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Monday, 16 June 2003
Page: 16467


Mr SNOWDON (7:46 PM) —I am pleased to be able to participate in this debate on the Health Legislation Amendment (Medicare and Private Health Insurance) Bill 2003. This bill, as others have pointed out, is the greatest attack on the Australian health care system and the health of Australians in the last two decades. It will destroy one of the best health care systems in the world. This bill will also entrench the city-country divide in health care in this country, decreasing the already appallingly low level of access to health care for people in rural and remote Australia through general practitioners.

We will oppose this bill to the very end. We will oppose this bill both in this chamber and in the other place. Labor are determined to fight tooth and nail for the fundamental principle that every Australian is entitled to quality health care, based on their need and not their capacity to pay. The Medicare system enshrines this principle. It is the reason that the system has managed to provide a first-class service for all Australians. This bill attacks the universality of Medicare, and it is the start of the slippery slope towards the Americanisation of the Australian health care system. It is clearly the thin edge of the wedge that would see people denied health care because they did not have health insurance or because they were too poor to afford it. I will later in the course of my address point out an example of where that is happening now as a result of the government's policies.

Labor will oppose this bill. It demonstrates that those who believe they are born to rule rule only for the few, because this bill ultimately says that quality health care is deserved only by those people who can afford to pay. I will also, I hope, if time permits, show the contradiction between the policies of the government in relation to private health care and private health insurance and the needs of Australians who live in rural and remote areas. The government's euphemistically named A Fairer Medicare package will do three things. It will create a two-tiered medical system under which families in my electorate will pay more to visit a doctor—they already pay more than other people around Australia—it will create a second-class system where Medicare is only available to those with a health care or concession card and it will make it easier for doctors who currently bulk-bill to start charging copayments for the first time and for other doctors to increase their fees. It will destroy the basic tenets of Medicare. Medicare is one of the great achievements of the Labor Party, and we will fight to save it.

I do not intend to go through all the major components of this bill, because they have been enumerated by others, other than to say that the proposals that have been put forward will not in my view solve the problems that we currently have in terms of the provision of health care to people who live in regional and remote Australia particularly—and it will not solve the problem for all Australians. All the measures that have been proposed will be opposed by Labor in this debate.

It is instructive to note that, when Labor left office in 1996, 80 per cent of visits to the doctor around the country were bulk-billed. Since the Howard government came to office, the rate of bulk-billing has steadily declined to where it is now: 68.5 per cent—the lowest level in 14 years. Not only has the rate of bulk-billing decreased; the average patient contribution has increased dramatically, from $8.32 in 1996 to $13.05 today. That is an increase of 55 per cent. The situation, as I pointed out earlier, in my own electorate is much worse than it is nationally. Territorians pay the highest patient contribution of any state or electorate in Australia. Territorians pay on average $18.61 more than the amount refunded by Medicare for a standard trip to the doctor. This compares to the national average contribution of $12.78. Indeed, there is a general practice in my own electorate where the up-front fee for a GP is currently $60. The patient contribution over the whole of the Northern Territory has risen by an incredible 13.7 per cent in the last two years.

It is important to note that some of those people who are paying the most for health care are some of the poorest people in our nation. While the quarterly figures show that Lingiari is approximately average in the number of bulk-billing consultations, these figures are seriously affected by the number of Indigenous clinics. The fact is that there are no bulk-billing private practices, apart from Aboriginal health clinics or government health clinics, anywhere outside Darwin or the Darwin rural area. If you are an average person coming in off the street, it is all but impossible to find a bulk-billing practice in the Northern Territory except for the Aboriginal medical services.

One of the most striking things about my electorate is its heterogeneity. A great diversity of people live in Lingiari, which is an electorate that includes everywhere in the Territory bar Darwin and Palmerston. There is a very stark contrast, therefore, between the haves and the have-nots. A very high number of families in my electorate earn below average weekly earnings, an income level which is difficult for a family to live on in any part of the country but is particularly so in the Northern Territory, where the cost of living is also very high. These people cannot afford an extra $20 here or there to take their child to the doctor or to go to the doctor themselves; it is simply not an option. But that is what the government proposals mean.

The latest figures on living costs show that the people in Darwin have the highest living expenses of any capital city. Unfortunately these figures are only available for capital cities, although in the last parliament I detailed at some length the cost of living survey that was developed by the Northern Territory department of health, which showed that in some remote communities in the Northern Territory people were paying 150 per cent of the cost of a basket of goods compared with the cost in capital cities across Australia. That is just one indication of the high living costs that people experience.

I have also relayed here on a number of different occasions, to the chagrin of the government, the high cost of fuel compared with the cost of fuel elsewhere in Australia. When you look at these figures it is very obvious that Territorians are grossly disadvantaged in terms of the cost of living. I know this is true for other parts of remote and rural Australia, but it is particularly pertinent to the electorate of Lingiari. Darwin has the highest weekly expenditure per household across Australia for food, household services and operation and transport and recreation. Darwin households pay the highest amount of income tax and have the highest mortgage repayments in Australia. In many parts of the Northern Territory, house ownership is not an option and, where it is an option, the cost of housing is extremely high. Another interesting indicator is that people in Darwin have the second-lowest health care expenditure—they cannot afford to visit the doctor. This is of grave concern. It is clear that the people in Darwin and the rest of the Northern Territory cannot afford the same level of health care as those in other capital cities.

The government's Medicare package will mean even higher health care costs for Territory families. According to the ACTU, the government's new reforms will cost working families an extra $500 a year in doctors' bills. To extrapolate, given the average differences that I indicated previously between the costs paid by Territorians and those paid by other Australians, you can add another 20 per cent or 30 per cent to that $500 for people who live in the Northern Territory. One clinic is already charging a $60 up-front fee. It is clear that the Prime Minister and his government have no particular regard to or care for the impact this Medicare package will have on the people of Lingiari. He has no commitment to maintain equitable health care; instead, he is preoccupied with destroying Medicare, a system Labor built.

Throughout the 1980s and early 1990s the Prime Minister campaigned on a public policy to demolish Medicare. When the Prime Minister was the Leader of the Opposition in the 1980s, he said that 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'. John Howard's 1987 formal election commitment stated:

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

They currently do that. In many practices now—and certainly in the ones I have indicated in the Northern Territory—doctors' fees are a commercial decision, not a health decision. They are about maximising the returns for the medical practitioners at a cost to the Australian community, at a cost to Australian taxpayers and at a cost to patients. The Prime Minister intended to create a two-tier system, and he has done it. This bill will perpetuate that structure. In the lead-up to the 1996 election, he did a chameleon act. In an interview with Laurie Oakes on the Sunday program, he said:

Oakes: Do you agree that Medicare would not be touched under a coalition government?

Howard: We absolutely guarantee the retention of Medicare and guarantee the retention of bulk-billing ...

Oakes: You see that people will worry about that: the retention of Medicare is exactly the phrase Malcolm Fraser used about Medibank. He promised the retention of Medibank and it went.

Howard: ... yes, well you're questioning John Howard and nobody else, and I am giving a guarantee that it is not going to be changed. I am giving a guarantee about bulk-billing.

What an absolute fraud to give an absolute guarantee about bulk-billing! What they are doing here is guaranteeing that the bulk of the Australian community will not have access to bulk-billing. As I have already pointed out, under this government no-one in my electorate who goes to a private practice, apart from an Aboriginal health service or a public clinic, has access to bulk-billing. What sort of fraudu-lent undertaking did the Prime Minister give Laurie Oakes in 1996? What sort of fraud has he perpetuated on the Australian community since that time?

The government's health care package will mean three things for people in rural and remote Australia: fewer doctors, poorer health care and increased pressure on rural hospitals. The measures in this bill will increase the cost of health care for families and will result in increased pressure on the public hospital system. That is clear. The government's health care package will mean families with two children and an income of more than $32,000 will have to pay each time they go to a doctor. The government wants to remove the constraint on doctors' fees, making it very easy for doctors who currently bulk-bill to start to increase their fees for the first time. It is much easier for a doctor to start off with a small fee than to move from bulk-billing, where it does not cost the patient anything, to a system where they charge a $40 up-front fee.

This new system is what doctors have always dreamed of—a universal benefit underpinning whatever fee they wish to charge. Again, this is a commercial decision and not a health decision. There will no longer be any constraints on doctors and prices will increase, and the government has as much as admitted that this will happen. Take careful note of the Prime Minister's rhetoric on this issue, which has been that `prices need not rise'. He refuses to say that fees will not rise. I have already demonstrated that fees have risen and will continue to rise, certainly in my own electorate.

Professor Deeble, one of the architects of Medicare, has stated on many occasions that separating doctors' fees from the Medicare benefit allows doctors to charge what they like and will lead to increased patient contributions. Any time you increase the cost of health care, you decrease people's ability to access that health care. People will no longer be able to afford to take their very sick children to the doctor three times a week, perhaps, or to take each of their children. I am a parent of four children so I know what this means, and I have a good income. What are working families to do if they have four or five children and need to access a doctor on a regular basis over a short period of time under the proposals which have been put forward by the government? The government knows that emergency wards around the country are already under pressure, and this will continue.

In response to the pressure on the emergency ward in Alice Springs, the federal government has put $260,000 towards the establishment of an after-hours clinic to alleviate the problem and the Northern Territory government has put in $140,000. I have raised this issue in parliament a number of times already. But what you need to know is this: as a mechanism to take the pressure off the public hospital in Alice Springs, the doctors who are going to control this clinic propose to charge a $50 consultation fee to those who are health care card holders, a $70 fee to everyone else and $100 to tourists. In trying to take pressure off the Alice Springs public hospital system, what they are offering the people of Alice Springs—if they can afford to pay the $70—is an after-hours service. That is middle-class medicine, and it will not help alleviate the problem for many people in Alice Springs and around Central Australia who need to use the public hospital system, because they cannot and will not be able to afford to pay this fee.

The creation of this two-tiered health system will see only the lower tier of health care available in the bush and will make it much harder for regional and remote Australia to attract and retain doctors. The lack of private hospitals in the bush is an example of market-driven, top-end private health care going only where people can afford it. There is no private hospital in my electorate, even though it covers 1.3 million square kilometres. If you are in that electorate, as I am, and if your income is over a certain level, you still have to take out private health insurance. If you do not take out private health insurance, you are slugged an extra one per cent on the Medicare levy. What return do you get for that? What you are doing is subsidising the health of the rich and those people who live in metropolitan centres who have access to private hospitals. Why do people in rural and remote Australia with no access to private hospitals have to take out private health insurance? Why do they have to pay the extra levy? What is the return for them? The answer is: a big fat zero.

It is already very difficult to attract doctors to remote parts of the Territory, and it is not just a matter of pay; it is about the conditions and the support networks as well. Despite offering salary packages of between $100,000 and $200,000, some remote communities are still unable to attract GPs. This is because of the difficult conditions and the perceived lack of support in some remote communities.

Labor wants to do things differently. It is worth pointing out that the Rural Doctors Association of Australia has dismissed the government's package, saying it will have little impact in rural areas, where most GPs have already stopped bulk-billing—and I have demonstrated that already using the example of my own electorate of Lingiari. While a large part of the reforms are focused on encouraging doctors in rural areas to bulk-bill health care card holders, the Rural Doctors Association President, Dr Ken Mackay, said few rural GPs will be interested in the package the government is offering. Dr Mackay told ABC radio:

I said to the Prime Minister several weeks ago that I would estimate that something like 10 to 15 per cent would take up this package.

... ... ...

Most of the doctors I've talked to don't feel as if they would take up the package.

A Crean Labor government, on the other hand, will immediately lift the Medicare patient rebate for all bulk-billed consultations to 95 per cent of the schedule fee, an average increase of $3.35 per consultation, and subsequently lift the Medicare patient rebate for all bulk-billed consultations to 100 per cent of the schedule fee, an average increase of $5 per consultation. In addition, Labor will offer four financial incentives to doctors to not only keep treating their patients without additional costs but also extend bulk-billing, especially in outer metropolitan and regional areas where the collapse in bulk-billing is hurting families most. 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, and doctors in rural and regional areas will receive an additional $22,500 a year for bulk-billing 70 per cent or more of their patients.

I represent some of the most disadvantaged people in Australia. They are also some of the sickest people in Australia. I represent the remote electorate of Lingiari in the Northern Territory; 35 per cent of my constituents are Indigenous Australians. While I am very proud to represent the electorate with the largest proportion of Indigenous people, I am absolutely ashamed that they are possibly the sickest people in the country. The statistics on Indigenous health are there for all to see. Rates of renal disease in the Indigenous community are seven times higher than they are in the non-Indigenous population in the Territory. Life expectancy for Indigenous Australian males is 20 years less than for their non-Indigenous counterparts. Not only is Indigenous health in the Territory poor; there are significant difficulties for all Territorians in accessing health care services. This bill should be defeated. This bill should be opposed. I would ask the government to look at the proposals the Labor Party has put before it. (Time expired)