Nick Champion (Wakefield, Australian Labor Party) Share this | Hansard source

I suppose it is a sad indictment on this government that they have taken what is a bipartisan issue—medical research, something that enjoyed broad support in the community; how could it not, given all the important things that are done by our research community and the outstanding breakthroughs that they make and the hard work that they do, that we all benefit from?—but have presented a bill to the House which, sadly, after their 2014 budget, turns this issue somewhat into a partisan one. The first way they did that, as the member for Throsby said, was by robbing Peter to pay Paul. That is, they are cutting from sick people today to fund research into the future. And we know how they were cutting, because this fund was originally linked to the first iteration of the GP tax, which was a $7 co-payment, not just when you visited the doctor but when you got a blood test, when you got a scan or when you returned to the doctor. And, as I have said to the House many times before, the people who were most at risk of that $7 GP tax were people with asthma, diabetes or some other chronic health condition. I have had asthma, so I know just how desperate a problem that can be. But if you do not go to see your GP you will only make that chronic condition worse. So, we saw the $7 co-payment morph into four different variations of that, until we got to the current iteration of that co-payment. And now, as described in the Sydney Morning Herald, on page 13:

'Co-payment by stealth' could push up costs of GP trips, says Owler

That article outlines Professor Brian Owler talking about how the cuts to Medicare rebates to doctors were going to implement a co-payment by stealth.

We know what the original co-payment would have done. It would have stopped a million visits to the doctor in its first year of operation and half a million visits the year after. In Senate estimates this week it was revealed that no modelling had been done on a cut of Medicare rebates to GPs, no modelling had been done about the effect that would have on people going to the doctor. That can have very serious consequences for health care in our community—in particular, for people with chronic conditions—and it will only cost the community more, in higher hospital costs, because if you are asthmatic and you do not see your GP enough you will end up in an emergency department. That is the worst-case scenario. And if you are diabetic and you do not see the GP enough, and even if you do not see a podiatrist enough, you can end up with very serious health implications, including amputation of limbs.

We know that primary care, which of course begins with our relationship with our general practitioner, is essential to a well-run health system. So, we know that many of the savings that are going into this fund are funded in a regressive way in terms of our health care—regressive for the consumers and regressive for the system in that we will see higher impacts on hospital costs later on. The problem with this is that they are not just cutting from the primary end. We had $57 billion worth of cuts to our health and education systems in the last budget. We had an additional $2 billion taken out of health in this budget, including from things like the Child Dental Benefits Schedule and from preventive health, including drug and alcohol counselling—which is odd for a government that is running ads about the ice epidemic and has backbenchers going out into the community holding forums about the ice epidemic. It is odd to then cut drug and alcohol counselling and drug and alcohol services in the community. We know these cuts are going on, and we know their impact will be felt today, tomorrow, next month and next year, compounding cuts as the capacity of health services in the community to respond to these very serious challenges is reduced. Once those networks and workers and community services disperse, it is very hard and very costly to put them back together. So, these cuts are a particularly stupid way of going about things.

We all support medical research. As the member for Throsby said, we put over $3 billion into it, and we largely operated within the framework of the NHMRC, which governments previously have done. I cannot remember it being an issue of controversy in my entire time in this parliament. I am sure that the Howard government, for all its sins, was entirely uncontroversial in this area as well. It was broadly an area of bipartisanship. Yet here we have no attempt to reach across the aisle and, importantly, no attempt to consult with the medical research community. And the announcement of this fund and of the way they were funding it came out of the blue. So I think there is an issue of consultation and productivity in the setting up of this fund. It was supposed to be set up by 1 January this year, and now we have backbenchers earnestly asking us about it, hoping it will begin by 1 August, hoping that this bill will pass the House. Yet in last year's budget this bill was meant to be in operation. The legislation was meant to be passed, and this fund was meant to be in operation by 1 January this year. So, there is an issue of productivity and the intentions of this government in putting together this fund. Even if you push aside the manner of funding it—the cuts, the GP tax—and say, 'We're setting up this fund,' there is the issue of the consultation they had before the time with members of the council and with other medical research organisations. As well as the issue of consultation, there is the productivity of actually getting the fund set up. That is a very important issue for us to consider.

The second issue that we have really got to think about is the issue of accounting: why have they set up this fund in the way they have? Ross Gittins has pointed out that one of the aspects of this fund is that it is a saving to the budget bottom line. This is what he is quoted as saying:

The saving to the budget bottom line is immediate, though the change means the saving will be reduced by a fraction by the increased spending on research. Like many budget fiddles, this one relies on exploiting loopholes in the definition of the bottom line, the 'underlying cash deficit'.

One of the attractions of this fund that the government does not talk about is that it improves their budget bottom line. It takes a whole lot of money out of health and puts it in a locked box—which is of benefit to the budget but, at least initially, it is not of great benefit to researchers. One of the savings of this fund comes from taking a billion dollars out of the health and hospitals fund and rolling it into this medical research fund. That health and hospitals fund was set up to fund health and hospitals, not research, and we have got the rolling of a billion dollars into that fund.

Another concern we have with this bill revolves around accountability and oversight. It is an important consideration because we know that there is anxiety in the community and, I think, in the medical research community about the architecture and infrastructure around medical research. Professor Warwick Anderson, a former CEO of the National Health and Medical Research Council, said on 15 April of this year about the fund:

I think the researchers out there and in the audience today have to keep an eye on this so the public benefit from this big investment, and the public will benefit best if the public disbursement is peer reviewed.

That is a very, very important consideration. We know that we have had this infrastructure, the NHMRC, disbursing some $700 million in grants every year. They have six principal committees: a health and ethics committee; a research committee; an embryo research licensing committee; a human genetics advisory committee; a health care committee; and a prevention and community health committee. We know they have already got an infrastructure set up to disburse funds which is trusted by this House, trusted by governments and, most importantly, trusted by the community. That is important because we do not want this fund of $20 billion left to the vagaries of a minister, a backbench or political concerns. We might not get the nightmare scenario the member for Throsby spoke of, but we might just have the normal operation of politics being applied: lobby groups, interest groups and the media. Sometimes this is a good thing for the House. Sometimes it focus our minds on areas of public concern. But sometimes that means where you get the best return for your money might not be where the public concern is or it might not be in the area of most pressing need. Public perceptions are often different from the real, or evidence based, priorities, so we have to be very, very careful about that. One of the things about having this infrastructure, the National Health and Medical Research Council, is that it applies peer review, science and rigour to the way we consider these things. And it is trusted.

These are the reasons for our amendments and the cause of our concerns. As I said before, we do not support the way this government has gone about funding this fund—with a GP tax of $7 every time you go to a GP, every time you go for a scan, every time you go for a blood test. That still remains their intention, make no mistake about it; they just could not get it through the other place. So what the government have resorted to is a brutal cut to the Medicare rebates for GPs—and we will see the consequences of that—even though they have not had the courage to model that.

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