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Wednesday, 28 May 2003
Page: 15258


Mr MOSSFIELD (6:35 PM) —I rise to speak on the Health Care (Appropriation) Amendment Bill 2003 and to support the amendment moved by the opposition. This bill amends the Health Care Appropriation Act 1998, which provides the legislative framework for grants of financial assistance under the Australian health care agreements. It will, if passed, enable the Commonwealth to enter into new health care agreements and maintain funding to the states pending the negotiation of these arrangements.

Other elements of this bill will redefine the definition of `eligible persons' to reflect the current definition in the Health Insurance Act 1973 and appropriate from the consolidation revenue fund an amount not exceeding $42.01 billion for hospital services provided and projects and programs conducted during the five-year period commencing 1 July 2003. It will also grant the Minister for Health and Ageing the power to delegate an SES employee in the department the minister's powers under the certain paragraphs of the act in so far as they relate to financial assistance granted under paragraph 4(1)(B). The bill will also amend section 5(2) to provide for conditions to apply for grants of financial assistance under section 4 to a state in respect of a particular appropriation period.

In a classic case of robbing Peter to pay Paul the federal government will cut nearly $1 billion worth of funding to our public hospitals over the next four years in order to pay for a package designed for no other purpose than to destroy Medicare. Budget Paper No. 2, on page 179, indicates that in 2003-04 $108.9 million will be cut, in 2004-05 there will be a further $172 million cut, in 2005-06 we will see a further cut of $264.6 million and in 2006-07 there will be another massive cut of some $372.9 million—a total over those years of $918 million. This is during a time when our public hospital system is under the increasing strain brought about by the policies of this federal government. Create the problem and then cut the funding—that is this government's modus operandi.

Bulk-billing rates have fallen every year under the Howard government, from a high when they took office of 80.6 per cent of doctors providing bulk-billing services to an average of only 68.5 per cent today and rapidly falling. This drop in bulk-billing means to the average family that more than 10 million fewer GP visits were bulk-billed this year compared to when this government came to power in 1996. That is 10 million more patients who had to pay up-front fees to see a doctor. The average out-of-pocket cost across Australia to see a doctor who does not bulk-bill is now $12.78, up 55 per cent since the Prime Minister came to office. In Greenway the figure is considerably higher at $16.65, up by more than 20 per cent in just the last two years—and in some cases I have found it is as high as $20.

Bulk-billing rates are a direct result of federal government policy. There is no way to pass the buck on this one to the states. But it is having an effect on state government responsibilities—that is, it is increasing the strain on our public hospital system and, in particular, on emergency department services. Families unable or unwilling to pay the spiralling costs of visiting a GP are instead visiting the emergency wards of their local public hospitals. Last year, in New South Wales alone, visits to emergency departments topped the two million mark for the first time, and there can be no doubt that falling bulk-billing rates are partly responsible for this increase. Our emergency departments are under enormous strain: doctors, nurses and other staff are overworked; waiting times are unacceptably long; and basic health care is suffering as a result. Yet, with all this happening, the federal government's response is to cut almost $1 billion from the public hospitals of Australia, thereby exacerbating the problem. This is robbing Peter.

Paying Paul is a different matter. Paul is going to rip the guts out of Medicare and completely destroy bulk-billing for all but concession card holders. In my electorate of Greenway, that means taking the option of bulk-billing away from over 80,000 people. At present, I am proud to say that my electorate of Greenway has one of the nation's leading rates in bulk-billing with an average of over 94 per cent. Any move against bulk-billing is a move against the families of Greenway. If bulk-billing is restricted to concession card holders then around 27,000 households will lose access to this basic service—60 per cent of my entire electorate. People should not have to consult their credit card statements before deciding if they are rich enough to go to a doctor. This is not the sort of society I want my grandchildren to grow up in.

The Whitlam government built Medibank and the Fraser conservative government, with the present Prime Minister as Treasurer, tore it down. The Hawke government built Medicare, a universal health care system that is the envy of the world, and now the Howard government wants to again tear it down. Our present Prime Minister has never disguised his dislike of universal health coverage. He opposed it at the time it was introduced when, 20 years ago this week, on 24 May 1983, he said:

The government will waste $400m of taxpayers' money next year through the needless introduction of the new Medicare arrangements.

He called universal health care a needless waste of money. There is not much you can say about that statement. Medical care for everybody is a needless waste of money? I do not think even the minister at the table, Mr Hockey, would agree with that. It perfectly illustrates the Prime Minister's philosophy of social Darwinism: dog eat dog and who cares if you fall through the cracks. In 1987, during the election campaign, the Prime Minister reiterated his opposition to Medicare when his party's official policy stated:

Bulk-billing will not be permitted for anyone except the pensioners and the disadvantaged. Doctors will be free to charge whatever fees they choose.

Does this sound familiar? Now he is finally acting on his desire to see people struggling to afford to visit a doctor. Make no mistake about this: it is not about budgets and affordability; it is about ideology, pure and simple. What else can it be?

Medicare is universal health coverage. It is medical coverage for everybody regardless of location, economics, background, race, religion or any label you wish to put on somebody—it does not matter. Medicare means that they are able to get the medical attention they need. Yet this Prime Minister describes it as `a miserable, cruel fraud' and `a total and complete failure'. Medical coverage for everybody who needs it is not and can never be a miserable, cruel fraud. Surely it should be the goal of a civilised society. What does the Prime Minister have against the people of my electorate and the people of Australia that he would treat them like this?

The government's announcement means that Australian families will pay more for their health care. Now there will be two tiers of Medicare, excluding everybody but pensioners and the poor from the bulk-billing doctors. The Prime Minister has refused to give a guarantee that his plan will stop the catastrophic decline in bulk-billing. Indeed, that seems to be the aim of the policy. The Australian Medical Association has confirmed that doctors `are going to have to charge their non-concession cardholders more' as a result of the changes, and the government has admitted it will have no control over the fees that doctors charge. The $918 million it is withdrawing from our public hospitals over the next four years will mean that fewer nurses will be employed, fewer operations will be undertaken and there will be longer waiting lists for elective surgery.

Already we have a chronic shortage of nurses throughout Australia due to the government's education policies. There is a shortage of some 5,000 nurses. The Senate estimates process has revealed that New South Wales universities trained 567 fewer nurses in 2001 than it did in 1996. In Victoria over the same period that figure was 737. In 2002 Australia wide some 11,314 people applied to study nursing and 2,934 of these were turned away. The government now belatedly has a plan to create 625 new places at universities for nursing students, but the money will not arrive until 2004. So the government has a double whammy solution to the health problem—train fewer nurses and reduce funds to pay nurses. This may make the bottom line look good, which is the government's real agenda, but it does nothing for the health outcomes of the Australian public. What do these cuts mean to the average Australian?

Take the case of Joan, an 81-year-old pensioner living in Seven Hills in my electorate. She rang me to complain that she had been quoted $1,650 to have a cataract operation plus $128 for glasses frames and another $128 for lenses. She told me that she lives on her own, her son having died of cancer five years ago. She told me that she had $6,000 in the bank to pay for her funeral and other necessities. She rang back a little bit later to say that she had made a mistake and that really she only had $5,000 in the bank. Quite clearly she cannot afford the $1,650 for a cataract operation.

I made some inquiries and found out that Joan could have the operation performed at the eye hospital in Macquarie Street. When I conveyed this to Joan she said that due to her ill health she had not been into the city for something like 20 years. The eye hospital in Macquarie Street could see Joan in October, five months from now and they would be able to operate within a month after the initial appointment. But locally at Westmead Hospital the situation is a little different. They could not make an appointment for an initial consultation until February of next year—nine months from now—and would not be able to perform the operation until some time around mid-2005. So here you have a classic problem of people living in Western Sydney, particularly the elderly and families with children. There is a shortage of specialised public health facilities, yet this government is cutting funding to public hospitals by an amount of $918 million over four years. This is a disaster.

The cataract operation is an important operation for people in the age group of the pensioner that I am referring to and even for people younger than that. I had the operation myself just a couple of weeks ago. I can say now that I can see you a lot more clearly than I could two weeks ago. It is an important operation. For pensioners to be denied this service because of where they live is totally wrong. It certainly shows that more money must be available to public hospitals to enable these services to be provided.

The Prime Minister became infamous for his core and non-core promises. I think we can say that his threat to pull apart Medicare was a core promise and he has honoured his commitment on this occasion. His promise to protect Medicare, which he took to the 1996 election, was obviously a non-core promise. Only Labor believes in a universal health care system that works effectively. That is why we created Medibank and then Medicare. That is why we will save Medicare from the destruction that this government is trying to inflict.

In his reply to the budget speech Simon Crean outlined a rescue package of $1.9 billion for Medicare. We will create viable incentives to restore bulk-billing and provide viable support mechanisms for doctors who continue to bulk-bill everybody. When elected to government Labor will immediately lift the Medicare patient rebate for bulk-billed consultations to 95 per cent of the scheduled fee—an average increase of $3.35 per consultation. Subsequently Labor will lift the Medicare patient rebate for all bulk-billed consultations to 100 per cent of the scheduled fee—an average increase of $5 per consultation.

Labor will also offer powerful financial incentives to doctors to not only keep treating their patients without additional costs but to extend bulk-billing, especially in outer metropolitan areas and in areas where the collapse of bulk-billing is hurting families. 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. Doctors in rural areas will receive an additional $22,500 each year for bulk-billing 70 per cent or more of their patients.

Finally, the argument quite often—although I must admit I have not heard it on this occasion—is: where is the money coming from? Quite clearly this is fully funded and Simon Crean has outlined in his reply to the budget speech just how this funding for Medicare and bulk-billing will be handled. There will be a scrapping of $1 billion of the business tax reforms that the government has announced. There will be a redirection of the government's Medicare savings. The rest—the $500 million over four years—will come from forecast surpluses. So quite clearly this is an affordable project that the opposition is putting forward. I certainly look forward to the opportunity of being involved in bringing this package to fruition.

This is one of the fundamental issues. There is no question about the issues that are facing the Australian public today. There is no doubt that the issues out there are bulk-billing, education and the environment. These are the three main issues that the government is weak on and these are the three issues that the Labor opposition is going to campaign on and campaign on very effectively.

Most of the Labor opposition members have been out in their electorates, talking to their constituents and explaining to them what the Medicare package is all about, and we are receiving very positive responses from the people who we represent. They are saying to us that they want bulk-billing to remain, particularly in areas which I represent, where we already have high bulk-billing rates. It is true that in other electorates in other parts of the country the bulk-billing rates are not high and therefore what the government is introducing will not have such an impact. But certainly in the area that I represent and in surrounding electorates the high bulk-billing rates that currently exist are very important to people.

For an average family, it is not a case of going to the doctor once a year. If you are ill, if you have young children or if you are an elderly person and you get an illness—it might be a virus of some description—it is not unusual to visit a doctor three times a week. If that doctor does not bulk-bill, what are you paying? You are paying, possibly, up to $60 per week to see a doctor. So we will be fighting to make sure that we retain bulk-billing.

Another area that is very important so far as our constituents are concerned is education. Of course, health and education really go hand in hand, because we have to have the appropriate places at our universities so that our medical professionals can be trained. That has been part of the problem. As I said earlier in my speech, there has been a lack of training places available for nurses, and now we have a shortage of nurses. The two policy areas are very closely linked, and we will be campaigning very hard on these issues.

Finally, 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. Under this Prime Minister, bulk-billing rates have declined by more than 12 per cent. By offering GPs a significant increase in the Medicare rebate and powerful financial incentives to meet bulk-billing targets, Labor will restore bulk-billing rates to acceptable levels.

These measurers are the first step towards Labor's objective of lifting the national average rate of bulk-billing back to 80 per cent or more. The Prime Minister is destroying Medicare and leading us down the road to an American style two-tier health system where, instead of your Medicare card, you will need your credit card. Under Labor this trend will be reversed, and we will again return to a decent, humane and civilised health care system. (Time expired)