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Tuesday, 17 June 2003
Page: 11632

Senator WEBBER (1:39 PM) —We have barely begun to debate the budget and its associated bills in this place when the government introduces the Health Care (Appropriation) Amendment Bill 2003 in what can only be described, to my way of thinking, as one of the most ridiculous three-card tricks that we have ever seen. Thanks to this government, the universality of Medicare will be reduced to the waste bin of Australian history if these and other measures are fully implemented. The government would have us believe otherwise. In fact, the Parliamentary Secretary for Health and Ageing said in the other place:

This bill delivers on the government's strong commitment to the principle of universality under Medicare.

I doubt very much that the Australian people believe that. From that comment and from others, you would think that the government has always been committed to Medicare. Nothing is further from the truth. Ask anyone and they will probably tell you that there is very little that is universal about Medicare under the stewardship of the Howard government. Firstly, you have to find a doctor or a medical practice that will bulk-bill. As we all know, over the last seven years this has become more difficult. In the electorate of Hasluck, in my home state of Western Australia, of the 62 local GP and other medical practices, only 25 bulk-bill. Of those 25, only two or three universally bulk-bill; the rest are just for health care card holders. If you do manage to find a doctor who bulk-bills, you will find that it is probably only for the young, the old or other health care card holders.

This government runs around the country sprouting this nonsense about its package delivering universality, but what it really delivers is `user pays'. This bill is part of that user pays nonsense. This bill delivers a $1 billion cut from the forward estimates for health care in our public hospital system. At a time when the public hospital system in this country is in crisis, the government is actually cutting money from it. We all know why it is in crisis, and it is a crisis of the government's own making. The government has presided over Medicare for seven long years and, during that time, has ensured that we have seen the beginning of its destruction. Bulk-billing rates have declined, from a high of 80 per cent down to 68 per cent.

What is the direct consequence of this? More and more of our fellow Australians are presenting at the accident and emergency departments of Australian public hospitals, seeking the provision of basic health care services. These are services that could be provided by a doctor or a medical practice but, as our fellow Australians can no longer afford to pay the fees charged by doctors, they go to the one place where they know they will not be turned away because of their lack of ability to pay.

This government is building a health system that is all about money: if you have the money, take out private health insurance; if you have the money, go and see a local doctor and pay the fees. But what happens to those without the money? They are condemned to lining up in the accident and emergency departments of our public hospitals for hours and hours, waiting to have their basic health care needs met. At a time when we know that the number of presentations at public hospitals is going up, this bill cuts their funding. The government is cutting the funding to public hospitals to fund its approach to Medicare.

In Victoria in 2002 an extra 50,000 patients presented to the public hospital system because of the failings of this government. Emergency admissions are increasing by eight per cent a year. In New South Wales in the same period, emergency department presentations exceeded two million. That means that each week in New South Wales some 40,000 of our fellow Australians are turning up in public hospital emergency departments. In my home state of Western Australia, on any given day 1,146 people are admitted to our public hospitals, a further 824 people are treated in our emergency departments and discharged, 11,283 people attend an outpatient session, and over 250 operations are performed. When you take into account all those statistics, what does this bill do? It cuts a billion dollars from the funding for those procedures.

The government's defence is that with the increase in private health insurance the load is being lifted from public hospitals. Let us examine that defence. For the small sum of some $4 billion—the private health insurance rebate, which is increasing all the time—private hospital admissions have gone up by less than one per cent. So let us be quite clear about this. Four billion dollars or so increases private hospital admissions by one per cent. Yet at the same time, in the case of Victoria, they get their share of the $1 billion cut and they get to treat an extra 50,000 people.

There is something fundamentally unsound about how this government approaches health care. It put in place a system that forces a whole lot of people into private health insurance, which costs a significant amount. Let us not fool ourselves by pretending that it does not represent a lot of money. Even with the benefit of the rebate offered by the government, I am aware of a family in the northern suburbs of Perth, a family of six with basic hospital coverage, that are paying nearly $180 per month. I am told by this family that their health insurance premiums have gone up at least once a year for the last three years. This family can now only find a medical practice that will bulk-bill for children under the age of 12.

Recently I travelled in the north-west of Western Australia. The north-west has the great distinction of having a fair number of high-income earners who work in the mining and resource sector and also a great number of people that are either in low-income groups or who receive Centrelink payments. If you go any further north in Western Australia than Geraldton there is no provision for private health services at all. There are no private hospitals and GP services are, in the main, delivered through the public hospital system, through organisations like the Aboriginal medical services, or there are salaried GPs provided by local government authorities. Yet that population still has to pay either the private health insurance premium or the extra tax this government has imposed on those who do not take it out. So they pay for a service that they cannot physically access, thanks to this government.

This is the rebate scheme that costs the budget more and more each year because of the increases that health funds seek to meet their costs, yet they do not deliver services to a significant proportion of those in my home state. It is an increase that the Prime Minister said would have to go before parliament, but which never really has. This approach was meant to relieve pressure on our public health system. This approach was said to be all about reducing the load on public hospitals, and yet we have ended up with the opposite result.

At the same time the government does nothing to relieve the pressure on Medicare. Bulk-billing rates have fallen by 12 per cent in seven years and the effect of the decline in Medicare bulk-billing is the increase in people going to our public hospitals. So for a whole lot more money the government has not fixed the problems in public hospitals nor addressed the problems in Medicare. In fact it has actually made them worse, with private health funds being subsidised to the tune of up to $4 billion supposedly to address the problems in the health care system. At the same time as this is meant to prop up the private health insurance scheme we have seen an enormous pressure on Medicare and a rampant increase in the workload in our public hospitals.

So what is the government's new response to that? This government cuts a further billion dollars from public hospitals. The logic is inescapable really. In fact the logic has escaped entirely from the government's approach to the delivery of health care services. If you want to reduce the load on the public hospital system you should invest money in those areas that will see fewer people presenting at our public hospitals. If you want more people to use private as opposed to public hospitals then you would perhaps look at the health insurance rebate. However, you would only do this in a situation where you could make sure that no other factors impacted on it. You would have achieved your goal if you did not then fill up the public hospitals with new patients. Where are these new patients coming from? They have come from all those medical practices and doctors' surgeries across Australia that have stopped bulk-billing or only bulk-bill a limited patient group.

So the health budget is being eaten away by the need to prop up the private health insurance rebate scheme. If this is not the worst case of taking public money and passing it directly to industry, I do not know what it is. All this money is going directly to the private health insurance industry and yet we are not solving any of the underlying problems in our health system. This would have to be industry welfare of the worst kind, and it is now paraded as reasonable health policy.

The Australian Labor Party have outlined a way of increasing the rate of bulk-billing within the budget's ability to pay, and by doing so we will relieve the pressures on our public hospital system and allow accident and emergency departments to deal with accident and emergency cases, not people that cannot access GP facilities. We believe that the best way to decrease the pressure on our public hospitals is not to fill up accident and emergency departments with patients who should be seeing their local GP—patients who have voted with their feet as a consequence of not being able to afford to pay for their visits to their local GP. Health should not be about how deep your pockets are but about need, and your ability to pay should not determine your level of need.

Nor should we accept the Commonwealth stripping the funding from public hospitals to fund the user-pays private health system. Government spending should be about reducing the load on public hospitals through increasing the rates of bulk-billing—and Labor has outlined a very clear way of achieving that. It should not be about the redistribution of taxpayers' moneys to prop up an industry that was failing to attract new members. It should not be about allowing those same funds to increase their premiums and therefore also increase the cost of the government's contribution as a consequence of their own actions. And then we get the complaints from the private health insurance companies because their members actually make claims.

What did the health funds expect was going to happen when they got a compliant government to force people into something they did not really want to join? Of course they were going to put in claims. Of course they would look at their private health insurance as a cost—but one the funds themselves marketed on the basis of being able to claim for health related items. So what did the members do? They put in lots of claims. Then the health funds, with this captive consumer base, had to put up their premiums because they were losing money. Should we actually be surprised? Of course not. When people are conscripted, when they are denied a choice, do not be surprised when they make sure they get everything they can out of it.

After all this, this government needs to strip $1 billion from our public hospitals. This government's health system is a cruel joke perpetrated on the Australian taxpayer. It has reduced universality to a concept of user pays. Unfortunately, the effect of this is that all Australians are paying, even if they are not in a private health scheme. They pay through the increasing cost of the rebate. They pay through the increasing strain on the public hospital system. They pay through their inability to find a doctor who bulk-bills. They pay and pay and pay and end up with poorer health outcomes.