Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
 Download Current HansardDownload Current Hansard    View Or Save XMLView/Save XML

Previous Fragment    Next Fragment
Monday, 16 June 2003
Page: 16463


Ms LIVERMORE (7:30 PM) —People out there listening to this debate over the past few sitting days could be forgiven for thinking that we have been debating two entirely different bills. On the government side of the House, speaker after speaker has risen to assure the House that this bill is no big deal. They would have us believe that it is simply a bit of minor tweaking to the Medicare system that this government has neglected and overtly undermined over the past seven years. On this side, we in the Labor Party know that this bill is a very big deal and represents a great danger to the future survival of Medicare as one of the essential pillars of equity in this country.

Of course the bill we are debating is the same. It is the attitude towards Medicare and the commitment to protecting Medicare that is different. It is a matter of fundamental difference between the Labor Party and the Howard government. On this side of the House, we are about protecting Medicare and restoring its value to the community—and particularly to working families—through an increase in the availability of bulk-billing. The government, on the other hand, is intent on dismantling it through measures such as those given effect to in this bill. Consequently, I join with my colleagues in opposing this bill and condemning the government's disingenuously named A Fairer Medicare package. The Prime Minister can call it whatever he likes but we will make sure that the Australian public understands that there is nothing fair about taking away Medicare's universality and creating an American style two-tiered health system where you are treated according to your ability to pay, not your medical need. As Professor John Deeble, the architect of Medicare, is quoted as saying:

What is fair about shifting the system from payment according to income to payment according to illness?

Let us give the Prime Minister the benefit of the doubt and take him at his word for a minute and see exactly what he means by a fairer Medicare. What is this package that he has proposed and how do its claims stack up? The main measures include incentives for doctors to bulk-bill Commonwealth concession card holders. Non-concessional patients will be charged the difference between the Medicare rebate and the doctor's fee. The doctor will claim the rebate directly from the Health Insurance Commission, leaving the patient to pay the gap. There will be a safety net for concession card holders so that the government will cover 80 per cent of the out-of-pocket cost of all out-of-hospital Medicare services over a $500 threshold each year. Private health insurance will be available to cover the cost of out-of-hospital Medicare funded services—including general practice, specialist and diagnostic services—once a threshold of $1,000 is reached in a calendar year.

Other measures are directed at work force issues in the health sector and of course there is a $21.1 million advertising campaign in the wings. What is a Howard government package, after all, without a lavish taxpayer funded advertising campaign? No doubt we are in for another beauty! By the end of it we will be wondering what was so great about bulk-billing anyway and lining up to pay another $100 or so on our private health insurance premiums each year. The trouble for the Prime Minister is that his package has not been very well received by either the public, who are the ones paying medical bills, or by health sector experts and commentators. Maybe it is because nobody actually trusts the Prime Minister when it comes to Medicare—and who could blame them? The Prime Minister has attacked Medicare too many times in his career for anyone to take him seriously when he claims that he now has the answers to rebuilding Medicare and redressing the decline it has suffered under his government.

I know we have heard some of the Prime Minister's most vehement denunciations of Medicare over and over during the course of this debate but I am going to repeat them. I am doing that because he needs to understand that the Labor Party will not forget—and we will not let the Australian people forget—his true colours when it comes to Medicare and health policy. The Prime Minister cannot trot out a package with a half-smart name like `A Fairer Medicare' and expect that to overcome 20 or more years of strident opposition to everything Medicare stands for. His past record will be thrown back at him to highlight to the Australian public that—just like the `never, ever GST' and just like `no worker will be worse off'—the Prime Minister will tell you anything to get himself elected but he will always return to his ideological themes that exacerbate division and inequality in our society rather than bridge them.

Here is a collection of beauties from the Prime Minister back when he was leader of the Liberal Party in the 1980s. According to John Howard, Medicare was a `miserable, cruel fraud,' a `scandal,' a `total and complete failure,' a `quagmire,' a `total disaster,' a `financial monster' and a `human nightmare'. Back then he told us he could not wait to `pull Medicare right apart' and `get rid of the bulk-billing system', which he described as an `absolute rort'. You have to hand it to the Prime Minister: back in the 1980s he was at least prepared to come clean with the Australian people and tell them exactly what he intended to do to Medicare if he won government. It was all spelled out in his 1987 election policy where John Howard stated that under a Liberal government, `Bulk-billing will not be permitted for anyone except the pensioners and the disadvantaged. Doctors will be free to charge whatever they choose.' There it was in 1987. Back then the current Prime Minister told the Australian people what he stood for in black and white. Now he tells them that black is white. He will dismantle Medicare in this package just as he has always wanted but this time he will tell the public that this is all about making Medicare fairer.

The Prime Minister has learned a lot since 1987 and he is certainly a patient man. Instead of taking to Medicare with an axe immediately after his victory in 1996, he has simply chipped away, biding his time, while a combination of the government's policies together with a distinct lack of action have created the current crisis in bulk-billing which is being used as a cover to introduce these changes. But instead of addressing the low levels of bulk-billing—and bulk-billing levels have been in free fall for a couple of years now—this package drastically reshapes Medicare in a way that spells the end of bulk-billing for a large proportion of the population.

One of the centrepieces in the government's package is the incentive scheme for doctors to bulk-bill those patients holding Commonwealth concession cards. The government is certainly making much of this initiative as a social justice measure but, in reality, it does not amount to a great deal when you consider that it is already fairly common practice for doctors to bulk-bill pensioners and concession card holders. In fact, far from being a social justice measure, it is this incentive scheme that strikes at the heart of Medicare's fundamental structure that up until now has guaranteed its fairness and strength as a universal health insurance scheme for visits to a GP. It does that because the incentive offered by the government to encourage GPs to bulk-bill all concession card holders is to allow those GPs to claim the Medicare rebate directly from the Health Insurance Commission for all other patients.

So the government is holding out an increase in bulk-billing for concession card holders that will effectively be subsidised by all other non-concessional patients, because that is what will happen if this measure is allowed to pass. Doctors will increase their fees to other patients to subsidise the bulk-billing of concession card holders. Who are these other patients without concession cards? They are anyone earning more than $32,300 per year. According to figures quoted in the Canberra Times by Dr Gwen Gray of the ANU, there are two million households in Australia above the concession card means test but with earnings below $41,000. It is those households of working families who need a commitment to bulk-billing in this country to give them some security and peace of mind but who instead have been ignored by this government's package and in fact will pay more to see a doctor if this bill is allowed to pass the Senate.

This is the government's A Fairer Medicare. Bulk-billing is for pensioners and low-income earners only, and the rest of community will pay more to see a doctor as a consequence. When the doctor only has to charge non-concessional patients the gap and can claim the rest from the HIC, you can guarantee that the size of the gap will rise. Why wouldn't it when the government is making it easier for doctors to do precisely that? Think about it. Right now a GP who does not bulk-bill might charge a patient $45, which amounts to an out-of-pocket gap fee of around $20 after the patient has claimed the Medicare rebate. Under the government's proposal, where the patient would only be paying the $20 out of his or her pocket anyway, it will be irresistible for doctors to push that fee up. The market pressure that would stop fees rising from $45 to $50 will not be there to prevent a rise from $20 to $25—or even higher, depending on what GPs determine the market will bear. It is a nice pay rise for doctors, paid for not by the government through an increase in the amount of rebate paid to doctors but instead by the Australian public every time they visit their GP.

The government members speaking on this bill have made much of the convenience this scheme promises for patients, because they will no longer have to visit a Medicare office to claim a rebate following a visit to a GP. It is a convenience that the Australian public will be paying for dearly through higher medical bills. The government members might consider that there is another way to provide that convenience to patients and do away with the need for them to make an extra trip to the Medicare office to claim a rebate from the HIC, and of course that is to expand the number of GPs who bulk-bill. That is something that we on this side of the House have been urging the government to do for years.

The government has its head in the sand when it comes to the implications of this package for the cost of medical care to the majority of Australians who do not hold a concession card. It is the same old routine of see no evil, hear no evil that we have seen so often when the government does not wish to be confronted with its policy failures. The Minister for Health and Ageing has been quoted as saying:

There is nothing in the Government's Medicare package that would cause doctors to increase the fees they charge their patients.

We now know that it is easy for the minister to make that claim because she has deliberately failed to analyse the effect of the package on either patient costs or the rate of bulk-billing. In a display of what is either extraordinary neglect or outright arrogance, the government has not prepared a regulatory impact statement for the Medicare package. It was admitted in Senate estimates two weeks ago that this package, which represents the most dramatic changes to Medicare—a key plank of our health system—in 20 years, has not been subject to any modelling by the Department of Health and Ageing of those two key questions.

The minister's department might not have done any modelling but there is plenty of evidence that this package will make it easier for doctors to put up their fees and, in fact, will encourage that. Those increased fees will come straight out of family budgets that are already straining. Here is what John Deeble said in the Australian on 30 April:

Bulkbilling was designed to give full coverage without a cost blow out. It has an inbuilt constraint. This new system gives doctors more freedom to charge what they like. It will increase costs.

Even more telling has been the reaction of doctors to the government's package. The Labor Party is indebted to Mark Lipscombe, the Practice Manager of Westcare Medical Centre in Melbourne, for pointing out a few home truths to the health minister in an interview in the Australian Doctor journal of 9 May this year. The article reads:

Contrary to the claims of federal health minister, Senator Kay Patterson he says if his outer-Melbourne practice enrolled in the scheme he would be forced to increase fees for non-concessional patients from the present $38 to about $45.

There you have it from two people who know exactly what this package will do to the cost of seeing a GP. The minister and the Prime Minister know too, but they persist with their charade of A Fairer Medicare. Other measures contained in this bill such as the new safety net arrangements and private health insurance for out-of-hospital costs are also clearly inflationary and are, in fact, proof in themselves that the government expects health care costs to blow out under its new package.

Medicare is an essential element of the fair go that we hold so dear in this country. Australians do not want to go down the American road, where health care is a source of division in society and where your status and wealth determine your access to quality health care. Here in Australia, Medicare has been an effective and fair system of insurance that has given Australians the security of knowing that they will get the health care they need, not the health care they can afford. And it is fair enough that Australians have that expectation of Medicare. After all, they pay for Medicare through their taxes and they are entitled to expect that it will be there for them, that it will work for them when they need it, and that means bulk-billing. You are not delivering on the community's legitimate expectations of Medicare if you are not delivering on bulk-billing.

That is certainly not happening in my electorate of Capricornia. Bulk-billing rates in Capricornia are below the 50 per cent mark. Everyone in my electorate needs better access to bulk-billing for their basic medical treatment. I say `everyone', and that includes pensioners, concession card holders and middle-income earners. Middle-income earners are the people who are ignored and forgotten by the government's fraudulent A Fairer Medicare package. Australians, including those people in Capricornia, know that, if you want Medicare protected and rebuilt, you do not rely on John Howard to do the job. He has always been about tearing down Medicare. He is fundamentally opposed to the concept of universal coverage. This Prime Minister is about a society where you look after yourself and you do not worry about anyone else.

Labor created Medicare and a Labor government will rebuild it by restoring bulk-billing to a level of 80 per cent of all GP consultations. We will do that by first of all lifting the patient rebate to 95 per cent of the scheduled fee and thereafter increasing the rate to 100 per cent of the scheduled fee. Further incentives will be given to doctors who meet bulk-billing targets, and those incentives will be targeted to lift bulk-billing in those areas where the rates are especially low, such as rural and regional parts of this country. Doctors in metropolitan areas who bulk-bill 80 per cent of services will receive an additional $7,500 a year, doctors in outer metropolitan areas who bulk-bill 75 per cent of services will receive an additional $15,000 each year and doctors in rural and regional areas who bulk-bill 70 per cent of services will receive an additional $22,500 per year.

The Labor Party have already indicated that we will oppose this bill here in the House and in the Senate. We will continue to fight the government over their package, because to give up that fight is to give up on Medicare. I can assure the government that the Australian community will back us all the way in that fight.