Julie Collins (Franklin, Australian Labor Party, Shadow Minister for Regional Development and Local Government) Share this | Hansard source

As we have heard from so many speakers, on this side, particularly, the Health Insurance Amendment (Safety Net) Bill 2015 is really a bill that came out of the government's 2014-15 budget measures and is really about looking for savings. It is about how we can cut money out of the health system, rather than how we can improve health services for Australians and make some savings while we are at it. We do have some serious concerns, as people on this side have outlined, about the impact of these changes on thousands of patients.

The Medicare Safety Net and the Extended Medicare Safety Net are important parts of the health system in Australia, because they are for vulnerable people who have chronic illnesses, who are suddenly diagnosed with a particular illness, or who have some injury or accident and in that particular year their health costs blow-out and their out-of-pockets are really high. This is about ensuring that they can access health services and are not actually having to make the very difficult decision to say, 'I cannot have this health treatment because I cannot afford it.' That is what the safety nets are there for. That is why they were introduced. They are there to protect vulnerable people who have a particular illness, a chronic illness or an injury or who have had an accident in a particular year and may not be able to afford access to health services during that 12-month period that they reached their safety net or their extended safety net.

I know many constituents in my electorate to have met this Medicare Safety Net or the Extended Medicare Safety Net from time to time; I know other constituents in my electorate who regularly meet it every single year, because their out-of-pocket costs are very high indeed. Interestingly, the Senate did a committee report recently on out-of-pocket health costs in Australia. They are a really serious issue. The Australian Institute of Health and Welfare estimates that in Australia, in 2011-12, $24.3 billion was paid in out-of-pocket expenses by patients, by Australians. That is an average of $1,000 per capita in Australia. So every Australian at the moment, on average, is paying about $1,000 in out-of-pocket costs for health care at the present time.

The Medicare Safety Net, of course, is mostly for out-of-pocket hospital expenses that have an MBS item—going to visit your GP, your specialist or your consultant. What the government is trying to do with this bill is just make a saving, as I said earlier, but the consequences of this saving and the people that it will affect are those people that need the services the most. As we have heard, they are patients who have been diagnosed with a cancer or a malignant melanoma, they are radiotherapy patients who have been recently diagnosed with prostate cancer, and they are victims of sexual abuse. They are also people with serious mental illnesses who will no longer be able to have access to psychiatric services. And, as we have heard so eloquently from the member for Adelaide before me, they are IVF patients who will face much higher costs if these changes go through the parliament. At the moment, out-of-pocket expenses are around $4,000 a cycle of IVF. That could go up to $10,000 to $15,000 per cycle, depending on where they are and the types of fees charged by their consultants.

This legislation will impact on some very vulnerable people. As an example, for radiotherapy patients who have been diagnosed with some cancers: we are talking about additional out-of-pocket costs of $7,000 to $8,000 per patient. When you have just been diagnosed with a particular cancer and you are trying to seek radiotherapy, the last thing you want to think about is how you are going to pay for the radiotherapy that you need to extend your life or, hopefully, have your tumours shrink, have your tumours go away and be able to have a very full and fulfilling life. The $8,000 per patient for radiotherapy is a very significant amount of money.

As I said, the Medicare safety net was introduced to assist and support vulnerable people so that they could access health services without having to worry about how they are going to pay for them. The country that we live in, Australia, is about a fair go for everyone, and I am sure that nobody in this place really wants people to be making decisions about their health based on what they can afford to pay. It is not the Australian way and it is not what Australians genuinely would support in the community.

These measures, as I said, were part of the 2014-15 budget. That budget also tried to make other health savings. You need to look at the health system in totality when you talk about better access to health care, better services for Australians and making savings. As we have heard, the issue with this bill is that the government has been lazy about the way that it has gone about it. The government is just trying to make a saving without looking at the impact on the broader health system or at other ways in which the Medicare safety net could be adjusted to provide some of those savings.

Of course, it was in the 2014-15 budget that we saw the GP co-payment proposal come from the government. Not once, not twice but three times we heard from the government that the GP co-payment was going to be introduced. It was only through pressure from people on this side standing up—like we are standing up in this debate today—and saying, 'No, we are not going to support that', 'That is not okay', 'The Australian public will not agree to this,' and, 'The Australian public never voted for this,' that we actually managed to get the government to back down on the GP co-payment. The reason, of course, that we had problems with the GP co-payment was that it was again about restricting access to health services that people need. It was about vulnerable people who may be making decisions about accessing health services based on whether or not they can afford it. That is not the Australian way, as I said previously. It is not the Australian way to say to people, 'You can only access health services if you can afford to pay for them—if you are wealthy enough.' That is not the country in which we live in today, and it should not be the country that we live in into the future.

Of course, with the freeze on the Medicare rebate for seeing a GP, we still have a GP co-payment by stealth from the government. We still have GPs in Australia with notices in the GP clinics saying that they may have to increase their charges or charge a gap rather than bulk-bill patients. They are saying that, because, of course, the government has frozen the rebate for three years, even though we know that health costs will increase over that period. We have had the AMA and GPs all over Australia coming out and saying that this will have an impact on patients accessing health services. They are still telling stories, of course, of when the 2014-15 budget first came out and a whole heap of people cancelled their appointments at the GP because they thought that the GP co-payment was already in place. So we know that it will have an impact on people accessing critical health services that they may indeed need.

We also know that primary health care is one of the cheaper ends of the health system. We know that if people see appropriate primary health carers at the correct stages of their illness or disease that can actually stop the hospital admissions that may occur. We know that we may be able to save more money further down the track by having patients seen on time and by getting doctors to see their patients. What we do not want in this country is those patients saying, 'I'm not going to access the GP, I'm not going to go to my specialist and I'm not going to go and have this radiotherapy treatment, because I cannot afford the out-of-pocket costs,' and that is what some of the changes in this bill will do. Some of the changes in this bill will see out-of-pocket costs increase for patients right across the country, particularly in those areas of radiotherapy, psychiatric services and IVF.

Last time we were in government, we made some changes to the Medicare safety net. We did look at some of the excessive charging that we thought was happening with consultants, and we did look at some changes to the Medicare safety net and, indeed, the extended Medicare safety net. We made some decisions based on evidence. We had two reports to us before we made those decisions. We had two reports looking at the consequences of the decisions that we were making, and that is not the case with this bill. The government are merely saying, 'We want to make savings in health system, so we are going to just cut some things and put caps on them in the extended Medicare safety net, because we can and because we want to make savings in the health portfolio.' That is the only reason the government are proposing these savings. They are not doing it because they want to provide better health services for patients. They are not doing it because they think that there is some systematic issue in the health system. They have not provided any evidence to suggest that that is the case. Certainly, to date, I have not seen any evidence at all from the government about why they are going down this path.

We have not had the health minister explain properly to people why the government have made the decisions about these particular services that we are talking about and why they have made the to decisions to cap what gap payments can be. We have not heard anything from the minister other than, 'We have to make savings.' The minister has not gone out and done her homework about why the Medicare safety net and the Medicare safety net need adjusting. She has not done her homework in terms of access to health services. She has not done her homework in terms of the consequences to some of these patients who may need critical care—either for radiotherapy patients or IVF patients that want to have a family. She has not looked at what impact this will have on those patients and those services.

The IVF issue, as the member for Adelaide talked about, is a really critical one for those couples who need IVF support to have the family that they dream of and to have the family that, for many years, many of them have been trying to have. It is traumatic and very difficult for couples to go through IVF cycles. Imagine going through those cycles of treatment knowing that every time you do so your out-of-pocket costs could go up from the current $4,000 to $10,000 to $15,000. It is a very significant impost on those couples who are having to make those difficult decisions about their families and their future families. They are very difficult decisions indeed—as I said, they are already under a lot of strain and no doubt are already emotionally in a difficult place trying to make those decisions.

This bill has not been thought through properly. This bill should not be supported. It is one of those government changes in the 2014-15 budget that tried to make massive cuts to the health system in Australia without the consequences for patient care being thought through. The government did not think about the consequences and the effect of the decisions that they were making in terms of the greater Australian community. They were not thinking about those people who have chronic conditions, those people who are ill—the elderly, those people who have an accident or an injury who might need to access health services in a particular year with the extended safety net and the Medicare safety net. As I said, there were various proposals for GP co-payments and there is the current GP co-payment by stealth. All we have seen from this government is a whole heap of savings in health. We have not seen any suggestions about how they are going to improve access to health services in Australia; all they do is talk about sustainability and what they mean by 'sustainability' is cuts. That is all they mean—cuts, cuts, cuts and more cuts. They are not talking about improved health outcomes for Australians, they are not talking about better access to health care, they are not talking about people being able to access health services when they need them and access health services in a way that will stop them having to impose further costs on the health system. They are not looking at preventing hospital admissions or any preventative health measures that could be in place. All we have seen from them is cuts. They just want to continue to cut—they want more out-of-pocket expenses for patients, for Australians, particularly for those Australian who are already sick and vulnerable and who already require additional assistance from government in many cases through the safety net and the extended safety net.

There is no way that I and members on this side of the House can support the bill, although I understand we will be referring it to a Senate committee so that some of the people who will be adversely affected by the bill—some of the experts and clinicians, some of the consultants and specialists in these areas—can put evidence before the Senate and before the parliament in the hope that those on the other side might listen and might look at other ways of making savings in health that improve access to health services and make savings at the same time. They could do some work and get some evidence and that is why we are going to refer the bill to a Senate committee—to see if some of that work can be done by the Senate given that the government does not seem to want that evidence before the parliament before the bill is voted on. I am proud to support the amendment but not the bill.

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