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Tuesday, 17 June 2003
Page: 11698

Senator HARRIS (6:12 PM) —I rise to contribute to the second reading debate on the Health Care (Appropriation) Amendment Bill 2003 and indicate to the chamber that it is One Nation's position that a government, once elected, ought to have a surety of supply. It is on that basis that One Nation will support the bill, but we will also point out some of the areas of concern that have been raised.

The government is removing money from health in one sector and transferring it into a different area. It is claimed that this appropriation will provide a 17 per cent increase in funding, but the states and territories have pointed out that it has been a decrease of $918.5 million. You do not have to be Einstein to work out where the money has gone when you see that the Fairer Medicare package is worth approximately $916.7 million. So why is the government cutting the health care budget and whittling away Medicare? These are two of the most common questions that are asked by constituents throughout Queensland.

The subversion of public health insurance and the deepening cuts into health care budgets are part of a global phenomenon, a worldwide trend towards privatisation of the health care sector. Canada, New Zealand, the US, the Netherlands, Papua New Guinea, Austria, Germany and Britain, to name a few, have slashed health funds in recent times and this government is slavish in following the trend. Multinationals are actively lobbying for the deregulation of public health care under GATS. They want to control health care, a very profitable and lucrative business. The institutions of the welfare state are to be scrapped. This is why health services are being starved of funds and this is why the coalition appears to be subverting Medicare.

The big stick is the World Trade Organisation's General Agreement on Trade in Services. This agreement is transforming services such as health care into tradable commodities. Service sector jobs including personal services like health care could be sent overseas and provided electronically, while service sector workers can be imported to provide care for less money with fewer labour protections. Once a country commits a sector to GATS, it cannot reverse or introduce new measures that would violate the agreement's far-reaching restrictions on government oversight and intervention.

The government declares that it has made no commitment to GATS in relation to health care, but the running down of our national health care system is merely setting it up to be privatised via GATS. That is typical of what a government does when it wants to sell an asset. It lets it wind down to the extent that it is not worth saving and it is handed to the private sector on a silver platter—and then come the increases to customers. Transforming health care into a tradable good requires transforming the way governments structure and regulate it. When Australia signed on to GATS, negotiated under Labor, we agreed to make it easier for foreign service corporations to compete in the domestic market. Also, subject to a wide array of laws and consumer and worker safeguards, we agreed to scrutiny by international tribunals whose proceedings are closed to the public. WTO members agree that government regulations in these areas must not interfere with the abilities of foreign corporations to compete, even if such regulations treat foreign and domestic hospitals, schools and utilities as the same. It will not be long before GATS negotiators consider a strict test for regulations that could put the burden on governments to prove that health care and other regulations are necessary.

The WTO has already identified key health regulations as inherent barriers to international trade. For health care professionals, these regulations ensure quality and professionalism and more equitable access to services. To corporations and their champions in the WTO they are obstacles to trade and they must be weakened. Under GATS, rules on domestic regulation and licensing requirements can interfere with foreign workers and provide for competition in the service sector. To health care professionals and customers, the quality control and oversight provided by professional licensing of doctors, nurses, paraprofessionals and health care facilities is a key consumer protection. In order to achieve the trade goals of importing foreign workers and providers—we have seen an example of that recently with Telstra importing foreign workers under GATS natural persons provisions—the WTO has called for recognition of foreign licensing requirements as equivalent to one's own, even if the foreign requirements are substantively weaker.

Consider this in the context of the nursing shortage here in Australia. Provider associations will be agitated to import workers from overseas so that they can pay less. To the extent that licensing requirements interfere with the flow of labour, industries will be pushing hard for Australia to recognise foreign standards that may be lower. If GATS is revised so as to require domestic regulations to be less burdensome to trade and even pro-competitive, principles which underlie health care being accessible to all could be restricted. Cross-subsidising—through which one service effectively subsidises another—is such a principle. There would be no place for uncompensating health care, unprofitable admissions to hospitals, research, education or public health activities—all chronic losers from a business point of view.

What we are seeing here in Australia is the development of a two-tier system which is aligned with GATS. The for-profit sector will cream off healthy and wealthy patients, public subsidies and staff, leaving the reduced public sector to deal with emergencies, to train staff and to cope with the elderly and the chronically sick and poor—the ones who need health care more. It is not just at the hospital level but also at the general practice level. There will be one tier for people who hold Commonwealth concession cards and one for those who do not. This creates the likelihood of a two-level general practitioner system: one for those GPs who, through their practice demographics, either are forced to or can afford to opt into bulk-billing for cardholders and another for a group of general practitioners whose practice, population or business practices limit their ability to maintain a viable business by opting in. The policies of the current federal government are driving us towards a more privatised health system, leaving the public system as a very poor cousin.

The government is shifting costs and responsibilities to the private sector. The issue of cost shifting between federal and state governments remains unresolved. In Queensland, the outpatient and paediatrics clinics at the Maryborough Hospital have been shut down. Closing down these clinics means that new and follow-up patients have to be seen in specialists' private rooms or by staff specialists in private practice clinics. This is privatisation by stealth. Regarding pharmaceuticals, the Queensland government has encouraged hospitals to move patients out as day patients. When the patient returns to access the hospital, the cost of pharmaceuticals is shifted to the federal government. This is one reason why there are now such short stays in hospitals. Patients should not become yoyos as a result of the fiscal policies of federal and state governments.

The government may be funnelling money out of this appropriation and into A Fairer Medicare, but the doctors, surprisingly—and it is surprising to me—do not like it. I have contacted more than 2,000 doctors in Queensland alone, and the responses that I have received so far indicate that they are totally against the Fairer Medicare package, with the exception of doctors in remote rural areas, for whom it would be an advantage. The government's package would see the need to seek doctors from overseas who would be willing to practise for a pittance. Again, this is GATS in action.

As I commented earlier, as we privatise our hospitals we create a situation where corporations are forced to move or they choose to move into only the areas of higher profitability. We then end up with a situation where private hospitals provide extensively in those areas where there are considerable margins and the public sector are left to provide for those that are less profitable. As I said earlier, on a profit and loss basis, hospital admissions, research that does not result in a positive outcome and the education of our doctors and nurses are all areas of chronic loss from a business point of view. The government's attempt to shift costs to the private sector is not being done in an equitable manner. Only the highly profitable areas are being shifted across and our public hospitals are being left disproportionately worse off.

For ordinary people, this budget continues the relentless process of gutting public health in order to transfer vast resources to private health companies. One Nation believes that we must retain publicly funded health and publicly provided health care services. We must modernise and improve them on the principles of democratic accountability, effective delivery, adequate funding, fairness at work and equality of access. There can be no other alternative but to reject the WTO's prescription for privatisation—reject it outright. The message has been carried very clearly in the responses of my constituents that to save the public health system we must pressure our representatives to withdraw Australia from the WTO without delay and cancel our membership. It can be done. All it takes is an act of parliament. As I said earlier, One Nation will support the bill, but only because One Nation and the people of Queensland believe that, once a government is elected, that government should be assured of supply.