Emma McBride (Dobell, Australian Labor Party) Share this | Hansard source

I rise to speak on the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018 and to support the amendment moved by the member for Ballarat. This bill implements a 2017 budget measure to improve Medicare Benefits Schedule compliance and debt recovery practices, and will result in an estimated combined savings over the forward estimates of $103 million. This bill amends three acts: the Health Insurance Act 1973, the Dental Benefits Act 2008 and the National Health Act 1953. These technical changes will hopefully lead to improved compliance by better targeting unusual business billing and improving the consistency of administrative arrangements.

As a health professional myself—I am a pharmacist, and the only pharmacist in this House—I know that the vast majority of medical and allied health professionals that bill Medicare for services to their patients do the right thing. But we know there are increasingly commercial interests in play in some areas, so compliance needs to be improved. Only 40 per cent of Medicare debts are currently recovered, and there is over $50 million in outstanding debt, so there is a need for action.

These changes clarify that the Professional Services Review, which investigates Medicare and PBS compliance concerns, has jurisdiction over corporate medical practices that contract health providers, as well as practices that employ providers and the providers themselves. It introduces compulsory offsetting and garnishee provisions for providers who does not voluntarily agree to repayment plans within 90 days. At present, these providers are still able to claim full Medicare benefits even when they owe significant debts. Where a compliance debt is issued, both the employer and the contracted provider will be responsible for part of the debt, reflecting their shared responsibility for accurate billing.

This bill also makes record-keeping requirements consistent across different health professions. In particular, allied health providers will be required to keep copies of referrals for two years, just like doctors. Pharmacists like myself will be required to provide prescriptions to justify queried claims. Dentists and pharmacists will face the same administrative penalties on unpaid debts as other Medicare providers. Further detail will be set out in regulations, and the new arrangements will start on 1 July 2019.

One of the main reasons I'm in this House is my 20 years working in health, my 15 years in mental health and the last 10 years I spent at Wyong Hospital, working in the inpatient mental health units. I'm proud to be a member of the Labor Party—the Labor Party that introduced Medicare and will always properly fund and support Medicare.

Medicare is about universal health care. It's about every Australian, wherever they live, whatever they earn, being able to afford health care when they need it and access it where they need it. The Labor Party is always willing to support sensible improvements to Medicare. The Labor Party is justly proud of its work over many decades to create, properly fund and properly protect Medicare. It is our universal public health system, the foundation of our healthcare system, the pillar that underpins universal access to health care in Australia and the envy of many countries around the world. It means Australians can access life-saving treatment and life-saving medications when they need them, and it means that they can afford them. More than 20 million Australians access Medicare services every year, including GP visits, vital tests and scans, and hospital treatments, and it is without a doubt one of the most important programs the Commonwealth government delivers. It is fundamental not just to our health system but to our economy and our society. It took two Labor governments more than two decades to shape and establish the Medicare that we know and benefit from today.

Many Australians don't know what health care in Australia was like before Medicare. My colleague Dr Mike Freelander is here in this House because he knows, and that was one of the things that drove him to stand for parliament. He didn't want to end his career with children not being able to access health services that they need, as it was when he started his career. People should be able to rely on Medicare whenever they need it, wherever they live and whatever their circumstances. Let's not forget that the conservatives opposed Medicare each and every step of the way. Labor had to fight hard to set it up, and now we fight hard to protect it. Official Bureau of Statistics figures show that one million Australians delay or avoid seeing a GP each year due to cost, with another 1.7 million Australians skipping specialist appointments. About the same number don't fill a prescription because of cost. As a pharmacist and someone who's worked in health for 20 years, this really troubles me. Older Australians fare the worst, with one in eight telling the Commonwealth Fund that they have problems getting care because of cost. This is only made worse by delays with My Aged Care and Centrelink and the problems we've seen recently with homecare packages and residential care.

There have always been challenges to Medicare's universality, such as the difficulty of accessing services for Aboriginal and Torres Strait Islander peoples as well as people in regional and rural communities and remote Australia. But in recent years, out-of-pocket costs have become a significant barrier to access. Medicare statistics show that 10 years ago Australians paid an average out-of-pocket fee of $21 to see a GP. If that cost had increased in line with inflation, it would be around $26 today, and we know that's not the case. The last Medicare data shows the cost of seeing both GPs and specialists is at a record high. In the first three months of 2018, Australians paid an average out-of-pocket fee of $38.44 to see a GP, up to nearly $47 in some states and territories. The national figure has risen nearly $4, from $44.53 at the end of 2017. The same is true for specialists. Ten years ago, Australians paid $44, which would be equivalent to around $54 today. Out-of-pocket fees to see specialists have soared even higher than those for GP visits, up to an average of $87.62 in the March quarter. Recently, my sister, who's expecting her second child, had to see a neurologist. The up-front cost was $400. That's just out of reach for most Australians. In some jurisdictions, the average out-of-pocket cost of seeing a specialist is now well above $90.

How has this happened? How have we landed here? Well, remember when the Liberals tried to introduce the $7 co-payment? That was an unprecedented attack on Medicare and access to Medicare, effectively trying to end bulk-billing. When they couldn't get that plan through, they resorted to extending their freeze on Medicare rebates. That freeze is still in place today. Again, under intense pressure from Labor, doctors and the public, Minister Hunt announced a thaw in the freeze in May 2017, but he still hasn't actually lifted a single element of it. Some elements will finally be lifted on 1 July, delivering GPs a paltry 55c increase in the rebate. That won't have much impact on soaring out-of-pocket costs, and other elements of the freeze will stay in place until 2020. That's six years of slugging doctors and, ultimately, patients simply because they need care. The rebate freeze has saved the government billions of dollars, and they're still banking those savings right now. That is billions of dollars that should've gone to providing health care, not paying for tax cuts for big business and big banks.

Meanwhile, the government is out there trying to portray a static GP bulk-billing rate as some kind of achievement. The Australian people are too smart for this spin. They know that the cost of going to the doctor has gone up. They feel it every time they get sick or injured and every time they get a prescription filled. That's why so many of them are delaying going to the doctor, delaying urgent treatment from their GP. Yet the Liberals claim that Medicare has never been stronger. Whether it's making Medicare more expensive, cutting public hospitals or trying to sell them off, as they attempted to do to Wyong hospital in my community on the Central Coast, the conservatives can never be trusted with our health care. You just can't trust them with Medicare. They keep talking about their rock-solid commitment to it, but we all know the truth: they want to dismantle it. They just don't believe in universal health care like we do. They look to health systems like in America, where people increasingly have to rely on private means to access health care, where people suffer for years because they can't afford to see a doctor, go to a hospital or get medication, and where you have to get out your credit card rather than your Medicare card whenever you visit the doctor or pay for medication.

They might say what they think the public wants to hear, because they know how much the Australian people value Medicare. It underpins health care in Australia. Australians certainly sent that message loud and clear at the last election, when the government was plotting to outsource parts of Medicare to the private sector. Labor, of course, opposed that move. In the two years since the election, the government has been busy trying to rewrite history, pretending it was all a scare campaign—but we all know that's nonsense. The public knows it's nonsense. This government was actively planning to outsource the Medicare payment system to a corporate player—one of the big four banks, perhaps, or a private health fund. If we had let them get away with it, that would have been the beginning of the end of Medicare. The government only dropped their plan because of Labor's tireless efforts to highlight the damage it would have done to our health system and because the Australian people agreed it wasn't a good plan and punished the government for it.

Eventually, as we all know, the Liberals will have another crack. They'll come up with another scheme to undermine or weaken or sell off parts of Medicare. In stark contrast, in his budget reply speech the Leader of the Opposition announced the first of Labor's new investments in Medicare—a significant investment in MRIs. Unlike other diagnostic imaging services, MRI scans only attract a Medicare rebate if they are performed on an eligible machine. The licence system worked relatively well until 2013, given that the last Labor government granted 238 licences. Unfortunately, the current government has neglected MRIs, granting only four MRI licences in almost five years in office. Labor established Medicare. Labor will always defend Medicare. Labor will properly fund health care for all Australians.

I will conclude by again going back to my community and to the hospital that I worked in, in Wyong, on the New South Wales Central Coast. In communities like mine, where there are pockets of extreme disadvantage, people need to know that they can trust and rely on being able to access healthcare services. In my work, particularly in mental health and working in inpatient units in public hospitals, I have seen the most vulnerable people in our community, people whose circumstances are such that they are unable to care for themselves. These are the people that we need to protect. These are the people that we need to support. Undermining Medicare sends a strong signal to these people that the government doesn't care and thinks that these people don't matter. And this is a real risk. People need to feel secure. People need to know that they will be able to see their GP. They need to know that they will be able to go to their psychiatrist and be able to afford it. They need to know they will be able to get their prescription filled and get other treatments that they need. This is something that really matters; it matters to all Australians. As a pharmacist and a mental healthcare worker, and as someone who is new to this House, I feel that we really need to make sure that Medicare is always properly funded, and Labor will always do that.

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