Mike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

In rising to speak on the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018, I congratulate the member for Ballarat for well summarising our concerns about this legislation. I fully support her amendment and agree with her comments. I rise today to speak on this bill, which we will not be opposing. However, in line with the amendment, it is critical to condemn this government's attack on pathology bulk-billing at the previous election and consequential election deal around rent control that overwhelmingly favoured corporate pathology giants and left the small pathology centres out to dry. This really does demonstrate this government's lack of ability to understand health care in this country.

I started my private practice in 1984, the year that the Hawke Labor government introduced Medicare. My practice was founded on the benefits that Medicare gave to our population in terms of health care. Unfortunately, this government has continued its thousand cuts to the Medicare system. The government rails against Labor's campaign supporting Medicare in the last election, but, really, this is just further evidence of how little this government understands health care in this country and further evidence of its continued attacks on the health care of people who really struggle to meet the current costs of health care in this country.

The government has done many, many things, even in the short two-year period since the 2016 election. One thing that was of grave concern to me was the sell-off of the Australian cancer registry, which this government quite happily did very surreptitiously, without much fanfare at the beginning of our term in parliament. It was a real shame and something that we will, I think, live to rue in the future.

We're constantly talking about cuts and freezes on bulk-billing rates, cuts to hospitals and difficulty accessing specialty health care. That's because this government has a real ideological problem in that it doesn't really understand a fair, accessible and equitable universal healthcare system. There have been many, many things that have demonstrated this in the past and even in the last two years since the 2016 election. In my own electorate, I have seen cuts to our hospital services and cutbacks in our GP after-hours service—in fact, the removal of the GP after-hours service co-located at the main hospital in my electorate, Campbelltown Hospital. That was a real shame for this provider of health care in the Macarthur electorate—and, again, something that happened very surreptitiously.

This government, I repeat, ideologically does not believe in a fair, accessible and equitable health system. In the government's 2015 Mid-Year Economic and Fiscal Outlook, it listed the changes to diagnostic imaging and pathology bulk-billing services incentives and said, 'The savings from this measure will be redirected by the government to repair the budget and fund policy priorities'—again, attacking the healthcare system for other priorities. I'm not sure what policy priorities are more important than providing equitable healthcare services, such as bulk-billed pathology testing, but, after campaigning by Pathologies Australia, the government did not reverse the cuts and instead cut a rent deal that allowed the pathology companies to get cheaper rent for collection centres located in GP clinics. In exchange, these companies would stop campaigning against the coalition, which is a real sign to me that this government is prepared to support its big business mates at the expense of equitable health care.

It is important also to remember that when we talk about pathology companies, we are talking about multibillion-dollar companies that have a monopoly over the sector and have squeezed out smaller independent pathology centres. The government have done very little to look at other alternatives to widen the pathology network but have concentrated on their big business partners. The only reason the government backed down was the fear of these companies campaigning against them and the electoral backlash. In return, these pathology companies agreed, even with the cuts to the bulk-billing incentives remaining, to stop any negative campaigning against the coalition—the coalition protect their big business mates; their big business mates protect the coalition. This is a poor deal for the general public, for the smaller healthcare providers and for the GPs in particular.

What's blatantly clear about the deal is the lack of consideration for the patients or the GPs. In fact, the Department of Health said that there was no evidence that rents pathology companies were being charged were above market value. Many GPs had formed their businesses based on the rents they were going to receive from the pathology companies, but the screws were put on them at the expense of their patients and the GPs to the benefit of the pathology companies. This was a deal the coalition made with the big end of town, with no consideration for the Australian public. This should not be a surprise to any of us, because this government only govern for their mates and not for the general population. We've seen this just recently with the government constantly giving in to the big media players, their mates, against the ABC, and we continue to see the government's persistent attempts to enact tax cuts for big business.

The ABC issue is very important to me because the ABC provides services to all Australians. It provides wonderful access, particularly in rural and remote areas, yet the government is prepared to campaign with thousands and thousands of dollars cut from the ABC budget at the expense of the ABC and to the benefit of the major media players—again, big business benefitting at the expense of ordinary Australians.

Labor fought off the proposed introduction of the GP co-payment. We all remember that from the Abbott government proposal and how pathetic the attacks on equitable health care were. Now we see this government consistently chipping away at funding for hospitals, chipping away at bulk-billing incentives and delaying the lift on the freeze on bulk-billing payments to GPs and others. In fact, the recent budget introduced a miserly increase in GP payments, really quite derisory, and yet they continue to support big business.

What's critical to understand is that this, as I said, is an ideological battle. The coalition just doesn't believe in a fully accessible universal healthcare system. I would like to refer to the recent Four Corners program that looked at access to health care. I have seen evidence of this in this my electorate and, indeed, amongst my own patients. There is now an increase in gap payments required to visit specialists. This really is across the board, but there are some specific procedural specialties that continue to charge increasing gap payments to the point where many people cannot afford access to specialist care. A visit to a specialist cardiologist in my electorate can cost a patient out-of-pocket expenses, over and above the Medicare rebates, of $500 or more, and this has put access to specialist cardiologist services out of the reach of many of the poorest in my community. This is an absolute tragedy. The major hospital in my electorate does not have an easily accessible outpatient clinic for cardiology patients. So, in fact, many elderly people, often on pensions, are being excluded from specialist care. We are seeing an increase in the inequity in health care to the point where we are rapidly developing a two-tiered healthcare system, and this is a great shame. This is not the sort of healthcare system that I was brought up to believe in. I really think that the government should look at itself, look at its policies and see what it's doing to health care in this country.

I said before that we are heading down the path to a two-tiered system, and I want to see some action to ensure that our healthcare system does not rival that of the United States where, effectively, only the wealthy can access quality care. With the government and industry putting profit before patients, I just cannot stress enough how much we are at risk of heading in this direction. This is a philosophical problem that the coalition has; it just does not understand equitable health care. We need to be doing more to make sure that we hold this government to task.

I'm proud to be part of the party that created Medicare. I'm proud that I've been through the introduction of Medibank, introduced by the Whitlam Labor government when I was a medical student. It was really destroyed by the Fraser Liberal government. Medicare was reintroduced by the Hawke government and promoted by the Gillard and Rudd Labor governments, but is now facing a thousand cuts by this Liberal coalition government. I want to ensure equal access to health care for all Australians, not just those who have a credit card and money in the bank. It's really unknown to me why conservative members of this place are intent on attacking this ideal. I thought this was something that everyone in this place supported—equitable access to health care for all Australians—but by the actions of this government, clearly not.

I really think that equitable access to health care has become part of who we are. The general population believe in it; we've seen how they respond when there are attacks on Medicare. We have called out this tirade of attacks time and time again, and yet those opposite continue to chip away and chip away at the fabric of a healthcare system that's provided equitable access to most Australians—nearly all Australians—for over 30 years. Unless we continue to identify and call out the more subtle moves by those opposite to undermine our health system, we'll find ourselves before long adopting this two-tiered system, which they seem to want, without even realising how we got there.

Throughout my professional career, prior to being elected, I witnessed respective Liberal coalition governments trying to eat away at the framework of our universal healthcare system. A change that may lead to different individuals paying different rates for their premiums may not seem that dramatic, and certainly will not have the effect of closing hospitals overnight. However, subtle changes over time, such as these to private health insurance rates, are far more significant than many members can understand. Eroding the level and quality of care all Australians have a right to is not something that we want to see.

The Four Corners program, as I mentioned, released its investigation, stating that out-of-pocket costs are totally out of control. My own profession has some responsibility for this. We are seeing more and more patients having to pay larger and larger out-of-pocket expenses, now to the point where many people cannot afford quality care. It is becoming harder and harder to find a specialist that bulk bills and the costs to patients are constantly increasing. Out-of-pocket costs to patients vary significantly from rural and remote areas to inner city areas to outer suburban areas. Sometimes there are differentials of 100 or 200 per cent between what doctors in the same field charge. Many people in the more disadvantaged areas are, interestingly, often those being asked to pay the larger gap payments. It's a shame that those who are most disadvantaged are being disadvantaged even further by our healthcare system. While the majority of Australians still have access to bulk-billing GPs, it is incredibly hard to find a bulk-billing specialist in the country. And when you do find a specialist that bulk bills, you may be waiting months and months for appointments.

Medicare is founded on the notion of ensuring equality of access to health care for all Australians. I will always call out threats to that when I see them, and I see big threats from this government chipping away at what is equitable care. We need to stop playing games with the healthcare system. We need someone on the government benches to stand up for equal access to health care across the board.

When I'm looking for political causes, I always find following the money interesting. When you look at the share price of some of our biggest pathology companies and healthcare providers, you find that the share price of the biggest provider of pathology services in Australia has increased by 15 per cent in the last 12 months. I think that's a very good sign of what has been happening: big business has been benefitting from the government's policies on health care. It is a real shame that that benefit is at the expense of those most disadvantaged. We need to support our general practitioners, we need to support our most disadvantaged to have access to health care and we need to make access to specialist care much more equitable.

What this government is doing is trying to chip away at a system that has provided wonderful healthcare support for all Australians for over 30 years. The government has been called out time and time again. It is no good their standing up and saying, 'We support Medicare,' when we know they don't. We know they don't support equality and equity of access, and that is a shame. Whilst we support the bill, the amendment is very important and it should be passed. I fully support the shadow health minister. I really despair of what this government is doing to health care and I want it to change.

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