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Monday, 15 June 2009
Page: 5873

Mr NEUMANN (1:42 PM) —I rise to speak in support of the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009. First, I want to congratulate the member for Cook and his wife on the birth of their second child. I have two daughters myself. Fortunately, we did not have any difficulties with my wife, Carolyn, falling pregnant. My daughters are now 18 and 19. They are the love of our lives and we rejoice in their development spiritually, educationally, socially and intellectually. It is wonderful to have children. They are a great blessing and heritage. Those of us of the Christian faith accept that scriptural injunction.

In relation to this bill, I say to the member for Cook that the trouble is that there is a great deal of inconsistency between what the coalition are saying and what they did in practice when they were in power. The truth is that in my area alone they effectively defunded health and hospital services. That is the reality. We have one GP for every 1,609 people in my area, the Ipswich and West Moreton area in South-East Queensland. Even the former Minister for Health and Ageing, the member for Warringah, admitted before the last election in October 2007 that the Australian Institute of Health and Welfare had got it absolutely correct in saying that the previous coalition government, under John Howard, had actually defunded health and hospitals in this country and that the states had had to take up the slack. The much-maligned state Labor governments had to take up the slack because the previous coalition government failed to fund health and hospital services. They capped the number of doctors in this country.

Labor has increased the number of training places for doctors. We have put $1.1 billion into that to increase the number of training places and to encourage more people to go into medicine and the allied health professions. We want to encourage nurses to go back into the system—into health and aged-care services. We want to try to get them working in regional and remote areas. One of the first things that the Rudd government did was to put in more money for elective surgery. About $1.6 billion was put in, in accordance with agreements with the states. The member for Dickson said that there was little or no money put into health by the Rudd government under our Nation Building and Jobs Plan. I looked around on budget night and saw him in the chamber when the Treasurer was talking about what the Rudd Labor government were doing to fund our health and hospital system. The Treasurer said:

… Australians deserve a world-class health and hospital system.

That is what we are providing. We are spending a lot of money not only locally in my electorate but also nationally. What we are doing under the legislation that is before the House today is in accordance with the report that was delivered on this matter. What gets me is that those on that side of the House think they have a monopoly on family values, on compassion, on heart and on care. But they do not. This legislation that is before the chamber is not about us being against women and men who struggle to have a child. It is not about that at all. I congratulate the member for Cook for having two children and contributing. From what he had to say, you could tell the love, the affirmation, the care, the wonder of birth and how fantastic it is that he and his wife have had children. We are not about punishing people in these circumstances. In fact, the inconsistency here is that in 1996, 1997, 1998, 1999, 2000, 2001, 2003 and up to 2004 those opposite actually agreed with the idea of having caps on Medicare. Do not come into this place and say that by putting caps on funding we are heartless, cruel, mean and nasty. It is simply not true. Through most of the time of the Howard coalition government it supported the idea of having caps. Before the introduction of the safety net in 2004 there was a limit on the amount of government contribution for Medicare services—that is, the Medicare schedule fee—but I did not hear the member for Dickson or the member for Cook say that. That was the policy of the Howard coalition government. That is what it took for most of its tenure in office.

The truth is that we are doing what we need to do to save $450 million to better fund our health system, our hospital system, our roads, our schools and other sorts of things. That is what we are doing. We are not about punishing people who cannot have children. It is simply untrue for the member for Cook to come in here and say and imply that. What we are doing here is in response to a report that we had commissioned. Under the Health Legislation Amendment (Medicare) Act 2004 the Minister for Health and Ageing tabled a report entitled the Extended Medicare safety net review report 2009 and it looked at the effectiveness, the operation and the implications of the safety net with respect to a variety of different things. The report was carried out by the Centre for Health Economics Research and Evaluation at the University of Technology in Sydney. That report said a number of things, and I think that the report’s existence and its recommendations seem to have washed over the opposition entirely.

The report was very clear. What we are trying to do here is stop doctors charging excessive amounts by effectively taking advantage of the safety net. That is what the doctors are doing. We want to make sure the safety net is sustainable. The report recommended and noted a number of things which are very important to note. The report noted that the safety net had helped patients that had very high costs and reduced the out-of-pocket expenses for some patients with cancer. Nonetheless, the review showed that there were some real concerns in obstetrics and assisted reproductive technologies, including IVF and other Medicare services. The report noted that 50 per cent of safety net benefits were paid to obstetrics and assisted reproductive technologies, and the Medicare benefits had more than doubled for both of those groups since the safety net had been introduced.

The reported noted that between 2003 and 2008—and the Minister for Health and Ageing has reported this in her speech—the fees charged for obstetricians for in-house hospital services went down by six per cent. However, the fees for those obstetricians outside of hospital, in private practice, and who charge people like the member for Cook and his wife, had increased by 267 per cent. How can it be possible to justify increases of that nature? Similarly, the fees charged for assisted reproductive technology services fell by nine per cent for in-house hospital services while the fees charged for out-of-hospital services increased by 62 per cent. It is very clear that some doctors were taking advantage of the safety net. It is crystal clear. The figures say very clearly that it is the case.

What are we going to do about it? Are we going to have a sustainable safety net? The unlimited nature of the benefits available through the safety net has led some doctors to take advantage. The truth is they knew that the majority of their expenses were being paid for by the taxpayers. That is what it was all about. Lest anyone says that somehow we are opposed to the safety net and that somehow we are making massive changes that will adversely affect Australians, I just point out that the government is supportive of the safety net. The truth is that the safety net operates in this way. Once an annual threshold has been met, Medicare pays 80 per cent of any future out-of-pocket expenses for all out-of-hospital services for the remainder of that calendar year. In 2009, the annual threshold for concession card holders and people who receive family tax benefit part A is $555.70. For singles and families the threshold is $1,111.60. That is indexed every year. The bill before the House allows the minister for health to determine by legislative instrument the maximum increase in benefit payable under the safety net for specified items. These are items that are specified in the Medicare Benefit Schedule. If it is not specified it does not apply. The total out-of-pocket costs incurred by a person for services will still count towards the safety net threshold amount. Once a person has reached that threshold, they will continue to be eligible to receive the benefits, equal to 80 per cent of their out-of-pocket expenses, for those items that are not specified by legislative instrument.

That is what is happening. We are actually putting a cap on certain things. We are doing it to maintain the integrity and sustainability of the system. In 2008, expenditure on the safety net was $414 million, 30 per cent more than in 2007. Why is that? The truth is that doctors are charging too much. That is the reality. And, if we do not do something, it is going to get out of control in such a way that the whole future operational sustainability of the safety net will be adversely affected. The government is not means-testing access to the safety net; the government is maintaining the safety net. The truth is that we are trying to get the health costs charged by doctors back under control.

We are doing a lot of things when it comes to health and hospital services. In my electorate, we are bringing in a GP superclinic. We have announced that, and negotiations on that are currently underway. We are trying our best to ensure that we get more doctors in the local area. Before I was elected to this place, I was on a health community council for a long time, and we struggled to get more local doctors to the area—and Ipswich is a fast-growing area. It is growing at about four per cent per annum. It is the fastest-growing area in Queensland at the moment. We need more and more doctors and so we are seeing a lot more overseas-trained doctors in the local area. But we need to get more local doctors. We need to train more doctors and we need to spend more money locally. So the $450 million we are saving here will go a long way towards helping my community and helping the communities in the 150 electorates represented in this place.

Unlike what the member for Dickson said, the Rudd government is working with the states to improve the health and hospital system in this country. Through COAG we are putting $64 billion over five years into the public hospital system in this country. That is an increase of $20 billion, nearly 50 per cent, over the previous Australian healthcare agreement and it is an indictment of the previous government for letting the health and hospital system run down. That is the reality of health and hospital systems in this country under the Howard coalition government. We are also improving participation in the health workforce as well as increasing access to health care.

One of the things that I think the government has done very well is the change we are making in relation to maternity services. The 2009-10 budget included a great provision which was warmly welcomed in my electorate, and that is funding of $120.5 million for maternity services. It is a reform package that will allow women greater choice. One of the most precious things a woman can experience in life is, of course, the birth of her child. My wife tells me that she will never forget the birth of our child, and I will never forget holding my eldest daughter in my arms. It is a wonderful experience. We are not about to punish women and families in this regard by this legislation. We are giving women the option of a home birth or having their child in a hospital. That is their choice. We need to increase freedom of choice for women when it comes to the birth of their children. It is a precious and wonderful experience.

So the Rudd government, through our last budget, are improving the options and opportunities for women. In this country we have a strong record in providing high-quality maternity services, and I know the women in my electorate, including those in the maternity coalition groups I have met who have been arguing for such a long time that we need to improve maternity services and improve the options for women, warmly welcome this funding. Cas McCullough, who is very well known locally and a very well known advocate for home births, has been arguing for this for a long time. I warmly welcome this funding. I support the legislation that is before the House and, once again, I congratulate the member for Cook and his wife on the birth of their second child.