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Monday, 16 June 2003
Page: 16472


Mr WINDSOR (8:07 PM) —I rise to oppose the Health Legislation Amendment (Medicare and Private Health Insurance) Bill 2003 and the Labor Party amendment. Before doing so, I was very interested to hear the member for Lingiari's comments on his electorate and some of the rural and remote issues which he raised. Although it is not as isolated as the member for Lingiari's electorate, some of the same aspects of health care delivery are prominent in the electorate of New England.

I paused to think about some of the issues that are before the parliament and the press at the moment. One of those issues—if I can divert for a moment—is the Prime Minister's proposed changes to the Senate. I have also been made familiar with some of the problems of representation that are going to come upon the Northern Territory. Having listened to the member for Lingiari, I think we as a parliament would occupy our time a lot better trying to help those people who are having difficulties in a representational sense because of the remoteness and broadness of their electorates rather than playing politics with the representational issues within the Senate.

Having spent a lot of time in the deserts of Australia, I can associate with some of the comments made by the member for Lingiari in relation to Aboriginal communities and the access, cost and social issues that are prevalent in some of those communities. I congratulate some of them, without mentioning them by name, on the way in which they have embraced some of those issues. I am sure the member for Lingiari would know some of those communities. It is not all doom and gloom out there; there has been a lot of positive stuff done and a lot of positive leadership shown within some of those Aboriginal communities.

But the bill being debated tonight is about Medicare. As I said, I will be opposing the legislation. Issues of concern have been raised by many members in the parliament. There are very real issues of concern from a country perspective. I have written to all the doctors in my electorate and asked my community to have some input on how they see this particular legislation impacting on their health care needs and the availability of health care, and my judgment is that the majority of people would not be in favour of this particular legislation. That is not to say that there are not good bits in it. Obviously that is the art of the political process, particularly when in government. I think the same thing applies in relation to the higher education reform legislation; there are some good things in that as well. But what we have to do as members of parliament is balance the good things against the bad things and make a determination on how to vote.

Health and education are very complicated in how they are promoted to the community. They are complicated and very significant issues. One of the things coming through very loudly and clearly to me on both of these issues is that the community do not particularly like to embrace a two-tiered system. I do not only mean a two-tiered system in terms of bulk-billing versus the other system; I also mean a two-tiered system in relation to city versus country. I do not think city people would particularly like to identify with some of the issues that have been raised in both the health and the higher education debates. I think politics is probably too much about putting a gloss and a fairly simplistic argument over fairly complicated issues. Calling things `fairer' and talking about giving people more access—and suggesting that that necessarily makes them good ideas—is, unfortunately, the way that the political process is run. It is unfortunate that a lot of people within the community are easily taken in by a number of fairly simplistic issues.

The vast majority of families, doctors and people I have spoken to do not believe that this piece of legislation, particularly from a country perspective, will increase the availability of doctors or care within a number of communities. Even the largest community within the electorate of New England, the community of Tamworth, has a massive shortage of doctors. It is favoured fairly well in the number of doctors, the number of specialists and the size of the hospital—it has the largest regionally based hospital within country New South Wales and, although I have not done the numbers, I imagine that means something in terms of country Australia—but, even there, there are difficulties in attracting doctors.

I congratulate the government on a number of initiatives, outside this legislation, that have encouraged doctors into country areas and that are putting in place longer term platforms, by way of scholarships and incentives, to get medical students to come to country areas. But the bill we are debating tonight is about Medicare. The Prime Minister says it is about a fairer Medicare; I doubt that, having talked to people who know the system a lot better than I do. A lot of people have spoken. I listened to the member for Calare, for instance, talk about the various threshold issues—the safety net issues for people who might be in some sort of chronic illness or disability situation where, because of their circumstances, they have to have a very large number of visits to doctors—and about the way in which those thresholds kick in. I think there is one threshold at $500 and another one at $1,000.

I believe—and the member for Calare raised the question with the Prime Minister last week—that there are certain cost issues in relation to those thresholds. I urge the minister in the Senate, when this bill gets through to the Senate, to examine the implications of some of the threshold issues and whether, through various medical manipulations, that system can be rorted to a certain extent. I do not think any of us would say that it never happens. I will not run through all the various issues that have been raised. I think I have raised the important issue from my electorate's point of view, and my judgment is that people are not sympathetic to this particular piece of legislation.

My first attempt at federal parliament was at the last election. I will stand corrected, but I think I was one of the very few people who ran on a platform of increased taxation. That platform was very much based on encouraging the government—and at that stage I believed that the Howard government would probably be returned—to try and get the medical profession to locate and, in this case, bulk-bill in certain areas, rather than look at these fairly piecemeal approaches of $5 here, $3 there, and a few dollars elsewhere. I thought the government should recognise that health is the key priority for all of us. I think that anybody in politics would recognise that health is the key priority; education is probably a close second. In recognising that issue, the government should also recognise—as I think all of us recognise—that the health system is staggering under the load. It is feeling an enormous number of pressures, whether it be the declining percentage of bulk-billing doctors or whether it be the medical indemnity issue. There has been a real stress on people, particularly on specialists but also on GPs, as to whether they remain in the medical industry. Again, I congratulate the government on a number of the initiatives that they have taken to try and come to grips with that. There are still issues out there that have an impact on whether doctors are completely comfortable with the indemnity issue.

Given all those positive things that are happening, we are still finding that the medical profession is not tending to locate within country areas and is not comfortable with the remuneration it is receiving. The Productivity Commission and others have done a great deal of economic and other work to try to determine what the problem is and how to rectify it. As we were going into the last election, to me it was clear that it is a classic case, if we as a community do believe that health is the No. 1 priority, of having to spend more money on it. Some would suggest that is what this bill does. I would question the use of that money and, particularly from a country perspective, the benefits that money will deliver in relation to country people.

My view was that the community would accept an increase in the Medicare levy and that that would, in fact, overcome many of the problems there are now, particularly in relation to the number of doctors in country areas. Within the last fortnight I have spent some time with many of the doctors in country communities. I stand to be corrected once again, but I am led to believe that the average age of a GP is something like 52 or 53 years. I can identify with that because that is about the same age as I am. There are a number of circumstances out there that are encouraging people in their 50s to leave the medical profession. If we allow that to happen, the whole debate about whether there is bulk-billing or not and what the pricing structure is—whether it is high enough or low enough—will be for nought if the doctors are not there to deliver the professional services we need.

A conference was held in the city of Tamworth not long after the federal election, or it may have been just prior to the federal election. The conference looked at the issues that revolved around the lack of country general practitioners, country specialists and, just as importantly, the allied health professionals. There is a great lack of these professionals in many country towns, and that leads to a lack of other services. One of the things raised at that particular conference was the use of the Medicare provider number by government as a way of driving the medical profession to where the service holes were. Another issue that was raised was the use of differential Medicare rebates that could be used in certain circumstances to encourage professionals into areas where they might otherwise not feel comfortable. One of the things included in this bill is the use of some differential Medicare numbers, depending on location.

After that particular conference in Tamworth, the National Party in particular but the government in general saw that the crude use of Medicare provider numbers and the use of differential Medicare rebates was a virtual interference in the market. They saw that the market should determine where people go and that you cannot use those sorts of instruments to try and drive people into particular areas. My view at that particular time—and I think I was still a member of state parliament then—was that we had a system where the medical profession was able to access the public purse through the Medicare system by choosing to locate where it liked, irrespective of whether there was a business load there in terms of the number of people requiring services. There was an inbuilt incentive to locate in city areas and rotate the patients to the advantage of those particular practitioners. Country doctors do not have that luxury. There are not enough of them to satisfy the needs of those communities.

The point I make is that, at the conference, the use of differential Medicare rebates and the use of Medicare provider numbers was pooh-poohed as something that could not be done. I was absolutely dismayed that in the 2002 budget, which was the first budget following my election as a federal member of parliament—I am pleased to see that the member for Lindsay is here; she would be well aware of all this and may well have been one of the people driving it, and good luck to her if she was—from memory, $80 million was expended in terms of using Medicare provider numbers and differential Medicare rebates to interfere with the market in an attempt to encourage the medical profession to go to certain areas; to encourage the development of the medical profession in certain areas of Australia where they were deemed by the government not to be filling the necessary needs of those communities.

I am sure the member for Lingiari is looking back and thinking, `I must have missed out on that, because surely they would mean the Northern Territory when they were talking about those sorts of issues.' One would have thought they would have been talking about west of the range in New South Wales and Queensland, but no they were not. They were talking about Western Sydney, western Brisbane, western Melbourne—those areas where they believed they had to interfere with the market processes that normally allocated the doctors, to put in place some incentives and to interfere with the system so that a system was developed that would encourage doctors into the western areas of the major cities.

The very important point in all of this—and it is very important to the way in which, in my view, our current Prime Minister thinks—is that those areas are very important to the election of a government within this parliament. I think that is a great shame. What that one thing did for doctors who were looking at working in regional and remote areas was put forward a financial incentive for them to return to Western Sydney, western Brisbane and western Melbourne. I am not saying that those people in the west of those communities do not deserve medical facilities—I am not saying that at all. In fact, they are using their political muscle to achieve an outcome, and I congratulate them on that. Maybe that is something that country people should wake up to; maybe they should start to use their political muscle to a certain extent as well. I am saying that the need to interfere suggested to all of us that the system was not working correctly.

This bill does not necessarily address the circumstances that are out there, and I do not think the Labor Party's amendment does at all either. The government and the opposition are both playing with the existing system and hoping they can buy time in relation to keeping a lid on Medicare. As a nation, at some stage we are going to have to address the issue of health. As a nation, in my view, we will have to increase the Medicare levy. We will have to design something that gives the practitioners of health the remuneration that they should have and recognise exactly what the Productivity Commission has recognised—that is, unless you remunerate people at a certain level, given their experience, the demands, the medical indemnity issues, the insurance issues and a whole range of other professional and social issues that are prevailing upon the medical profession; unless we take the lid off this and address those issues, we will see a system that is slowly strangled. (Time expired)