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Tuesday, 17 June 2003
Page: 11622


Senator FORSHAW (12:57 PM) —I rise to speak on the Health Care (Appropriation) Amendment Bill 2003. In doing so, I move the second reading amendment to this bill which has been circulated in the name of my colleague Senator Evans:

At the end of the motion, add:

“but the Senate condemns the Government for its health policy failures, including:

(a) the Howard Government's withdrawal of $918 million from public hospitals over the next 4 years;

(b) the Howard Government's unfair Medicare package which will result in bulk billing, in time, only being available to pensioners and concession card holders and families being left to pay more and more for their health care;

(c) the Howard Government's decision to increase the cost of essential medicines by up to 30 per cent, hitting the sickest and the poorest hardest; and

(d) the Howard Government's refusal to review the $2.3 billion private health insurance rebate to ensure that it provides value for money for consumers and taxpayers”.

The amendment encapsulates Labor's view on the government's health policy failures, which I will describe in a little more detail later on in my speech. This bill sets the scene for the Commonwealth to make its ongoing contribution to the funding of state public hospitals through the Australian health care agreements. The opposition supports the legislative framework that enables the Commonwealth to continue to fund the health care agreements over the next five years. Our great complaint with the Howard government is the level of funding.

People interested in this area may recall that, at the health ministers conference in 2002, all the states, both the territories and the Commonwealth—through the Minister for Health and Ageing, Senator Patterson— agreed on a reform program. A task force of clinicians was charged by the health ministers conference to look at a range of reform proposals and reform mechanisms. This set up expectations that there would be, firstly, adequate funding of the states through the health care agreements and, secondly, implementation of some reform measures. But people will remember that in November last year, as well as last week in Sydney, all Australian health ministers turned up with the exception of the federal minister, Senator Patterson. The Commonwealth was represented by an empty chair. A decision had already been made by the government, effectively by the Treasurer and the Prime Minister, on the amount of funding for health care. It was clear that, as far as the federal minister for health and the Commonwealth government were concerned, no discussion would be entered into between her and the states and territories, despite the states' and territories' greater appreciation of the sector's needs.

In January this year, the Treasurer said that we should proceed on the basis that there would be no new money for health in the budget. He was right. For once the Treasurer kept his promise, because that is precisely what we have seen. The forward estimates revealed that $918 million would be dragged out from funding of the health care agreements over the next four years. A virtually identical amount, $917 million over four years, will be spent instead on the government's unfair Medicare package, with zero net gain to health spending by the Commonwealth. This is a great lost opportunity. Nothing has been done and nothing will be done to improve one of the great problems that we have in health care funding in Australia at the moment—cost shifting. We know that for years the system has been bedevilled by cost shifting between the states and the Commonwealth, and here was a perfect opportunity for the Commonwealth to move beyond the old style approach and initiate solutions to the problem.

This bill and the negotiations leading up to it provided an opportunity for the Commonwealth to consider open, transparent, up-front pooling of funds between the states and the Commonwealth, not just for hospitals but potentially for aged care, pharmaceutical benefits and a range of other health areas. For the next five years every jurisdiction would know where each other jurisdiction stood on matters of health expenditure. This bill therefore represents, on one level, a great lost opportunity. But the greatest damage that the government is doing in this legislation is to rip between $1 billion and $1.5 billion out of Commonwealth funding for state public hospitals.

It is also appropriate in this context to examine briefly what impact the new unfair Medicare package has on our public hospitals. We know that when the Howard government came to office in 1996 bulk-billing rates were at 80 per cent and that shortly after Labor left office in May 1996 bulk-billing rates peaked at 80.5 per cent. In every year since then, under the Howard government bulk-billing rates have fallen. With the release of the statistics for the March 2003 quarter we see that the national figure for bulk-billing has plummeted to 68.5 per cent. In round figures, that is a 12 per cent drop in bulk-billing in the seven years that the Howard government has been in office. Over half of that drop occurred in the last year or so, effectively a six per cent drop within the last 12 months.

In December 2001, the health department advised that unless the government took dramatic action there would continue to be a serious and dangerous decline in bulk-billing. In response to this salient reminder, the government did absolutely nothing. As late as December last year, the Prime Minister stood in the other place and claimed it was factually incorrect to say that there was a problem with bulk-billing. Every quarter, when we saw the release of official statistics, the minister for health would say, `These are disappointing rather than disastrous.' They may not have been disastrous for the minister but for an individual who cannot find a bulk-billing doctor it is bordering on the disastrous. Where does such an individual go? What happens is that the states and territories ultimately have to pick up the tab when a person who cannot find a bulk-billing doctor subsequently seeks assistance from a hospital. It might take two days, two weeks, two months or two years but we know that sooner or later low-income Australians who cannot find bulk-billing doctors end up in the emergency departments of public hospitals, thus putting even greater pressure on the state system. State and territory health ministers have been saying for some time that the collapse of bulk-billing is putting additional pressure on our emergency departments. They are now being inundated with people who could and should have been dealt with by a GP.

It is also the case that those people who are least able to afford to see a doctor or pay for a script are also those people most at risk of serious illness or chronic disease. So how has this government responded to the collapse in bulk-billing? As I mentioned a moment ago and as this bill shows, the government has responded simply by taking $918 million over four years out of the funding for the health care agreements and by introducing its unfair Medicare package. Its Medicare package pays incentives to doctors to bulk-bill pensioners and concession card holders only. That effectively destroys the universality of Medicare and the integral role of bulk-billing within it. Whilst it is disappointing to Labor and it is indeed disastrous for the health care system in Australia, the package comes as no surprise to the opposition. It reflects the long-held views of the Prime Minister, views expressed by the Prime Minister when he was the Leader of the Opposition in 1987, when his formal election commitment to the Australian people at that time was that bulk-billing should be restricted to pensioners, concession card holders and poor people and that doctors should be free to charge everyone else what they chose. It has taken him a few years but the Prime Minister is now endeavouring to implement this objective. That is what this government's unfair Medicare package now seeks to implement: to reduce Medicare essentially to bulk-billing for pensioners, concession card holders and the poor.

The second thing that the government's unfair Medicare package seeks to do is enable, for the first time, the patient rebate to be split from the doctor's charge or copayment. That gives the green light to doctors to charge whatever they want. On the release of the package, the AMA said that doctors' fees would inevitably rise. The Parliamentary Secretary for Family and Community Services, the member for Parramatta, Mr Ross Cameron, has also acknowledged this. Any family with an income of $32,300 or more is not eligible for a health care card or a concession card. As a consequence—bit by bit, visit by visit—members of each of these Australian families will end up paying more and more every time they visit the doctor.

So the government's unfair Medicare package does not provide a solution to the dramatic collapse of bulk-billing or to the funding of our state public hospitals. As I said, the government is ripping $918 million out of the health care agreements and effectively funding its unfair Medicare package, costing $917 million, by that transfer of funds. When you look at the great areas of public health policy—Medicare and bulk-billing, health care agreements, state public hospitals, the Pharmaceutical Benefits Scheme, private health insurance—the government has dramatic failures for which it should be and is being condemned on every score.

With respect to the Pharmaceutical Benefits Scheme, we find in last year's budget and again in this year's budget, the government committing itself to increasing the cost of essential medicines by 30 per cent. We know from the health department's own analysis that five million pensioner scripts will not be taken out as a result of the increase in the charge. What is the consequence of the Australian population, particularly pensioners, not taking out their scripts? It is the same as the consequence of not seeing a bulk-billing doctor. They end up in the emergency departments of public hospitals. Combined with the crisis in bulk-billing, more and more people will be attending the emergency departments of our public hospitals at precisely the same time that the government is ripping over a billion dollars out of the funding for our health care agreements.

Australians know that Medicare is the world's best health system and that only Labor has a plan to save it. We created it and we will now save it. Last month, Labor announced a $1.9 billion package to reverse the collapse in bulk-billing by lifting the patient rebate for bulk-billing. That will apply to all Australians, no matter where they live or how much they earn. A Crean Labor government will immediately lift the Medicare patient rebate for all bulk-billed consultations to 95 per cent and subsequently to 100 per cent of the schedule fee. That is an average increase of $5 per consultation. In addition, Labor will offer powerful financial incentives to doctors to support and 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. Doctors in rural and regional areas will receive an additional $22,500 each year for bulk-billing 70 per cent or more of their patients. These measures are the first step towards Labor's objective of lifting the average national rate of bulk-billing back up to 80 per cent or more.

Everywhere you look the effect of the government's policies on health increases the burden on individuals and that is at the heart of the unfair Medicare package—to shift the cost to a user-pays system. That runs through every area of health policy: authorising increases in private health insurance premiums; hitting the sickest and poorest with a 30 per cent increase in the cost of essential medicines; reducing funding to the states for public hospitals; and giving the green light to doctors to charge Australian families with incomes of over $32,300 more every time they visit a doctor. These are the great issues of health care and health care policy before the Australian community. As far as the government's unfair Medicare legislation is concerned, we will fight those changes tooth and nail when they come before the Senate because the only consequence of those measures will be to hit Australian families.