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Thursday, 16 February 2012
Page: 1708

Ms BURKE (ChisholmDeputy Speaker) (11:47): I rise today to speak about Appropriation Bill (No. 3) 2011-2012 and Appropriation Bill (No. 4) 2011-2012. I do so with some excitement because some of the measures in this bill will go a long way to assisting with the introduction of the clean energy bills package—something quite welcomed in my seat.

While I do not dispute the member for Barker's desire to represent his electorate and to speak forcefully for it, I am sick and tired of my constituency—people who live in the suburbs—being held to ransom and being told that we can no longer spend money in the suburbs. I hate to point it out to everybody, but that is actually where most people live! If you look at proportion of spend, that is where it goes. I can attest that in my years in opposition—all nine of them—the Howard government put no money into my electorate beyond normal program funding. I did not get one spend beyond that—not once. Being in a marginal seat, I always found it quite interesting that they were not trying to attract some votes by funding something. I used to try to get them to fund something in my seat so that they could claim it and we could have it done. But in the nine years of the Howard government where I was in parliament not one additional spend was made—not one sports centre, not one additional road upgrade and no extra money into my hospitals, which are two of the largest in the country. Now, under a Labor government, we have seen spending based on requirements and not just on vote buying.

I also want to point out, in discussing these appropriation bills, the quite outrageous hypocrisy and inconsistency of the amendment moved by the member for Goldstein, Andrew Robb, of putting these expenditures on hold. This is at the same time, in the last couple of days of parliament, as we have had those opposite moaning that we have now finally passed the changes to the private health legislation to cap and means test the private health rebate. On the one hand, the opposition is telling us we cannot afford to spend money, but on the other hand they are trying to prevent the government of the day securing better outcomes in health by taking back a proportion of the money going towards private health funds. That money was in no way, shape or form assisting the health system of this country. I want to spend a bit of time on these inequities in the opposition's argument and some of the inconsistencies around the private health insurance rebate. A lot of people in my electorate take out private health insurance, and I commend them for that. I myself have private health insurance and understand how expensive it is. But putting a rebate into the private health system did nothing to repair the health system. Let us look at this: it was money going to an insurance scheme. It was not going to private hospitals; it was not going to patients; it was not going to doctors. It was going to private health funds, to insurance schemes.

I said at the time the bills were introduced into the House by the Howard government many moons ago that this was inequitable. It was bad policy. Ask any health economist, any health expert. It was bad and flawed policy because, over time, more and more revenue from the health budget was going to prop up private health funds, insurance schemes. Surely if the coalition had wanted more people to take up private health insurance they would have made their schemes better.

I am sure that all of you in this place have had to deal with family members and individuals going to hospital. In the last couple of years my family and I have had to deal with both the private and public systems on many occasions. Tragically, 12 months ago my father died. He spent an enormous amount of time in the public health system. We could not have asked for better care than the care he got. Given the procedure that he needed and the fact that he was then going to spend an awfully long time in ICU, he could only have got that care in the public system. He spent a lot longer in ICU than any of us would have desired and several months ago he unfortunately died. But it was not because of the health care he got in the public system. No private system could have provided that care.

A couple of months later my mother ended up in a private hospital, where she was told: 'We can't do that procedure. We're going to put you in an ambulance and send you to a public hospital and we're going to charge you $500 for the joy of being here for the last couple of hours while we assessed that we cannot look after you.' She got nothing back from her private health fund. The inequities in the system are about how the system works, not about throwing more money at it. We have never gone to the crux of it: actually repairing the system.

My son has had to undergo surgery on numerous occasions because he was born with fused fingers. This was a very odd thing, a very simple little thing, but I wanted my son to have fingers that he could eventually use. All of this surgery was performed by a private practitioner whom we chose but it was done within the public hospital system. Why? Because the surgeon wanted to perform the surgery at the Children's Hospital because that is where all the care and equipment are that were going to be needed if, touch wood, anything ever went wrong. It never did. But that is where the surgery happened. He could have had all that surgery in the public system and we could have chosen to go as public patients but we elected not to because we could afford not to. It would have been the same surgeon and the same team but we chose not to. We were asked on that day whether we wanted to go public or private. It is about the inequities in the system, not just throwing more money at it and propping it up.

Health is a big issue in my electorate. A great proportion of my constituents take out private health cover. A lot of my constituents work in the medical sector. I have in my electorate two of the largest hospitals in the country. Many people from outside the electorate come to these hospitals. Members opposite probably have constituents who have come to Box Hill Hospital and Monash Medical Centre. Monash Medical Centre is a very big hospital that also has a private hospital within it, so it has the two systems working together. I also have Epworth Eastern, a great private hospital that works really well in conjunction with the public hospital across the road. I have some smaller private hospitals that do great work. I have amazing medical researchers at both Monash Medical Centre and Monash University. Health is a big thing in my area. It would probably be the largest employer after Monash University. It is a big issue and it plays an important part. But it is about funding it appropriately. Where should we fund this? I say propping up an insurance system is not the right way to go. Carol Bennett, CEO of the Consumers Health Forum of Australia, wrote in an interesting opinion piece:

Contemporary health policy discussions are generally about vested economic interests competing within an antagonistic political system. While these ‘policy’ discussions impact directly on health consumers, they are rarely referenced to real health outcomes.

Real health is about how we look after ourselves, our family and friends, our workplaces, our communities and our environments. It is about regulation and safety (seat belts, random blood alcohol testing, OHS, etc.), access to quality food and water and hygienic sanitation, access to preventative health. It is about exercise, nutrition and well-being. It is about belonging. It is about us.

Discussions about our health care systems are usually about money and there is a compelling case for adopting this approach. Around 1 in 8 Australians are employed in the health sector, making it the largest employment sector in Australia—

On the record, I flag a vested interest because my husband, as many of you may know, works within the health sector as a MICA paramedic. He also lectures at Monash University within that sector and I know it quite well. My father-in-law is a physician. I know there are a lot of people who work in the healthcare sector; I am quite related to it. I will go on with the article:

It is also a sector that is growing at a much greater rate than most others—healthcare needs are expanding, as are community expectations from our ageing population to have access to the best possible care. Health is a remarkably resilient economic powerhouse in Australia and around the world.

Almost all health policy creates economic winners and losers among the existing players. If a particular drug becomes much cheaper to consumers by being listed on our subsidised Pharmaceutical Benefits Scheme, the drug manufacturer makes more money through increased sales. A higher Medicare rebate for certain procedures allows doctors to charge more and increase their income.

Any Health Minister proposing cost saving changes to the health system is going to have to run a gauntlet of opposition from those who will lose money if the policy change is implemented.

The article goes on to cite the situation under the last parliament when the then Minister for Health and Ageing, Nicola Roxon, tried to reduce the Medicare rebate for cataract surgeries. The article further states:

Cataract surgery rebates is one example cited by Dr Tony Webber, the former head of the Medicare watchdog, the Professional Services Review, in the current edition of the Medical Journal of Australia. Dr Webber argues that billions of dollars of savings can be achieved if the government is prepared to take on vested interests across the health system. He is right.

...   ...      ...

Vested economic interests in health care systems will always oppose any change that potentially reduces their income. Oppositions will usually seek to gain political capital by joining any chorus of disenchantment. Unfortunately these two forces currently seem to be the major drivers of our health care system.

That is right. It is about the politics, not the health. What we need to get back to are good health outcomes. Let us actually talk about where money should be going: into good health outcomes. The majority of the consumer watchdogs have welcomed the changes to the private health rebate, and there are great needs within that. Many of the players within the sector have welcomed the change because it will put money back into the system, where it is needed, not propping up the rebate.

Back in February 2009, the Australian Healthcare and Hospitals Association wrote:

The $3.5 billion private health insurance (PHI) rebate needs further scrutiny in the light of advice from the Federal Treasury that it does not deliver value for money, according to the Australian Healthcare and Hospitals Association (AHHA).

The AHHA is the peak national body representing public hospitals, area health services, community health centres and public aged care providers.

AHHA has previously called for the PHI rebate to be evaluated to assess whether or not it represents the best use of scarce health resources ...

Since the program was introduced by the Howard Government it has never been assessed against its objectives. This is despite the fact that many economists and other health experts have expressed serious concerns that it is an inefficient use of tax-payer funds.

That is who is paying for this: the taxpayers. I am not talking about winners and losers or rich and poor. I think that is a spurious argument. I do not think it is about people subsidising others; it is about the best use of the money. It is about assessing where the health dollar can go. Again from the AHHA, yesterday:

Means testing the rebate will result in a fairer use of public health funding and not impose any additional burden on public hospitals.

AHHA has done extensive modelling on the impact of the proposal and found that only 15% of the insured population or about 1.53 million people will be affected by the changes. For this small group - the wealthiest in the community - their rebate will fall by between 10% and 20%.

We know from past experience that price has relatively little effect on private insurance membership. For example, when the rebate was first introduced in 1999, membership grew by only 2% for every 10% reduction in price. The proposed reforms will simply reverse that for higher income people. At an average 14% increase in price, only 31,000 would now be expected to drop their private insurance. This estimation is almost identical to that reached independently by Treasury.

Only a small proportion of those who drop it will ever appear in a public hospital setting. So it is about where the best bang for your buck can be found within health. In the short time remaining I would also like to put on the record what benefits my electorate has received from the changes the government has introduced. We have actually seen some infrastructure spending within Chisholm. I have been delighted to go to all of my school openings for the BER and the National School Pride program. I am going to go along very soon to Box Hill High School, where they have had a community partnership working together, to open the SATERN science block, which is a federally funded initiative. I had the delight of going to Ashwood College in my electorate, which was promised money by the Baillieu government. Tragically, Ashwood College has now been hit twice by arsonists and it has not been repaired after either of those fires. Whilst the state member for Burwood went to the election promising that the high school would be rebuilt, nothing has happened. Those children are being educated in an environment that is just appalling. The previous state government had committed the funds to build an entire new school on the site. That has now been scrapped. No money has been given. The only new building that has been opened on the site of Ashwood College is a new science wing built under the BER funding arrangement. It is a testament to what you can do in those schools. It will lift that school and it will help the community greatly.

I have had the joy of going to all of my Catholic and private primary schools, who have welcomed, embraced and are incredibly grateful for this funding. It has allowed them to do things they would never have done. Particularly in the Catholic sector there is great appreciation for what has gone on and most of them say, 'We spent the money wisely. We don't know what all the fuss is about.' I have had money go to all of my state, private and independent schools. I have had money go into the two universities and the TAFE within my seat. This will help us into the future in this education space. I commend the bills to the chamber.