Harry Jenkins (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Dickson proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The failure of the government to support the private health insurance system.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

What we know about in 18 months of this government already is that it is a government of many faces. There is certainly a case that has been made out today that this is a Prime Minister of many faces and we know that the Minister for Health and Ageing, sitting today at the table, is a minister of many faces. This government has been built on a fraud. It went to the Australian people last year saying one thing and it has delivered something very, very different. There is no better example of that than in the area of health. This is a government which predicated its election on saying to the Australian people that not only would it fix the public hospitals but also it would fix them by mid-2009. There is only a matter of a few short weeks to go before we reach that deadline and there is absolutely no prospect of this government fixing public hospitals by mid-2009.

In fact, over the last 18 months there has been no doubt in the minds of all Australians that public hospitals around the country, and in particular in regional and rural areas, have deteriorated in the services that they have provided to patients in those hospitals. Not only did this government mislead the Australian people at the last election about patient outcomes but also they misled those hardworking people who are working in the health sector, be it in the public or private system. This is a government which promised so much. It promised to end the blame game. It promised to fix these hospitals and, over the course of the last 18 months, it has gone from one bungle to the next. The minister in the area of health has gone from one bungle to the next, which has made the situation in health not just in the private sector but also in the public sector in this country much worse.

Let me take the House through a little time line of this minister’s contribution to the private health insurance debate. On 26 September 2007, the health minister issued a press release headed ‘Roxon promises to retain all existing PHI rebates’. This is what the press release said:

On many occasions for many months, Federal Labor has made it crystal clear that we are committed to retaining all of the existing Private Health Insurance rebates, including the 30 per cent general rebate and the 35 and 40 per cent rebates for older Australians … The Liberals continue to try to scare people into thinking Labor will take away the rebates. This is absolutely untrue.

This was a scare campaign, the minister claimed at the time. Only a couple of months later, on 20 November 2007, there was a letter from the now Prime Minister, then Leader of the Opposition, to the Australian Health Insurance Association. He said:

both my Shadow Minister for health, Nicola Roxon—

‘the illustrious Nicola Roxon’; no, he did not say that—

and I have made clear on many occasions this year that Federal Labor is committed to retaining the existing private health insurance rebates, including the 30 per cent general rebate and the 35 and 40 per cent rebates for older Australians.

Federal Labor will also maintain Lifetime Health Cover and the Medicare Levy Surcharge.

They were the words of the Prime Minister only a short time ago. On 25 February 2008, Mr Rudd said that rebates will remain unchanged. He was quoted in the Australian as saying:

The private health insurance rebate remains unchanged and will remain unchanged.

In May 2008, the health minister stated on Macquarie Radio:

We continue to support the 30 per cent, 35 per cent and 40 per cent for those Australians who choose to take out private health insurance.

Towards the end of 2008 we found out something very different. In Senate estimates we discovered that at the end of 2008 this minister decided to seek advice from the Department of Health and Ageing, not about how they would maintain support for the 30, 35 and 40 per cent rebates, as was continually espoused not just by her but also by the Prime Minister, but about how to change the rebates. Out of one side of her mouth, the minister says that they are continuing their support for existing rebates for people in private health insurance and yet, out of the other side of her mouth, behind closed doors, she asks her department to go off to see how they can tear down the rebates. This is a duplicitous government and a duplicitous minister. We learnt in Senate estimates that on 8 September 2008 the minister told the Health Insurance Association conference: ‘Consumers will still be able to claim the 30 and 40 per cent rebates.’ This is despite the fact that this minister has been organising with her department to devise a scheme which will pull away the government’s support for the private health insurance rebates.

We know that on 12 January 2009 the minister got departmental advice on the changes—she actually physically received it. On 20 February the Treasury advice on the rebate changes arrived for the government. On 22 February this year, the health minister got Department of Finance and Deregulation advice on rebate changes. On 23 February the advice of the Department of the Prime Minister and Cabinet arrived for the minister’s consideration.

Let me repeat it to the House: this was not advice about how they could live up to the promises that were made to the Australian people that they would further enhance private health insurance coverage in this country; this was advice about how they could go about tearing private health insurance down. This was about how, because of their ideological stand against private health, they could undermine and tear down the private health insurance system in this country—despite the fact that during the campaign they made solemn promises on a number of occasions to the Australian people that they would maintain the rebates and therefore the incentive for people to stay in private health.

Why is this debate so important to the Australian people? For a number of reasons—firstly, we have to maintain public confidence in our health system in this country, and this minister has over the last 18 months only gone about undermining the support of that system. People have taken up private health insurance for a number of reasons over the last few years. Principal among those reasons is the fact that many people are disturbed by what they see in our public hospital system and what has happened under the control of the state governments, who own and operate these public hospitals, over the last 10 years. Australians were provided with support by the previous, coalition government to maintain their private health insurance because, if we did not—if we had a situation in this country where we drove the 10 million or 11 million people out of private health into the public system, which is the want of the Rudd government—then our public system would collapse under the pressure. There is no question about that. People read stories in the newspapers on a daily basis about failures in public hospitals around the country, and yet they expected this Prime Minister to deliver on his promise that he would fix public hospitals by 30 June 2009—only a matter of a few weeks away.

This is an amazing revelation about the government. They believe that Australians are wrong, that public hospitals have been fixed and that there is no reason for the Prime Minister to live up to his promise that he would further improve public hospitals and that he would maintain support of private health insurance. That is something this minister and this Prime Minister should be condemned for.

If we look at the record not just of this government but, importantly, of the previous government and the government before that, we see that this ideological attack on private health by the Labor Party started a long time ago. We know that Labor’s record in relation to health over 13 years when it was in government was a disgrace. It was a disgrace because we know that private health insurance membership when Labor was last in power fell from 64 per cent to less than 34 per cent. Health insurance premiums rose on average by 12 per cent year on year and there was no commitment to quality and safety in hospitals or community care.

Contrast that for a moment, just in terms of private health, with what the coalition did over a period of 11 years. Whilst Labor dropped private health coverage from 64 per cent to 34 per cent, we increased it from 34 per cent to 44 per cent. That was a remarkable achievement in the face of the fact that this Labor Party when in opposition—not just when they were in government previously but when they were in opposition—completely opposed every move that we put in place to support, underpin and strengthen private health insurance in this country. We know that under the coalition total investment in health went from $19.5 billion in 1995-96 to $51.8 billion in 2007-08 and that support under the PBS went from $2.2 billion in 1996-97 to $6.4 billion in 2006-07.

Why do we find ourselves in a position where we have a government having promised to support private health now attacking it? As I said before it is an ideological bent that this government has had against private health from day 1. But there are other reasons of course. We know in relation to the advice that we have received through Senate estimates that over two million Australians will be impacted on by these changes. The government proposes, in their rip-apart of support for private health insurance in the current changes—leave aside the changes they made to the MLS in last year’s budget—that people will face increased premiums, because this government predicts that they will raise $1.9 billion in extra revenue over four years, and that money has to come from somewhere. This government goes around saying ‘Well, only 25,000 Australians out of the 11 million will drop their private health cover and only those people will be impacted.’ These are the ones referred to as the so-called rich as part of this debate. But there are over one million Australians who have private health insurance and who earn $26,000 a year or less. Those people are going to be impacted and hit hardest by the cruel cuts that this government is putting in place in relation to private health, because there will be a roll-on impact to those people who maintain their private health coverage. Many part pensioners who have private health insurance will drop their private health insurance, or they will drop their ancillary cover or they will drop part of their hospital cover. They will drop it because there will be extra premium pressures because of this government’s cruel decision.

This government has made this decision not just because of ideological reasons but, clearly, because they are desperate for revenue. So at a time when they have ripped $1.9 billion out of the assistance for helping people to stay in private health they have also put in place some incredibly cruel cuts in relation to the health budget announced only a few weeks ago: they have cut money from cataract surgery, which was an incredible decision by this government, and they have cut money for providing support to families who need an IVF program to have a child. And from some of the correspondence, surely, not even this minister in her darkest day of incompetence could be blind to the fact that people are suffering because of this government’s economic incompetence.

In closing, I say in her defence that most of this clearly could not have been driven by this minister; it could only have been driven through a cost-cutting exercise by the Treasury and the finance department. Sure, they are ideologically opposed to private health insurance—they hate it; they hate the fact that people have private health insurance. They would prefer a nationalised system similar to that which operates in the UK, but the reality is that not even this incompetent health minister, in her darkest hour, could have contemplated cutting funds to cataract surgery or to the IVF program. If these are examples of the way in which this minister has administered her portfolio, then pity help health in this country over the next 10 years, because this style of management is an exact replication of what has gone wrong in the way in which Labor has managed health at a state level over the last 10 years. If this minister rolls up to cabinet each time and has put in front of her decisions from Treasury and Finance about these cost-cutting exercises, which are not going towards health outcomes at all, then she is not worth the huge amount of money she is paid.

The Australian public deserve more in relation to the health debate and they are not getting it; they have not got it over the last 10 years from Labor and they certainly have not got it over the last 18 months from this government, because this government is not about improving the health system; they are about tearing it down; they are about covering up the mistakes of their incompetence at a state level; and they are at their core about trying to rip apart private health in this country. And if they succeed in doing that—if people drop their health coverage or they make private health unviable for many low-income earners—it will be a sad day.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

That was an embarrassing spray from the shadow minister, who has been unable to get a question asked about a substantive matter in health since he became the shadow minister, and he certainly has not bothered to have any asked since the budget. I am sure that on a day like today the shadow minister was pleased that he had the opportunity to debate something that should have been a serious issue for this parliament. But instead we have had the shadow minister speak for 15 minutes on a matter of public importance, which was allegedly about private health insurance, and for the entire 15 minutes he did not bother to mention the eight million people who will continue to receive the full 30, 35 and 40 per cent rebates—the low-and middle-income earners who we agree need assistance. In these difficult financial circumstances it is particularly the low- and middle-income earners who might be making decisions to drop their private health insurance. He did not mention once that those people are going to continue to have the support of the government and that those people are in fact, in the difficult financial circumstances that we are in globally, the very people that we should prioritise.

I cannot sit here and have the shadow minister shed crocodile tears over people who are on very low incomes, scaring them that something is going to happen to their private health insurance, when in fact what the Liberal Party is trying to do is ask those very people to pay for the private health insurance of people who are better off—to pay for the member opposite’s private health insurance rebate and to pay for my private health insurance rebate. I do not expect people on low incomes to help fund my private health insurance. I do not think it is sustainable for the Liberal Party to act under the pretence of this being some massive attack on private health rather than a sensible and targeted change that is needed in these difficult financial circumstances. I do not think you can actually take the member seriously when he says he is worried about those people on low incomes.

I also cannot sit here and have the shadow minister cry crocodile tears over the issue of our public hospitals. You have to have a fair amount of gall to have been part of the previous government, part of the previous cabinet—oh, no, he was not in the cabinet—who pulled a billion dollars out of our public hospitals, happily washed their hands of it, blamed everything that went wrong on the states and were not a partner in trying to fix the system, and then expect us to have fixed every single problem after we have been in government for five minutes.

He wants to verbal the Prime Minister and me about the promises that were made, but our promises were very clear and we stand by them. We are going to make an assessment in the middle of this year of whether or not the Commonwealth should take over financial responsibility for hospitals. In making that assessment, we are going to look at the final report from the Health and Hospitals Reform Commission and the progress that has been made with our state and territory governments.

It does not serve our debate about health well to have the shadow minister constantly talking down the system, saying that things have got worse and ignoring that some of the indicators are improving. The truth of the matter is that the biggest indicator that is improving is the Commonwealth’s investment in a partnership with the states and territories. Of course, that investment will take time to start showing, but we have seen the things that we can measure quickly, like our investments in elective surgery, far exceed our targets. We have seen the states sign on to agreements for quite significant reform. We are seeing change. We are seeing emergency departments being rebuilt across the country. We are seeing new elective surgeries—I opened one fairly recently here in the ACT—with money from the Commonwealth that the previous government was never prepared to invest in the system.

If we are going to have a fair dinkum debate about private health insurance, that is fine—let’s have a debate. Let’s have a debate about whether or not somebody earning over $120,000 a year needs to have Commonwealth assistance via the rebate, paid for by the taxpayers—

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

You promised it wouldn’t change.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Bowman!

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

to keep their private health insurance. Do couples who earn more than $240,000—

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

Why did you promise it, then—why did you promise not to change it?

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

a year deserve to have their private health insurance rebate paid for by pensioners and low-income earners?

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

Why did you promise exactly that?

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

We exactly know—

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Dickson!

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

The shadow minister can bellow all he likes, but I and the Prime Minister are on the public record saying we have changed our policy. We are quite open about that. We have changed our policy because the global financial circumstances mean that we have had to change our policies in a number of areas.

Opposition Members:

Opposition members interjecting—

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

If they think it is funny that we are looking at the pressures that this puts on individual families, on the health budget and on the whole economy then they have been living in a different world for the last few months, and for the last year, than everybody else.

This is a change which is carefully designed and carefully targeted. By reducing the rebate only for those that are on higher incomes, by staging it and by increasing the surcharge, we have been able to ensure—

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

Mr Laming interjecting

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Bowman is warned!

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

as shown in the Treasury modelling, that only a very small number of people will drop out of private health insurance. The estimate is 25,000. That will of course have some impact, but, with nearly 10 million people with private health insurance, it is a negligible number. We even have those in the industry, the chairman of Healthscope and others, saying that, because the surcharge is also changing, very few people will decide not to continue with their private health insurance.

So, yes, difficult times mean difficult decisions need to be made, and we have made one of those decisions. We now ask the parliament, the Senate and those opposite if they could look at this in a sensible way and actually assess the impact and who is targeted. If you are a single-income earner earning more than $120,000, we do not think the public needs to help you pay for your private health insurance. For couples or families, $240,000 is the cut-off point. We think that is reasonable, but we have not heard any debate about that in here. We have not heard why the member opposite or the Leader of the Opposition, if they have private health insurance—I do not know whether they do—think that other taxpayers and low-income earners should help fund that. There is no sustainable argument.

If the member came in here and said, ‘I think the cut-off is wrong,’ ‘I think these people are earning more,’ or, ‘Let’s have a serious debate about the impact on public hospitals,’ then we would take their concerns seriously. But we do not, because for the whole 15 minutes of the debate the member opposite pretended that the millions and millions of Australians who will get a sustainable, ongoing benefit because of the decisions we are making have been ignored. They are running a campaign that is pretending that we are abolishing the rebate altogether, and that is true to form—it is what they have said in the past. I have had, as I am sure other members have had, people, worried and concerned because of the comments of the Leader of the Opposition and the shadow minister, calling up to say: ‘What are the changes going to do to me?’ When you say, ‘Well, what’s your income,’ and explain how it works, they say, ‘Oh, I’m not affected at all; that seems very reasonable. Higher income earners are not going to get it: that’s fair enough.’ But we do not hear any of that sort of debate going on. It is really a pathetic effort from the shadow minister opposite.

One of the other things that I think does not serve us well, as I said, is talking down the system all the time when we are actually starting to see some changes. I would not for a moment stand here as the health minister and pretend that there are not serious problems and challenges in a number of public hospitals. Our job as elected representatives is to try to fix those problems. But you cannot expect everything that has been destroyed in 11 years of neglect, blame, pulling money out and not cooperating with the states and territories to be instantaneously fixed. That is just not a possibility. We need to have a proper debate about how to fix the problems. If we had even an idea from the member opposite about how we could fix something we could start to have a real debate.

The only contribution that he and his leader have made so far is that they would like to get private patients out of public hospitals. In their perfect world, everybody would have private health insurance. They are absolutely, deadset determined to talk down our public health system, to starve it of funds and to say that it is not improving at all, when it is. Maybe that is why they want everyone to have private health insurance—maybe the Liberal Party sees no space at all in the community for a public health system.

We have a very different view. We think there should be a strong public system and a strong private system. We think having a balanced approach actually enhances the services that both the public sector and the private sector can provide. That is why we have invested an extra $64 billion into our public hospital service. That is a 50 per cent increase on the previous government. That money will start delivering real improvements, real services, real extra doctors and real extra nurses every single day that the next five-year agreement runs for. But do we hear anything from them about that? Absolutely nothing.

The contribution from the member for Dickson and the Leader of the Opposition of getting everybody out of public hospitals and into private hospitals and of saying that if you have got private health insurance then you should not use the public hospital system is just a downright silly idea. We know it is silly because we know that, even if you are privately insured, you might still need to use a public hospital, particularly if you are in an emergency situation. I am sure that the member opposite is not so slack in his duties as the shadow minister for health that he is not aware—

Government Members:

Government members interjecting—

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

I am being generous. I know that is being generous but I am sure that even he would be aware that most of the private hospitals around the country do not have emergency departments. I think the shadow minister’s suggestion that if you have private health insurance then you should not be allowed to go to a public hospital is all well and good unless you actually have an emergency and need to be able to go to a public hospital to be treated. There are 24 emergency departments in private hospitals. That is all there is across the whole country. For example, is there anybody here from New South Wales?

Government Members:

Government members interjecting—

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Yes, we have a couple of people from New South Wales. If you have an emergency in New South Wales, the only private hospitals that have emergency departments are in the middle of Sydney. If you have an emergency and you are not allowed, as a privately insured person, to go to a public hospital and you are in the Minister for Ageing’s electorate, do you expect people to travel to Sydney to get their public hospital services? If you are in Dobell or Shortland, do you expect that privately insured constituents in those electorates should be travelling down to Sydney to get their emergency department treatment?

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

That’s rubbish!

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

It is your suggestion, Shadow Minister. The reason it is your suggestion is that you think that private patients should not go to public hospitals. You are on the record having said it. The Leader of the Opposition is on the record having dreamed his utopian dream that everyone should have private health insurance. Our system will need to fundamentally change if he is going to make it work.

Let me have a look who else might be here. Do we have any Western Australian members? That is going a little bit too far away. In Queensland there are hardly any so we really are not going to be able to—

Honourable Members:

Honourable members interjecting—

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! There has been enough about football for the last couple of days. Let us get on with the MPI.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Even if it is good-humoured, I have to say I think it is a sad reflection that those opposite are only interested in talking about football when they have the opportunity to debate about our private health system and our public health system. I really think it is fairly pathetic.

The other thing that the shadow minister refused to mention and did not actually want to look at during his entire debate, where you might have expected that he would talk about those in the community who he thinks will be most affected by these changes, are the tax cuts that are being delivered by the government on 1 July in advance of these measures coming through. If the shadow minister wants to be honest about the impact on families, he should look up the tax scale of those who earn $120,000 as a single or $240,000 as a couple. When they stop receiving support for their private health insurance rebate, depending on the product that they have—anywhere between $300 to $500—most of them will receive three, four or five times that amount in a tax cut. You cannot in these circumstances say that these people will not be able, either on their ordinary income or when they take account of the benefits provided by the tax cuts, to afford to keep their private health insurance.

But we agree with those opposite that we want to keep people in private health insurance. That is why we are increasing the ‘stick’ if people on high incomes choose not to take out private health insurance. But that has not been mentioned even though it is a key part of the changes that we are making. Ultimately, I am disappointed that the shadow minister, with an opportunity to talk about serious health issues, came in and talked down the public health system. He wants to scare those eight million people who will not be affected in any way by these changes. He wants to pretend that we are not still spending billions of dollars every year on the private health insurance rebate when we are. He honestly wants the public to believe—(Time expired)

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

The reason for today’s MPI is fundamentally an issue of deceit. It comes across very rarely in politics that you have true barefaced deceit and this is just one of those moments. If you read out the statements by the then opposition health spokesman and the then aspiring Prime Minister, it is absolutely cut and dried. Ordinary people who do not live in this chamber or watch it every day will see the promises and the commitments made in private health to have been rock solid guarantees. You have erosion of that and the kind of deceit where you simply turn about on what you claim before an election in order to win and then tear it down immediately after. You see it very rarely. That is why it has to be highlighted and it will be today.

The second issue here about changing health outcomes being a slow process is quite right. But it was not this side of politics that went to the Australian people and said: ‘We will set a deadline. We will put a line in the sand at full time—to use a football analogy—and, by June 2009, we will be taking over the health system if there are not substantial improvements.’ Look at the words very closely. They did not say, ‘If there is not more investment put into health then we will take over.’ They simply said, ‘We will fix the health system.’ Those blanket promises were taken very seriously by Australian voters. They trusted in the Prime Minister that we would see a change. What you are witnessing today if you are listening in to this debate is a complete shift from outcomes in health that mean so much to every Australian to inputs. Now we have a Prime Minister who is utterly focused, more as a bureaucrat than a leader, on inputs. They are really just trying to conceal the very fact that the health system has not been improved at all. We can promise these enormous amounts of money from billion-dollar funds, from sources which the average Australian does not understand, but that is not making our health better.

If you go right down to my community, where we expected a change in health outcomes, they were promised a new helipad on top of the hospital. It sounded great. But it did not improve the health of the local community, so they built a waiting room for the waiting room. That didn’t improve things, either. The fundamental misunderstanding here is that inputs do not always mean improvement in outcomes.

In the time I have available I want to touch on five issues. PHI will be the main one, and the final one, but let us just look at what has been an utter fixation, verging on needing medical attention, on alcopops. When it comes to health, this government has virtually given no attention to anything except alcopops. We effectively have a minister for alcopops in this government who has abrogated any responsibility for the health system. On smoking, the perfectly legitimate proposal was put, as an alternative funding measure, to increase the tax by around three cents per cigarette. You would have thought the politburo of left-wing health economists would have rallied behind that but, no, they remained mute and this government refused to accept a simple proposition that could have supported our private health system.

I move on to cataracts. I did not choose a life as a cataract surgeon; I chose one here. But I know that many cataract surgeons across Australia spend enormous amounts of time delivering these kinds of services and making a loss in remote and rural areas. These surgeons will tell you, if only the government would listen, that it becomes virtually uneconomical to perform an operation for a Medicare rebate that is less than the mark-up on a pair of designer spectacles from an optometrist. Eventually, if you just keep trying to slash capacity and squeeze funding, there will eventually be some sort of kickback in quality. Without meaning any offence, what we have, effectively, is a health minister who is so far down in the caucus pecking order that it is unlikely we are ever going to get meaningful reform of health. That is just a political reality, and that may well be Australia’s lot for the next three years.

The greater problem here is that we have a health minister who is hostage to Treasury. We have a health minister who is selling Treasury cost-cutting measures more vigorously than any other form of health reform. It seems like the only things that come through the current health minister are basically Treasury minutes to save money. It is quite okay to say we have a global financial crisis, but let me make two points. First of all, there was, effectively, no means testing of stimulus payments. There was no targeting of stimulus payments towards those who needed them most. People who did not pay tax, the disabled and the unemployed effectively missed out. If your philosophical interest is one of looking after the battler, you would think you would have a concern with the stimulus payments and then you would think you would have some solutions after 18 months. When you choose your own deadline on performance, you would think we could see some improvement. I can show you every health report card that has come out in the last 18 months, and there are no significant improvements. That is a real problem for the government. Just ask all of the groups—they have been asked to comment. We know from the Private Hospitals Association the impact these changes will have. We know from the surgeons the impact they will have on waiting lists.

I want to draw attention to the changes to PHI and what they will do to the poorest of Australians. This is so detached from the government’s thinking that they do not realise that when people move from private cover onto the public system, for whatever reason—number them in your thousands if you wish—those people queue up at public hospitals or they turn around and elect to pay a much bigger gap. This is the great challenge of health delivery in all developed countries: even with insurance, there is a gap. What this health minister is doing is making those gaps for ordinary Australians chasing a cataract operation so much larger. What happens when gaps go up? The wealthy pay the gap and the poor do not. So what this health minister is doing in nickeling and diming the average Australian who is paying for their private health cover is simply guaranteeing that the wealthy can still pay for a one-off operation without paying private healthcare, and let it be someone’s grandparents, and the people who cannot pay that even greater gap miss out. A stark reality is that when you scrimp and save on Medicare rebates, the alternative to cataract surgery is blindness; the alternative to other ailments is untreated morbidity or early death; or the alternative is fewer quality years. It is quite a simple equation.

What we know from the report cards from the AMA is that there has been no improvement in the time the Prime Minister promised an improvement. We know there is no improvement in hospital beds, we know things are getting worse with cost adjusted separations and we know that people are waiting longer in the waiting room. We know there is juggling of waiting lists to make it better, but I think everyone listening to this debate knows that we are not seeing the improvements that we need to. I can almost imagine a conversation between the current health minister and the Prime Minister: ‘It is June 2009; where are we now with improvements in health?’ ‘Well, we have been really focused on the alcopop measure, and I need to remind you that that was a health measure, to reduce binge drinking. We have no figures on that whatsoever. We have a binge drinking problem that we had two or three years ago. We just have ordinary Australians drinking less alcopops.’ ‘Okay, well, we might need another reason.’ ‘Well, we have a prime minister out looking for hair dryers in Afghanistan and flying around the world annoying flight attendants, and he really has not been able to truly turn his mind to health the last 18 months.’ Once again, he made the promise to the Australian people of significant improvements in health.

Finally, what we have under the cloak of secrecy and hidden in the detail of the budget are these slashes to the very promises that were made before the election. Ordinary Australians have picked it up. They remember the promises. They did not have to be listening to the radio; they know the promises and they know that they are not being kept. To suggest that Australia is on the one hand performing so well in the global economic crisis and not slipping into recession but that at the same time we cannot afford to deliver basic health care is that dishonest contrast that I think becomes obvious to the Australian people. In answer to the health minister, who said ‘I don’t see why as a government we should be helping people earning over $75,000, tapering to $120,000’, the answer to that is simple: all around the developed world we have had one fundamental tenet in the delivery of social policy, and that is that we do not means test access to health. It is just one area where we try to keep some semblance of equity. That distributive notion upon which I thought that party was founded is actually disappearing. Sure, they can start to attack health, and the next moment they will be means testing education, and then they will be means testing welfare even more. This is the slow and steady creep of Labor ideology successfully veneered over by the Prime Minister at the last election campaign but it is now coming through. It is a very important to point to make, and it has been made in this MPI, because today marks that line in the sand—the promise made by our Prime Minister has not been kept.

In closing, as we go around the country people will see that where there was a promise for improved health care it has not happened. Where there was a promise to protect PHI we have seen thousands of families who are effectively going to be pushed off that cover, and that will have a snowballing effect. It affects people who otherwise were contributing large amounts of money out of their own pocket into health care; it affects those under $75,000, who have to pay higher rebates, and that is completely obvious; and, most concerning of all to me, when it comes to access to surgical services and waiting lists, he or she who can pay the gap will get the service. This is not the health system that anyone in this country deserves. (Time expired)

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

This has certainly been an edifying debate so far. We have had the member for Dickson come into the House, move a matter of public importance and pretend that the government does not support private health insurance when actually everyone on this side of the House supports a strong public and private health system. We are committed to strengthening not only private health but public health and the health system as a whole. We have also had the member for Bowman make statements that, ‘Everybody knows,’ ‘This is a fact,’ and ‘That is a fact,’ but he is not presenting any evidence whatsoever to back up the statements he makes.

Graham Perrett (Moreton, Australian Labor Party) Share this | Link to this | Hansard source

Puffery.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

As the member for Moreton says, it is puffery and he would know that the member for Bowman is an advocate of puffery because their electorates are near each other, and he would also have seen the performance of the member for Dickson. The member for Dickson is a man who is a slave to sectional interests. The alcopops debate showed how much he was in the pocket of the distillers. On the one hand it was put forward by the member for Bowman that we should not have supported the position we did on alcopops, and on the other hand he was quoting the AMA’s report card. I say to the member for Bowman that the AMA supported the government’s position on alcopops. They saw that it was a very important initiative. It has been read into the records of this parliament on various occasions by a number of speakers and that is fact, whereas the member for Bowman talks about ‘everyone knows’.

When it comes to the health insurance industry, we support private health insurance and we also support private hospitals. But we like to put a line in the sand between us and the private health insurance industry, whereas the member for Dickson runs to them all the time for advice. My question to the member for Dickson is: when is he going to stop being a slave to sectional interests and become a slave to the Australian people? When is he going to listen to the people of Australia and make decisions that are based on their interests? He is one of the most out-of-touch members of this parliament.

Let us be very clear here and make sure that all the people in Australia listening to this debate know what the member for Dickson wants. He wants people on low incomes to subsidise his private health insurance. He wants people that are earning a third of what he earns to subsidise his private health insurance. I do not expect that; I do not expect the people of Shortland electorate to subside my private health insurance.

The member for Dickson and members of the opposition generally have put forward a smear and fear campaign. They have put forward a proposition that this policy will have an impact on pensioners. Mr Speaker, show me a pension who is earning $75,000 a year. The member for Dickson is distorting the truth, he is not being honest with the Australian people and he has put forward a position that is just blatantly untrue.

The member for Dickson was a minister in the failed Howard government that chose to direct a large proportion of its spending on health to the private health insurance rebate. It ripped $1 billion out of hospitals, it closed the Commonwealth Dental Health Program and it claimed that it supported dental health through the private health insurance rebate. There are a number of people within Australia that received absolutely no assistance from the former government in relation to dental health. The former government put in place the chronic dental health program but there were only a very, very small percentage of people that could actually access it. There was a message for the member for Dickson from a GP in a coalition-held electorate which was that the program did not work, that it took a lot of time and effort and that the outcomes were very poor, and there were a number of people who missed out when they should not have. The government has a Dental Health Plan for all Australians but has been frustrated by the opposition. Further, when the failed Howard government was in power they allowed a chronic workforce shortage in the mental health area.

I want to place on the record that the Rudd government strongly supports a strong, vibrant public and private health industry, and that the member for Dickson is just full of huff and puff. He is all about looking after his mates. He is not about universal health care; he is about a two-tiered health system where people who can least afford it have to pay for basic health care. We on this side of the House believe that any decision on health should be based on need and not on the ability to pay, and I condemn the member for Dickson for his stance on this issue.