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Thursday, 11 March 2004
Page: 21406

Senator ALLISON (3:37 PM) —The Democrats will not support the Health Legislation Amendment (Medicare) Bill 2003 at the third reading largely because we think it could have been a lot better. A uniform and universal safety net was the bottom line for us. Without that, we do not think the bill stands up as being fair or universal. As we said earlier, our proposal was that the threshold should be $500 across the board. We have been given no reason why it should be $300 and $700. It sets up so many anomalies and means that so many people miss out on one category or the other that it is hardly worth discussing.

There are no incentives for bulk-billing, and that is a major weakness in the package before us. For all we know, we could be paying out $7.50 for every consultation that is being bulk-billed that goes no further than the current number in that category. There is no evidence that doctors in those country areas will bulk-bill more or will bulk-bill concession card holders and children. They are not even being asked to bulk-bill all of those patients. There is also unfairness for some electorates because RRMA has been chosen as a measure of need. There are probably as many anomalies as there are needy areas that are actually getting the extra rebate. A far better measure would have been to look at those areas where there is a low Medicare dollar flowing in and find alternative and flexible ways of dealing with that.

We are disappointed in the access to allied health and that it is tied up in red tape and with the GPs. It means that instead of having a very simple referral system from GPs to allied health professionals—and it would be very easy to contain that so that costs do not blow out—we have a complicated system doctors do not like. It is full of red tape and there is no guarantee that the amount of money being given to doctors will be passed on to those allied health professionals or that they are in any way seen as professional clinicians in their own right through this system. As I have said, doctors have already said they do not favour this, so it is doomed to not succeed in our view.

It could have been better. I say to the government that our package was a lot better. It did not cost any more. It had more logic associated with it. It was fairer. It was universal, as it were. At the end of the day, we wish there was no need for a safety net but, again, the government has not tackled the big question of specialists' out-of-pocket costs. This will continue to be a problem into the future, so we are looking at a short-term fix. Again I hesitate to use the word `fix', because I think it is only a patch-up rather than any sort of fix. It is a grab bag of quick trade-offs, and we seriously do not think it will work.

We are pleased that a review at least has been agreed to that allows us to look at the success or otherwise of this package and holds the government accountable to some extent to the public for its decision. We would hope that after the three years—maybe it will be necessary before; I do not know—a sensible approach can be taken to a proper overhaul of our health system and measures can be put in place to bring it back on track in terms of the schedule fee and the contract I spoke about earlier between the government and doctors that see much more adherence to it.

I will finish by saying that the Senate poverty report tabled today told us that there has been a massive increase in the working poor. These are people not on concession cards and who will miss out on the $300 threshold and have to pay $700 before getting assistance. We think they should be paying only $500 before they get assistance from the government. These are people who will obviously be worse off with this package.

It has been an interesting debate. We have taken this to committee. It is almost 12 months since it was first introduced as A Fairer Medicare. We have done this work thoroughly, and whatever improvements are in the bill are due to the Senate. I thank and congratulate everybody for their involvement in the changes that have been made. It is certainly a great improvement on the original package. We got rid of things like the private health insurance cover, although I need to be reassured that it will not sneak back in another form. It is a credit to the people who have worked on this issue over the last 12 months.