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Wednesday, 28 May 2003
Page: 15235


Mr NEVILLE (4:53 PM) —I will commence my remarks in this second reading debate on the Health Care (Appropriation) Amendment Bill 2003 by saying that, much as I respect the member for Lowe—and he is a mate of mine in this place—there was one glaring inaccuracy in his speech. That was when he said that the government was trying to deprive people earning above $32,000 a year access to bulk-billing. Nothing in our budget papers or anything to do with Medicare has ever suggested that. In fact, one could argue that making it more accessible for people on lower incomes will be an encouragement for some doctors to bulk-bill right through their practices. I just do not know where he got that idea from.

In addressing this Health Care (Appropriation) Amendment Bill 2003 today, I will commence by saying that, in the Australian health care agreement running from 2003-08, the Commonwealth has put on the table $42 billion for Australia's public hospitals. The member for Lowe may not recognise this. He talks about $900 million being withdrawn. That is an increase of $10 billion over the previous agreement—or the equivalent of 17 per cent, in real terms, of Commonwealth funding. Queensland alone stands to gain $2.1 billion under the 2003-08 health care agreement, bringing the state's total allocation to around $8 billion during the term of the agreement.

What I find staggering is not the increase in allocation from the Commonwealth, nor the fact that it represents a significant real increase in our commitment, but the fact that not one member of the Queensland government—not the Premier and not the health minister—will confirm what Queensland is prepared to do to match the Commonwealth's increased funding. They run away from this concept at every twist and turn because they know it exposes their diminishing contribution to health care. I find it an incredible situation that the Premier, who has openly described this health care agreement as a `bloody disgrace', refuses to state his own commitment to providing adequate funding out of his own state coffers. And yet here we have a government which fails to support its own health system to the tune of the national average. Don't take my word for it: just ask the Queensland Nurses Union. They raised this matter in a submission to the Senate Community Affairs References Committee inquiry into public hospital funding in 1999. The QNU put it on record that Queensland's health expenditure was the lowest in the nation during the mid-1990s. In fact, in 1996-97 Queensland outlaid just $595 per capita for health, while the national average was $660.

Queensland's ongoing neglect of public health services is further reinforced by the latest figures from the Australian Institute of Health and Welfare, which show that the state and territory share of total health funding fell from 47.2 per cent in 1997-98 to 43.4 per cent in the year 2000-01. Bear in mind that these are all Labor governments. The Commonwealth share has risen from 45.2 per cent to 48.1 per cent over the same period. So it must be pretty obvious to the member for Lowe and to the apparatchiks of the Queensland government that the Commonwealth contribution in relative terms is increasing, not decreasing.

Mr Beattie has the audacity to call the funding contained in the new health care agreement a `bloody disgrace'. If Mr Beattie is so concerned about the shortfall in funding, it is within his power to allocate some of the state's GST revenue to bolster the state's public hospital system. And there I point out that Queensland is the first state, after the adjustments that had to be made to accommodate the Democrat amendments in the GST, to get into positive territory with the GST, and over the next three years it will do rather well out of the GST. It will be very interesting to see if they put some of that back into health. I will come back to the GST a little later in my contribution, but it is a point that deserves further discussion in the context of this legislation.

Let us instead look at some of the finer details of health service delivery within the states and some of the utter rubbish that we have heard both from those states and in this chamber today. One particular item which has been bandied about as a political football is the previous Commonwealth Dental Health Program. It seems to have slipped some people's minds that dental health was always something accepted as a state responsibility. In fact, for 98 of the 102 years of Federation, this has always been a wholly state responsibility. The four-year Commonwealth Dental Health Program was introduced by the Keating government in 1994 and was designed to deal with a backlog of dental problems—a catch-up, if you like, to help the states get ahead of them. Labor never intended to continue this program if elected. It was not anywhere in its forward estimates.

The coalition did not terminate the program when it came to office in 1996, as some would have you believe and as some of the contributions to this debate would sleazily suggest. We completed the program, and it was a one-off program. It was not terminated as a program, as such. Perhaps the states' comment on the dental health program is indicative of their attitude towards health service provision overall: they want the extra money provided by the GST, but in turn they want the Commonwealth to pick up the bill for various items. I remember that not so long ago we funded—as we should have done—a mammography program with the states, fifty-fifty. It was interesting that Queensland was the last state off the mark on that.

The Queensland state government cannot have it both ways. This double standard, peddled by the state government, also carries over to the relief that the 30 per cent private health insurance rebate provides for the public hospital system. By encouraging people to be proactive in managing their own health care, the Commonwealth has created a better balance between the public and private health care systems, and this has produced tangible results. For the first time in the history of Medicare, between 1999-2000 and 2000-01, public hospitals actually treated fewer patients—down by 4,591. This is attributable to more attractive private health care cover. Imagine the burden that this has lifted from the public hospital system and the burden that would be reimposed on the public health system if we were to follow what Labor has proposed in the House today.

This system that the government have put in place has reduced national public hospital expenditure to the tune of $3 billion in 2001-02, but we do not hear the states acknowledging that fact—no fear we don't; not one word of it. In fact, in 2003 the coalition government will invest over $30 billion in the health care system. That is nearly twice as much as Labor spent in its last year of government—a mere $16 billion. You do not need to be an economist to know that that is way in advance of inflation or CPI. In other words, there has been a real increase in funding to health.

Our government is working to keep the ideal of free universal health cover in Australian public hospital services alive and well. We have done this by focusing on the three original pillars of Medicare: the free hospital service—and I have just talked about what we have put into that; Medicare payments to all Australians attending general practitioner services—whether by bulk-billing or by copayment, the contribution remains the same; and the pharmaceutical benefits scheme, or the PBS as we know it.

Subsidising the cost of pharmaceuticals is one of the most effective, tangible health programs in place. I acknowledge that the ALP put this system in place originally, but disingenuously in the debate today none of the speakers mentioned that the ALP also introduced the copayment. The ALP put the copayment in place because they knew it was necessary to maintain the health system. I do not want to see the copayment go up to $28.60. I do not want to pay $28.60 for my scripts, and I do not want to see pensioners or low-income earners paying $4.60. But I recognise that, if we do not do something like that, we are going to be in a very difficult situation.

I am appalled by the way in which the opposition and the minor parties have colluded in the Senate to block passage of this reform to the PBS system to ensure its long-term viability. If the PBS system collapses, there is no doubt that it will have a staggering impact on Australians who rely on prescription medication for their health. Why on earth would this motley crew in opposition object to responsible measures proposed by a government that has a proven track record of economic responsibility and a desire to maintain the PBS system? I think they all know deep down that we have to increase the copayment for the PBS. You cannot have a system that is increasing by a rate of 14 per cent per year and then blindly turn away from the reality of the increased costs.

Interestingly, I have in front of me a table listing the cost of just some of the drugs that are available today—even if you were paying the higher copayment of $28.60 instead of the $22.40 or $4.60 instead of the $3.60 copayment: lipex costs nearly $61; losec, for peptic ulcers, costs $64; celebrex costs $46; zyprexa, for schizophrenia, costs $219; zyban, for nicotine addition, costs $249; humulin, for diabetes, costs $189; and, zoladex, for prostate and breast cancer, costs $726. These are all new drugs. Most of them have come onto the PBS list since this government took office. We have been generous in adding these new drugs to the list—and the few drugs that have been dropped from the list are readily available across the counter—otherwise, very few of these drugs would have been available.

If we want to continue to have these high-quality drugs available but at comparatively low cost, compared with their real cost to the taxpayer, we will have to do something about the copayment. There is not one shadow of doubt in my mind that, in the unlikely event of the ALP winning the next election, they would increase that copayment, because they know the importance of maintaining that system. From 1990-91 to 2001-02, the PBS went from $1 billion to $5 billion and the copayment scarcely moved, and that is just not sustainable. I am prepared to go out and tell that to the people in my electorate, and I am prepared to defend it, because I do not want it to come to the point where we start dropping lifesaving drugs from that PBS list.

By 2040—if you want to look ahead at what medicine is likely to cost—we will be paying $60 billion for our prescription drugs. If we do not have a PBS system, there will be a lot of people missing out. This government has kept consumers' medication costs the lowest in the developed world. That has been proven by the Productivity Commission's report of 2001. In fact, apart from annual indexation, PBS copayments for consumers have not risen since 1996-97. If only those who oppose this government had such a strong track record of keeping costs and services on track. In fact, state governments around Australia have got rid of around 14,000 public hospital beds over the last decade. The once-proud free hospital scheme, supported by both ALP and coalition Queensland governments—up to the Whitlam era, I might add—also provided an outpatient GP service at all hospitals. But the ALP have been slowly closing these down, often in the face of fierce public opposition. The final analysis shows that all they are doing is cost shifting that small component of public-operated outpatient services from their own system to the Commonwealth's. There has been no consideration whatsoever of the patients or the people they profess to represent politically.

Let us look at the revenue which GST alone brings into Queensland—if you like, as a counterbalance for this cost shifting. Between 2000 and 2002, Queensland received around $10 billion in GST payments from the Commonwealth. The Queensland government seem to conveniently forget about the GST revenue they receive from the Commonwealth. They carp about the funding cuts from the Commonwealth government in terms of housing and health but fail to acknowledge their swelling bank accounts, courtesy of the Australian taxpayer. The former Queensland Treasurer, David Hamill, was not shy about this fact. He certainly appreciated the impact of the GST on the state's coffers. As state Treasurer, Mr Hamill wrote to the federal Treasurer, Peter Costello, in January 2000 urging him not to grant exemptions from the GST. He said:

Broadening the existing list of GST-free items has the potential to adversely impact on the quantum of GST revenues that are available ... for the delivery of core services.

He knew the truth of it; the opposition in this parliament knows the truth of it. Let me conclude with a little example from my own electorate. Miriam Vale shire, which stands between Bundaberg and Gladstone in my electorate, is the fastest-growing shire in Queensland, but it is very much undeveloped in terms of community services. It does not have a hospital, and doctors come and go infrequently. There are now about 6,000 people in the shire. After a health study conducted by the Bundaberg and District Division of General Practice, we were able to convince the former health minister, Dr Wooldridge, to grant a $2 million three-year program to put health services into the shire. It was the responsibility of the Queensland state government, pure and simple.

We tried to get that scheme going and, in the meantime, a doctor who left town left a very good surgery and house in place, which we tried to purchase. We could not purchase it out of the $2 million because that was for recurrent expenditure. We thought that the state government would at least provide the headquarters for this work, but nothing happened. Then my state colleague the Labor member for Burnett gave a speech in parliament in which he pledged $600,000 for a community health centre. When the Miriam Vale Shire Council approached the state government through its Bundaberg headquarters to find out when the $600,000 would be available, they were told it knew nothing about it. I then called on him. I said, `Trevor, when are we going to get this money so that we can get on with delivering these health services?' He seemed particularly uncomfortable. He said, `Paul, the truth of the matter is we were hoping you would provide $500,000 of that $600,000 under Regional Solutions.'

So the Queensland government not only got a bonus of $2 million being delivered by the Miriam Vale Shire Council in its shire, but the state government even had the cheek to come back and expect us to fund $500,000 of the $600,000 that would have gone into putting the headquarters in place. Fortunately, the Miriam Vale Shire Council had the good sense to lease a property out of its recurrent expenditure. It took an option over that to purchase it in the first 12 months. As you know, the real estate boom hit about 18 months ago and that property became very valuable. They exercised the option, with some help from Minister Tuckey under Regional Solutions—he gave a grant of $150,000—and now the whole health service in the Miriam Vale shire is not delivered by the state government but by the shire council; yet it is the responsibility and in the purview of the state government. That is an example at grassroots level of the appalling record of the Queensland government, its lack of concern for people on the ground and its lack of ability to master its resources to give all the citizens of Queensland a fair and equitable go.