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Tuesday, 28 May 2002
Page: 2501


Dr EMERSON (8:20 PM) — The Taxation Laws Amendment (Medicare Levy and Medicare Levy Surcharge) Bill 2002 lifts the low income thresholds for the Medicare levy and in so doing is a progressive move, one of the rather few progressive moves that this government has initiated in its term of office starting back in 1996. It should not come as a surprise, because it is doing what a Labor government would do— that is, making sure that low income families do not pay the Medicare levy. For those very basic and fair reasons, Labor supports the legislation.

Equally, Labor supports the second reading amendment to this legislation, because we remain very concerned about the direction of the government's health policy under the stewardship of the Prime Minister of Australia. When the Prime Minister was elected to that position in 1996, the Australian people knew very well what they were getting. He had been a man in public life already for a long time and, in lieu of any sort of vision for the country's future, he had a very simple agenda of three or four items. One of those items was changes to the industrial relations system, essentially to tilt the bargaining table in favour of employers at the expense of employees. Certainly under the current Minister for Employment and Workplace Relations the zeal with which the government pursues the Prime Minister's long cherished aims is undiminished. In fact, I think it is fair to say that even more zealotry is being displayed day by day under the current minister.

So that has been a fundamental item on the Prime Minister's agenda for many years. Another, of course, was the implementation of the goods and services tax, which he first flirted with as Treasurer of this country as early as 1980—more than 20 years ago. We know that in the year 2000—20 years later— the Prime Minister achieved his cherished goal there and implemented the goods and services tax. I will say a little more about the implications of the financial arrangements flowing out of the GST for health in a moment.

A third and critical item on the Prime Minister's narrow agenda has been the dismantling of Medicare. You do not need to rely on my assertions to form a judgment that what I am saying is true; you need to rely purely on the words of the Prime Minister himself when he was opposition leader. In the lead-up to the 1987 election in an interview with Alan Jones—the same Alan Jones who is still on radio in Sydney—on 27 May 1987, the then opposition leader and present Prime Minister said:

What I'm going to do is take a scalpel, without punning too much, to Medicare. I'm going to say to people if you want to get out of Medicare and make your own private health insurance arrangements you can do so. They will be given an incentive to do it. They will not have to pay the levy. I'll get rid of bulk billing completely for people other than pensioners. I'll free up the whole private health insurance market so that health funds can in competition with each other offer a variety of packages to help consumers.

That was the Prime Minister's agenda then, 13 years ago. Just a few days later, on 1 June 1987, he told the John Laws program:

There will be many major reductions in health, the Medicare system is a total disaster, we will be proposing changes to Medicare that amount to its de facto dismantling. We will pull it right apart.

That is what the Prime Minister has been on about all these years. But the Australian people delivered an adverse verdict on that agenda in 1987 and the Hawke government was returned with an increased majority. The opposition went underground with its desire to pull Medicare right apart, to take a scalpel to Medicare, and it decided that the smartest thing to do was to do it by stealth, because Medicare was, and is, very popular with the Australian people.

They appointed an unfortunate man, as it turned out, as their health spokesman—Peter Shack. Peter Shack was an aspiring politician. He had made it to the opposition frontbench. He was a relatively young man and was given the job of coming up with an alternative health policy. Three years later, after the now Prime Minister had been saying that they would pull Medicare right apart, that they would make money out of the process and that they would make no-one worse off, he gave these as terms of reference to poor Mr Shack and, of course, they were impossible to achieve. Mr Shack did not know that and the pin was pulled on him just before the 1990 election. I would like to remind members of the parliament, many of whom were not around at that stage—I was a staffer—of a famous press conference where the coalition sent him out to explain how after three years there was no health policy. He had these remarkable statements to make:

Now I want to say to you, with all the frankness that I can muster, the Liberal and National Parties do not have a particularly good track record in health and you don't need me to remind you of our last period in government.

That last period in government was when they tried to gut Medicare, in the form of Medibank at that stage. He then went to say at the same famous press conference:

We went through Medibank Marks 1 to 4, or 4½; or 5, when we were last in government. Since we have been in opposition we have had four health spokespersons and we have produced four health policies—two of which were never made public. I think the last one in the 1987 election probably lost us votes instead of winning us votes.

That was the current Prime Minister's health policy in the 1987 election, and Mr Shack was right: it did cost votes. The hapless Mr Shack conceded at this great press conference, in this great moment of candour:

You might accuse us of a lot of things but one of the things I don't think we're guilty of is learning from our past mistakes.

Never a truer word was said. That was in 1987. In 1990 the Prime Minister was still at it, but he knew that the way to do it, because Medicare was so popular, was to dismantle Medicare by stealth—and that is the agenda. The parliamentary secretary at the table tonight used to work for the—


Fran Bailey —The member for McEwen.


Dr EMERSON —The member for McEwen, indeed. I am happy to acknowledge her as the member for McEwen. She was a staffer for the recently departed health minister.


Fran Bailey —For a very short period of time.


Dr EMERSON —For a short period of time, she reminds me, and I am sure that she would not disown him! But the health minister at that time, I assert, did have some commitment to Medicare. I think the health minister, though a member of the coalition and a Liberal, did have some commitment to Medicare. If he had had no commitment to it, I think the Prime Minister's agenda of dismantling Medicare by stealth would have happened faster. I cannot pass a judgment in these early days on the new health minister, but I hope that she does stand up to the Prime Minister because he certainly will be continuing with zeal his ongoing effort to dismantle Medicare by stealth.

That is why we moved the second reading amendment, which notes that `the government's overall approach to Medicare has seen the regrettable position where general practitioner bulk-billing usage has declined to only 74 per cent'. That is the lowest level in a decade. Let us recall what the Prime Minister said in relation to bulk-billing:

I'll get rid of bulk billing completely for people other than pensioners.

That is what he said in 1987 when he was telling the truth to the Australian people and that adverse judgment was delivered, but he is still committed to getting rid of bulk-billing. As a result of that, we have this appalling situation where bulk-billing has fallen to 74½ per cent.

The second reading amendment goes on to note that `the average extra cost to a patient for a non-bulk-billing GP visit is now $12'. This is making it harder for patients who go to doctors who do not bulk-bill, because the average payment is a very significant sum— again, part of the ongoing agenda to dismantle Medicare by stealth.

The second reading amendment also notes that `those who can afford private health insurance have been subject recently to substantial increases in premiums, on average $150 extra per year'. In the government's official projections before the last election, the projections for increases in the cost of private health insurance were much lower than what has actually happened—yet another example of the government saying one thing before the election and doing another thing after the election, saying and doing anything that it deems necessary to save its political bacon.

We then move on to the next part of the second reading amendment, which notes that `pensioners and concession cardholders and those families under financial pressures will suffer further as a result of the government's latest budget measures'—that is, those measures in respect of the Pharmaceutical Benefits Scheme. We have just heard from the previous speaker a very Orwellian observation that, although the changes in the PBS are going to yield hundreds of millions of dollars, they are really not going to hurt anyone. If you listen to his speech, he says, `No-one's really affected; we're just going to collect hundreds of millions of dollars.' It would be lovely if you could collect hundreds of millions of dollars from the community without them being affected, but of course we know that they will be adversely affected.

We do not have to think back very far to remember the government's proud boast that health would be GST free. The argument at that time was whether there would or would not be a 10 per cent GST on health. The government said, `Of course we wouldn't do that; that would be a terrible thing to do.' That was before the election. After the election, changes to the PBS—if they pass the Senate—would increase pharmaceutical costs by up to 30 per cent: three times the 10 per cent GST. So the government had one position before the election and another position after the election. It is all right if you tell people before the election what you are going to do. But of course the government never told the Australian community that they were going to impose such large increases in the costs of pharmaceuticals for so many Australians. In fact, when the previous health minister was interviewed in the media before the election, he said that the Pharmaceutical Benefits Scheme was sustainable, that there would therefore not be any necessity for these dramatic changes, for these increases in cost to people who use pharmaceuticals. But of course once we get past the election the story changes: say one thing before the election and another thing after the election. Labor will use all our power in this place and, more importantly, in the Senate to do everything we can to protect Medicare, to protect universal health insurance, to ensure that the Prime Minister does not achieve his objective of dismantling Medicare by stealth, because that is what he wants to do.

I was very encouraged that the Courier-Mail is onto the government. The heading of the Courier-Mail editorial on Saturday, 25 May is `States face attack on GST funds'. It points to the Intergenerational Report, which was used to justify these increases in the cost of pharmaceuticals. The article says, in part:

However, it is likely the forecasts will be used by the Federal Government to push the states to take up more of the anticipated burden of providing services for an increasingly ageing population.

That has always been on the cards. We indicated well before the last election, when the GST was coming in, that there would be a fundamental realignment of the financial arrangements between the Commonwealth and the states, and so there was. The Commonwealth introduced the GST and, on the same day, they abolished all of the untied grants. You do not hear the present government talking about the fact that they abolished $17,000 million worth of untied grants to the states, but they did. Not only that; they are now attacking the tied grants to the states—again, something that we said would happen. The government put their hand on their heart and said, `No, that will not happen because we have signed an agreement with the states,' pretty much the same sort of agreement that the Treasurer signed with the then shadow Treasurer about fixing up the tax system by cracking down on tax avoidance. He said, `Yes, we'll do that,' and later laughed, virtually saying, `Why would you believe anything that I've put in writing?' Of course, the government did not do that; they reneged on those promises and they are reneging on the commitments that were made with the states to protect the specific purpose payments to the states, the tied grants to the states, just as we said they would.

At the last meeting with the premiers, there were a number of aspects in which the government had already reneged. I can confidently predict that it will do the same thing with health payments. The specific purpose payments for health to the states add up to $8,000 million. The government's agenda will be either to cut those in absolute terms or to allow them to erode with inflation over time. The Courier-Mail is right. We were right in the statements that we made in the parliament. In fact, in an article that I had published in Labor Essays I predicted that this would happen, that the specific purpose payments would be attacked by the Howard government after the election; it would allow them to erode over time and it would break its agreement with the states. That is precisely what is happening.

The total consequence of all this is that the Prime Minister is pressing ahead with his agenda to dismantle Medicare by stealth. It is a shameful agenda. He has never believed in Medicare, he has never believed in universal health insurance in this country; he has believed in people looking after themselves. Wealthy people will be able to, but if lower income people cannot look after themselves he believes that that is a bit of social Darwinism that they will have to come to terms with. I proudly stand here in the parliament tonight supporting wholeheartedly the second reading amendment to this legislation and condemning the Prime Minister for his ongoing efforts to dismantle Medicare by stealth.