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Wednesday, 28 May 2003
Page: 15239


Mr GIBBONS (5:13 PM) —The debate on the Health Care (Appropriation) Amendment Bill 2003 has shown just how sensitive those opposite are as a result of the substantial changes the Howard government is proposing to the nation's health system with this bill. Government speaker after government speaker has launched scathing attacks on the health policies of state governments in order to deflect attention away from the outrageous proposals in this bill, which has the potential to trigger the ultimate demise of the best health system in the world. We always know on this side of the House when we have those opposite on the back foot. They always indulge in either the time-honoured Tory tradition of trade union bashing or the equally time-honoured Tory tradition—in the best Yes, Minister fashion—of blaming the states and everyone else for their own shortcomings.

It is not the state governments that are attempting to decimate the current Medicare system so that it will be just for those who cannot afford appropriate health care. It is a return to the Prime Minister's longstanding public policy view of the 1980s when he said that he wanted to `tear Medicare apart', that bulk-billing should be restricted to the disadvantaged and that doctors should be free to charge everyone else what they like.

These changes to Medicare can mean only one thing—a two-tiered, user-pays health system under which Australian families will pay more for visits to the doctor. Distortion of the facts and attempts to create a diversion by inappropriately blaming the states for problems with the nation's health system—problems that these proposals will worsen—will not convince Australians that their health needs will be enhanced by ultimately destroying Medicare. The changes proposed in this bill are partly funded by pulling out over $900 million from a public hospital system already under severe financial pressure directly as a result of the Howard government's policies. Under this government's proposal, doctors will be given financial incentives to bulk-bill concession card holders—which is, in reality, a de facto means test—and they will be given the green light to charge higher fees for everyone else.

Australian families with two kids that earn more than $32,300 a year are not eligible for a concession card. For them bulk-billing will end and when they visit the GP they will definitely be asked to pay more. This will impact most severely in my electorate of Bendigo, which has a median weekly family income of just $736. Compare this with the Prime Minister's electorate of Bennelong, which has a median weekly family income of $1,300, and the Treasurer's electorate of Higgins, which has a median weekly family income of $1,570. You can see why they are so out of touch with the health needs of low-income families.

To add insult to injury, central Victoria is not getting a fair go in the delivery of Commonwealth health services. We have campaigned now for almost two years for a Commonwealth licence for an MRI facility at Bendigo, and the Howard government has so far refused to allocate the licence. Bendigo has the fourth-lowest level of bulk-billing of all the federal electorates in Victoria, yet it has the third-highest increase in out-of-pocket expenses for seeing a doctor. In Bendigo last year just 48 per cent of services were bulk-billed, but the increased costs for seeing a doctor rose by 25.7 per cent. The large number of veterans in central Victoria are finding it increasingly difficult to afford to see a GP, because most GPs find it necessary to charge a fee over and above the veterans' gold card entitlement.

A central plank of the government's Medicare package is the introduction of two incentives for doctors to bulk-bill concession card holders. The first incentive is a payment of up to $20,000 for bulk-billing patients with concession cards. The second incentive is the promise that doctors will be able to bill Medicare directly for all their other patients and charge patients a fee on top of that—a practice that I understand is currently unlawful. If this were so convenient, why is it only being held out as a carrot for those doctors who agree to bulk-bill those with concession cards? It has not been introduced across the board. It is there simply as a financial incentive for doctors to bulk-bill concession card holders by making it easier to charge everyone else more than they are already paying today. It will make it easier for those doctors who currently bulk-bill Australian families to start charging them copayments for the first time. For doctors who are already charging private fees rather than bulk-billing, it will be much easier for them to increase their fee from $20 to $25 than, for example, to increase it from $45 to $50.

Since Medicare was introduced, doctors have never been allowed to bill Medicare as well as charging patients directly for the same service. This has helped maintain bulk-billing and helped to keep doctors' fees reasonable. The fact that the package includes a new safety net for concession card holders and a new capacity for others to insure privately for medical expenses over $1,000 is an admission that costs will rise. Apart from being inflationary, this new capacity to privately insure against doctors' fees is the real thin edge of the wedge for the Americanisation of our health system. The Australian Medical Association, the Royal Australian College of General Practitioners, the divisions of general practice and the Rural Doctors Association—these organisations are normally not widely renowned for their radical views—formally met to assess the government's package and concluded that the package did not adequately address the issues of access and affordability and warned it would bring about a two-tiered system of care.

The fundamental principle underlying Medicare is that health services should be available according to medical need, not a patient's capacity to pay. Medicare is a system of health care for everyone, not a welfare system for some while everyone else pays their own way. If in the future bulk-billing is only effectively available for pensioners and the poor, it is only a matter of time before someone makes the suggestion that our public hospitals should only be free for pensioners and the poor as well, as John Howard himself did in the 1980s. Medicare and bulk-billing are not dead but they do desperately need to have life breathed back into them.

It will not be easy to turn around in a short time what John Howard has run down in seven years. If Medicare is to be preserved and bulk-billing restored, Australians first of all need a government that is committed to Medicare and to bulk-billing rather than the Howard government's pure ideological commitment to destroying the current system. The solution will require a combination of policy approaches including targeted increases in remuneration for GPs, supporting sensible medical work force measures and making general practice sustainable and attractive again.

When Labor was last in power, bulk-billing by GPs was at a high of more than 80 per cent, and there is no reason why we cannot get it back there again. In fact opposition leader Simon Crean has announced a comprehensive policy that will save Medicare with a $1.9 billion package to reverse the collapse in bulk-billing by lifting the patient rebate for bulk-billing for all Australians, no matter where they live or how much they earn. Labor will immediately lift the Medicare patient rebate for all bulk-billed consultations to 95 per cent of the schedule fee—an average increase of $3.35 per consultation—and subsequently lift the Medicare patient rebate for all bulk-billed consultations to 100 per cent of the schedule fee—an average increase of $5 per consultation. In addition, Labor will offer powerful financial incentives to doctors not only to keep treating their patients without additional cost but to extend bulk-billing, especially in outer metropolitan and regional areas where the collapse in bulk-billing is hurting families most. Doctors in metropolitan areas will receive an additional $7,500 each year for bulk-billing 80 per cent or more of their patients. Doctors in outer metropolitan areas and major regional centres will receive an additional $15,000 each year for bulk-billing 75 per cent or more of their patients.

Lifting the patient rebate and introducing financial incentives for bulk-billing will help stem the current dramatic decline in bulk-billing and act to make bulk-billing available to more Australian families. Under John Howard, bulk-billing by GPs has declined by more than 12 percentage points, from a high of 80.6 per cent to a low of 68.5 per cent at this particular time. By offering GPs a significant increase in the Medicare rebate and powerful financial incentives to meet bulk-billing targets, Labor will restore bulk-billing to respectable levels again. These measures are the first step towards Labor's objective of lifting the average national rate of bulk-billing back to 80 per cent or more.

John Howard is destroying Medicare, leading us down the road to an American style two-tier health system where, instead of your Medicare card, you need your credit card. Bulk-billing rose every year under Labor and has fallen every year under the Howard government. The decline in bulk-billing is denying families access to affordable health care and forcing them to pay more and more to see a doctor, despite the fact that Australians have paid for Medicare through their taxes and their Medicare levies for nearly 20 years. In conclusion, let me say that Medicare is the world's best health care system. Labor created Medicare; Labor will fight for Medicare. Medicare makes sound economic sense, but John Howard is destroying Medicare. Only a Labor government will save Medicare.