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Shadow Minister discusses Medicare; bulk billing; ALP leadership.

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Stephen Smith MP Member for Perth Shadow Minister for Health and Ageing


Subjects: Medicare, Bulk Billing, Leadership

JOURNALIST: As leadership tensions continue to simmer within the ALP, the future of Medicare has become the chief issue on which Mr Crean’s future is likely to be decided. So a lot rides on the man behind Labor’s plan to revitalise Medicare. Stephen Smith is the Shadow Minister for Health and Ageing. He’s in Adelaide today pitching that plan. Good afternoon to you.

SMITH: Good afternoon, Kevin.

JOURNALIST: What is the essential difference between your position on Medicare and the Government’s?

SMITH: Well, our position on Medicare is that we believe that Medicare is absolutely essential to the welfare of Australian families and that bulk billing is an essential part of that. We want to resuscitate bulk billing, restore it to respectable levels for all Australians, for all Australian families.

On the other hand John Howard wants to effectively restrict bulk billing to pensioners and concession card holders. What that means for a family on an income of $32300 or more is that they can effectively forget about bulk billing. Forget about their Medicare Card, they’ll need a credit card.

JOURNALIST: Why should Medicare be available to all?

SMITH: Because it’s absolutely essential, when you look at the foundations or the fundamentals of our health care system, that health care applies universally. Now that’s a nice word but what it means is that all Australians, irrespective of where they live and irrespective of what their incomes are, have access to quality health care. And you make sure that people make their contribution to funding that through a progressive taxation system - the more money you earn, the more money you pay through your taxes and the Medicare levy.

What you don’t want is families making judgements about whether they should take their sick kids to a doctor on the basis of how much money they’ve got in their pocket. You want decisions made on the basis of health and not wealth. The great danger of going down John Howard’s road is that you end up with a two-tier system. A long term second-class safety net for

poor people and for other Australian families - as John Howard put it in 1987 when he was Opposition Leader then - doctors free to charge everyone else what they like.

So you will have a second-class safety net and everyone else will pay more and more, bit by bit, every time they go to the doctor. Families under financial pressure will start making judgements about the health of their kids on the basis on how much money they’ve got in their pockets - not a worry about whether there’s a clinical need for them to see a doctor.

JOURNALIST: A lot of people say its impossible for the budget to fund universal health care in the face of rising health costs.

SMITH: Well in our view, it can. The Budget Papers last week revealed a Commonwealth health budget of $32 billion dollars. The Government’s so-called programme - what it describes as a “Fairer Medicare” but which is actually an unfair Medicare - provides $917 million over four years. The

Budget Papers also reveal that it takes away $918 million from the State public hospital systems as well, that’s how they essentially fund the programme…

JOURNALIST: We hear a lot in South Australia about the cost blowouts in health care, how difficult it is to maintain funding for hospitals. But you say we need to be able to maintain universal health care for bulk billing by GPs?

SMITH: And maintaining universal health care, maintaining access to bulk billing for Australian families will in the long run help contain and constrain that budget. The point I was making earlier: the Commonwealth health budget is $32 billion, the package that we’ve announced in Simon Crean’s Budget Reply is $2 million over four years. In terms of remuneration that goes to doctors to encourage them to bulk bill, it is about $1.5 billion over four years and that contrasts with John Howard’s figure of about $350 million over four years. So in terms of the overall health budget, they are modest amounts.

But how does making sure people have access to GPs, how does that help contain and constrain costs? GPs historically in Australian society have been that point where mums and dads get primary and preventative health care. In other words you go and see your GP, you nip problems in the bud. If we have people deciding not to go to a GP because they don’t have money in their pocket it might take two weeks, it might take two months, it might take two years but sooner or later they’ll end up in the emergency department of a public hospital at a far greater personal cost to themselves and a far greater cost to the state and the Commonwealth taxpayer because a much greater medical intervention is required.

JOURNALIST: Will this be a difficult policy to sell in the election… [inaudible]?

SMITH: No I think this pervades all. You remember when John Howard got himself elected in 1996 he said “For all of us”. That was his slogan. People now know that under him Medicare will just be for some of us. They don’t actually trust John Howard on Medicare and bulk billing. They remember John Howard in the 1980s saying that he wanted to destroy it, he wanted to gut it, he wanted to take the knife to it.

They’ve always known that John Howard in 1996 basically said he’d drop off the GST and that Medicare and bulk billing would stay to get himself elected. Now Howard sees the opportunity of going back to the policy position he’s always had, which is restricting and corralling bulk billing and Medicare to pensioners and concession card holders and everyone else pays their way.

The Australian public will understand this only too well. There is no greater issue for them than the health of their kids. And they know if they’ve got to start worrying about how much money they’ve got in their pockets to look after their kids’ health and welfare then that focuses their minds very much indeed.

JOURNALIST: It’s not just a matter of paying for the doctor, they also have to consider whether they can afford the drugs that the doctor prescribes.

SMITH: Well again we have John Howard and Peter Costello out there wanting to increase the cost of essential medicines by nearly 30%. Now we stared that down in the Senate and we will stare it down again, because again you don’t want people making judgements about whether or not they’ll take their scripts to the chemist because they don’t have money in their pockets.

I obtained through Senate Estimates last year the Health Department’s own calculations, its own estimates, that if the 30% increase went through, that over a four year period a half a million Australians in families wouldn’t take out

scripts and five million pensioners wouldn’t take out their scripts. And it’s the same story, if they don’t take the medicines which their doctors prescribe for them, sooner or later they’ll end up in a public hospital again at far greater expense.

The more we can get people the primary and preventative health care that a GP and a pharmacist can offer, the more chance you’ve got of keeping them out of the hospital system which means you’ve got a better chance of containing and constraining health care costs generally.

JOURNALIST: Well a lot of people are suggesting that the position of Simon Crean depends on Medicare. Are you surprised though at the leadership tension?

SMITH: Well, I’ve made a bit of an art form in recent days and weeks of frankly not talking about that subject for all the obvious reasons. I think that the most important thing that I can do for the Labor Party and the most important thing I can do for Simon Crean is to be out there, day in and day out, drawing attention to the problems and now more importantly drawing attention to Labor’s solution.

JOURNALIST: Do you think Kim Beazley should also be doing that?

SMITH: Well I think we all should. I think we all should. There’s no point trying to pretend there’s not an issue between Simon and Kim, and there’s no point in trying to pretend the Labor Party federally is not going through tough times. We’ve got to work our way through that. From my perspective, the most important thing that I can do to make a contribution to getting through the tough times is to draw attention to what John Howard wants to do to destroy Medicare effectively and bulk billing for Australian families.

JOURNALIST: [inaudible]

SMITH: Well I had a doorstop with David Cox after we’d been out to visit doctors in the suburb at Morphett Vale. I got that question on a number of occasions. I simply said that I’ve made extensive comments about the leadership and opinion polls previously and I find there’s not much point in adding to them, because if you add to it all it does is to encourage it.

I think the most important thing I can do is to say we’ve got a $1.9 billion package out there to rescue Medicare and to restore bulk billing to respectable levels. That’s a very important commitment that we’ve made to Australian families under financial pressure and something that I think they will pay very careful attention to because it’s about the welfare of their kids.

JOURNALIST: Stephen Smith, thanks for coming in.

SMITH: Thanks Kevin.


Contact : Andrew Dempster - 0407 435 157 or 02 6277 4108