Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Hansard source

I am pleased to be able to make a contribution to this debate, especially as I have just come from the launch of the 2015 AMA report card on Indigenous health. I want to commend the AMA for the excellent work that they have done and for the content of this document, which will have implications across portfolios and within government, and which is one which I think should be widely supported by the whole community. I will come to it in a moment, because it has particular relevance for some areas of this particular bill.

I remind us that this year is the 40th anniversary of the dismissal of a Prime Minister. Whilst the dismissal itself is something which has received a lot of media attention since that day, the 11th of the 11th, we are seeing a lack of appreciation, I think, of the important changes that were made to our social policy and health policy landscape as a result of the Whitlam government. Among them is our system of universal health care, which is clearly under attack—prior to this by the Abbott government and now by the Turnbull government—with cuts in hospital funding, cuts to Medicare Benefits Schedule items, and cuts to preventative health and public dental programs. There seems, sadly, to be a continuing but obvious plan under the current Prime Minister following on from Prime Minister Abbott to kill Medicare by 1,000 cuts.

The latest element of the anti-Medicare plan is the private health insurance survey—a so-called survey but a very poorly concealed push poll—is to undermine the community rating system of private health insurance, which prevents premium cost discrimination on the basis of age, gender or health status. This push poll's timing is interesting as it coincides with the attempt to push through today the changes to the Medicare safety net contained in this bill. Labor opposes this further attack on our system of universal health care. Broadly, the bill restricts the out-of-pocket costs that count to reaching the safety net. It then further caps what will be covered towards those costs. The bill, therefore, seeks to undermine the existing arrangements in which all out-of-pocket costs for out-of-hospital Medicare services count towards the threshold and once a patient reaches the Extended Medicare Safety Net, 80 per cent of their out-of-pocket costs are covered for out-of-hospital Medicare services, except if it is in an MBS item to which a cap applies.

The principle of Medicare—that every Australian should have access to the highest quality of care regardless of their capacity to pay—would be further diluted by this bill seeking to limit the amount patients receive back to a cap of 150 per cent of the MBS fee, less the standard MBS rebate. This bill would have damaging effects on the provision of care to several specific groups of people, whose health would be seriously diminished by the proposed changes. Importantly, these changes include this bill giving effect to the 'Budget 2014-15: Simplifying Medicare safety net arrangements' measures. This, as was a theme with that budget as well as this government's general approach to the health portfolio, represents a cut to the safety nets of $270 million. If you have a cut, someone is paying. We know who will be paying as a result of this exercise. The new so-called simplified safety net involves abolishing the existing original Medicare safety net and the extended Medicare safety net. Those changes mean that many patients will reach the safety net sooner but only in the context of a $270 million cut! So Labor has really, really serious concerns about the adverse impacts that these changes will have on patients across the country.

Although the bill lowers the safety net threshold for all patients, restrictions on the out-of-pocket costs that contribute to a patient reaching the safety net are introduced and the amount patients receive back once they reach the safety net is also reduced. We are concerned about the impact that these changes will have on radiation oncology patients, patients needing ongoing access to psychiatrists, and IVF patients. Specifically, I am concerned about my own electorate of Lingiari because of the changes and the impact that they will have on those low-socioeconomic disadvantaged patients and Aboriginal and Torres Strait Islander patients, particularly surrounding oncology and psychiatric services.

The latest data from the Australian Institute of Health and Welfare indicates that Australian patients continue to incur high out-of-pocket costs for their health care. In 2013-14, individuals spent an estimated $27.7 billion in out-of-pocket expenses on health goods and services. Out-of-pocket expenditure by individuals has grown at a faster rate than overall government expenditure on health. Over the decade, it grew by an average of 6.2 per cent a year in real terms compared with 5.3 per cent for all non-government sources. In the 2014-15 budget, the coalition announced that annual indexation of Medicare fees would be paused for two years, which was then extended to 2018. This pause in indexation has an effect on the incomes of medical practitioners who bulk-bill, as they accept the Medicare benefit as full payment for their services. If practice costs increase, fewer practitioners will opt to bulk-bill and many patients will face higher out of pocket expenses. That is just logical. The concern I have, in particular, is the impact it will have on Aboriginal community controlled health organisations around this country, because they will have to absorb these additional costs. Ultimately, these safety net arrangements will be manifold, and, ultimately, they will disadvantage the most disadvantaged. Health commentator Jennifer Doggett described the proposed lowering of the safety net thresholds as:

… woefully inadequate to support the increased numbers of people who will have difficulty meeting their healthcare expenses.

Anne-marie Boxall, writing for The Conversation, noted that while some patients will qualify for the safety net after spending less money:

… they will have to pay more of the high out of pocket costs than they do now.

These cuts will hurt people in my electorate, as they will hurt people across the country. They will most particularly hurt those who live in regional and remote Australia, because they are the sickest of Australians. I am surprised that our friends in the National Party have tolerated these changes, because of the impact they will have on their communities. On the introduction of the bill, the AMA President Brian Owler said that the AMA opposes the changes and that:

… the sickest and most disadvantaged Australians will be hit hardest …

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