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Monday, 16 June 2003
Page: 16451


Ms HOARE (6:35 PM) —I rise to speak on the Health Legislation Amendment (Medicare and Private Health Insurance) Bill 2003. The so-called A Fairer Medicare package is not fair for the majority of ordinary Australians who are struggling to hold down a job, provide for their families and meet the economic costs of the necessities of life. The A Fairer Medicare package does not provide better, fairer or more equitable access to health services for the majority of ordinary Australian families. The A Fairer Medicare package could be seen to be a better deal for GPs. We are all aware of the serious decline in the number of doctors who provide bulk-billed medical services. We understand the economic reasons why many doctors have been forced to cease bulk-billing. The Medicare rebate for general practice consultations has not risen in line with inflation for many years. The costs associated with running a practice have increased at a faster rate than the growth of the rebate. The introduction of the GST and the consequences of the medical indemnity crisis impacted badly on doctors' costs, and this has meant rising costs for patients.

Many of the surgeries and medical centres in my electorate of Charlton have been forced over recent years to curtail their bulk-billing services to only those patients with a valid concession card. Some doctors have provided bulk-billing only to established long-term patients and not to new patients, even when they hold concession cards. Some have been forced to cease bulk-billing altogether. Many families are severely disadvantaged when doctors are forced to demand payment in full and up front and they are then required to claim the refund from a Medicare office. This has deepened the divide between those who can afford health care and those who cannot. We all know that since the Howard government was elected in 1996 it has become harder and harder to see a doctor who is prepared to bulk-bill, making visits to the doctor much more expensive for Australian families. Under the A Fairer Medicare package, health care costs can only rise and families will be hurt even further.

In my electorate of Charlton, only 66.8 per cent of GP services are now bulk-billed. That is down from 78.6 per cent two years ago—nearly a 20 per cent decline. The majority of bulk-billed services are already provided to concession and health care card holders. This means that the percentage of working families who receive bulk-billed services is well below 50 per cent, and this percentage will plummet under the A Fairer Medicare package. The families that I represent are hurting already.

The proposed capacity to privately insure for out-of-hospital medical services—essentially, to privately insure against doctors' fees—can only be inflationary. Private health insurance is an optional extra, and no-one should feel pressured into purchasing it simply to attempt to cover basic medical requirements that are becoming inaccessible to ordinary Australians. In the last year we have seen increases in the cost of private health insurance that have resulted in families paying additional premiums of between $150 and $250 each year. Private health insurance is fast becoming out of reach for most ordinary Australians.

Non means tested safety net arrangements already exist to protect all Australians who have high out-of-hospital, out-of-pocket expenses. The proposal to privately insure for out-of-hospital medical services is a very real admission that fees charged to non-concessional patients under the A Fairer Medicare package are going to rise and rise significantly. The proposal to allow participating practices to charge patients copayments and receive the Medicare rebate is simply a financial incentive for doctors to bulk-bill concession card holders by making it easier to charge non-concessional patients more.

How are the ordinary families in my electorate going to be able to cope with these escalating charges? Many of my constituents live on very strict budgets, and when they fall sick there is simply no money to pay for medical services. When the health of ordinary Australians is being threatened because they cannot afford to see a doctor, because doctors' books are full or because there are no doctors prepared to bulk-bill, the government must act to ensure that access to health care services is there for all.

The proposed concessional safety net is also a tacit admission that out-of-pocket costs will rise for concession card holders. Doctors will be able to charge concessional patients higher fees. How will pensioners and other low-income earners, many with chronic debilitating medical conditions that require multiple ongoing doctors' visits, be able to afford these higher fees? Where will they find this $500 each year before they reach the safety net threshold? They already do not have the same access to health care that other members of the community have, and now they will be thinking twice about going to a doctor when they actually need to go. This is simply not a good health outcome.

The Australian Medical Association, the Royal Australian College of General Practitioners, the Divisions of General Practice and the Rural Doctors Association have all concluded that this package does not adequately address the issues of access and affordability and have warned it will bring about a two-tiered system of health care. A survey conducted by the Australian Divisions of General Practice showed that 83 per cent of general practitioners did not support the government's proposals. Unless current trends in the provision of health care services are reversed, the government will create a situation in which the emergency rooms of our public hospitals will face greater pressure than ever before. When people need to see a doctor but cannot, because doctors' books are closed or because they are unable to afford the up-front cost of a visit, it is inevitable that public hospitals will pick up the burden.

The government appears to believe that it can shift the burden of responsibility for health care costs onto the states and onto individual Australians. This is patently unfair. Much has been said about escalating costs and, on this basis, the inability to continue the provision of bulk-billing for all. How, then, can the federal department of health and the minister justify paying $39,000 to a private company to coin the brand name `A Fairer Medicare'? How can the department and the minister justify paying $100,000 to a consultant for strategic advice on marketing the A Fairer Medicare package or spending $148,000 for newspaper advertising and a further $90,000 for a telephone hotline? Surely this money could have been used in a better way. How many general practice consultations would it have provided? What kind of rise in the rebate could it have subsidised? It could have been used to fund a regulatory impact statement to actually consider the likely inflationary effects of this policy. How can the government introduce this policy without adequately researching the impact that it is going to have on costs?

Labor maintains that bulk-billing services should be available to all Australians, irrespective of income. Medicare is a universal health care system. Labor's new deal to save Medicare policy has shown that Medicare can and should cover all Australians. The new deal to save Medicare has been fully costed. It is affordable, and it can be achieved without raising taxes. The new package to save Medicare addresses the increasing problems of bulk-billing and is the first positive initiative on bulk-billing in 10 years. The proposed increases in the Medicare rebate will encourage doctors to bulk-bill all patients, no matter where they live and no matter who they are—not just concession card holders but all Australians, including hardworking, ordinary families who will be the hardest hit by the government's current proposals.

Under Labor's new deal to save Medicare, individual doctors can choose to access the increased rebate if they choose to bulk-bill individual patients based on their actual need and not just on geography. The package supports general practitioners who choose to bulk-bill low-income families and others who do not qualify for concession cards but who are experiencing difficulties with affording their medical treatment. This system has far more chance of being adopted across the country. It will provide access to quality care for everyone and will overcome the current inequalities of access between rural and metropolitan areas. Labor is absolutely committed to Medicare, and restoring bulk-billing is Labor's highest priority in health.

My constituents in Cooranbong, Elermore Vale, Toronto, Warners Bay, Wyee, Cardiff and all the other towns in the electorate do not want a health system in which only the well off can afford quality health care and ordinary Australians are left without any guarantee of medical treatment. I have received many letters and many phone calls, and have presented petitions with thousands of signatures to the parliament, reflecting the very real concerns about the proposed changes to Medicare and the threat to bulk-billing. My constituents know that the proposed changes to Medicare can only destroy the health system and leave them and their families worse off. They overwhelmingly support Medicare and bulk-billing and they deserve to be considered.

I have a couple of examples of correspondence from my constituents. Mr and Mrs Robinson of Balcolyn emailed me and said:

We are full pensioners and are fed up with all the unfair taxes, the rules for some in influence or part of the better than others elite, who can't do anything wrong, and the ignorance of major problems by the media.

So then to our present gripes ... Health.

When we began with Medicare or Medibank as it was, the Government guaranteed 85% cover. When we joined what became Medibank Private we were covered for 75% and upwards cover with travel insurance and many other things included.

More recently bulk billing was introduced and has proved very useful.

With the private health funds, over the years, removing services from their insurance and continually reducing benefits on all services we are now doing well if we get 50%.

We now find Medicare subject to constant rises in what the Government pays the doctors, our money, and what we, the patients, pay the doctors ... also our money.

The email concludes:

The whole Bill is so conglomerated and confusing and unnecessarily complicated, perhaps deliberately so, to make difficult any comparisons or appreciate final outcomes. It appears to us that we will be paying extra on all aspects of Health cover with more for insurance gap cover which is conditional upon an extra annual cost of $1000 plus we will still be paying our GPs insurance cover. The future is frightening. If we look at present costs we find we pay $2000 pa per couple plus gaps on MP items plus $5 pp per visit to GP.

That is from just two of my constituents. Bobbi from Cooranbong wrote to me to say:

I ask that you pass on our concerns re the demise of Medicare to the Senate as it seems that only the Senate can help us save a great general health insurance scheme.

She writes:

I returned from my unpaid government job today:-

*I collected and paid tax for the past quarter of this financial year (BAS).

*I paid tax (IAS) for my husband and myself for the past quarter, and I will continue to do this for the rest of our working lives.

At the end of the financial year both my husband and myself will have to pay personal income tax on top of what we have already paid out ... and we are not big earners. Together we earn less than fifty thousand a year; we have two dependent children and a mortgage etc.

We pay our Medicare levy with our tax and are happy to do so. Our taxes also go to pay the 30% private health rebate to those who can afford private health cover. Except for ambulance cover we cannot afford to pay for any private health insurance.

With an injection of the much bragged about surplus and a modest increase in the Medicare levy I am sure the scheme can be rescued.

She continues:

John Howard is `screwing us'. He wants to turn this wonderful country into an American state.

We are relying on Labor to save Medicare and our health system.

There are many people in this country with ideas and solutions to the Medicare problem. Please listen to them.

The government should restore bulk-billing, provide real incentives to make general practice sustainable again and instigate a national approach to overcome the current doctor shortages. We must ensure the provision of a robust world-class health system accessible to all. This is a basic human right for all Australians.