Senator DENMAN (9:58 PM) —I rise to speak on the Health Care (Appropriation) Bill 1998. The Tasmanian Minister for Community and Health Services, Mr McKay, has been very outspoken and candid in relation to the stalled negotiations between the Commonwealth and many of the states over a replacement for the current Medicare agreements. Negotiations on the new agreements commenced in May last year, and the sticking point has been the quantum and security of funding.

The frustration has resulted in an unprecedented level of public exchange and in-fighting. In Tasmania, Mr McKay started the ball rolling with comments such as, `The Commonwealth is making a Clayton's commitment to Medicare.' Attacks like this led the Prime Minister to call in the support of his seven Tasmanian Liberal colleagues to defend an offer which represented a $137 million cut over five years to Tasmania. Each member signed a press statement describing the Premiers Conference offer as fair and reasonable.

The Parliamentary Secretary to Cabinet and member for Braddon, Mr Miles, accused the state Liberal government of running a scare campaign on the health crisis. Mr Miles cast total blame for the crisis on Liberal state governments of the past. Subsequently, the health minister accused Mr Miles of white-anting his constituents and of being too long in Canberra. Mr McKay said that Mr Miles was using wrong figures in his criticism of Tasmania over the Medicare row and changed his figures daily to suit his argument. While all this verbal warfare has been ensuing, the quality of patient care has remained under threat.

With the Medicare agreement wrangle, we have also had in Tasmania conjecture about options that will need to be explored within the public system so as to deal with the projected funding shortfall in the next financial year. On top of all that, there is the public sector nurses industrial campaign in support of a pay claim. This industrial campaign has ended with members of the public being asked to volunteer their assistance during the dispute at public hospitals. All these happenings have stressed and underlined the fact that public health finances in Tasmania are at crisis point. A recent editorial in a Tasmanian daily newspaper stated:

It is the public's right to a good education and good health, so Government spending should not stint on the best possible standards of care, certainly nothing less than the politicians and the bureaucrats who frame budgets would accept for themselves.

The editorial went on:

Federal as well as state attention to health funding is overdue, and the Commonwealth could start by reviewing the terms of the new Medicare agreement, which most states, including Tasmania, are steadfastly refusing to sign. Appropriately financed, Tasmania could build a health system capable of meeting the demands on it.

As we know, Commonwealth funding for public hospitals runs out tomorrow. Agreements are vital to fixing the crisis in public hospitals. This bill typifies the hatred that the Prime Minister harbours for Medicare and the public hospital system. We on this side of the chamber will not forget when the Prime Minister said that Medicare had been an unmitigated disaster. It is not Medicare that is a disaster; far from it. Rather, the disaster that is occurring in public health emanates from the backdowns and reversals by the Prime Minister on his health assurances to the states. The assurances were that every dollar would be provided to the states on time and in full.

When you turn to the detail of the offer in this bill, you discover that the Prime Minister's previous assurances have all been nonsense. With the decline in private health insurance, there was an assurance from the Prime Minister that payments would recompense any state if reductions in private health patient numbers were to occur. Other factors were promised to be taken into account to ensure that there was no erosion in the value of funds provided. Alas, that is not the case, as this bill provides a lump sum each year with no indexation.

The Prime Minister may attempt to hang his hat on the claim that funding in real terms to the states has been generously increased by 15 per cent over the next five years. However, we heard from the majority of state health ministers that that claim does not stand up to close scrutiny. The government is deliberately attempting to orchestrate a decline in the provision of public hospital services and the whittling away of Medicare. The government wants to dismantle the safety health net for Australians. This bill, in allocating $29 million, will be the start of the efforts of the government to undermine the confidence that has until now been so strong in Medicare and within public hospitals throughout the nation. This bill heralds the development of a two-tier health system. Where will this lead us?

I recall reading not so long ago an article in my local paper about a Swedish dentist who left his patient with only titanium screws in his lower jaw. He took his dental implants back as the patient could not pay his bill. That was a dramatic example of the health cutbacks that have been made to Sweden's public dental scheme and health insurance. That example may be dramatic, but one needs to ask oneself how long before examples as stark and concerning as that one in Sweden start to emerge in this country and, for that matter, in Tasmania? How long will it be before compulsory hospital charges are levied for in-patient care on eligible persons who elect to be treated as public patients? Finally, in closing, I quote the Tasmanian Liberal minister for health, who said of the federal government and its miserly allocation to the states:

The only people that are hurting are the patients.