Mrs Bronwyn Bishop (Speaker) Share this | Link to this | Hansard source

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

The Government's unrelenting attack on Medicare and the damage it is inflicting on Australians.

I call upon those honourable 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—

Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

We saw it again on display in this question time. We know what the Prime Minister really thinks about this GP tax and what his plans really are for Medicare. He has said that he is committed to it. The new Minister for Health committed to a value signal, a price signal, on Medicare. The Prime Minister remains committed to the destruction of Medicare. Over the past 18 months he has committed to his GP tax at least 53 times. He has defended it as good and decent policy and necessary for saving the health of this nation. So the weasel words we are starting to hear from this Prime Minister, which he is using today, to say that he has shelved his GP tax today have, of course, only one aim in mind, and that is keeping his leadership on life support. Be in no doubt: that is the only reason. This Prime Minister is not proceeding with the $5 GP tax, not because he cares about Medicare, not because he cares about the health of this nation; it is because he cares about the health of his numbers in the next Liberal party room split. That is what this is all about.

Be in no doubt: this government is not standing up for Medicare. It is not abolishing the GP tax because it believes that it is the right thing to do by patients. It is doing so because there is no way that Labor would allow this destruction of Medicare to get through the Senate, so it knows it cannot get the policy through. And it has been at war with doctor organisations and with patient groups across the country, and that remains so today. The government and those backbenchers who are going back to their electorates today are kidding themselves.

What happened today is that the health minister got rolled. The health minister got rolled in cabinet and has been unable to deliver to the doctors at all. She got rolled and was not able to deliver to the doctors. She has had to ring them and say: 'I'm sorry. I'm sorry. The cabinet didn't actually do what I wanted.' That is what she has had to do today, which shows just how ineffective this health minister is in standing up against the Prime Minister, whose agenda is to get rid of Medicare, a universal health insurance scheme which we all pay into according to our means and draw down on according to our healthcare needs. If this minister thinks that she is going to be able to keep bulk-billing rates at the rate they are currently, with the policy she has just announced, a $1.3 billion continued cut to primary care, she is kidding herself. If she thinks bulk-billing rates are going to stay exactly the same and that it is going to be a system for people who are vulnerable, not just concession card holders—because there are people who fall $1 short of becoming eligible for concessional cards who have chronic disease conditions, who are trying to keep in marginal jobs, trying to keep an income, who will be affected by the policy this government has announced—she is kidding herself. If you think bulk-billing rates are going to stay at 82.3 per cent—and bulk-billing is important in making sure we constrain costs in Medicare—then you are kidding yourself. The Prime Minister, when he was health minister, presided over a collapse in bulk-billing rates. The only reason the Prime Minister, as health minister, had to do something about it was because Labor ran a very strong and effective campaign, and he was forced to do so. The then Prime Minister John Howard came in and put in place bulk-billing incentives.

We are going to see again, under this government's policies, a collapse in bulk-billing. It is happening already today. GP surgeries across the country—I have visited many, many of them—are already today changing their billing practices, not just for general patients but for concessional patients as well. They are saying that the government has sent them a very clear signal that it does not value general practice. It does not value our primary care system, because if it valued our primary care system it would not have tried to cut $3.5 billion out of it and to transfer every one of those costs onto patients.

The only reason the government has been forced to back down on one element of its GP tax is because Labor has stood up against it, and because the Prime Minister is trying to salvage his job. He knows that this policy does not have popular support. It does not have doctors' support. And, now, it does not have the support of his backbench, because they have realised the damage it has been doing in their electorates to their own jobs and to their own votes. The damage that it will do to the healthcare system does not seem to have entered this government's mind one iota.

We have seen from this government several iterations of this GP tax. First we had the $7 GP tax. Then we had the policy that would have seen $20 ripped off doctors and passed onto patients—a $20 GP tax. Then we had the $5 GP tax and the four-year freeze to indexation, which the government is now continuing. This amounts to cuts to Medicare by stealth, now. The government is presiding over the destruction of our universal health insurance scheme. And be in no doubt: today that absolutely continues.

The Prime Minister, on no fewer than 53 occasions, said that he thinks it is an absolute priority for health policy. In fact this is the only health policy the government has. I admit the new health minister has only been in this job for six weeks now—or a little bit more than that. She has been brought in to try and salvage a bit of the mess that has occurred. I get that she is new to health policy. And I get that suddenly she is finding herself in a space that is really complex.

But they had six years in opposition. The came to government with no plan for health policy. How embarrassing! After 18 months in government members of the government are now saying, 'We're going to consult about health policy.' What were you doing in opposition for six years? What were you doing then, and what have you been doing for the last 18 months in government? For those 18 months in government you have been at war with doctors, trying to absolutely smash Medicare. The government continues to do that, not understanding the complexities of what they have done.

Let's have a look at what they have done across the entire health system. There have been major cuts, with $57 billion in cuts to public hospitals. Those cuts are already starting to hit in every public hospital in this country. There has been $300 million taken out of preventative health. Over $600 million has been taken out of dental health. And there has been an attack on the Pharmaceutical Benefits Scheme, transferring costs onto patients by increasing the PBS co-payment. That, again, is something we are standing against in the Senate.

What you have seen from this government is an attack across the entire health system. They have targeted $3.5 billion worth of cuts to primary care and to general practice but they have also cut billions of dollars across health. Now sitting on the table they have to find $800 million. There has been speculation in the newspapers today that they will be finding that out of the public hospital system. There is that $800 million, and a $1.3 billion cut still sitting there on the table.

Be in no doubt: what this about today is the Prime Minister trying to shore up his job. It is not at all about the health of this nation. We know that the Prime Minister has said on several occasions—53 of them—that this toxic GP tax is good policy. The health minister again today has said that the GP tax is good health policy. Be in no doubt: the government do not actually want to change this GP tax, and there is only one reason they are here today. If they had been able to get this through the Senate it would be in place today. Be in no doubt: this is exactly what this government wanted to do.

We know that this government has not learnt a single thing from its attacks on primary care. They still believe in the GP tax. Ridiculously, the Minister for Health is now calling it a 'value signal'. I can tell you this much: you do not value general practice by cutting $3.5 billion out of it. What sort of value signal do you think that sends to every single GP in the nation? I am sure the minister has been hearing it every time she sits down in a GP surgery across the country. In many of those small kitchens in GP surgeries they will be telling you, pretty loud and clear, that they have never been so angry at a government policy, and never so angry at a government.

The GP tax has been wrong. Why has it taken until today for the government to acknowledge it? It has been eight or 10 months since the budget. They have taken this long, because this is all about the Prime Minister's job. Be in no doubt: when the New South Wales election is over and the heat is off them in New South Wales, when the Prime Minister has maybe managed to shore up some of his numbers in this place—maybe he will manage; maybe he will not—he will do this again. There is no doubt. This attack on Medicare is in the DNA of the Liberal and National parties and they should own it every single day.

Sussan Ley (Farrer, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

I listened with growing amazement to the shadow minister. There was a string of invective, nastiness, gossip and innuendo. If the shadow minister characterises doctors and medical professionals with a certain view why is she not quoting them? If people are saying these things, why is she not giving direct information? Why is she just saying, 'I'm reading it in the newspapers,' or 'This is what we know is in the DNA of the Liberal Party.' She is saying, 'This is what we think you should do.' There is a possibility in an MPI to have a constructive, real debate, and we should start it with Medicare itself, and we should start it by understanding the principles upon which Medicare was founded, and the principles by which we, as Liberals and Nationals, are determined to sustain Medicare. If you are in charge of a system of government spending that goes from $8 billion to $20 billion to $34 billion and has as its source of revenue, partly, the Medicare levy, which every year falls further and further behind in its contribution to that source of revenue, then you should ask, as responsible managers of economic policy, 'What should we do to keep the system sustainable?'

If we do not keep the system sustainable, it will collapse, and that is the last thing any of us wants. That is an area that the shadow minister and I actually do agree on. Sometimes it seems to me that Labor just wants to say, 'Hands off; we'll sit on our hands; no problem; everything will just be okay.' No, everything will not be okay, unless we work at this. And we have never said it would be easy. Nothing is easy when you come into government. The shadow minister asked what I was doing for six years. I was sitting over there on the opposition benches watching with horror and amazement while one Prime Minster followed by another Prime Minister followed by the same Prime Minister flung money out from carefully secured asset funds, secured by us, in government, by the Treasurer, attached to the Future Fund, meant for investments in the nation's long-term wealth. It was flung across the country in extravagant, unnecessary, poorly targeted projects. And I use that word with reluctance, because some of them barely did make the title of projects.

So, that is what we did while we were in opposition. And now we are in government, and I do not need to be lectured to by this Labor Party and this shadow minister about what it means to have to run an economy responsibly. Now, there are some areas that the shadow minister and I do agree on, including that doing nothing is not an option. I thought that perhaps the shadow minister was running the line of her leader, which is that everything is okay with Medicare. But a couple of weeks ago, on Sky News, she actually said that the opposition would be kidding itself if it did not recognise that there were challenges in the budget and that savings needed to be found. The shadow minister then said that there is no area that is going to be exempt. So, everything is in scope, shadow minister, when it comes to your savings.

We are simply doing what good governments do: consulting, listening, hearing, learning and acting. That is what the public would expect of us. So yes, I did go out there to consult on a policy that involved a $5 cut to the rebate and an associated optional co-payment. I told it like it was, I talked to general practice, they talked to me, and we came away and revised our policy. I actually think I have a pretty good relationship with the doctors and health professionals of this country. The fact that you could not quote a single one bagging me out for this measure means, I think, that we are getting appreciation for doing this. Contrast that—

Ms King interjecting—

Well, if you want to make policy by Twitter, you probably would not make very good policy. But let's contrast that with the Labor Party. They brought in a tax that they never consulted anyone on, that they did not listen to the Australian people on. This is the electricity tax. They brought that in, and then when people said they did not want it they ignored them. They left it alone and it did untold damage until we got rid of it. That is Labor's approach to listening, consulting and acting—that is, not doing any of those things. I am proud that we are a government that listens, consults and then acts. That is a good thing to do. That is what good governments should do.

The shadow minister also characterised the pause in indexation of the rebate to GPs and non-GPs, which I concluded today that we were continuing with, as a 'sneaky attack on Medicare' and 'evidence that we want to kill off Medicare' and 'evidence that we don't want Medicare to survive'. The shadow minister characterised the pause that will continue while we consult as a sneaky attack on Medicare. So, how does the shadow minister characterise her own statement, only a few days ago, when she said about the indexation freeze, 'We did it, and we will own that we did freeze rebates'? That makes absolutely no sense. So, is the Labor Party now saying that it is carrying on a sneaky attack on Medicare itself? I do not know. It does not make sense.

This is a serious issue, and I want to address more remarks that the shadow minister made, and they were about bulk-billing. We are determined as a government to protect bulk-billing for the vulnerable, and I recognise, as the shadow minister has said, that there are people on low incomes who do not qualify for concession cards and for whom the cost of going to the doctor is difficult. I care about those people, just like you do. That is another area we agree on; we are finding a few more areas of agreement. Hey, we might be working together soon in some areas of public policy that matter to the Australian people! But the levels of bulk-billing for those who can afford to pay a modest contribution to the cost of going to a doctor are too high. More than seven out of 10 non-concessional patients are bulk-billed when they go to the doctor.

Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

No, that is wrong. You are confusing services and patients again. Services are not patients.

Sussan Ley (Farrer, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

Over 70 per cent of episodes of care to non-concessional patients are bulk-billed. What that tells us is that there is a cohort of people with the ability to pay a modest contribution to their medical services who are in fact paying nothing. Remember this: behind every bulk-billed consultation there is a government fee. There is a cost to government, and that payment to government is coming from a government increasingly constrained in our ability because of the national accounts left to us by Labor.

So, I say to the shadow minister: if you are comfortable with the level of bulk-billing for those who can afford to pay a modest contribution, then you should stand up and say that, because that is an unsustainability in Medicare that you as members of the Labor Party should not support. You are the party of means testing. You are the party that says that if people can afford to pay then they should. But you are now the party that is saying, 'It's okay; everyone can have a bulk-billed consultation.' When we say that Medicare is universal in coverage, that does not mean that it is free. But it does have built into it a strong equity argument, and that equity argument is an important one.

If we are to keep Medicare sustainable, equitable, simple to administer and universal in coverage, we need to understand that the cost of bulk-billing for those who can afford to pay is too high. Behind every one of those bulk-bill consultations lies a payment, and governments do not have money—

Opposition members interjecting—

Shadow minister, I did not interrupt everything you said. I know it is a tactic of yours at the dispatch box—

Ms King interjecting—

I said one thing—I said we had sat here and listened to you rack up debt—but I did not sit here and interrupt the way you have. I know that you are probably concerned because I might be about to reflect on your time as regional infrastructure minister. You are probably hoping that by presenting a wall of noise I will not get to talking about your time as regional infrastructure minister. Do you remember when the audit committee had a close look at the things you did and found that they were not quite right and that you used ministerial discretion in a way that it never should have been used in distributing funds to government projects and programs? You certainly did not do a very good job.

There is an important issue here. There are areas that the government and the opposition agree on—we do want to sustain Medicare, we have listened to the professions and we are committed to working with the professions. While, I admit, we paused the rebate, the opposition has determined that it will freeze the rebate, because it admits that it owns that policy. We are saying that we will pause it, we will consult, we will continue the discussions that we are having around the country, with one aim in mind—to make sure that the Medicare system, of which we are all so proud, is kept on a sustainable footing to protect the vulnerable and to make sure that those who cannot afford to go to the doctor are supported, as they should be, by sound government policy.

Stephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Link to this | Hansard source

Mr Deputy Speaker, you cannot imagine the excitement that rippled through the opposition benches when the Minister for Health stepped up to the dispatch box. We anticipated this was truly going to be a red-letter day—this was going to be the day when the Minister for Health unleashed the fourth health policy that the coalition had put before the Australian people in no less than four months—that is right, four health policies in four months. If we wound it back to the election, it would have been the fifth health policy since they had occupied the Treasury bench. We all remember the solemn promise of the Prime Minister that there would be no cuts to health and no cuts to Medicare. That lasted until budget night in May, when the Treasurer stood over there and dropped the budget night bombshell that there was going to be a $7 co-payment. He argued for it passionately, as did his former minister for health. When we on this side of the House pointed out that this was going to have a terrible impact on pensioners and sick people and old people, the Minister for Health defended their policy saying, 'That's right— but we can't exclude them because pensioners and sick people and old people go to the doctor and if we exclude them we won't get the revenue from the GP tax.'

That lasted from May until November, and at the end of November, after parliament had packed up for the year, we saw the November step-back. This was a lonely, orphan policy because it was the policy under which they were going to convert the $7 co-payment to a $20 slashing of the Medicare rebate. I say it was an orphan policy because nobody would own up to it. The health minister was pointing at the Treasurer, the Treasurer was pointing at the Prime Minister and all of them were saying they didn't own it, it was not their idea—it was somebody else's. It was an orphan of a policy, and little wonder that the health minister interrupted her sojourn to the Australian Open to introduce her own little foot-fault, the GP tax mark IV. This was a policy that lasted not four weeks—it did not have the stamina to last four weeks. He we are on this red-letter day when we were expecting the government to announce their fourth policy in four months, and still they have provided no detail to the Australian people and no detail to the Australian parliament.

It is quite clear from this sorry passage, from the last election to today, that, being as committed as they are to their GP tax, it is as difficult to dump as their own Prime Minister. We can imagine the hope that many of them had on the backbench—they thought that if they could not dump the policy because the Prime Minister was so wedded to it, perhaps they could put all of their faith in the Duke of York, the member for Wentworth—the Duke of York, the member for Wentworth, who so recently marched his troops up to the top of the hill and then marched them back down again on Monday. They had hoped that the Duke of York was going to rescue them, until they heard him say this:

I support unreservedly and wholeheartedly every element in the budget.

He went on, thundering to Alan Jones:

Every single one … I support every element, of course, including the Medicare co-payment.

There we have the Duke of York, the alternative Prime Minister upon whom the backbench based their hope that if they dumped the Prime Minister they could also dump the GP tax—but that was not to be, because he was as wedded to this horrendous policy as the current Prime Minister. Here we all were, thinking that today, on this red-letter day, after four goes at getting a health policy, they were going to provide some detail and some information. Our hopes were dashed. We got a preschool lecture from somebody masquerading as a health minister, and we are still waiting. We can imagine what is going through the minds of the people of Australia tonight— (Time expired)

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

I would classify the speech of the member for Throsby as hypocrisy and the pot calling the kettle black. It was full of emotion, froth and bubble—it was more like a lather. I remind the House of a quote from a minister for health:

By targeting funding, prioritising spending and making tough but responsible decisions, we are ensuring that health spending is focused where it can be of greatest help to Australians most in need and at most risk.

Now, that was not us. That was the last minister for health, in the ALP's 2013 budget, in which they took $160 million out of Medicare payments in the first year, then $664 million in the forward estimates, in their last budget. They introduced a pause in indexation, as was elegantly outlined by the current Minister for Health. On one hand they come in and have an emotional speech, rather than a logical speech, criticising the pausing of indexation, but then we realise that it was initiated by the ALP.

Not only have they attacked the Medicare system and had the hide to come in here and criticise our initiatives to fix the budget deficit and debt left to us as their legacy, they have a long history of attacking health management in the country. They attacked health insurance on many occasions. They means tested the rebate on private health insurance. They may have an ideological problem with it, but the reality is that it delivers health care for so many people. If these people were not in private health insurance, the public health system in the hospital scene would be absolutely swamped. Australia has a dual system—a mix of private care and public care. Yet, they keep trying to blow up one half of it. They means tested the rebate in 2009 and 2011; they also attacked the Lifetime Health Cover rebate. They changed indexation to attack private health insurance by stealth. Look at the PBS—one of the other pillars. They politicised the PBS and stonewalled decisions and recommendations by the PBAC. Since the coalition has been in power, over 388 drugs have listed by us. With medical research, which this country is extremely good at, in 2011 they tried to sneak $400 million out of the NHMRC. People were awake to that and, fortunately, it was shelved. But then they returned in 2013 and took $140 million out by clever accounting—by delaying payments for a month or two in the hope that no-one would notice. Talk about hypocrisy.

We have listened and we have consulted. There has been a change of health minister. There are no problems with that. Things like that happen in every government. The previous government had six ministers for small business, for goodness sake. So they have no credibility at all in talking about defending the Medicare system. Because we have listened, there has been a removal of the co-payment. When situations change, governments are meant to listen to their voters. We have certainly done that. We will continue to consult and take the Australian populace and the medical profession with us in these difficult times. We have inherited one almighty mess in the financial sphere. You cannot make any good decisions as a government unless you get your books in order. So we have to do that.

We value general practice. Every patient values what their general practitioner does. That is why we have listened. It was disturbing in a major way the business model of how most general practitioners work. We recognise that. There is no sin in that. That is common sense. We are all about delivering solutions. To get to the nub of it—

Pat Conroy (Charlton, Australian Labor Party) Share this | Link to this | Hansard source

Real Solutions?

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

Real solutions means managing to pay your way.

Pat Conroy (Charlton, Australian Labor Party) Share this | Link to this | Hansard source

Show us your booklet.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

And, as a government, we have been living on— (Time expired)

Nick Champion (Wakefield, Australian Labor Party) Share this | Link to this | Hansard source

) ( ): The other day I was in the backyard with my little dog, Baron, and he was running around—all around the backyard—chasing after three tennis balls. Eventually, he got so excited he threw up at my feet. And then there was this pause—

Government members interjecting —

Bruce Scott (Maranoa, Deputy-Speaker) Share this | Link to this | Hansard source

Order!

Nick Champion (Wakefield, Australian Labor Party) Share this | Link to this | Hansard source

There was this slight pause, and his ears went back. There was this look of shame as he ate his own vomit. Now, you cannot blame the dog for this. You cannot blame Baron for doing it because it is in his DNA. Just as it is in Baron's DNA to return to his own vomit, it is in the Liberal Party's DNA on health to attack Medicare—to hate Medicare. It is in their DNA. That is why in the Fraser years, in 1975, they promised to keep Medibank. In 1978 they charged a co-payment of $20. In 1981 they abolished it. In the 1980s Howard called Medicare a 'miserable, cruel fraud.' He promised to pull Medicare right apart. This is the hero of the Liberal Party. Fightback! We remember how Fightback!, on page 7, offered to end bulk billing unless you were a pensioner or a concession card holder—that is, a price signal. It was written in the document, there in black and white. Go and have a look at it.

Then, of course, we have Mr Abbott at the last election with Real Solutions. All those opposite went to the election with their little document. There was nothing about a $7 dollar co-payment in there. There was nothing about a $20 co-payment in there. No was nothing about a $5 cut to rebates in there. There was nothing about Medicare at all. But what do we have in government? We have it off again, on again. First, we had the $7 co-payment. And it was not just $7. It was $7 every time you go to a GP; $7 every time you get a scan; $7 every time you get a blood test—seven times seven times seven. That was what it was going to do. If you were diabetic, had asthma or some other recurring problem, you were going to be charged not $7 once but over and over again.

Eventually, the penny dropped in the Liberal Party and the panic set in. They worked out that the public was not all that keen on that. So what did they do? They went to the next phase. The next phase was, 'We'll just hack into the doctors' rebate. We'll just hit—

Alan Tudge (Aston, Liberal Party, Parliamentary Secretary to the Prime Minister) Share this | Link to this | Hansard source

What has this got to do with the dog vomiting?

Nick Champion (Wakefield, Australian Labor Party) Share this | Link to this | Hansard source

I will get to that. I will take that interjection. I will get to that. It is an interesting story.

To avoid the Senate, they did it by regulation. They said they would introduce it on 19 January. We all know that that was an attack on fee for service. It was an attack on every general practice in the country. It was going to force GPs to be the bad guys. GPs were going to have to introduce a fee. They were going to have to collect the money.

Alan Tudge (Aston, Liberal Party, Parliamentary Secretary to the Prime Minister) Share this | Link to this | Hansard source

What about the vomit?

Nick Champion (Wakefield, Australian Labor Party) Share this | Link to this | Hansard source

I will get to that. So what we have is a God-almighty mess. It is in the Liberal Party's DNA. They have been at this for a long time—attacking universal health care, attacking Medibank and attacking Medicare. That is what they do. That is why we have had Prime Minister Abbott on 53 separate occasions saying things such as, 'It is right and proper to have a modest Medicare co-payment.' That was said in question time. He has said these things 53 times, I am informed. He asked 3AW, 'Why isn't it fair enough to have a modest co-payment for Medicare?' This is what the Prime Minister says, and this is why the Liberal Party cannot be believed.

The members opposite ask what this has to do with Baron. Well, just like it is in Baron's DNA to go back to his vomit, the Liberal Party are going to come back to this co-payment. They are going to return to it over and over again. You may believe them at the next election when they promise to keep Medicare, but I can bet you this: if they are in government, then in 2016 or 2017 the co-payment will be back and the attacks on Medicare will be back. They have been at this for 30 years. They will do it again. (Time expired)

Andrew Southcott (Boothby, Liberal Party) Share this | Link to this | Hansard source

I think it was Paul Keating who used to talk about dogs returning to their vomit. What we have had is Keating-lite. The wannabe member for Wakefield somehow sees himself as the inheritor of that tradition. This seems to have escaped members opposite, so let me just restate it. It has been the Liberal Party's position for the last 20 years that we support Medicare, we support bulk-billing and we support community rating for private health insurance.

I noticed in the previous speaker's long discourse on the last 40 years that he completely ignored the 11½ years of the Howard government and its very strong record on health.

Mr Champion interjecting—

You mentioned the bulk-billing incentives, Member for Wakefield. We invented them. We invented the incentive for concession card holders. Who invented the concessions for children under 16? Was it Neal Blewett? No. Was it Brian Howe? No. It was the Prime Minister when he was Minister for Health and Ageing.

Also, elements in Medicare that we are strong supporters of are access to the Pharmaceutical Benefits Scheme, free access to public hospitals and universal access to the Medicare rebate. I do not know how many speeches I have stated this in over the last 20 years. Not only did we strongly support Medicare when we were last in government; we improved it. We greatly expanded access in the area of mental health. What did the previous government do? What did the Rudd-Gillard-Rudd government do? They started cutting back some of the rebate that we had given on mental health. We expanded the access for allied health professionals in the areas of team care arrangements and chronic disease management plans. It was also the Prime Minister when he was Minister for Health and Ageing who decided to expand Medicare to access dental services. He understood that people needed access to restorative treatment. That is one thing we did.

In question time, the Minister for Health said—and I think it needs to be restated—that we value general practice and we value primary health care. This is the important part of our health system. We have 43,000 general practitioners. It is very important that we continue to see general practice as a valued and rewarding path for medical students to go into.

A number of other similar countries to us, such as New Zealand, the UK and Canada, have looked at reorienting their system towards primary health care. I pay tribute to the previous government for initiating the National Health and Hospitals Reform Commission. It published an enormous amount of work and a primary care strategy. The reform commission was chaired by Christine Bennett. All of this work was done and then what happened was that Kevin Rudd got it completely wrong and focused on hospitals and not on primary health care. It is very important that we reorient our system towards primary health care.

When you look at how we have performed over the last 25 years, you can see we have done very well on mortality rates, cancer survival rates and so on. We compare very well with other OECD countries. We are improving our rankings on all of those things. But the challenges we will face in the future will be in the area of management of chronic diseases such as diabetes and others.

This is a question I would pose for members. We have had a good debate here about Medicare, but we need to start thinking about what we are getting for our money. We need to be asking: how we can improve the system? I think there are a number of mechanisms through which we can improve coordination and care, such as through the new Primary Health Networks. If you look at New Zealand and the UK, they use these mechanisms very much. There are the blended payments with the practice incentive payments. Again, there are a number of mechanisms through which we can see improvement. We have a good primary health care system. There is no doubt about that. We have great health system in Australia. There is no doubt about that. But there are a number of improvements we can make to face the challenge of chronic diseases and how we keep people out of hospital. (Time expired)

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

The one thing that every Australian knows is that, when it comes to health, you cannot trust the Abbott government. The one thing they know is that, if there is a way to undermine Medicare, those on the other side of this parliament will find it. They have attempted to do so ever since they were elected. Their first attack came in the May budget, and they have had to back away from it now. The one thing that you know is that you cannot trust the Abbott government, or any Liberal government, when it comes to health. I will have to admit, the government's attack on Medicare did achieve one thing. It actually united doctors, patients, pensioners and even children. It united all sections of the health system against this government's mean, evil-spirited attack on Medicare—its failed attack.

Today, the government announced that it would not proceed with its unpopular Medicare tax. But who believes that? No-one on this side of the House believes that. All they have done is push the pause button.

An opposition member: That's right. The New South Wales election must be on.

Yes, the New South Wales election must be on. They have paused it and they are going to wait until they have the numbers in the Senate or, alternatively, until after the next election, when they will try to sneak through a co-payment, a value signal, a price signal or whatever they want to call it. Those on the other side of this House do not believe in Medicare. They do not support universal health care and they will use any and every opportunity to undermine it.

When Tony Abbott was the health minister, he used to stand up in this parliament, at the dispatch box, smirking—literally smirking—saying that the Howard government and he himself were the best friends that Medicare ever had. We saw what sort of a friend he was. In the Shortland electorate, bulk-billing plummeted to under 60 per cent. You might ask what the bulk-billing rate was when Labor's term in government finished. It was 82 per cent—what a contrast. Can you ever believe a man that stands up and says he supports Medicare, when every action that he has ever taken has been an attack on Medicare? Now he thinks the Australian people will say, 'Hey, we've listened and we've learnt.' They know that at every single opportunity, those on the other side of the House will be back attacking Medicare.

An opposition member: That's right. It is in their DNA.

It is absolutely in their DNA. They do not know how to support universal health care. They believe that only those people that are 'worthy' welfare recipients—make sure they are worthy though—should be entitled to go and receive bulk-billing from their local doctor. They do not acknowledge the fact that every Australian contributes to Medicare through the Medicare surcharge. We pay for Medicare. Medicare is an Australian institution. Medicare guarantees that all Australians can access health care when they need it, not when they can afford it.

Medicare is the backbone of our health system, and those on the other side of this House have only one agenda: to attack it and, finally, to reintroduce a co-payment or, as it really is, a GP tax—a tax on the sick, a tax on the chronically ill, a tax on the elderly and a tax on children.

Andrew Nikolic (Bass, Liberal Party) Share this | Link to this | Hansard source

I was going to resist the temptation to be too hard on those opposite, but there is frankly too much material that we have heard this afternoon and it is far too tempting. We heard the member for Wakefield who claimed to save Holden. But given five minutes to talk about how we might save Medicare, he spent about half of his speech talking about his vomiting dog—extraordinary! The member for Throsby, while the health minister was speaking, said that we should pay more attention to Twitter when it comes to healthcare policy. We should pay more attention to Twitter? I know that Twitter is a source of much progressive policymaking on the left of politics, and the member for Throsby obviously supports a Twitter-led approach to policy development, but 140 characters is superficial and unsatisfactory when it comes to the big strategic issues confronting our country. I was most interested to see the word 'unrelenting' in the motion by the member for Ballarat because she and members opposite have been unrelenting in their unwillingness to address the strategic problems confronting our country. Health care is one of those areas.

By any measure, health care requires urgent attention. There is an abundance of evidence to say that in the last decade, our spending on health care has more than doubled, from $8 billion to $20 billion. We have heard members opposite claim there is no problem with Medicare, but we only raise half of that through the Medicare levy—about $10 billion. There is a structural problem that we need to fix. Spending is projected to climb in the next decade to $34 billion. So when we say it is a strategic challenge deserving of strategic leadership, it is because of the unmistakable fact that the healthcare system we established in July 1975 no longer meets the needs of our community today and, more importantly, into the future. It is a challenge that deserves extensive consultation to understand the friction points of why that economic problem will persist into the future and to identify areas of waste, and how to ensure the future sustainability of the system. The Minister for Health, Sussan Ley, is doing a great job. She was in Launceston only a few weeks ago, visiting the Launceston Medical Centre, sitting in a room with a whole bunch of GPs in my electorate and having them tell her what they think the issues are. As Minister Ley says, quite correctly:

Doing nothing is not an option.

My message to those opposite is: enough of the shrieking—

Mr Champion interjecting—

mendacious claims about the destruction of Medicare. It represents an appalling lack of composure from a party that once understood how important it was to address the big strategic issues of our country.

Nick Champion (Wakefield, Australian Labor Party) Share this | Link to this | Hansard source

Don't lecture us.

Andrew Nikolic (Bass, Liberal Party) Share this | Link to this | Hansard source

And I say to the member for Wakefield—or 'the persistent interjector', as he is known in this parliament—if you are not going to listen to us, listen to Bob Hawke, Paul Keating and John Howard, who on 1 January this year, the start of the new year, said in The Australian that in the past, the not-too-distant past, both major parties of this parliament used to actually approach some of these big strategic issues in a bipartisan way. I say to the member for Wakefield and his colleagues: work with us to address the future sustainability of Medicare, to improve patient outcomes and to respond to the challenges of an ageing population.

The Intergenerational report is going to point to some of those challenges. I often use, as a canary-in-the-coalmine insight into what lies ahead for this country, what is happening in Japan, which has a major ageing-demographic problem. In Japan at the moment, the sale of adult nappies exceeds the sale of the baby variety. In Australia, the consequences for health care, the consequences for the Pharmaceutical Benefits Scheme and the consequences for residential aged care are profound. To say we should not have to do something about that is simply burying your head in the sand.

People who can contribute to better outcomes in that area are in this room. The member for Wakefield and his vomiting dog, if he likes, can be part of that solution! People who can make a difference in that area are in our hospitals. My daughter is a young doctor and my wife is a career nurse; they can point to some areas of the healthcare system where we can really make a difference. People who can make a difference are in the GP practices and clinics.

I say to those opposite: if you don't like the coalition proposals to make health care sustainable, tell us what your alternative is. I am listening. We want to work together— (Time expired)

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

Before the election, this government said there would be no cuts to health, education or pensions. After coming to government, it proceeded to trash each of these election promises. Now the Prime Minister says he has changed his mind about the GP tax, the Medicare co-payment. Why? Is it because he has realised that you have to keep your election promises? No. Is it because he has realised that it is unfair to poorer and sicker Australians? No. The Prime Minister says it is because he has remembered—'remembered', if you do not mind—from his days as health minister that you cannot do anything without the support of the medical profession. This is a remarkable response. The only reason we do not have a GP tax right now is that Labor and the minor parties blocked this tax in the Senate. What a lame and unconvincing backflip this is. If it were in the sport of diving, it would be a complete belly whacker. If the government could get the support of Clive Palmer and the other crossbench senators, they would do it. Make no mistake about it; they would do it in a heartbeat.

The Prime Minister said in question time:

… the co-payment is dead, buried and cremated.

Now, where have we heard those words before? Yes, that is right; we heard them concerning Work Choices. But we know that the government are itching to bring back Work Choices. We hear a constant drumbeat from members opposite about penalty rates, individual work contracts and employers' dismissal powers. Just as they want to bring back Work Choices, in their hearts they still want to introduce a Medicare co-payment, a GP tax. Just wait a few days. We will get the Intergenerational reportthe member for Bass let the cat out of the bag here. The Intergenerational report will be a dodgy document where those who are digging a hole for Australia will ask to be given a bigger shovel.

Deputy Speaker, one of the things you will hear—indeed, we heard it this afternoon—is that our health expenditure is unsustainable and that consumers need to contribute more. But this comes from a government for whom Medicare and health spending are not priorities. Their priority is to cut corporate taxes. They could find more money by cracking down on multinational tax avoidance, as Labor would do and as we outlined in detail yesterday.

The government's attack on Medicare is not confined to the GP tax. They are in the process of cutting more than $57 billion from Australia's public hospitals and they have cut $368 million from preventative health programs to tackle obesity, smoking and alcohol abuse. According to the results of a global study into obesity rates published in the medical journal The Lancet, almost a quarter of the country's children and 63 per cent of the adult population are now deemed overweight. In my own community of Wills, diabetes is a major concern, with Moreland ranked fourth in metropolitan Melbourne, with 5.3 per cent of residents suffering the disease. Wills has been named by the National Stroke Foundation as Australia's 10th highest hot spot for strokes, with an estimated 106 deaths in 2014. The slashing of preventative health programs is short-sighted and shameful, and there is no prospect that, under this government, costs for patients will be contained. The Rural Doctors Association of Australia has said this afternoon:

… RDAA remains concerned about the Government's current commitment to maintain its freeze on the indexation of Medicare rebates paid to patients.

This 'Big Freeze' has the potential to increase costs for patients to a greater extent than the proposed co-payment, with the resultant restrictions and difficulties in accessing primary care services.

It will also put increased pressure on the viability of many rural practices.

Freezing indexation on these rebates is a one way road to nowhere and a seriously false economy… many practices will be forced to continue to raise their consultation rates …

I am proud to be a member of the Labor Party, which established Medicare over the strenuous objections of those opposite. We have continued to defend Medicare from the efforts of those opposite to subvert, undermine and white-ant it any time in the last 30 years when they thought they could get away with it. They never change. It is still our job to protect Medicare, and we are as committed to this task as ever.

Fiona Scott (Lindsay, Liberal Party) Share this | Link to this | Hansard source

It is quite an honour to speak on this matter of public importance on Medicare, but I am wondering where the shadow minister who brought it before the chamber is. If it is so important, where has she gone?

Opposition Members:

Opposition members interjecting—

Bruce Scott (Maranoa, Deputy-Speaker) Share this | Link to this | Hansard source

Order! On my left!

Fiona Scott (Lindsay, Liberal Party) Share this | Link to this | Hansard source

Is she in her seat? No.

Ms Hall interjecting—

Bruce Scott (Maranoa, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Shortland is being very disruptive.

Fiona Scott (Lindsay, Liberal Party) Share this | Link to this | Hansard source

Is she at the despatch box? No. Where has she gone?

Mr Champion interjecting—

Bruce Scott (Maranoa, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Wakefield might find himself out of the chamber.

Fiona Scott (Lindsay, Liberal Party) Share this | Link to this | Hansard source

She wanted answers from the government. We are all here, ready and waiting to tell her, but she has disappeared.

Andrew Nikolic (Bass, Liberal Party) Share this | Link to this | Hansard source

It is her matter of public importance!

Fiona Scott (Lindsay, Liberal Party) Share this | Link to this | Hansard source

It is her matter of public importance. Is she at the despatch box? No, I don't think so. Maybe she is back in her office with her feet up on the table, having a Tim Tam and a cup of tea. That is where the shadow minister for health is. It is a matter of importance to her but she is not in the chamber even to hear about it.

Andrew Nikolic (Bass, Liberal Party) Share this | Link to this | Hansard source

The chamber is clear!

Fiona Scott (Lindsay, Liberal Party) Share this | Link to this | Hansard source

In fact, the chamber is clear. There are only three opposition members left, plus a couple who are leaving. Clearly the opposition do not think this is an important issue. It is lucky that the government is committed to the sustainability of Medicare.

Medicare costs this country over $19 billion a year. In fact, Medicare has doubled in the last decade, from $8.6 billion in 2003-04 to $19.1 billion in 2013-14. Over the next decade Medicare will see an increase of about 80 per cent, with spending projected to reach $34 billion by 2023-24. If you average that out across every single Australian taxpayer—the first $2,000 tax you pay goes towards paying for Medicare. I think that that is a great thing, but it is a lot of money. Can we afford to continue to pay that amount in the future and then see that much of consolidated revenue go to Medicare? In 10 years time the $2,000 will have blown out to $4,000 a year for every single taxpayer. How are we going to look after the sustainability of Medicare for our children and our grandchildren? In fact, we are stealing from our children and our grandchildren.

If Labor is truly honest about Medicare they need to plan and tell us their vision for this blow out. How are they going to plan for the blowouts to Medicare as our population ages? It is crunch time. It is time for the responsible government that we are to make decisions to make Medicare sustainable well into the future.

Those opposite have already straddled us with what is projected to be a $300 billion debt cheque. Labor has made such a mess already of the budgets that we are cleaning up. We need to look at how we are going to support Medicare. We need to look at the health of future generations.

I commend the Treasurer, the Minister for Health and the former Minister for Health for establishing a medical research fund. In Western Sydney we are building a medical research facility. We are pairing with international institutions such as the Beijing University of Chinese Medicine, with which we will be looking at how you can fuse Eastern and Western techniques. The medical research fund will provide Australia with the opportunity to have a healthy population and also to lead the world in medical research. It is important for Australia. It is important for jobs. It will create jobs for people right around our country. The science park we have built in Luddenham will mean 12,200 jobs in the medical research space. There will be a further 10,000 students who will be studying medical research. Sydney Science Park in Werrington will create a further 6,000 jobs in medical research.

Those opposite are not interested in technology. They are not interested in looking after the country. They are not interested in how they are going to make Medicare sustainable well into the future. They are not even interested in their own MPI. Out of the entire opposition there are only three members in the chamber. This is their question. They wanted to know the answers. The government is here. The government is telling them exactly what it is working on. But those opposite are clearly not interested. All they are interested in doing is grandstanding and pretending they care, when what they are going on with is absolutely useless.

Ian Goodenough (Moore, Liberal Party) Share this | Link to this | Hansard source

Order! The discussion is now concluded.