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Wednesday, 28 May 2003
Page: 15249


Mr SIDEBOTTOM (5:55 PM) —The fact that the words `health care' are contained in the title of the Health Care (Appropriation) Amendment Bill 2003 is almost like a cruel hoax because, instead of health care, this is about unhealthy care.



The DEPUTY SPEAKER (Mr Mossfield)—Order!


Mr SIDEBOTTOM —In fact, the bill itself does two things in relation to health care: first, it attacks the public hospital system and, second, it attacks the universalism of Medicare. I would like this evening to go through these two points that I contend and demonstrate that this is about an unhealthy care package, a package from the budget which robs Peter to pay Paul. First and foremost, it attacks the public hospital system. The emergency departments of our public hospitals are already under great pressure because the Howard government has let bulk-billing run down by more than 12 per cent over the seven years since John Howard became Prime Minister.



The DEPUTY SPEAKER —Order! The minister will cease interjecting.


Mr Hockey —State hospitals!


Mr SIDEBOTTOM —The minister opposite can shout all he likes. He was humiliated today in the MPI and he feels that tonight, by the degree of volume, he can vent his spleen because he was so humiliated. Keep doing that, Minister—from Sydney's North Shore—but I am pleased to tell you what this bill means to people who live in north-west Tasmania and the rest of Australia: it is an attack on public hospitals. Instead of recognising the pressure that public hospitals are under—an undisputed fact—the Howard government is withdrawing a further $918 million over four years from our public hospitals. If the minister opposite wants proof then he can go to Budget Paper No. 2, page 179. Clearly set out there is a withdrawal of $918 million over four years from our public hospitals. We know what that will result in: fewer nurses being employed or being able to be employed, fewer operations being undertaken and longer waiting lists for elective surgery.

But there is an interesting thing about this bill with the words `health care' in its name: the cruel hoax is that the cut to public hospitals has precisely offset the budgetary impact of the government's so-called $917 million Medicare package—a fundamental change which will destroy Medicare and put an end to bulk-billing for many Australian families. Indeed, if you go to the budget papers—the minister obviously needs to fill in his time with these because he is not doing his portfolio, tourism, much good—and in particular Budget Paper No. 2, pages 162 to 167, you can have a good old read, because you cannot sleep at night. Over the five-year period from 2003-08, the total funding withdrawn from public hospitals will be in the order of $1.5 billion.

Why has the government made changes to Medicare and why will these changes mean higher costs to Australian families? Yet again, part of this hoax is that the health minister, Kay Patterson—who is trying to be in charge of health—said that the Medicare changes are `for all Australians'. That serves as a reminder that, in 1996, John Howard was elected as Prime Minister under the slogan `for all of us'. We all know what that means: one big fat wedgie for all of us; wedge politics personified.



Mr SIDEBOTTOM —You can go on, Minister, if that is what you want to do. Waste our time.


Mr Hockey —Mr Deputy Speaker, I rise on a point of order. I find that language offensive. I ask the member for Braddon to withdraw it.


The DEPUTY SPEAKER —I ask the member for Braddon to stick to the debate. I also warn the minister to cease interjecting or I will have to take action against him as well.


Mr SIDEBOTTOM —We all know that, in the 1980s and thereafter, the current Prime Minister had no love of bulk-billing and no love of Medicare. An example of his wedge politics is that he intends to dismantle the universalism of Medicare, to attack our public hospital systems and to throw the onus back on the states. Of course, that would affect Australian families. If that is what the minister opposite, the minister for the North Shore, wants to do, that is fine. He can bellow and bleat about his concerns. These changes to Medicare can mean only one thing: a two-tier user-pays health system under which Australian families will pay more for a visit to the doctor. Doctors will be given financial incentives to bulk-bill concession card holders—a de facto means test; nothing more, nothing less.

Minister, I notice you are not rushing to means test the 30 per cent rebate for private health. You are not rushing around to quickly means test that, are you! But you are quite happy to do it to struggling Australian families who must use a doctor. Doctors will be given the green light to charge higher fees for everyone else. How will they do it, Minister? Just to inform you a little—you are not informed in your own policy area, so you may as well get informed on this—they will do it by splitting the patient rebate from the copayment out-of-pocket charge to the patient. You will be able to watch it happen, Minister. Australians families with two kids and who earn more than $32,300 a year are not eligible for a concession card under this plan. That is a fact. Bulk-billing will end for them. When they visit their GP, bit by bit they will be asked to pay more.

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 concession is a payment to doctors 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 them a fee on top of that, a practice that is currently unlawful. If billing Medicare directly is so convenient, as the other side trumpet, why is it being held out as a carrot only for those doctors who agree to bulk-bill those with concession cards? It will not be introduced across the board; it will be there simply as a financial incentive for doctors to bulk-bill concession card holders by making it easier for them to charge everyone else more than they do today. It will make it easier for those doctors who currently bulk-bill Australian families to charge 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, say, $20 to $25 than to increase it from $45 to $50.

Since Medicare was introduced, doctors have never been allowed to bill Medicare as well as charge patients directly for the same service. There is a nice fact for you, Minister. Get your ears unplugged and listen! That has helped to maintain bulk-billing and helped to keep doctors' fees reasonable. That is a fact, Minister. 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 of over $1,000 is an admission that costs will rise. The fundamental principle underlying Medicare—and any investigation of the history of Medicare will tell you this—is that health services should be available according to medical need and not according to a patient's capacity to pay. That is at the heart of it.

Medicare is a system of health care for everyone. It is not a welfare system for some while everyone else pays their own way. If in the future bulk-billing is available only to pensioners and the poor—and that is the plan of this government—it is only a matter of time before someone makes a suggestion that our public hospitals be free only for pensioners and the poor. Of course, we know that because that is what John Howard used to talk about in the 1980s. You do not have to take my word for this. I found some very interesting reading in a parliamentary research note by Amanda Elliot. There is a good deal of definition work in the note—particularly under the heading `Universalism and Medicare'—which I think would be enlightening to all members. I would like to quote from this a little more extensively, because it goes to the heart of the differences between Labor's approach to Medicare and health care and this government's approach, which is to create a two-tiered system where concession card holders are bulk-billed and families above a certain income threshold pay more for their health care. I quote from Amanda Elliot's paper:

... it can equally be argued that bulk-billing contributes to the creation and widening of health inequalities. Without easy access to bulk-billing, access to medical services increasingly relies on an individual's capacity to pay rather than on their health needs.

The article goes on:

... if access to bulk billing is means tested—

and that is what we are talking about with this government's plan—

or if low income and chronically ill patients are provided with access to a more substantial Medicare rebate, then the Australian health system will take on the characteristics of a selective (targeted) and residual (safety net) health system. This contradicts the original intention of Medicare; it was first and foremost designed as a universal and institutionalised health insurance system - where individual and population health and the risks associated with ill health were seen as collective risks that should be collectively insured against. One of the reasons for the popularity of Medicare is its universalism (that is, universal access to the Medicare rebate).

I say it again: universal access to the Medicare rebate. That is the very principle—the very essence of universalism—that is attacked by this government's unhealthy plan.

Labor has a plan to save Medicare and restore bulk-billing. That was ably demonstrated and illustrated by the Leader of the Opposition in his reply to the budget. Labor would 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. The fundamental fact about this government and bulk-billing is that, from the introduction of Medicare by a Labor government in 1984—and let us remember, Labor invented Medicare, Labor supports Medicare and Labor will restore Medicare—bulk-billing rates in Australia increased until that magical, tragic moment in 1996 when, with the introduction of this government, bulk-billing rates began dropping. Today they are 12 per cent lower than they were at their highest point, at the end of Labor's term in 1996.

Labor would restore Medicare with a $1.9 billion package to reverse the collapse in bulk-billing. It would do this by lifting the patient rebate for bulk-billing, as I mentioned, for all Australians—no matter where they lived or how much they earned. There would be universalism in the application of the Medicare rebate, and that is the principle of Medicare. We would immediately lift the Medicare patient rebate for all bulk-billed consultations to 95 per cent of the scheduled fee—and that is an average increase of $3.35 per consultation—and we would subsequently lift the Medicare patient rebate for all bulk-billed consultations to 100 per cent of the scheduled fee, which is an average increase of $5 per consultation. Labor would also give powerful financial incentives to doctors to not only keep treating their patients without additional costs but to also extend bulk-billing, especially in outer metropolitan and regional areas where the collapse in bulk-billing is hurting families most.

Indeed, in my region of Braddon on the north-west coast of Tasmania, for example, doctors would receive an additional $25,500 a year for bulk-billing 70 per cent or more of their patients. Lifting the patient rebate and introducing financial incentives for bulk-billing will help to stem the current dramatic decline in bulk-billing and act to make bulk-billing available to more Australian families. That is the heart of Labor's policy to restore Medicare, because that is indeed the heart of the principles that underpin Medicare.

I am about to offer my electorate some information. This will not just be related to the government's poor plan for health, outlined in the budget; I will also outline Labor's plan to save Medicare. In my information, I am including a poll, because I like to try and maintain some objectivity in presenting issues to the electorate—and I must say that most punters out there do not so much want the politicisation of issues as to be able to deal with the facts of the issues. The poll demonstrates one of the interesting things that emerged from the budget—and that very generous $4 tax cut to most families. It is the Nielsen poll of 20 May, and it appeared in the Age. It was very interesting that, amongst a number of questions in that poll, there was one which said:

Given the choice, would you prefer to keep the tax cut or have the money go to services like health and education?

In other words: do you want the tax cut, or would you prefer to see those moneys go into health and education? The answer was that a whopping 77 per cent supported the moneys going into services like health and education, while 20 per cent indicated that they wanted to maintain the tax cut. Labor's plan maintains the tax cut and also introduces a $1.9 billion plan to restore Medicare to those principles that I outlined earlier, in terms of universality and an institutionalised health insurance system. Of course, that is very important to many families.

I have said before that bulk-billing has been declining in our community since 1996, since that tragic day that the Howard government took over the Treasury benches. The average out-of-pocket cost to see a doctor who does not bulk-bill now is $12.78. That figure is up 55 per cent since 1996. Families earning more than $32,300 a year, as I mentioned earlier, will be denied access to bulk-billing. In my electorate, that is 60 per cent of families on the north-west coast.

Really what that is saying is that we are now introducing a two-tiered system. If you are not a concession cardholder, you will pay more for your health care. Of course, that is not the only increase in cost that families will need to bear, because the other unfortunate plank of this government's terrible budget is going to be the introduction of higher fees for people going to university to continue their education. So families will also pay those. The user-pays principle is going mad, the concepts of universalism in Medicare are being abandoned and we are getting the creation of a semi-Americanised pay as you go user-pays system, which will not deliver the benefits to health care—and indeed down the line to education—that Australian families so much believe in. My pamphlet is headed `$4 is not enough'. A $4 tax cut is indeed not enough and this government will learn that it is not enough.