Robert Oakeshott (Lyne, Independent) Share this | Hansard source

I also rise to speak on the Fairer Private Health Insurance Incentives Bill 2009 [No. 2] and associated bills, with the changes to the Income Tax Assessment Act, the Medicare Levy Act and bringing in the three private health incentive tiers to commence from 1 July 2010. Hopefully, as legislators and policy makers, we can get an outcome this time on this legislation package. I would hope that no-one in this place or in the other likes standing and talking and achieving nothing. We have seen various pieces of legislation come before this chamber and get bounced by the other chamber. I would hope we have more success this time around.

I was interested to listen to the previous speak and thought I heard a criticism of the market. In many of the conversations going on at the moment in this place I am left scratching my head when I hear a Liberal criticising the market that is being endorsed by a Labor government. I sometimes wonder where the consistency is in public policy. If the question is about the market and about the fairness of the market, and if this is the legislation in question, then I think we can have a debate, but if the implication is that the market based response from the coalition on the ETS, which was presented yesterday, is somehow a non-market response, then I think people are being a bit two-faced.

There is also the question that is raised in the heading of this legislation—and I raised this the first time around—of ‘fairness’. It is a growing pet hate of mine to see this pushing of a particular view in the titles of bills before this place. I think it is for the debate of the chamber and the view of the parliamentarians to decide what is fair and what is not. It is not for the proponents of particular legislation to almost push a view of fairness onto policy makers. Once again I raise that issue: it is through this process of discussion and debate that we will decide what is fair or not. When we see words included in legislative headings that push particular emotions it is, as I say, starting not only to get my back up but, I know, to get the backs of a few backbenchers and members of this chamber up as well. So I would hope a bit of a resistance movement to that can be formed over time.

Also, there is the question of universality in health. This is also a point raised previously. It still, within communities, sometimes comes up as a point of division and debate about whether in Australia today there is universal free health coverage for all. I would hope that argument is dead in this place. I would hope there is an acceptance of the symbiotic relationship between public health and private health. Each relies intimately on the other and each will fail without the other. It is a concern at times to still hear comments that government should provide free health care to all regardless of the circumstances. I still remember Graham Richardson, when he was health minister, making that point very clear: there is no such thing as free universal health care. The private system has been built very much to support and allow for public health care in Australia. But this idea of free universal coverage is one that seemed to enter the mythology of Australia incorrectly. So I would hope everyone in this chamber, regardless of what side of politics they are on, does accept and promote the importance of that symbiotic relationship between the public sector and the private sector in the delivery of health care in Australia.

Representing the mid-North Coast of New South Wales, I can assure this place that we are intimately aware of the importance of this symbiotic relationship. The Port Macquarie Base Hospital—I am sure it has been mentioned in this place many times over the last 15 to 20 years—was the test case in Australia for a privately run public hospital, with a contracted agreement between the New South Wales public sector and a private company going way back. It started out as Health Care of Australia, worked its way through to Mayne Nickless and in 2005 was returned to the public health network. We in our community are intimately aware, therefore, of the potential divisions that can be caused due to this concept of privatisation within the health sector and the divisions when the private and the public are played off against each other. On the flip side, we are intimately aware of the importance of both sides in this ongoing debate about health care between the public and the private sector. There are enormous benefits when the two of them work together well.

So I would hope that, when this public-private issue is referred to in the provision of insurance, there is this test of fairness. I can accept a means testing on the figures that are put before us, and I think it would meet a community standard of fairness if a rebate no longer applied to a family that is on an income of just under $250,000 a year. Representing a lower socioeconomic region, I am pretty confident we can pass the pub test on the mid-North Coast by saying that there should not be any government money going to a family that is earning nearly a quarter of a million dollars a year in income and that there should be some dip into their own pockets if they are earning over that. So I do think that passes the fairness test, even though I am critical of the word ‘fairness’ being used in the title of the bill. Likewise, from the income scales that have been presented—the three tiers—I am pretty confident that they can also pass that pub test and that community standard of what is fair in regard to whether government incentives should be given to people to take out private health coverage based on the certain income levels attached to the three tiers.

So it is a watching brief that I will be taking, making sure that government keeps those commitments. I hope the figure of 99.7 per cent still stands in regard to the impact of these changes and that only 0.3 per cent of people with private health coverage will leave because of this means testing. I think that is one that we will all be watching very closely, and quite rightly so. If the impacts are greater and therefore the impacts on public health delivery become greater then hopefully there will be a fair rattling of the tin by many of us to have this policy reconsidered and reviewed. Representing a high-growth region with a high elderly population, I think it is fair to say that the ‘house full’ sign is up on, certainly, four of the hospitals within my area, and any greater pressures that could come from legislative change such as this are certainly not welcome under current funding arrangements for regional hospitals such as mine. So I will be watching that issue closely to see whether there is transfer of anyone who may take great offence or see it as a huge burden that sees them drop out of private health insurance, and then I will be watching the direct impacts of that on public health delivery in a regional area such as mine.

The final point I want to make is that I expect there will be savings made from this, so there is the question of where that health dollar that is saved is going to go. It relates back to the point I was just making about current funding arrangements. They are a huge burden on high growth areas such as ours, where state governments such as New South Wales do not even follow their own funding formulas when it comes to the distribution of resources. On the North Coast of New South Wales, where we are now starting to drift up to a population in the North Coast Area Health Service of not much under a million people, we still remain below equity in the resource distribution formula—the government’s own formula—for how they split up the funding pie around the state. For the Commonwealth to blindly act without considering areas where there is high growth which remain underfunded, and therefore have extraordinary pressures on health delivery, would be folly. It would be folly for the Commonwealth not to consider that in their future allocations of funding, COAG agreements and future dealings with the states, because that is the critical issue for areas such as mine. Whilst we are under equity only by about two or three per cent, in dollar terms that equates to about $40 to $50 million a year. That money would make the delivery of health in our region substantially different. If any of the money potentially saved through this legislative package is going to go via this ugly path of going through the states to get on the ground then I would hope that a big stick is used to make sure the states deliver equity through their own funding formulas, which up until now they have been allowed to get away without. It is a blight on the delivery of fair, equitable and just health care within Australia. Populations move, and the funding formulas seem to lag a long way behind that movement of population. In an area such as mine, where there is high growth, we suffer because of that, and that will mean poor delivery of health care by government until it is addressed.

That would be the final question in allowing this legislation through this chamber from my point of view; I am not going to oppose it. I would want to know with any money that is attached to this that might be saved, or if we are going to start to see some reallocations of health dollars through this and other pieces of legislation, that finally we will get fair dinkum about funding in health in this country. That is going to take the big stick to the states that we have not seen before. In my short time here, I have seen a lot of kowtowing to the states: relying on the states to put up infrastructure priority lists which might be completely wacky. But that is what has been allowed to happen up until now, through programs such as the Health and Hospitals Fund. New South Wales quite publicly got slapped for putting up a wacky list. In the delivery of health in a region such as mine, that has implications, so I would hope that the Commonwealth will start to take more of a lead on this, will start to take ownership of the flow down of those public dollars and will start to take a real interest in the impacts on the ground, particularly in high growth areas. I was flattered and pleased that we had the Prime Minister visit four or five months ago and sit with doctors at the Port Macquarie hospital, the controversial one. He sat for over two hours with doctors and it was appreciated. I think we are now starting to get to the point of wanting to see the response from meetings such as those. With all the talk about health reform, the 2007 election commitments and where we are going with the health restructure, we are starting to come to the point where a few people have to come home with some commitments and plans, and we really need to start to engage communities who have acted in good faith in participating in this process.

My broader call to arms is for government to get the skates on in regard to health reform. This is one step, but there are people on the ground who are hurting. Port Macquarie Base Hospital, for example, is operating at twice its capacity. It is certainly the most efficient hospital in regional New South Wales, and I reckon it would give the metropolitans a good run as well. It is getting no benefit for being efficient. It is full, and at the moment none of that is recognised within the government’s own funding formulas. I am happy to let this legislation through, but it is the broader changes that we want to see. We want to see where the money is going to go and how serious the government is going to be about taking some ownership of that flow of money through to the delivery of health on the ground.

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