correctly, the bulk-billing rate in the Prime Minister's electorate is around 85 per cent, and I think the bulk-billing rate in the member for Werriwa's electorate might be in excess of 90 per cent.


Mr Latham —Yes, 95 per cent.


Mr FITZGIBBON —In my own electorate the bulk-billing rate is about 50.7 per cent. Again, that is a function of competition. So there are short-term, medium-term and long-term solutions to these problems. Labor has put up a proposal which will address them in the short and medium term. It includes incentives to bulk-bill and an increase to 95 per cent of the schedule fee for local GPs. At the end of the day, bulk-billing will only be saved by an influx of doctors to country areas. I acknowledge that the Commonwealth is doing a bit in this regard. It is providing more university places to students from the country—students who, one would hope, will return to the country after they have completed their training. I still think that not enough is being done. We need to focus much more heavily on those university places and on getting kids from rural and regional Australia to study medical courses. They are the most likely people to return to and practise in those country areas.

There is no doubt in my mind that health will be a focal issue at the next federal election. I am very confident that Labor's plan will be well received by the electorate. I am also very confident that the majority of the electorate will reject the Prime Minister's plan. As I said earlier, it is a plan that is designed to dismantle the Medicare system. One of the scary things about the debate we are having today is that it again underscores the government's approach to public policy in this country. We are moving away from a tax and spend approach—an approach of raising revenue to fund public services in the community—and towards a user-pays approach.

The Minister for Education, Science and Training stands here every day and says, `Seventy per cent of Australians do not go to university, so why should they have to pay?' I think the Australian community accepts the logic in raising taxes to provide community facilities and public institutions. We fund museums, for example, and I think that many people in Australia will never walk into a museum. Certainly, people in electorates like mine, who do not have easy access to such cultural institutions, do not regularly visit museums. But that is not an argument to say that we should not publicly fund those institutions. That is just a silly argument. It is the sort of argument the minister is trying to run on education. Of course, he forgets the fact that education is a great and important investment in the future of this nation. If we want to be competitive in this global economy, we must adequately fund our university system and be prepared as taxpayers—


The DEPUTY SPEAKER (Mr Barresi)—The member for Hunter will be reminded of the bill that we are debating.


Mr FITZGIBBON —Yes, Mr Deputy Speaker. Even if as individuals we do not intend to use that facility ourselves, we must be mindful of the need to ensure that the system remains strong and that there is access for all those who want to use it. These are very important issues. I think the electorate will reject the Howard government's approach to this new paradigm of user pays in this country. The role of government is to raise revenue, and fund facilities, institutions and programs that would not be funded if government was not in there playing a role. That is the role of government in this country, and it is one we should continue to perform. It is a shame that the intentions of the Health Care (Appropriation) Amendment Bill 2003 do not reflect the role we have always enjoyed and should retain but, instead, reflect the government's new user-pays approach.