Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I rise to join my colleague the shadow Treasurer in speaking on the Medicare Guarantee Bill 2017 and the Medicare Guarantee (Consequential Amendments) Bill 2017. This is, quite frankly, an insult to the Australian people. It is an insult because the government, at the same time as we debate these bills, continues to inflict savage cuts which make it harder for Australians to access the health care they need. Only this government would have the audacity to introduce a so-called Medicare guarantee while continuing to rip billions of dollars out of Medicare services.

Let us be clear about what is in front of us. This is a transparent attempt to pretend to care about Medicare, without actually addressing the damage that the government's policies have done and will continue to do to our healthcare system. In fact, only a government that cannot trust itself with Medicare, that knows it has a political problem with Medicare, would seek to introduce this sort of bill. Guaranteeing Medicare would have meant dropping the freeze on the Medicare Benefits Schedule immediately and entirely in the last budget. Guaranteeing Medicare would have meant properly investing in our public hospitals. This government has done neither.

Instead, they have introduced this bill in a farcical attempt to distract from the damage they have done to Medicare. The Medicare Guarantee Fund is not a guarantee. There is nothing in this bill to stop the government from making further cuts to Medicare or to the PBS. In fact, it looks like the government, in its attempt, has been constantly saying Medicare is not sustainable. They have created this bill, this fund, to show and shine transparency on Medicare, and this is their next step in continuing the campaign against Medicare by saying Medicare is not sustainable.

While this bill creates two special accounts used to channel funding through to Medicare benefits and the PBS, this is essentially what actually happens now under the special appropriations in the Health Insurance Act 1973 and the National Health Act 1953. For the purposes of budget mechanics there is absolutely no difference with this current scheme. Stakeholders have quickly called this out for exactly what it is—a meaningless stunt. The former secretary of the health department, Stephen Duckett, says the fund is 'an accounting trick' that

…provides no guarantee of policy stability, no guarantee of additional funding, and no guarantee that a future budget will not tear into the Medicare fabric … .

In fact, the finance minister has admitted that it is not a guarantee; that it is actually about visibility and confidence in Medicare, not a guarantee of Medicare at all.

Bizarrely, this fund does not include public hospital funding, which is a fundamental part of Medicare—our universal public health scheme. Medicare includes: the Medicare Benefit Schedule, our commitment to pharmaceuticals and to universal access of public hospitals. It shows how little this government understands Medicare that it has not included public hospital funding in this guarantee. By leaving out public hospital funding, even the government is conceding that our public hospitals face a future of uncertainty and cuts under their watch and that this government no longer considers them as part of Medicare.

It is no wonder that this government is trying to use the bill to distract from its health cuts. They have an appalling record when it comes to Medicare. The track record includes: repeatedly attempting to introduce a GP tax, only to ram it through by stealth through a six-year freeze to the Medicare Benefit Schedule; attempting to slash Medicare Safety Nets, the extra assistance relied on by Australians with high medical bills; fighting to hike the cost of life-saving medicines for every Australian; attempting to abolish a program which provides dental care for low-income children; slashing basic dental support to Australia's most vulnerable adults, putting further pressure on public dental waiting lists; ripping almost $1 billion out of preventative health, ending successful programs including those which teach children in kindergartens and schools about healthy eating; and, of course, more recently cutting the capital fund that allows public hospitals and others to upgrade their cancer diagnostic and treatment equipment. The list goes on.

The impact of those appalling decisions is that patients have been paying more and our health system has been dragged backwards. This bill does absolutely nothing to guarantee that a future Turnbull government will not continue to wreak damage on Medicare. The bill does nothing to address the fact that our public hospitals are in crisis under this government. Elective surgery waiting times are now the worst they have ever been since records began to be kept in 2001. Patients presenting to emergency departments who require urgent medical attention are being left in emergency departments for longer. In the last financial year only 67 per cent of emergency department patients classified as urgent were seen within the recommended 30 minutes. What has this government done? It has cut the extra funding going to public hospitals from the Commonwealth to improve elective surgery and emergency department wait times. I know the members opposite do not care about people waiting in public hospitals but, critically, we do know that public hospital capacity is not keeping pace with population growth and it is not increasing to meet the growing demand for services. And yet the government's budget has done absolutely nothing to address the crisis in our hospitals—nothing for elective surgery, nothing for straining emergency departments. Not only that, but the government in the budget has changed the funding formula for 2021, meaning that public hospital funding from 2021 will revert to the levels set in the disastrous 2014 budget without a new agreement. The government has a problem here—either it has a big black hole when it comes to public hospital funding or it has an unfunded liability if it intends to increase public hospital funding in 2021.

The fact is that Medicare is under as much threat under this government as it has ever been. The damage done by the Prime Minister's freeze will continue to rip $2.2 billion out of Medicare, out of those patient rebates over the next four years alone. That is $2.2 billion in patient rebates that should have been going to ensuring that people in our communities have the care they need through general practice and specialist appointments.

Frankly, it beggars belief that almost a year after the election, Australians are still bearing the brunt of health cuts that millions of them voted against. And it beggars belief that the government's budget will keep many of these in place well beyond the next election. The GP freeze will not be fully lifted until 2020, including items such as pregnancy support, counselling, GP mental health plans, family counselling help and items when a patient is at imminent risk of death. That is not what a Medicare guarantee looks like; that is what a government desperately seeking to distract from its cuts looks like.

I have a particular question that I would like the Treasurer to respond to when he returns to speak in summing up this bill. I want to ask a particular question about section 15 of the Medicare Guarantee Bill. Section 15 states that 'surplus amounts in the Medicare Guarantee Fund (Health) Special Account' will be transferred to the general consolidated revenue fund. That seems to mean that, if the appropriation for these bill is surplus to what is required to fund Medicare, that money will go back into the contingency reserve fund. What if the reason that it is surplus is that this government has made cuts to the Medicare Benefits Schedule or it has taken drugs off the Pharmaceutical Benefits Schedule?

What this bill in fact does is guarantee that none of that money will stay in health; it will go back into consolidated revenue. So it in fact does the opposite of what a good health minister would be seeking to do, and that is guarantee that that funding that is appropriated for health purposes stays within our healthcare system. That is the problem with section 15. I ask the Treasurer when he comes to sum up on this bill to actually respond to that problem. If surplus funds are moved back into consolidated revenue rather than being reinvested back into Medicare, it will show that, it does not matter how much money is put into the Medicare Guarantee Fund Special Account, the government can get away at any point with cutting it. If they reduce the Medicare Benefits Schedule at all and less money is required for the appropriation of Medicare, that money will not stay in health. This bill actually locks that position in.

Only Labor can be trusted to fight for Medicare. Only Labor can be trusted to protect Medicare. That is exactly what we are doing. We will be introducing amendments to this bill that will properly protect the future of Medicare. These amendments will mean that the bill cannot be considered until funding to support universal access for public hospital treatment is included in the Medicare Guarantee Fund. As I have noted, it beggars belief that funding for public hospitals—a core pillar of Medicare—has been left out of this fund. The amendments will guarantee immediate and annual indexation of Medicare rebates that have been frozen by this government, including GP rebates, rebates for specialist consultations and procedures, allied health services and those diagnostic imaging services unfrozen in the budget in the 2019-2020 financial year. Every day the government's Medicare freeze remains in place is another day that Australians are paying more for their health care.

Finally, given that we know that this government cannot be trusted with anything on health, the amendments I will move will mean that the bill cannot be considered until there is a guarantee that savings from the Medicare Benefits Schedule Review and agreements with stakeholders, including those savings from the deal with Medicines Australia that we want to see used to fund new drugs, can be reinvested in Medicare and not used as an excuse to further cut and undermine Medicare. This government is hell-bent on gutting Medicare through any means possible.

At the last election, Labor committed to reinvesting every single dollar of savings found through the ongoing Medicare Benefits Schedule Review back into Medicare and new innovations in our Medicare benefits system. The government has not made the same undertaking, and we know that it will cut into Medicare if it can get away with it. If the government votes against any of these amendments, it will be more confirmation that, when it comes to health, its budget is a complete and utter sham. With a disastrous record on cuts to health and Medicare, we know the government can never be trusted to do the right thing.

Medicare will never be guaranteed while this government continues to rip millions of dollars out of it. Medicare will never be guaranteed while the government fails to properly fund our public hospitals and to seriously address elective surgery queues and emergency department waiting times. Medicare will never be guaranteed while the Medicare freeze remains on GP items, specialist items and allied health items, in some cases until 2020. The plain truth is that Medicare will never be guaranteed under this government, and this bill does not change a thing. Therefore I move the following amendment:

That all the words after "That" be omitted with a view to substituting the following words:

"consideration of the bill and related bills be deferred until the Minister amends them to include actual guarantees for the future of Medicare, specifically amendments that:

(1) set out the purpose of Medicare, namely to provide a universal public health insurance scheme that provides access to medical, pharmaceutical and public hospital services based on clinical need, not capacity to pay;

(2) include funding to support universal access to public hospital treatment, along with medical and pharmaceutical benefits, in the purpose;

(3) guarantee immediate and annual indexation of Medicare rebates that have been frozen by this Government;

(4) guarantee proper Commonwealth investment in public hospitals, so that all Australians can access acute care without financial or other barriers; and

(5) guarantee that savings from the Medicare Benefits Schedule Review and agreements with stakeholders will be reinvested in Medicare, and not used as an excuse for further cuts".

This amendment is what a real guarantee for Medicare actually looks like, not a pretend guarantee to try and get yourself out of a political problem. We know that is what the government is attempting to do with these bills. We know that the government is basically creating an accounting trick—creating two new funds to replace the purpose of two existing pieces of legislation. We see that in the consequential amendments bill. This bill does absolutely nothing to stop the sort of havoc that we have seen a Liberal-National Party government wreak on our Medicare system: cuts to GP services and the undervaluing of general practice in our communities; the undervaluing of specialists and the important services that are provided by them; cuts to patient rebates; and cuts to child dental services. Only Labor guarantees Medicare. Only Labor will protect Medicare. I hope the Liberal Party finally sees some sense and supports the amendment circulated in our name.

See this speech in context