Julian Hill (Bruce, Australian Labor Party) Share this | Hansard source

Deputy Speaker Kevin Andrews, as much as it is always a delight to have you present in the chair, I do confess to a moment of sadness, because I had made a promise to the previous Deputy Speaker who was there, Mr Irons. The promise was that I would spend at least one minute talking about the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Amendment Bill 2018 itself before moving on to the second reading amendment—but I'll still keep the promise.

I think it's fair to say that this is not a riveting bill. You wouldn't classify this as groundbreaking reform that's going to improve the health system in any meaningful way. Indeed, despite the government's claims, I suspect that—when they finally get around to answering some of the questions put to them by the shadow minister, if they can—it's probably not going to do much towards reducing the regulatory burden for government and industry.

The bill amends the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000 to change the frequency of how often people pay this tax. Currently, you pay $1,000 every year if you're a particular kind of pathology business. In a moment of brilliance, the health minister took a bit of time out from yelling at grandmas and came up with the idea that you would pay a tax of $2,000 every two years. It's a little bit less paperwork for the same amount of revenue, so that's pretty good. As I said, it is intended to reduce regulatory burden for government industry while maintaining revenue.

The shadow minister has asked some questions. 'How much do you raise?' Don't know; still waiting for an answer. 'What's the cost to the Department of Human Services for administering this approvals and renewals system?' Don't know; still waiting for an answer. As I said, we're still waiting to hear what the supposed reduction in regulatory burden is actually costed at. That will be of great excitement to the Australian people and the parliament, no doubt.

Having acquitted my promise to the previous Deputy Speaker with honour, I turn now to the second reading amendment, which condemns the government for their attack on pathology and for their desperate pre-election deal with Pathology Australia, which they then shamelessly ratted on. They ran away from it, realising that it was a stupid idea, and then created an even bigger mess when the GPs rounded on them. They thought: 'Panic! Panic! Well, let's rat on that deal and we'll go and make a different mess over here.'

We do need to retrace history. In the 2015-16 mid-year financial update, the government announced out of the blue that they were cutting $650 million from Medicare bulk-billing incentives for pathology and diagnostic imaging, including the incentives for pathology. Now, I was a candidate running for parliament then, and I remember starting to pick this up when I was visiting businesses and talking with local people through the media and in the community. The campaign started by Pathology Australia was called Don't Kill Bulk Bill—straight to the point. They collected a petition with, I think, over 600,000 signatures, such was the of strength of opposition.

But it's important to understand what the incentives for increasing bulk-billing in pathology were. They go back to 2009, actually, when they were introduced by Labor. They were additional payments which were made by providers, who, in response to the payments, then chose to bulk-bill their patients in an out-of-hospital setting so that their patients don't face out-of-pocket costs. It was sensible policy and it actually worked, because, in just six years, diagnostic imaging bulk-billing rates rose 10 per cent thanks to these fairly sensible, well-targeted measures. By 2014-15, there were 114 million pathology services provided out of hospital, and 98 per cent of them were bulk-billed.

Bulk-billing pathology and removing barriers when you need a test are good things for getting tests done quickly. You are not muddling around, waiting for weeks to find $20 or $30 or $50. To many people in this House, that doesn't sound like a lot of money, but I can assure you that, to people in many parts of my community, $20 is an enormous amount of money when you're living hand to mouth. It is important that we don't provide disincentives to people to get tests because the evidence shows—I know the government is quite challenged by the word 'evidence'; think climate change or any manner of things—that it is important that poor and vulnerable people, indeed anyone, are not delayed in getting tests because those delays make them sicker. People are more likely to get sick and develop more serious conditions if they are not diagnosed quickly so that they can be treated properly. This is a false economy because, when people get sicker, they cost the health system more. You'd think that even the boneheads in the government would understand that it is not a good idea to remove incentives, but apparently not. They will remove incentives, which will make people sicker, will delay them getting tests and treatment and will run up the costs to the health system.

Labor ran hard on protecting Medicare at the election. The member for Oxley outlined the history of Medicare through the 1970s and 1980s, and through multiple elections, where we proposed a great public health system for the country so that anyone, regardless of their income or place in society, could access high-quality medical care. They could bulk-bill to see the doctor or pathologist and so on, if that's what they needed. We ran hard on that. We build it, and coalition governments try to cut it. Over the last few decades it's been in the Liberal Party's DNA to oppose universal services every step of the way.

The government then panicked. They did a deal with Pathology Australia, and, just before the election, the pathology sector accepted this deal. The government said: 'We'll abolish these bulk-billing incentives, but we understand that you want bulk-billing, so we'll do something different. We'll re-regulate rents to general practitioners where you are co-located.' In some crazy, silly idea, the health minister—I won't even speculate on it because it's unparliamentary to speculate what might have been going through her brain or body—came up with such a ridiculous proposition without consulting and without understanding that if you squeeze one side of the balloon then the other side is going to bulge out.

The government did a deal to remove the bulk-billing incentives and re-regulate rents with GPs. That didn't go very well, did it? We told the Australian people: 'You should not trust the government on this. You can't trust them on Medicare; you certainly can't trust them on this deal.' The government said that we were lying; we were exaggerating; all of that was not true and of course people could trust the government because the government stick to their word on health and Medicare all the time. What happened? The government won the election. That's right—they fell over the line with 76 seats. Eventually, the Prime Minister got out from under the doona at Point Piper on election night. His wife must have pushed him into the car and said: 'Come on, come on! I know you don't like it but I think you're going to get there; you're going to get 76 seats. You have to man up and face the people.' They won the election. But, as it turned out, they lied. They shamelessly, cynically broke their deal and created a ridiculous mess. They ratted on the deal. What they discovered, of course, was that it was a stupid arrangement. The GPs were now furious because the GPs said: 'We're locked into leases. We have commercial business models in our practice. Government, you can't just come in randomly and re-regulate the rents on which a whole other set of other commercial arrangements rely. That's not very clever. That's not going to have the outcome you want.' So the government ratted on the deal.

This shows that health is always the Liberals' last priority. They talk a big game, but, when push comes to shove, when you have a look at where they put the money and at their record, it is clear that at the end of the day Medicare is just a logo to them. It's a green-and-gold logo. The thing that made the Prime Minister most furious—remember that tantrum that went on for weeks after the election—was that someone had used the Medicare logo. This was the health system, apparently. We had all that debate and an inquiry through the electoral matters committee to try to make it a Commonwealth offence to use the Medicare logo. That is completely missing the point: Medicare is not a logo; it's a public healthcare system that enables people, wherever they are in society, to access quality and affordable health care.

I believe we should be so proud of Medicare, and Australians generally are. We should be so proud, not just that we can see the GP but that, over time, as technology has changed and improved, we've continued with the ethos of a public health system that Labor introduced. They call it 'socialised medicine' in America—shock, horror. They spend a greater percentage of GDP per head of population on health care in America than we do, yet tens of millions of them can't see a doctor. They cannot get treated. That's what privatised medicine looks like. You only have to look to the United States. It's a country that I admire a lot, but we are a better society.

We should be proud of the public healthcare system delivered by Labor and our legacy in creating this incredible asset that Australians love and value. We should be proud of it. It's not perfect. It never will be. Of course it won't be. But this is idiotic meddling, thinking, 'We'll cut the incentives.' They've just been proven, with evidence, to be driving up bulk-billing rates and enabling people to get tests in a timely matter and not pushing up future costs and make people sicker. That's when we should be going, 'That's a good idea.'

As the then head of the AMA, Dr Michael Gannon, said, getting rid of the bulk-billing incentives was a 'co-payment by stealth' and would hit the poorest and the sickest hardest. He went on to say that evidence showed that many patients—again, particularly the sickest and the most vulnerable—defer their treatment, exacerbating the pain and suffering for people in the community and pushing up the cost to the healthcare system. You'd think, as speaker after speaker has said, that the government would listen to the experts, the profession, and also consult with them. If you're going to come up with a stupid pre-election deal that stuffs up one part of the system while thinking you're fixing another, it's not good reform. It's not good policy.

This is important to me. I failed my family destiny to become a doctor or go into the health profession. My father was a specialist, my mother was a nurse and my uncle has two PhDs in nursing. I didn't want to go into medicine, but, surrounded by my family, I was brought up with that ethos that it wasn't just health care and service. My mum did always say: 'Darling, if you go into medicine, be a dermatologist. Don't be an obstetrician like your dad. The phone rings all night. Please don't do that.' But she also told me the family story about his GP practice. He died when I was four, so we hadn't won the Medicare battle with you guys opposite at that time. Apparently he was a great doctor but an awful business person. He never made any money from his GP practice because he felt sorry for his patients because they couldn't afford to pay the bills, so he wouldn't send them the bill. I think mum always maintained that he had to have a few days a week being an obstetrician so he could actually charge people.

Suffice to say this is a another bandaid fix, cleaning up the mess left by the previous health minister. You can only imagine—the mind boggles, doesn't it?—how the current health minister is going to go in and clean up the mess. He's going to say, 'Don't you know who I am? You can all f-off!' and somehow that will fix it.

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