Rowan Ramsey (Grey, Liberal Party) Share this | Hansard source

When the member for Lingiari rose to his feet, he stated that Medicare was under attack. It is not under attack, Member for Lingiari. The coalition is a great supporter of Medicare. It is under great stress. Medicare will collapse under its own weight unless governments do something to alter the market signals to try to rein in the exponential growth in the Medicare benefits scheme.

In relation to the Health Insurance Amendment (Safety Net) Bill, it is no secret that the incoming coalition government faced incredible difficulties that were largely left to us by the previous government. There were a lot of unfunded government policies needing urgent attention. We faced unprecedented debt and unfunded promises far into the future, courtesy of the Rudd-Gillard years. Tough times call for tough decisions—tough decisions but fair decisions. Fairness is what must be offered up by governments caring for Australia—not that you would know that, of course, from the Labor Party's position.

I am amazed that, along with the many other sensible reforms they oppose, they oppose these reforms. In fact, the Labor Party are all care and responsibility. Labor have blocked the accumulated savings measures that they had suggested in government and not legislated; they block the savings that this government would support. Then there are the new expenditure items which Labor back. In total, the three lines of Labor Party decisions come to $59 billion between 2015-16 and 2018-19. It is not as if they have not had a go at savings. They have been brave enough to put forward a whole $5 billion worth. That leaves a gap of $54 billion. You would think that the Labor Party would support this legislation. You would think that one day they might hope to return to government and not want to have a sea of debt and deficits as far as the eye can see. You would think that, if they were not prepared to support these measures, they would support different efficiencies, but in fact it is a policy-free zone on that side of the chamber at this stage. Many oppositions in the past, and perhaps more in recent years, have elected to become a small target coming into an election. At the moment, I think you could say the Labor Party is trying to disappear up its own target.

I note a recent press release from the Minister for Health, who is in the chamber. Recently Medicare claims topped one million a day—not $1 million, but one million claims. There are only 23 million people in Australia, but there are one million claims a day. That has increased by 56 per cent over the last 10 years. Medicare is costing the taxpayer $20 billion per annum. Even more scarily, it is estimated that in 10 years time, in 2025, Medicare will cost the nation $39 billion per annum. Basically, that is a 100 per cent increase over the next 10 years. The population of Australia is growing, but it is not growing that fast. Incomes are rising—though not very much the moment—but they are certainly not going to rise by 100 per cent over the next 10 years. We also know, because the Intergenerational report tells us so, that today, when we have about five taxpayers funding each person who is a recipient of welfare, by 2050 that figure will be down to just over two. These are long-term issues that governments have to grapple with. In fact, there are more than 5,700 items on the Medicare list now, which is an increase of 50 per cent over the last 10 years.

Australia should be alarmed, because this type of growth is unsustainable. It is not the only line of government expenditure in this area of generalised welfare that is projected to rise substantially. The National Disability Insurance Scheme, which is not really costing the nation a lot at the moment because it is in the start-up phase, is estimated cost $32 billion per annum by 2025-26. Child care is expected to cost $20 billion per annum and aged care $32 billion per annum. One wonders where governments—whoever they might be, whichever side of politics they might come from—will find the necessary resources to keep those very fine and admirable arms of government funded. What we really need is a steady, methodical approach to addressing the long-term funding and technical challenges of health.

Health costs are going to keep rising; we will live longer and require more care; and new technologies will keep us alive longer to require medical assistance on another day. Health will continue to make greater and greater demands on the budget, and that is why we need careful adaption and reform. This reform is not just about savings, even though, it must be said, it does deliver some to the government. More importantly, it is about resetting the incentives in the medical system and, to be very blunt about it, to stop medical practitioners deliberately pushing customers beyond thresholds. I know we all have very high opinions of our local doctors, but probably on average they are not much better than any other breed of person and to think that people are not manipulating the system to best suit them is pushing the bounds of credibility. We need an incentive system that affects not only the consumers but the providers as well.

At the end of the day, there is no such thing as free cover. It may seem free to the individual, but somebody is certainly paying for it. Currently there is a complex web of safety nets—the extended Medicare safety net, the original Medicare safety net and the greatest permissible gap. How is anyone supposed to understand all that? No wonder my constituents and sometimes my family and other friends throw their hands in the air and say, 'How on earth is anyone supposed to understand all this?' Unfortunately, some people understand it only too well and they know how to make the system do the very best for them in a personal sense.

Currently there are no incentives at all. Some reach the current threshold in the first month—in virtually no time at all, once the new year begins. Once they have met the threshold under the current arrangements, they pay nothing towards their Medicare health requirements at all. So there is no signal; it is in their interests and in the interests of their health providers to reach the threshold as soon as possible. Really, that is about as dumb a case of economics as anyone could design. It is a system of all care and no responsibility.

The government has developed a new safety net, one which will advantage more people but one which requires some contribution, so there is a price signal so that people understand the service does not simply fall out of the sky—that people actually have to pay for it. Increasingly we will have to ration services and to find ways to bring the exponential growth of services under control. The government has had two independent reviews; it has met widely with stakeholders and the public; and it has the broad support of industry. But still the Labor Party avoids any responsibility. This legislation will of course pass the House of Representatives, but I am very hopeful that others in the Senate will see the value in this legislation—whether it be the crossbenchers or the Greens—and step up to the plate and recognise that Australia has long-term responsibilities in this area. In other words, we must design a Medicare system that is here for the long term and we must manage the exponential growth. If you applied any of the figures of growth onto a graph, eventually they would reach the point where it goes pop—there is nothing left—and the whole program stops. If there is no more money to provide for the program or there is no more money left for growth, what do we do? Do we stop anybody else going on to Medicare? Do we start rationing services? What do we do? We cannot allow the system to get to that point. It is not possible to continue to raise the extra amounts of money in the economy when these services are growing so much faster than the population or the economy.

The new threshold for people without concession cards will reduce from $2000 to $700 for singles and to $1000 for families. That means that families will be able to receive support for extra out-of-pocket expenses at a lower threshold. That is a good thing for families, and it is a good thing for everybody. If you start to incur higher expenses, the Commonwealth will be by your side faster. Concession card holders thresholds will go down from $638 to $400, and so more will qualify for safety net protection—in fact 53,000 more Australians will qualify, especially concession card holders. These are well-rounded reforms—a considered response. It is about trying to ensure the stability and the longevity of Medicare and to ensure government has the ability to meet all its other commitments—in the NDIS, in aged care, in child care. It is just so important that we get these fundamentals right.

This single little reform of Medicare is no silver bullet; it is just part of a raft of ongoing reforms that need to be done. I know the minister currently has people studying the Medicare listings to identify the ones being overused. I had a doctor come to me the other day quite indignant about the overuse of arthroscopies and a whole range of medical tests. She said to me, 'This is just simply not required medicine. It is not best practice.' While we hesitate to hurl stones or point fingers, it means that the people who are with responsibility are not doing the right thing and it is the government's responsibility to make sure that they do. The safety nets are only one little part of the Medicare system, but they are a sign that we need to provide some kind of market signal to those in the system. Certainly the proposal for co-payments that came in the first Abbott government budget was shouted down by the population at large. That has gone; it is off the agenda. If that plan is finished, we have to find other gentle and fair ways to care for Australians to ensure they have the medical services they need—not just today, but in 10 or 20 years' time. We have to ensure too that the Medicare system is still strong and performing well for Australia at that time.

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