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

I wish to give voice to the grievance of millions of Australians with private health insurance who now find themselves the target of what can only be described as a push-poll designed to justify making them pay higher premiums. In launching this survey the Minister for Health highlighted smokers, posing the question of whether smokers should pay more for health insurance because of the additional burden they place on the health system. It is a very emotive issue. It is true that the question of whether different premiums should be charged for smokers is indeed there within the survey. But when we finally went to the survey itself last night, it was pretty obvious that there was a much more serious agenda at work here to justify not just higher premiums for smokers but also higher premiums for older Australians, higher premiums for Australians with health risk factors and higher premiums on the basis of gender. I can only assume that somehow gender has been included, because women tend to be higher consumers of health for various reasons but largely to do with childbirth, who frankly have the temerity to want to start a family.

In short what is being proposed here is the dismantling of Australia's system of community rating, enabling health funds to price policies on the basis of risk. This is coming at a time when even the United States, through the Affordable Care Act, is trying to make sure or put in place measures to move private health insurers away from offering policies on this basis. But this is what the minister wants to have a consultation about.

I want to take a few minutes here tonight to outline precisely what is at stake here and who the government now has in its sights. The minister in various interviews highlighted smoking and young people doing adventure sports as examples of these risk factors, but she is well aware, and we are all aware, the single greatest risk factor for health insurers which, unlike smoking or adventure sports, is simply unavoidable. Any doubt that age in fact is one of the principal targets of this exercise is immediately put to rest when you go and take the survey. It begins by explaining community rating and how that prohibits insurers from charging people different premiums on the basis of their age, health or likelihood to claim and that they must provide cover to anybody who seeks it. But then it goes on to explain that:

The private health insurance benefits paid for different age groups vary significantly. The average hospital treatment benefits which private health insurers pay for people in different age groups is approximately:

- $440 per year for 20-24 year olds

- $630 per year for 40-44 year olds

- $3,360 per year for 70-74 year olds

It then declares that:

Some people have suggested that community rating should be relaxed to allow insurers to vary premiums to account for age, sickness or lifestyle factors which increase a person's health risk.

It then asks whether insurers should be permitted to vary their premiums for a range of factors which it then goes on to list includes smoking, age, gender or health risk.

Having just read that, it then singles out people over 75 and suggests that they are a huge burden on the health system. It is pretty clear what answer the government is trying to lead people to have. It wants health funds to be allowed to charge people, including older Australians, more for health insurance and has created a push poll to provide it with the justification for this decision. It is deeply discriminatory and a deeply unfair proposition. Many older Australians come from the generation prior to Medicare or even Medibank. Many have had health insurance for decades and have rarely used it and now, just when they need it most, the government creates a dodgy survey designed to justify an agenda that could price health insurance out of the reach of older Australians.

The discrimination of course does not end there. The survey also asks if health premiums should be priced according to gender. Any reading of the health statistics makes clear what that is about. The two peak periods for the use of the health system are, as mentioned, old-age and, for women, their child-bearing years. When the survey asks, 'Should help insurers be allowed to charge patients according to gender?' what it is really asking is: 'Should they be allowed to charge women more for having babies?' Finally the survey also asks: if different premiums should be charged according to a person's health or health risk factors. Let us be clear here: this goes way beyond smoking because, when you scrap community rating and say that people should pay more on the basis of their health risk, where do you stop? Where do you draw the line? Should people be charged more because they are overweight? What about those who drink an extra glass of alcohol beyond the NHMRC recommendations? Or those with fit fixes who do not register 10,000 steps a day? What about people with a family history of cancer or heart disease? Or women whose mothers have the BRCA gene for breast cancer? How soon before a health fund can compel people to have a genetic test before writing a policy?

We already have an issue before the courts at the moment where travel insurance is being discriminatory against people with mental health problems. That is the slippery slope this government has embarked upon with this particular survey.

After yesterday insisting she was not afraid to ask these sorts of questions, the minister has been running a million miles an hour away from this survey today, insisting she has no intention of slugging anyone any more and this is all just some sort of academic exercise. Well, can I say, Minister, this is not some sort of university research project; this is a Commonwealth Department of Health survey, a government survey, and you do not ask these sorts of questions in this sort of survey unless you are trying to get an outcome and, at the very least, are seriously considering these changes. If you are not, why ask the questions in the first place?

The changes, of course, do not stop there, with just who we should slug more to pay for health insurance, because another question clearly signals this government's intention to introduce private health insurance into currently Medicare-only-funded services, by asking whether the current ban on health funds covering general practice should be lifted. Respected health economist and former Secretary of the Commonwealth Department of Health Stephen Duckett has spelt out what this could lead to: the undermining of universal access to health care, the fundamental principle of Australia's Medicare system. Under Medicare, Dr Duckett points out, the existing high rate of bulk-billing, which is around 84 per cent of GP consultations, acts as a lid on prices by encouraging other doctors to bulk-bill or it keeps fees down. If health insurers could cover GP visits, they might pay doctors more than the Medicare rebate, changing the market dynamics entirely, or they could do special deals with GPs for their members and require them to only visit these GPs for a set few, leaving patients who cannot afford private health insurance with what is left of a residual system.

So let us be clear about what is at stake here. If the government were to proceed with this measure, it would mark the breakdown of the universal health insurance scheme that is Medicare and take us down the path of an American two-tiered system. The minister keeps saying, 'That's not my intention.' It is the consequence of the decision you take, if you go down this pathway, that you will be introducing a two-tiered American health system. You can pretend all you like that it is not your intention, Minister, but in fact it is the consequence of the action that you take.

The government has already had a couple of goes at this, of course. It had a go through its $7 GP tax, its $20 GP tax for short consultations and its $5 GP tax for non-concession card holders. Now it is doing it through the four-year freeze on Medicare rebates, which is designed to drive down bulk-billing and has already had an influence on the billing practices of general practitioners.

Once again, here we have a push poll seeking to justify an outcome to undermine universal health care, rather than spelling out the benefits of the existing Medicare system and the crucial role played by the Commonwealth acting as the universal purchaser of these particular services and the impact that has on price. The minister justifies this on the basis that there is great dissatisfaction with the existing private health insurance products, which she says is leading to people downgrading their policies. The fact that private health insurance membership continues to rise and is now at 47.4 per cent seems to have escaped the minister's notice. However, there is no doubt that members are dissatisfied. They are dissatisfied because this government has increased the private health insurance premiums twice now, for the highest amount in almost a decade, and members are getting less back for what they pay. So it is no wonder people are saying that they are not getting value for money, when the government has hiked up premiums such a huge amount. This minister clearly has an agenda here when it comes to private health insurance. She is not protecting consumers. She is not putting consumers first in this debate at all, no matter how she pretends she is. Frankly, this survey should be withdrawn.