Mark Butler (Hindmarsh, Australian Labor Party, Deputy Manager of Opposition Business in the House of Representatives) Share this | Hansard source

I hear the interjection from across the table.

A government member interjecting—

You whispered it! It was another play from the Republican playbook. Like they do with so many things—the treatment of women, universal health insurance—they pulled out the equivalence chapter. They said the Labor Party started it. One of the great falsehoods of the last decade is that the Labor Party froze the indexation of the MBS system in the way that those opposite have done. It is quite clear that the realignment of MBS indexation in 2013 to the beginning of the financial year, which is when every other health program is indexed, was not a freezing. It is quite clear from the budget papers in 2013—page 177—that, under a Labor government, the next indexation of the MBS system was to be 1 July 2014. Unfortunately, we didn't bank on those opposite getting hold of the Treasury bench and freezing those indexations for year upon year. Those years of real cuts to Medicare funding have seen gap fees skyrocket.

In question time, the minister said—quite falsely, I think—that 86 per cent of patients are getting bulk-billed. He said there had been a six per cent increase in patients, when he knows that the 86 per cent for bulk-billing is about consults. It's not about patients, and it reflects the fact that older Australians go to the GP far more often. The government doesn't release the number of patients who get bulk-billed against the number of patients who actually pay gap fees, but the Australian Institute of Health and Welfare estimates that one in three patients who go to a GP has to pay a co-payment. Those are working families. That is the middle class of Australia. Those Australians have seen their gap fees, in the face of indexation being frozen by this government, skyrocket. They've skyrocketed by one-third for visits to GPs and by fully one-half for visits to specialists. On average, one in three patients is paying $10 more for every GP visit than they were paying when this government came to power and $30 more for a visit to a specialist. On average, if you are seeing a GP seven times a year—as most patients do—and a specialist once a year, this government has lumped a $100 Medicare tax on you over the last eight years. It's all a product of the Medicare cut through the freeze on indexation for year upon year.

Remarkably, under this minister the average gap to see a GP now, for the standard level-B consult, is actually more than the Medicare rebate. The gap was supposed to be a small contribution by the patient. But, under this government and under this minister, the average gap now is actually more than the government contributes to the cost of going to a GP. You pay your Medicare levy. You pay your private health insurance. And now, under this government, middle-class Australia—working families—are funding the majority of a standard level-B consult. That's the contribution to primary care and Medicare under this government.

The concern we have about the latest MBS changes is that they continue this pattern of behaviour that will increase patient costs. They add surgery to GP consults and specialist consults that have seen gap fees and copayments go up. Now, we're not opposed to a review of the MBS to ensure that items in the MBS reflect contemporary practice. It's a sound idea. But, like so much about this government, it's been utterly bungled in its implementation, just like the 2018 changes to spinal surgery that were an earlier tranche of the MBS review. It was sound in approach, properly updating the MBS items associated with spinal surgery to reflect contemporary surgical practice. But, according to the AMA:

Patients were left out of pocket, spinal surgeries were delayed, and doctors couldn't provide patients with informed financial consent about potential gap fees.

And with the latest tranche—more complex, more broad—we are seeing history repeating.

The minister tried to say there shouldn't be any increase in gap fees as a result of these 900 changes, but the Grattan Institute has said:

This will almost inevitably mean that patients will face increased out-of-pocket costs.

Mr Hunt interjecting—

I hear the minister scoffing at the Grattan Institute's analysis, but the AMA also said that that's guaranteed, that patients will see increased costs.

As I said, a review of the MBS is a sound idea. But increased gap fees as a result of these changes that the AMA says are guaranteed are no accident. Just like low wages, they are a deliberate policy feature of this government. They are a deliberate design feature of their approach to public health care, because they have never, ever accepted the concept of comprehensive and universal health insurance. The minister says, 'Trust us.' The minister says, 'There's no reason that patient costs should rise.' But that has been the story of this government for eight years: patients having to put their hand in their pocket to go to the GP, patients having to put their hand in their pocket to go to a specialist and now patients having to put their hand in their pocket to have life-changing surgery. Well, when the minister says, 'Trust us,' I say to Australians: you should never trust the Liberal Party on Medicare.

See this speech in context