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Transcript of doorstop: Parliament House: 11 March 2004: Medicare Minus deal in the Senate.

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Julia Gillard, MP Shadow Minister for Health



Subjects: Medicare Minus deal in the Senate

Gillard: There are 20 million Australians who rely on Medicare, and Medicare today according to its architect, Professor Deeble, is dead.

And what Australians have got in exchange is the following: 150,000 Australians who are chronically ill will get limited access to allied health. There has been reporting today about otherwise fit 60-year-olds getting access to physiotherapy. That reporting is completely wrong. 150,000 chronically ill Australians will get some access to allied health and no one else will.

23,000 Australians will get some access to dental care. They need to be chronically ill, have significant dental problems and those dental problems need to be contributing to their illness. And 440,000 Australians will qualify for the sham safety net. That's the limit of the benefits in the package. 150,000 getting access to allied health, 23,000 to dental care, and some 440,000 Australians will qualify for a benefit under the sham safety net.

For everyone else, the vast majority of Australians, what this package means is the death of bulk billing. No one apart from concession card holders and children will be bulk billed in this country in the long term. Secondly, it will lead to price inflation in doctors' and specialist fees because of the existence of the safety net.

I note today there's been some reporting about what costs can be counted for the safety net. That has included pharmaceutical costs. That's complete nonsense. Pharmaceutical costs do not count towards the sham safety net calculation. And there's been some reporting that allied health costs will go towards the sham safety net calculation. That is not true either.

So for an incredibly limited package of measures, what we're going to see today is the death of the universal health system, Medicare, as we know it.

And on another topic, I note today that there is reporting from the United States, the United States Trade Representative, Mr Zoellick, has been before a Senate Committee in the United States and indicated that the US FTA with Australia will increase drug prices in Australia because Australians will be required to pay their fair share of research and development costs. Australians can today can now pick who they think is telling the truth. Bob Zoellick or John Howard.

Question: Does this Medicare package trump Labor's though, given that we're talking - the Labor package is $1.9 million [sic] - we're talking $2.85 billion for the Liberal package?

Gillard: Well of course the Liberal package has brought together a number of health measures. Labor's $1.9 billion package was dedicated towards increasing bulk billing for all Australians. Nothing in any of this expenditure is about increasing bulk billing for all Australians. It's only Labor's package that will get bulk billing rates back up to 80%. And I note today that the Minister for Health, Tony Abbott, has effectively conceded that this package will make no difference to bulk billing rates and of course we know he's intending to cover up the figures because that is true. If he actually had any faith in this package, then he would be releasing the bulk billing figures month by month by electorate between now and the next election so Australians could judge the effect of his package because he knows it's a dud and it will not increase bulk billing rates in Australia. He's going to cover that information up.

Question: Julia, you say that this package isn't going to help many patients, but the Government is spending $2.85 billion. Where's all the money going?

Gillard: Well exactly, $2.85 billion cannot help [laughs], not help many people. It's a good trick when you think about it. Obviously what Tony Abbott has done is he's comprehended in that calculation a range of other measures, practice nurses which Labor supported, MBS rebating for practice nurses which Labor supported, his workforce measures to get overseas doctors to fill the training gaps that the Howard Government has created. All of that's gone into the calculation of the costs of this package.

In terms of the measures though, the actual health measures, how they are going to affect Australians who are looking to see a doctor, what we know is in this package is a limited set of benefits, 150,000 chronically ill getting access to allied health, 23,000 getting access to the dental plan and the vast majority of Australians worse off because they won't be getting access to bulk billing. They'll never get anywhere near the sham safety

net arrangement. They won't qualify for the allied health care and they won't qualify for the dental plan.

Question: …inflationary pressures and doctors taking, specialists taking advantage of the safety net. Are you saying that they'll exploit it, that essentially they're going to rip us off in that regard?

Gillard: Look the evidence from all around the world is doctors and specialists believe that there is some safety net program on which people can rely, then that is a factor in their thinking about the setting of price. That doesn't - isn't meant as a criticism of doctors or specialists. Doctors or specialists set fees because they want to earn an income. Most Australians want to earn an income and there's nothing wrong with that. But the evidence from all around the world is the very existence of these sorts of safety net shams feeds into a doctor's calculation about price. Now I know the AMA takes exception to…

Question: …based on you, in them, if you're saying they're going to abuse the system.

Gillard: I'm not saying abuse the system. I'm saying there is nothing wrong…

Question: …artificially inflate their prices.

Gillard: No, a doctor when taking into account what price he or she is going to set is likely to take into account the existence of this sham safety net. That is not a criticism of the doctor. They will take that into account because it's one of the government's…

Question: If they were ethical, they wouldn't take it into account. They'd just charge the fee that was appropriate for the service.

Gillard: Well the question of what's the fee appropriate for the service. Obviously doctors should charge the fee appropriate for the service. But doctors are setting fees in a system largely controlled by the Federal Government. This is where Tony Abbott constantly gets it wrong. He pretends that the Federal Government's got no role in doctor fee setting or access to medicine. The Federal Government has a role. You can run the system so doctors have got the right incentives to bulk bill. That's what Labor did and that's what Labor will again do and get national bulk billing rates back up to 80%. Or you can run the system to send a price signal to doctors that putting your fees up is okay,

and that's what Tony Abbott's sham safety net is, that kind of price signal.

Question: But four Independent Senators obviously thought it was a good enough deal. How do you convince the public that Labor's not just being obstructionist?

Gillard: Well what will happen next week, the week after, the month after and every day up until the next election is Australians will try and find a GP to see them and they won't be able to. Australians will look for a bulk billing GP and they won't be able to find one because bulk billing rates will get worse. Australians will go to emergency departments and wait in huge queues because people who couldn't find GP care are there looking for medical help. And Australians in this country will see their public hospitals under pressure because frail aged people are in acute hospital beds because the Howard Government hasn't fixed the aged care prices,

and because the Howard Government ripped a billion dollars out of the public hospital system. Not one dollar of this package is going to fix any of those problems.

Question: But the AMA say it's okay. The Australian Consumers' Association say it's okay. The four Independents say it's okay. You and the Greens are the only ones that say it's not okay.

Gillard: That's completely untrue. The architect of Medicare, Professor Deeble, has today said that this package ends the universal Medicare system he built in this country. Bill Glasson and Mukesh Haikerwal, the representatives of the AMA yesterday criticised aspects of the package and Mukesh Haikerwal today criticised the differential rebates and said that that…

Question: …interview he said he was overall, he was happy with the product.

Gillard: Well it's not true to say that the AMA has endorsed all of this package. They have significant criticisms. They think the allied health stuff is very unlikely to work because it's built on the foundation stone of the enhanced primary care system.

Question: [Indistinct]

Gillard: …well this is a package, the comprehensive range of measures, each measure when you look at it is flawed. The package is therefore flawed. What is the packaged designed to do? It's designed to destroy the universal health care system in this country. That's not my judgement call. That's the judgement call of the man who designed it in the first place, Professor Deeble. We only have Medicare in this country because Professor Deeble and Labor built it. The man who was there designing it on day one has said that universal Medicare in this country is dying today. Today he has pronounced it officially dead. Now I think, when you look at the track record of Professor Deeble having built Medicare in this country, compared with Tony Abbott, then one would have to say Professor Deeble is going to be right and Tony Abbott's going to be wrong.

Question: For a bloke who had a dud package, he looked quite happy yesterday. He appears to believe he's neutralised health in an election year and you're in trouble.

Gillard: Tony Abbott I think was relieved to get a package through. That wasn't about health care in this country. That was about him thinking that he could deliver a political fix. Tony Abbott was put in as Minister for Health, not because he's worried about health care in this country, not because he's said his target is improving health care in this country, he was put in for one purpose and that was to put a political fix on the perceived problem that the Coalition had with health.

He was happy yesterday because he thought he'd delivered that political fix and then obviously in the Coalition leadership troubles, he wanted to at least be seen equal to Brendan Nelson. And so in a personal career sense, he was happy about that.

But the reality of this package is health care in this country as Australians live and breathe it, as they experience it every day, will be made worse by this package. Less access to bulk billing for those who aren't concession card holders or children; increased medical fees; and no access at all to any of the measures that were announced yesterday.

Question: Seeing there is going to be a safety net now, what level do you think it should be set at if not [indistinct]?

Gillard: We're opposed to this sham safety net arrangement. You best protect people from high health care costs by investing in the core of Medicare and that's what should have been done. Thank you.

For further information contact: Julia Gillard MP on 0417 361 637 Jamie Snashall on 0407 438 746