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Tuesday, 3 June 2003
Page: 15825


Ms JANN McFARLANE (8:26 PM) —I rise today to discuss the Health Care (Appropriation) Amendment Bill 2003. This bill provides the legislative authority for the Commonwealth to continue to make payments under the Australian health care agreements to the state and territory governments. In particular, I wish to add my support to the amendment condemning the government for its health policy failures. The people living in my electorate of Stirling have suffered great financial stress under this government and they are about to be squeezed yet again. They are angry, and justifiably so. Since the Howard government came to power in 1996, it has slowly dismantled the Medicare system that is so important to this country. With this budget it will be completely destroyed. At the same time, public hospitals, already under enormous pressure, have had their funding cut yet again.

The people of Stirling are not fools. They do not believe that an extra $4 a week will compensate them for the loss of bulk-billing and the running down of their public hospitals. They do not accept the government's claims that it is acting in the interests of all Australians. It is in all our interests to have a Medicare system that ensures that health care is accessible to everyone and which gives the same quality health care to everyone, regardless of how much money they have in the bank. The families living in my electorate do not want a two-tiered Medicare system—a flawed system that puts quality health care out of the reach of all but the rich.

In his speech to this House in reply to the budget, the Leader of the Opposition argued for the importance of a health care system that is available to everyone on the basis of medical need and not on the basis of their ability to pay. The Howard government seems unable to recognise this. It has shown time and time again that it does not care about those Australians who do not have a bank balance large enough to pay the high price for health and education that this government is imposing on us through its policies and through bills such as this one.

The Labor Party supports bulk-billing for every Australian. Bulk-billing is the foundation and the core of Medicare. Bulk-billing provides us with the means for everyone to access a GP when they need to, without having to worry about whether or not they can afford to pay for it. The only card that anyone should need when they visit their GP is their Medicare card, not their credit card. Without universal access to bulk-billing services, Medicare, as the Australian people understand it, will be no more.

As I have mentioned previously in this place, I have produced a guide to the bulk-billing services available for the people in my electorate. This list has been decreasing in size ever since I first produced it. When updating it in April, I was very concerned to discover that eight more doctors had to be removed. That is close to 25 per cent of doctors who have dropped out since October last year. Twenty surgeries remain on my bulk-billing list. Of those, only 10 offer bulk-billing to every patient. This trend cannot continue. There are many low-income working families within my electorate who are not entitled to a health care card but who are struggling every day to feed and clothe their children. The average out-of-pocket expense for a trip to the GP in my electorate of Stirling is $12.57. This amount will almost certainly continue to rise over time, unless GPs are given an incentive not to raise their fees. Every time any member of a family has to visit a GP they will have to pay this amount. As anyone with children will be aware, it is usually the case that all the kids get sick at the same time. Two or three kids at once, averaging six visits a year—that is quite a price to pay for a $4 a week tax cut.

Australian families with two kids who earn more than $32,000 a year are not eligible for a Centrelink concession card. For them, bulk-billing will end and when they visit their GP, bit by bit, they will be asked to pay more. Low- and middle-income families are affected negatively by this bill. Another major change to bulk-billing will be to give GPs the ability to ask patients to pay only the copayment and to bill Medicare directly for the rebate. This will make it easier for GPs to increase their fees. An increase from $20 to $25 will not receive as much attention as an increase from $45 to $50, but the effect will be the same—an increasing financial burden on Australian families.

This government, through this policy, continues its ideological obsession with the concept of user-pays. The problem we have in this situation is that not every user can afford to pay. Bulk-billing is not about giving people free medical care. My constituents pay for Medicare every year through their taxes, and they are entitled to receive the benefits. It is simply unacceptable to allow Medicare to become a second-class system of welfare for the poor. No family should have to worry about whether they can afford to take their sick children to the doctor. We do not want to see a further slide to an American style health system. In America, no cash means no care.

I want to make it clear that I do not blame the doctors for this situation. We have many hardworking GPs in my electorate of Stirling who are dedicated to ensuring that their patients are given the best care possible. However, increasing costs make it difficult for many of them to continue to provide the bulk-billing option to their patients. I congratulate those that do so despite the constant financial pressure, especially those who offer bulk-billing to all their patients. It is not their job to provide subsidised health care. But I call on the government to provide more of an incentive to GPs to provide a bulk-billing service to all their patients. This is nothing more than the people of my electorate expect when they pay their Medicare levy in every pay packet.

Because of the decline in bulk-billing, more and more people are turning to the emergency departments in our public hospitals, putting extra pressure on an already struggling system. Yet the federal government will not even allow the unused bulk-billing allocation to be redirected into this area. It is simply transferring its responsibilities to the state governments. So we have a situation now where the people of Australia are forced to pay their Medicare levy and pay again when they visit their GP, or they are forced to endure ever-increasing waiting times in the emergency departments whilst adding to the waiting time for others. This is not a situation that would be tolerated by any government that truly cared about the health of its citizens. This government's actions suggest that it does not care about such things. Not only has the Howard government allowed the bulk-billing rate to reduce by more than 12 per cent, it is also withdrawing a further $918 million from our public hospitals over the next four years. These cuts will mean the employment of fewer nurses and an increased waiting time for elective surgery. What will the government be doing with this money? This amount matches the amount that the Howard government will spend on destroying Medicare by ending access to bulk-billing for the majority of Australian families.

Australian families are being treated appallingly. Many will avoid seeing their GPs because they are unable to allow for the extra costs in their weekly budget. Many are unable to afford private cover, and even if they can they will receive very little benefit from the new rules concerning private cover of the gap cost. In my electorate, approximately 54 per cent of people are in a private health fund, which means approximately 46 per cent are not in a private health fund. But what do the new gap rules mean for people in a private health fund? They will still be $1,000 out of pocket, on top of private insurance costs, before they will receive any benefit. To show the House how ridiculous the private health cover policy is that this government is proposing, I share the following example.

A person decides that they will insure to cover a gap caused by increasing doctors' fees under the Howard plan. This may cost them an extra $100 per year on top of their normal private health insurance. Say there is a $25 gap on the cost of visiting their local GP. It would take 40 visits to the doctor—almost once a week—to reach the threshold where the private health insurance kicks in. If the gap is $20, then it will be 50 visits to the doctor before the private health insurance kicks in. The health minister says that this is protection for catastrophic events. Most families who take out the insurance will be $100 worse off without visiting a doctor. Before accessing this so-called catastrophe protection, the person will be $1,100 out of pocket. This is proof that the government is aware of the costs faced by Australian families. It just does not seem to care.

The people of Stirling work hard to provide for their families. They pay for the Medicare system through their taxes. They pay for the hospital system through their taxes. They expect the government to ensure that these resources are available when they need them. This is hardly an unreasonable expectation. The government is taking away resources that belong to the Australian people, and they are justifiably angry. This is in stark contrast to the commitment that the Gallop government have made to improve the health system in Western Australia, particularly within my electorate of Stirling. They recently announced an additional $3.8 million for a state-of-the-art theatre complex and day procedures unit at Osborne Park Hospital, bringing their total expenditure to $10.3 million. There has been extensive consultation with medical, nursing and occupational health and safety personnel from Osborne Park Hospital and other hospitals in designing this upgrade.

Each year, Osborne Park Hospital handles more than 1,500 births and more than 1,500 medical and rehabilitation cases, and performs more than 6,000 surgical procedures. The Gallop Labor government will be building three spacious new theatres, which will be fitted with the latest equipment, allowing Osborne Park Hospital to pick up more complex elective surgery work from the waiting list. Once work is completed in 2004, local residents will have access to a purpose-built day procedure unit, a new endoscopy suite and a new central supply unit. I am very pleased that such a project is being undertaken in my electorate. It will be of great benefit to all West Australians. The Gallop Labor government should be very proud of this development. Dr Gallop and the Minister for Health, the Hon. Bob Kucera, are doing a superb job of ensuring that the Western Australian health system provides for all West Australians—a very difficult job, given the lack of assistance given to them by the Howard government.

Another area in which the Howard government has failed the people of Australia is in the provision of aged care. I have already mentioned a local constituent of mine who has recently faced great difficulty finding a place in an aged care home for her mother, who is 100. No new capital grants funds have been provided to my electorate of Stirling since 1998. Without this funding the bed licences that have been granted are of little use. This is a terrible situation that must be remedied. It needs to be a priority of the Howard government to provide enough places in aged care for those who need them.

We need to look after our seniors and treat them with respect. At the moment our health system is not doing that at all. Not only is the Howard government failing in its responsibilities to families, it is failing to provide for seniors. The federal government is neglecting the most vulnerable members of our society. Our seniors have spent their lives contributing to this nation. They have worked to build our country and enrich our culture, and their taxes have helped to create the services that are now under attack. Yet now their government has forgotten them.

The people of the Stirling electorate want their health care system to be improved, not destroyed. They want access to a GP when they need one, without worrying about whether or not they can afford to pay for it. They do not want funding for public hospitals to be cut any further. They want aged care places to be available for those who need them and they want to know why the Howard government is ignoring their demands.

Labor will provide a real alternative to Howard's plan to destroy Medicare, with a $1.9 billion package to reverse the collapse of bulk-billing. A Crean Labor government will immediately lift the Medicare patient rebate to 95 per cent of the schedule fee for all bulk-billed consultations. Soon after, this will be lifted to 100 per cent of the schedule fee. This is an average increase of $5 per consultation.

As well, a Crean Labor government will offer real incentives to doctors to extend bulk-billing and keep costs from rising. Doctors in metropolitan areas will receive an additional $7,500 for bulk-billing 80 per cent or more of their patients. In outer metropolitan areas this amount will be lifted to $15,000 each year for GPs that bulk-bill 75 per cent or more of their patients. To assist those in regional and rural areas, who have suffered most due to the decline of bulk-billing, we will offer an additional $22,500 to GPs for bulk-billing 70 per cent or more of their patients.

These fully costed measures will ensure that bulk-billing is made available to more Australian families and correct the declining rate that we have witnessed under John Howard. This is fundamental to the system of Medicare that has made this country great. The solution will require a combination of policy approaches—including targeted increases in remuneration for GPs—that support sensible medical work force measures and make 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 we cannot get back there again.

Federal health minister Kay Patterson confirmed in a media release that the Commonwealth's health care funding offer represented a $1 billion real cut to the states and territories. The state and territory health ministers unanimously rejected this offer at a meeting in Canberra to discuss the next Australian health care agreements. In a media release they said:

On Monday, John Howard killed Medicare—today his Health Minister tried to bury public hospitals.

The minister repeated the Prime Minister's admission that the agreement fell $1 billion short of what would have been provided if the existing agreements had been continued. State and territory health ministers said they would continue to fight for ordinary Australians' right to affordable and accessible health care following the federal government's moves to dismantle Medicare and cut real funding to the states and territories. The ministers said that any discussion about funding for public hospitals could not be separated from the Commonwealth's planned overhaul of Medicare.

We do not want to see an American style of health care, where the level of care available is based on how much you are able to pay. That is becoming a theme in our community. Labor is committed to rebuilding Medicare and ensuring that all Australians, regardless of how much they earn, will have access to high-quality services both at their local GP and in their public hospitals. This is what the people of Australia expect and demand. It is not too late for the Howard government to rethink the Health Care (Appropriation) Amendment Bill 2003. Until they do, I cannot support it.