Susan Templeman (Macquarie, Australian Labor Party) Share this | Hansard source

When you are trying to convince the general public that you have suddenly found a heart and a brain, it is not surprising that there is some attempt to duplicate your opponent's policies and, of course, that is what we saw in the budget and that is what we are seeing in this legislation—a pale imitation of a genuine commitment to Medicare. You know it is merely an attempted imitation when, rather than taking steps to show a commitment to something, the best you can do is bring on a bill that says you have a commitment to it—and that is what we have here. Instead of doing all the things they could have done to show that the right to universal health care is a top priority, they have opted for words. Clearly, they do not realise that actions speak louder than words and, in this case, the actions tell us plenty about the commitment to Medicare.

Let us look at the actions, or the lack of action. If they really wanted to protect Medicare, they would have dropped their freeze on Medicare services entirely. If they really wanted to protect Medicare, they would have properly invested in public hospitals. They did neither and, in fact, have outsourced where they can and have explored ways to reduce the federal commitment to hospital funding.

This bill is a case of 'perhaps, if I say it often enough, people will believe me.' But let us look at the facts about the basic tenets of Medicare. The first is that universal access should be available both in and out of hospital but, also, that the health services we access to prevent an expensive hospital visit, like seeing a GP or getting a blood test or scan, should be available. The last budget locked in a $2.2 billion reduction in funding to GPs, specialists and allied health services like physiotherapy. Far from lifting the freeze on indexation of payments for visits to these health professionals, in order to keep pace with the rising costs, the government is only spending $9 million next financial year to ease the freeze. That represents 1.2 per cent of the funding that has been missing. We also know that the freeze will not be lifted for many items until 2020—not this year, not next year, not the year after, but the year after that. The government will gradually lift the Medicare rebate freeze, starting this year with bulk-billing incentives for GP consultations, then other GP and specialist consultations in 2018, specialist procedures in 2019, and finally targeted diagnostic imaging services in 2020. But there are some hidden extras that will stay frozen for another three years, among them consultations for mental health plans. Federal health minister Greg Hunt says he wants to focus on mental health—Deputy Speaker, my message to the minister is that if you delay the lifting of the freeze on mental health plans, that is a very poor way to show your commitment. The visit to a GP is often the first port of call for people with a mental illness, and a GP has to identify not only what is going on but what the best way forward might be, so to keep this rebate on hold is a real betrayal of individuals with a mental health issue, and a betrayal of their families. Also on the list of items which will stay frozen are chronic disease assessments—assessing people who are at risk of heart disease or diabetes—and pregnancy support services. The official Medicare data shows the list of items where the freeze is not lifted until 1 July 2020, and that those items were used 23 million times last year—that is, in the last financial year those same services were used 23 million times. This is not a small number of items. Many are things that we want people to use a GP for—to reduce the incidence of hospital admissions—because this means that people are managing their health issues. We also know that for diagnostic imaging—scans, X-rays—only seven per cent of these items will have their rebates indexed. As the Diagnostic Imaging Association has said, the government has broken its promise. Too bad if you are pregnant and need an ultrasound; if you have a brain tumour and need an MRI; or if you require a PET scan to assess the extent of your cancer; or if you need any one of hundreds of other vital radiology services—there is no relief. That hardly sounds like something that guarantees Medicare.

To those on the other side, Deputy Speaker, it may not be a big deal to put your hand in your pocket to pay an ever-increasing gap. It is incredible that so many GPs in my electorate have held off passing through the increase to patients, but it just goes to show the incredible commitment that they have to their communities. It has been cost-shifting on a massive scale. I know it is wearing down the energies of some very long-serving and very hardworking GPs in my community. The gaps on many other services really hurt. New South Wales AMA president, Brad Frankum, says the 'small and incremental' increases to the Medicare bulk-billing incentive and Medicare rebate are not enough. He says:

At this rate it will be many years before patients see an appreciable difference in out-of-pocket costs. This is a crushing blow for general practice in NSW and continues to be an ongoing problem for specialists and the patients who need their care in this state.

So much for a commitment to Medicare.

Let us look now at hospitals. Anyone who has had the misfortune to be in hospital in recent times will tell you stories of a staff and a system under pressure, and I have certainly seen that firsthand. I think we forget the massive reduction in health spending that has occurred. In spite of the amazing efforts of the people who work in our public hospitals, things are tough. The Gillard government tried to move to a long-term funding arrangement where the Commonwealth took on a specific share of the growth in hospital costs, initially set at 45 per cent and due to rise to 50 per cent from 1 July this year. In opposition, then leader Mr Tony Abbott endorsed this approach. The election policy of the coalition made this commitment:

Our public hospital system needs certainty.

…   …   

A Coalition government will support the transition to the Commonwealth providing 50 per cent growth funding of the efficient price of hospital services as proposed—

But only the coalition will deliver, they claimed. They certainly have not delivered on this one. The 2014 budget led to a backflip on this commitment, one of many broken promises. This was actually the second time a Liberal government had reneged on a Commonwealth-state hospital deal. The first one of these occurred in 1976, just one year after Medibank, the precursor to Medicare, was introduced. Then, a Liberal government had promised—prior to an election—to maintain the hospital funding scheme. But then they ignored the promise. The Australian Financial Review editorial on the topic was headed 'Mr Fraser's Shabby Renege'.

Forty years later, we have renege No. 2. The 2014 budget created a fiscal cliff for the states from 1 July this year by replacing a 45 per cent cost-sharing scheme with indexation unrelated to either actual hospital cost movements or increases in hospital demand. The deal done last year followed a concerted campaign by the states and territories to oppose those 2014-15 budget changes, supported by the Australian Medical Association, the Australian Healthcare and Hospitals Association, consumer health groups and other stakeholders. The amount of funding still falls short of what is needed. The AMA described it as 'an inadequate short-term public hospital funding down payment to appease desperate states and territories ahead of the federal election', which they said, 'will not be sufficient to meet current and future demand'. The AHHA described the agreement as a 'partial turnaround from the $57 billion cuts to health funding imposed in the 2014 budget.' So it is not a great history.

Recent Treasury figures show the Commonwealth savings from cutting funding to the states for hospitals and schools will escalate rapidly, rising from $1 billion in 2017-18 to $3 billion in 2018-19 and $7 billion the following year. By 2020-21, it will be $10 billion. This needs to be seen in the context of a system that is meant to keep people well and help them recover when they are ill. The New South Wales government's own report says that its health system faces a massive drain on resources from an ageing population, general population growth, the burden of chronic diseases and the cost of new healthcare technologies. The latest Intergenerational report states that health services are headed for a fiscal cliff when Commonwealth government funding drops off steeply after 2020.

Emergency department presentations hit record levels in New South Wales in 2016 and elective surgery wait lists have climbed to an unprecedented nearly 75,000 patients. Our smaller hospitals at Windsor and Katoomba face ongoing challenges to meet demand, while our major hospital, Nepean Hospital, is dramatically understaffed and underfunded. You might not believe what my constituents tell me—many of whom work in the hospital system—but the former president of the AMA put it this way:

Public hospital funding is about to become the single biggest challenge facing State and Territory finances—and the dire consequences are already starting to show.

Bed number ratios have deteriorated.

Waiting times are largely static, with only very minor improvement. Emergency Department (ED) waiting times have worsened.

Elective surgery waiting times and treatment targets are largely unchanged.

These are the sorts of assessments that show us that there are problems.

I think it is worth commenting on the staff who are having to cope in these circumstances. The hardworking doctors and nurses and the other healthcare practitioners who work in public hospitals are still managing to provide a world-class hospital system. They tell me that that is because they are so committed to their patients. It is not because the system is making it easy. We need to start to support these doctors, nurses and other healthcare providers before it simply gets too much for them.

All of this is happening in an environment where we could be making improvements. But before us we have a bill that does absolutely nothing to make things better. I believe that Australians aspire to live in a country where your postcode does not determine your health outcomes. I think that is what we all want. We know that it is not the case yet, but we also know that we currently do a better job here than the United States—but for how much longer? The Australian Institute of Health and Welfare reveal that patients living in higher socio-economic areas have significantly lower waiting times than those living in lower socio-economic areas. One example from their recent report was that an Australian classified as living in the lower socio-economic area will have to wait more than twice as long for a cataract extraction compared to someone from the highest socio-economic tier. So one person waits 63 day and the other 137 days—two months versus more than four months.

Inequality of incomes is at a near-75-year high. The three richest Australians own more than the million poorest put together. The consequences of economic inequality show most painfully in health—when people have to choose between having a meal and visiting a doctor. We have to ensure that access to quality health care is protected, but this so-called guarantee does nothing to enshrine that. This bill is simply a decoy, a mask for what we know the coalition would really like to do if they could get away with it. They must cry for the era of Malcolm Fraser, when you could just get rid of universal access to the health system. 'What a bother,' they must say, that not only does the pesky Labor Party seem to keep bringing it back but people actually want it. If anything showed the true intentions harboured by those opposite, it was the revelation only a couple of months ago of the secret hospital task force to cut public funding and abolish the private health insurance rebate and their actions in selling off the $220 million contract to Telstra Health for the national bowel cancer and cervical screening programs. That shows what they would do if they had the chance. We know there is potential that other cancer screening registries, such as breast screening, might also be contracted out sometime in the future.

Let's look at what protections this bill does provide. Sadly, there are none. The finance minister himself admitted at Senate estimates:

If any government were to decide to touch it, obviously there would be immediate visibility of that and all of the related consequences that come with it.

Great. If they touched it, we would see it, not that we could do anything about it. The community could just watch it happening. The bill merely allocates the revenue from their planned increase to the Medicare levy, after using some of it for the NDIS, into a separate fund. For a start, if the NDIS were in such dire need of funds, how can there be any left over from the Medicare levy increase that they are pushing? But that is another issue. Apparently, there will be some left over, and then it will be topped up with an additional contribution from income tax revenue to cover the projected Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. But the fund does not include the Commonwealth's contribution to public hospital funding. That is not part of it. Using the word 'guarantee' linked with the word 'Medicare' might be a good PR exercise, but this bill gives absolutely no assurance of secure funding for hospitals, absolutely no assurance that Medicare rebates to doctors and allied health professionals will be secured and absolutely no assurance that the needs of Australians accessing health services will be secure. In other words, it is a total waste of this parliament's time.

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