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Tuesday, 7 October 2003
Page: 20646


Ms PLIBERSEK (4:12 PM) —It warms my heart to see how worried the new Minister for Health and Ageing is about his opponent. He is so worried that he does not believe that our health spokesperson can come up with her own speeches. He imagines that if she says anything articulate or sensible she has got the speech writers in. We do not have such resources. We write our own speeches, and I am sure Julia Gillard wrote her own speech today. It is not hard to make the case that the government is out to destroy Medicare. It does not take a genius to make that case.

It is interesting that this Arnold Schwarzenegger of Australian politics, who is all punch and no policy, blames everyone but himself for the crisis in Medicare today. He blames the doctors. He is saying that the doctors are careless in their insurance—that the doctors did not ring the insurer and ask, `Excuse me, are you charging me enough?' So the doctors are careless, and patients are selfish because they want new and modern treatments as they come out. `Selfish' patients should not expect too much from this government.

The minister blames the states. He never blames the Commonwealth; the only group that he never blames is the Commonwealth government. He is never prepared to take responsibility there. He says that our health spokesperson, Julia Gillard, is using the big lie. I say that this health minister patented the big lie. I think the Australian Competition and Consumer Commission is worried that this government has the patent on the big lie—that it has cornered the market and there is no room elsewhere for the big lie. This government has an article of faith, the health minister says, that it will protect and extend Medicare. I wonder if that article of faith is like the article of faith that the clergy remain celibate. I wonder if that is his definition of an article of faith.

This government's plan to destroy Medicare and the government's creation of the medical indemnity crisis is something that concerns every Australian. This government has long had a plan to destroy Medicare. The Prime Minister has made no secret of that desire. When he was Leader of the Opposition in the 1980s John Howard 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'. He promised he would `pull Medicare right apart' and `get rid of the bulk-billing system' which he called an `absolute rort'. His 1987 election commitment was that `bulk-billing will not be permitted for anyone exception pensioners and the disadvantaged' and `doctors will be free to charge whatever fees they choose'. That is the only promise he has delivered on in all those years. Obviously it was the only core promise of that election campaign.

The facts speak for themselves. There were 10 million fewer bulk-billed visits to doctors this year compared with when John Howard came to office. In my own electorate the rate of bulk-billing has gone down 5.8 per cent and the cost of visiting a doctor has gone up 11.2 per cent. But this is nothing compared to other areas of this country where the drops have been even greater—much greater than this. The Australian Medical Association admits that GPs will have to charge non concession card holders more under the government's plan, and the government has admitted that it will have no control over the fees that GPs charge. This is in stark contrast to Labor's $1.9 billion plan to renew and restore Medicare by paying 95 per cent and then 100 per cent of the scheduled fee and by providing incentives to doctors who bulk-bill 80 per cent or more of their patients in metropolitan areas and 70 per cent or more in other areas, with bonuses of up to $22,500.

The government's Orwellian doublespeak in alluding to A Fairer Medicare system is truly frightening. Australian families with two children will be denied access to bulk-billing once they start earning over $32,300. The system will encourage doctors to charge a gap fee and increase the cost of medicines by 30 per cent. The government has recently held a gun to the head of the states and insisted on their accepting a shortfall of about $1.5 billion by 2008 in their health agreements. Surely the $7.5 billion surplus that we have just heard announced could cover some of that $1.8 billion shortfall in hospital funding.

The government shirks its responsibilities both in a financial sense and in a policy sense. It shirks its responsibilities in the financial sense by not providing the funding that states need to provide decent hospital services, but it also shirks its policy responsibilities in that it is doing nothing to take pressure off emergency departments in major hospitals. The federal government could very easily follow the New South Wales government's lead, where GPs have been co-located at hospital sites, and it will be extending this trial program soon. So people who formerly would have seen a bulk-billing GP but who instead turn up at hospital emergency departments are now able to visit a GP. People who could see a GP if one were available but instead turn up at casualty cost the health system about $400 million each year; if they went to GPs, it would cost about $115 million each year—a saving of nearly $300 million. That is the sort of positive policy leadership we would love to see from this government.

Another area crying out for reform is that of elderly patients who, instead of receiving the proper nursing home care they would benefit from and living in an environment they would benefit from, are in hospital beds. It is not that we begrudge them hospital treatment, as the government has tried to make out in the past, but they cannot be cared for as well in hospitals as they would be in nursing homes.

This government is presiding over a crisis in health care. We heard tales last week from Victoria, where children were being denied cancer treatment because of a $25 million shortfall in funding for that state's hospitals. We have an expert committee recommending a new suite of immunisations for children, but the government will not fund them. This is unprecedented: an expert panel is recommending immunisations that the government will not pay for. So the children of the wealthy presumably will be immunised while the children of the poor will not receive the necessary immunisations that have been recommended by experts.

Like my colleagues, I am constantly contacted by both doctors and patients crying out for help because this Medicare system is in such crisis. Kylie, a constituent of mine, told me that she could not find a bulk-billing sharedcare doctor to see her through her pregnancy—and her nearest doctor charged more for a half-hour visit than she and her husband spent in a week on groceries. Doctors at a Glebe family practice told me when I visited them a few weeks ago of some of the problems that they face. They face the usual problems with paperwork and the costs of running a practice, and people would assume that an area like Glebe would have no trouble in recruiting doctors, but that is not true. A great deal of difficulty is faced in finding GPs to practise even in inner city areas like Glebe.

We have known for a long time that we are facing a shortage of GPs, and it is truly incompetent that this government has not acted to do anything about it. The same is true for nursing. The government says that we need an extra 6,000 nurses. Last year alone, 2,500 applied to do nursing at Charles Sturt University but only 10 per cent got in. Contrast that with Labor's policy to introduce another 3,000 nursing places to do something to begin to address the shortfall in this area.

This government has form. Every single time it ignores these emerging issues until they are crises, and then it blames the people who are affected worst by them. The Tito report six years ago, in 1997, warned this government that there was an emerging indemnity insurance crisis. It has known since 1997. It has not known about it just since Tony Abbott became health minister but for seven years, and it has done nothing about it. Indeed, Michael Wooldridge boasted that nothing had been done about it.

The doctors believe that they are being asked to pay too much. We are not in a position to judge that because this minister will not release the calculations. The doctors say that the calculations are based on legal systems before tort law reforms were introduced and, if that is the case, there might be a very good argument that they are being charged too much. Surely the first step should be for the minister to release the calculations and let us know just how they are being made. He should reassure the doctors if he has a good case—although I think we are all very sceptical that he does.

The Prime Minister has said that he wants to do something about catastrophic injuries. He mentions it, and it sinks without a trace. This minister says that, if the doctors are resigning, they are not doing so because of the levy—but that is not what they say. This situation has reached crisis point now. The government cannot afford just to flick it off until after the next election and hope that the doctors will go away quietly for the next 18 months; they will not do that. This government has absolute responsibility to take this crisis in hand and provide a reasonable solution instead of just a moratorium. A moratorium is no solution.