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Thursday, 21 June 2018
Page: 3600


Senator LINES (Western AustraliaDeputy President and Chair of Committees) (13:41): It is sad to say that I am old enough to remember life before Medicare and life after Medicare. I might talk a little bit about that later on. I'm a passionate advocate of Medicare, having experienced both systems. Labor will support the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018. As Senator O'Neill outlined, we're more than willing to support bills which look to improve and streamline how Medicare functions and, indeed, to ensure that money expended is returned to Medicare, although we haven't got that commitment. We know that the savings at this point are not going back directly to Medicare, which is really where they should go, because the savings are being derived from new measures.

The Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018 will amend the Health Insurance Act 1973, the Dental Benefits Act 2008 and the National Health Act 1953 to implement parts of a 2017 budget measure on Medicare compliance. I was a bit surprised and shocked to read that, currently, we are recovering only about 40 per cent of the Medicare debts, which means that there's about $50 million of outstanding debt. If this measure sharpens up that statistic, it will be a very good measure. Hopefully, this bill will improve the recovery arrangements.

It will also clarify the Professional Services Review—the PSR, as it's commonly known—which investigates Medicare and PBS compliance concerns. It will have jurisdiction over corporate medical practices that contract health providers as well as over practices that employ providers and over providers themselves. I think that's particularly important in an ever-changing medical model where we are seeing big corporate practices across the country. It is really important that we have legislation in place which is wide enough and has enough scope that we can make sure that, however our health system adapts in the future, we'll have a good model there when providers are not doing the right thing. It is absolutely critical, given that health is a significant part of our budget spend, to make sure that we are in a position to be able to recover moneys that are owed to the Commonwealth.

I think it's important, too, that the bill will introduce compulsory offsetting and garnishee provisions for providers who do not voluntarily agree to repayment plans in 90 days. It's very easy, I think, for people to avoid, to put off and to make promises that they'll get to repaying a debt in a certain time frame yet fail to do that, so the chasing of that debt continues. This move is to make sure that we have an enforceable repayment plan in 90 days. I hope we don't have to use that. I hope that most in the health sector in Australia will come to the table and pay the debts that may be owed, but, at the hopefully rare times that that doesn't occur, we've now got a real tool there to ensure that those moneys are recovered. That, too, is a good thing.

Again, the bill is looking at record-keeping requirements that are consistent, because it is very hard in a compliance regime to go after outstanding moneys if they're able to be hidden or highlighted in a particular way that doesn't quite make sense. Consistent record keeping will give a much sharper focus to that ability to quickly see what's going on and to get into a recovery payment plan with health professionals if it's needed. We're roping in additional allied health professionals, who will be required to keep referrals for two years.

Australia does have a universal health system, and whatever we can do to protect that universal health system is obviously going to be supported by Labor. We introduced Medicare, and despite the opposition of the Liberals particularly, who fought it off twice, it has survived. I'm not sure that the government really does believe that it should be a universal scheme, but for us, for Labor, it's an essential part of who we are to provide that universal health scheme.

It was Mr Fraser who messed around with Medicare. At the time that he did that, I was a much younger person and just starting out having a family. My first child, my daughter, was born outside of the Medicare system. We'd had it for a short time, and then it was cancelled. At the time I was not in paid employment. My partner at the time was a very low-income earner but just a few dollars above what would have given us access to a health card. So, when I had my daughter, all of the associated medical costs—like most young kids, she had all sorts of illnesses and conditions and so on, so we had to see a number of specialists—had to be paid for out of our own pockets. As I say, we were low-income earners—I think we were $2 or $3 above the cut-off for getting a concession card. Quite frankly, if it hadn't been for my grandmother and my mother-in-law, who from time to time gave us the cash to pay those bills, we would not have survived. I don't know what we would have done. Certainly, when my children were sick, the first place that I went to was the accident and emergency at the fabulous Armadale-Kelmscott Memorial Public Hospital, because, quite frankly, I couldn't afford other services. There weren't that many after-hours GPs available when my daughter was young, but I certainly couldn't afford the fees that they charged. So on weekends and late at night, when children tend to get sick, you would find me, more often than not, sitting in A&E waiting to get health care for my children, because that was the only option available to me. Now, I knew that I was churning up the valuable time of those in the accident and emergency department but, quite frankly, I didn't have any other options. I didn't have hundreds of dollars to pay out to GPs and specialists. My only option—and I'm sure the only option of many other people—was to sit in emergency.

A couple of years later my son was born. We had Medicare again. It was back, obviously because there was a Labor government in power. And what a difference it made to have that weight of bearing the health costs of my children lifted off my shoulders by Medicare. That was something I still remember, and my children are well and truly adults now. But I remember that burden—the difference between my daughter's birth and her early years and my son's birth and his early years. All of us in this place who are parents or grandparents know that when children are young they often get sick—they get viruses—and you're worried about their development, so there are lots of visits to health professionals. So my own personal experience has well and truly made me a passionate advocate of Medicare.

As I said, we can't trust Liberal governments with our health system. Certainly Mr Abbott and Mr Turnbull have demonstrated that by the actions they've taken in reducing funding to various parts of Medicare, the attack on women's health care in particular, and just their general view that it shouldn't be a universal healthcare system. I can't quite remember when it was, whether Mr Abbott or Mr Turnbull was the Prime Minister of the day, but do you remember that we had that very serious proposition whereby the government was looking at how we had a view—not a scientific view, but a view—that GPs were being overused, that we were just being pests and going off to GP clinics way too many times? They didn't have any real scientific evidence of that, and perhaps the rise in chronic disease in Australia is the reason people make more visits—if indeed they do—to GPs.

For quite some time there was serious contemplation of restricting GP visits. If you went over a certain number of GP visits, you'd be paying much more. What an outrageous position: for a government to stand in the middle of the relationship between a GP and a patient. But that's exactly what the government was seeking to do. It was saying, 'We're going to fund X number of GP visits for you each year, and if you exceed that limit we're going to charge you for it.' Now, obviously they met a lot of resistance. We were very strong on that and really fought against it. The AMA saw it as an attack on their professionalism. Eventually that proposition was dropped. Maybe privately it's still being entertained, but it's not something the government is publicly talking about any longer. But that proposition was floated not that long ago—that you would have a certain amount of GP visits and then your quota was up. Imagine having a quota system for visits to a doctor. Imagine that. Imagine if you were the young mother that I was, with two children getting sick, and you overtook your limit. Where would you go? You'd go back to A&E, because you wouldn't have had the money to pay for additional visits.

The other thing we've seen the Prime Minister do—and this is really very poor—is use Medicare as a bargaining chip. We saw recently, in relation to One Nation's support for the corporate tax cuts—and we don't really know where they are on that at the moment, because it's created a split in their party; they've gone from three senators to two, at today's count—that One Nation had managed to negotiate getting an MRI licence in Kalgoorlie. For those of you who are not Western Australians, Kalgoorlie is a regional town towards the east. Regional towns in Western Australia are not massive, but by Western Australian standards Kalgoorlie is a major regional town, and of course it has all the Centrecare and other sorts of offices that you would normally expect in a large regional town. It is 600 kilometres away from Perth CBD, yet it didn't have an MRI. So what do we see? We see Mr Turnbull willing to do a deal with One Nation to provide an MRI licence in Kalgoorlie if they signed on the bottom line for the corporate tax cuts. Isn't it a disgrace that we have a government that is willing to trade away the provision of a fundamental health service? Labor has made that commitment with no strings attached. We didn't do any dirty deals with any crossbenchers. We have said, as a party who's committed to Medicare, that we will make available that MRI licence.

We've seen during the life of the Turnbull government that only four MRI licences have been granted in the last five years. By contrast, under the Labor government, there were 238 licences granted, and they're an important tool in today's diagnosis. If you go to your GP with, say, a hip problem or something like that, you get referred to a specialist. Even today, specialists will insist upon an MRI scan, because it has become a tool. Of course, it gives the specialist a much clearer picture of what's actually going on. So they're not just the fancy, if you like, of surgeons who want all the bells and whistles; they've become a fundamental tool of good health practice. Yet we've seen the Turnbull government, in its negotiation with Pauline Hanson's One Nation party, well and truly ready to trade on that. What a disgrace!

These compliance measures are really important across the nation because we see, unfortunately, that in Australia there's an increase in chronic diseases, some of which are preventable if we were able to get to people when they're children or young adolescents to talk about good health, good eating, good exercise and so on. Some of these chronic diseases are absolutely preventable, so that's also where we should be focusing energy. With greater chronic diseases and an ageing population, it is more important than ever that we make sure that our health system is streamlined, that we are recovering debt and that we're making it easy for practitioners and providers to comply with regulation, because, at the end of the day, doctors are there to provide a health service and, if we can make the reporting procedures more streamlined, that in turn that will deliver better health.

I want to make sure that we get this bill done and that we can start, particularly, to recover the moneys that are there. But we'll watch it very closely because, as we say, we don't believe that the Turnbull government can be trusted with our health system. We don't believe that the Turnbull government really believes in a universal health system, which is part of Labor's DNA. It is absolutely a fundamental core value of ours. Senator O'Neill spoke about an American type of system. Certainly when I visited the US before I became a senator, I saw low-income earners having to fund their own breast cancer treatment or go on waiting lists for benevolent services that would accommodate them and look after them—shocking. I was truly shocked to see and talk to women who worked in jobs where there wasn't a healthcare system and had to fund breast cancer treatment. Believe me, there's no way that we would want that sort of system as any part of the Australian health system. Our universal health system's something we need to be proud of.

Debate interrupted.