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Wednesday, 28 May 2003
Page: 15253

Mr MARTYN EVANS (6:15 PM) —I rise tonight to speak in this second reading debate on the Health Care (Appropriation) Amendment Bill 2003. It is more than 30 years since the Medicare system—in the original form of a Medibank proposal—was first put forward in this country by Doctors Scotton and Deeble and adopted by the then Leader of the Opposition, Gough Whitlam, in his original proposals for a Medibank scheme. You would think that after all these years John Howard and his conservative colleagues in what is now the coalition government would finally have come to terms with a universal health care system. But they have not. They have not yet come to terms with that universal health care system. They have not yet been reconciled with the notion that Australia and Australians can indeed have their health care needs funded and financed by a universal health care system—a system which we now know as Medicare and a system which can be financed by a Medicare levy provided by all Australians and one which can, through a system of bulk-billing, through a system of public hospitals and, of course, through a system which also has a substantial contribution from private providers, GPs, private hospitals and private insurance, well provide for Australian health care needs. But, of course, the underpinning and very fundamental nature of that system is the universal health care nature of the Medicare system. Without that, Australia's health care system will never be universal, it will never properly be equitable and it will never fully meet the needs of all Australians together. John Howard and his coalition colleagues, after 30 years, have still not fully understood the nature of that system.

We finally saw that properly revealed when the health ministers of Australia met to see the proposals of the Howard government and to understand, in all its naked reality, the fact that there was $1 billion less for the states and territories to use in their public health care systems and their public hospital systems—and to understand the impact that that would have on the way in which Australians were able to make use of their public hospitals, to understand the way in which their emergency departments would be squeezed by the Howard government's other proposals in relation to bulk-billing and to understand the fact that many GPs in this country would no longer be bulk-billing their clients to the extent that they had been to date. Indeed, we can see the decline from the overall figures that come out each statistical period, and since this government has been in office the decline has been quite dramatic. In 1996 just over 80 per cent of transactions were bulk-billed, and now of course we are down to just under 70 per cent. That is quite a dramatic decline.

When we saw a decline in private health insurance numbers just after this government was elected back in 1996, that was portrayed as a major crisis in the health care industry of this country and the government insisted that immediate action was required. They subsequently came to this parliament and sought the appropriation of billions of dollars of taxpayers' money to fund the private health insurance industry—because of the extent of the crisis, which they indicated was revealed by the declining levels of private health insurance in this country. Yet, now that we see dramatic declines in bulk-billing, they do not respond with a similar rescue package for bulk-billing. Indeed, they respond with a so-called new deal for Medicare, a new deal for bulk-billing and a fairer deal for Medicare, which in fact is targeted at ensuring that bulk-billing will decline even further, because that is the reality of their package.

Why is this so important to Australia and Australians? Well, health care is now more important to people than ever. I want to look right back in history, because if we look back many thousands of years—20,000 or 30,000 years, which is looking a long way back in the history of humankind—we will see that the life span of the average human was 20 to 30 years of age. You only lived to maybe 30 years of age, if you were lucky, right back in the Neolithic and Palaeolithic periods. Indeed, that did not change very much. If you look back to 2000 BC, the average life span was still 30 or 31 years of age. By the Bronze Age, it was maybe 32 years of age. By the time we reached the Roman era, you were making 35 years of age if you were lucky and providing you did not work for the army. I think the life span was a bit shorter if you were in the army, but if you were reasonably well to do and an average citizen, you might make it to 35. If in fact you lived in the Middle Ages, the average age at death was probably back down to 28 years of age, because disease was taking its toll and nutrition was not all that good. By the 1800s, we were right back up to 38 years of age at death—you were doing quite well back in the 1800s, making it to 38 years of age, as an average age at death. That, of course, is only a couple of hundred years ago, so in the whole of human history really—although the numbers went up and down a little—we were only talking about a variation between maybe an age at death of 30 and really getting as high as 38 years of age 200 or 300 years ago. It is only in the modern era—the last hundred years—that our life span has risen to numbers like 40, 50 or 60 years of age at death. In fact, it is only in the last 50 years or so, since World War II, that we have reached numbers like 78 or 80 years of age at death. The reality is that modern medicine has delivered the kinds of health outcomes that see people living long enough to die in their late 70s, 80s or 90s, on average.

So modern medicine, modern public sanitation, modern vaccination programs—modern health care, if you like—have delivered fantastic revolutions in the standard of health care, in the standard of lifestyle and in the age at death that most citizens of our western countries, and indeed of many countries throughout the world, are now able to enjoy. Of course, we should at the same time spare a thought for those countries which are not able to enjoy those benefits and look to the day when they can, like us, also enjoy those benefits. It is appropriate to remember those who do not share that privilege with us. But we do enjoy that privilege, and that has made it very worthwhile for the average citizen to look very closely at the health benefits which their government provides and at the way in which those benefits are financed.

Fifty to 100 years ago it was not worthwhile looking at the cost of medicine, because medicine was not able to deliver you very much. But in the last 50 years or so it has certainly become very important for the average person to look very closely at how their government provides health care, how their health care is financed, how they are going to pay for it and how taxes are going to be used to ensure that that health care and the cost of it is distributed equitably. Those have become very important social justice questions. Unfortunately, they are not questions that this government has been able to come to grips with.

But 30 years ago they were questions which the then Labor government of Gough Whitlam was able to come to grips with. If this government had equally shared the vision of the Whitlam government all those years ago and had joined in that vision with this side of politics, a shared, bipartisan vision for health care financing in this country could have been jointly developed over the last three decades and Australians could now share an equitable and just financing of health care in this country. Instead, we have seen a twisting and turning of health care financing politics in this country, in such a way as to ensure that the public have never been able to be certain what the next twist and turn from the coalition parties would be in the health care financing political jungle. That is really what has been the cause of the difficulties we find today.

If you think back to the elections under John Howard as Treasurer and Malcolm Fraser as Prime Minister—and the elections we have had subsequently—you see this. I agree with my colleague from Braddon, these are terrible thoughts, but we must face them, because they are the reality of why we face the difficulties we often face these days. They were at pains to stress, when under political pressure, that they would maintain Medicare. But having Medicare maintained by a conservative government is an all too frightening thought, because they really can never bring themselves to maintain it in a way that actually promotes the future health of the Medicare financing system. Because ultimately that is what it is: it is a national insurance and finance system that actually provides the equitable financing of these schemes and ensures that all Australians have equitable access to them. Without that universal access, the freedom of access and the certainty of access is not there.

But what did we have? We had the spectre, back in the eighties, of Malcolm Fraser forcing the debt collectors back into the state public hospitals and back onto the doors of patients. The reality of that was that it was undone. Then we had the reality of John Howard's changes, which over the last few years have been quite traumatic for the system, and now we have even more changes being reintroduced into the House today. These changes will force people back into a system where bulk-billing will no longer be a reality for many people in this country, and that will ensure that universality is again under threat.

The problem with this is, of course, that many of those people who earn more than the cut-off threshold of some $32,000 for a health care card—and that includes many working families in this country—will no longer have the certainty of bulk-billing. And of course with the way it is falling now that is indeed a very serious proposition, because in many cases those people are the ones who most need the kind of health care certainty that bulk-billing provides. That will force the rationing of health care in this country—but not on the basis of clinical need. The experience of the United States shows that, when those whose income is lowest and whose health care needs are perhaps greatest are put under financial pressure, they will take decisions about their health care and they will make those decisions under financial pressure. They will make decisions about when they can visit the doctor and about which prescriptions they can have filled, but they will not make those decisions on the basis of clinical need or medical judgment; they will make them on the basis of financial judgments. They will do that because they are not in a position to make those decisions on the basis of clinical need. They are forced to make them on the basis of week-by-week, day-by-day financial decisions, on the basis of financial pressure and not on the basis of real clinical need.

We have had some quite bizarre outcomes in this country because of the financial pressures which this government has placed patients under as a result of their changes to Medicare over the years. We have seen quite bizarre changes to private health care structures. Private health care remains an essential part of health care delivery in this country, and no-one on this side of the House wants to see it eliminated from our structures. Of course private health care has a role to play, but unfortunately this government has demanded nothing in return for the billions of dollars it has pumped into private health care. The government has given private health care a billion dollar open-ended cheque, year after year, and it has not demanded anything in return.

Private health care's administration costs remain much higher than Medicare's costs. Medicare, of course, through the Health Insurance Commission, is able to maintain very low administration costs for its insurance delivery. It delivers administrative costs that are extremely low by comparison. Probably the average cost of administration for a private health fund is four times that of the Health Insurance Commission. Does the Howard government place any pressure on private health insurance funds to deliver low administration costs in exchange for the massive federal taxpayer subsidies they deliver? Absolutely not. Has it placed any pressure on private hospitals and private insurance funds to deliver lower clinical cost outcomes in private hospitals? Not that I can see. I have not seen any evidence before this parliament to that effect. These are the things that should be occurring.

In the United States, where private health insurance is the norm, it is also quite normal for private health insurance companies to negotiate significant cost reductions in exchange for their contracting processes as part of the tender process which they negotiate. Of course, we on this side of the House are not proposing HMO type structures, but the reality is that those companies do negotiate reductions in costs. Health insurance companies in this country have done nothing to help negotiate reductions either in their own cost structures or in the cost structures of private health funds, despite the availability of contract structures in the act.

The private health insurance companies here also remain a bastion of bureaucratic infrastructure and have a very limited innovative infrastructure. They do little to encourage innovation within their own structures and produce products with minimal innovation in them. They are also unable to deliver to their clients any innovative infrastructure whatsoever. None of their products, it seems to me, ever deliver innovative ways of delivering the product to the client, they make little use of information technology and they hardly ever deliver innovative outcomes, yet the government simply continues to provide them with a blank cheque, drawn on the taxpayers, when they make no changes.

Some of the very distressing features of that also remain in the fact that they continue to subsidise dental care, for example, through that taxpayers' blank cheque. While most uninsured people in this country, those who have the lowest incomes, are unable to obtain much in the way of assistance for dental care and often wait for years in public hospital structures to get any assistance with much-needed dental care—and they are often in pain waiting for dental care, and I do not want to use that term in any light sense—there are massive subsidies for well-off families who can afford private health insurance and who get that massively subsidised by the taxpayers to obtain dental cover through private health structures. That subsidy is quite enormous, yet one of the first acts of the Howard government when it came to office was to cancel the minimal start which the previous Labor government had made towards public assistance with dental cover.

In the May-June issue of Tracking Trends in Health Care there is a five-country survey of the inequities in health care. It shows that 38 per cent of Australians on below average incomes reported much difficulty in obtaining needed dental care and that they could not see a dentist due to the cost. The reality is that those on higher incomes obtain substantial subsidies for their dental care through the open-ended cheques which the taxpayers provide through the Howard government's subsidies for dental care.

These are the kinds of inequities that the government must address if there is to be any fairness in the distribution of its health care income policies. This government, I am afraid, has never been about that. Despite all the years that we have had a universal base to our health care structure in this country, the government has not got the message. We are getting close to spending 10 per cent of our GDP in this country on health care. In a modern Western society, the reality is that that is where we are going to settle. Australians demand fair and equitable health care. Given the way in which modern science and modern medicine can deliver real and effective gains to your health care, there is no reason why we should not spend those kinds of amounts of money.

As I demonstrated earlier in my comments, we have seen real and significant improvements in the standard of the health care outcomes which people now enjoy in 2003 in our society and in societies like ours around the world. Given the way in which people value their own health, their children's health and the health of other family members, why shouldn't we enjoy the benefits that modern health care can bring? The reality is that those benefits are a public good that should be enjoyed by all Australians equally and equitably, but access to those benefits is limited by the access to universal health care and universal funding for that health care.

If all Australians are to enjoy that equitable standard of health care, Medicare represents their best and only opportunity to do that in this country. Australians deserve a fair go at that system of funding, and this government is currently denying them that access. The opportunity to do it has been there on a bipartisan basis for 30 years. Our side of politics calls on this government to do that in a fair and equitable way. You have had your chance to do that. It is now high time that you seized that chance and gave Australians the fair go they have been demanding for the last 30 years.