Tony Smith (Speaker) Share this | Link to this | Hansard source

The original question was that the bill be now read a second time. To this the honourable member for Ballarat has moved an amendment that all words after 'That' be omitted with a view to substituting other words. The question now is that the amendment be agreed to.

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

I would like to continue my contribution to this debate, a contribution I started last night. The Health Insurance Amendment (Safety Net) Bill 2015 has been put to the parliament and the people of Australia as a simplification of the safety net. This simplification involves abolishing the existing original Medicare Safety Net and extending it in a new Medicare Safety Net.

Labor has some real concerns about these changes and the impact they will have on thousands of Australians. Although the bill lowers the threshold level at which a patient's out-of-pocket expenses qualify them for access to the safety net, the amount a patient receives back—the amount all Australians receive back once they reach the safety net—is reduced. So Australians will be receiving less. Labor is concerned about the impact these changes will have in a number of areas. I will touch on that a little later.

The Turnbull-Abbott government do not support universal health care. Each and every day in this parliament we have seen them attack Medicare. Their lack of support for universal health care is evident from their attempts to introduce a GP tax—and now they are introducing a GP tax by stealth by freezing the rebate—and through their shifting of costs. This legislation is shifting costs from the government to the individual. This means, as I have already stated, it is going to increase out-of-pocket costs for every Australian who reaches the safety net. It will have the greatest impact on those on fixed and lower incomes—and that is what we find with just about every piece of legislation that this government introduces into the parliament. They are shifting the cost to those who can least afford it. This legislation will have the greatest impact on those who are least able to pay.

We have acknowledged that the new Medicare Safety Net has lowered the threshold for all patients, as I have already stated—but there are specific concerns. Those specific concerns relate to a number of areas. One is people who are having treatment for cancer. It has been very graphically described and identified that people with malignant melanoma are facing out-of-pocket costs of up to $7,400, and that cost is $8,000 for Australians having radiotherapy for prostate cancer. When a person is having intensive psychotherapy their out-of-pocket costs will skyrocket. An online petition has even been run in relation to that. Looking at IVF, there are inputs and costs for women who are undertaking fertility treatment.

The original Medicare Safety Net was set at $440.80 from January 2015 and it provides an additional rebate for out-of-hospital services when the sum of the difference between the MBS fee and the MBS rebate reaches a threshold. The Medicare benefit payable to the patient is $156 once a patient reaches that safety net and it is increased to 100 per cent of the scheduled fee rather than 85 per cent. Under the new scheme, the threshold will increase to $638 for concession card holders and $2,000 for all other singles and families.

This safety net was introduced in 2004 and it has helped a number of people over the years. On this side of the House we have real problems with legislation that is changing it and increasing the out-of-pocket costs for Australians. I am going to refer to a source that I do not usually use—that is, the Daily Telegraph. The Daily Telegraph on 31 October identified:

Nearly 800,000 Australians with high medical bills will get back less from the Medicare safety net when they visit GPs and specialists under controversial changes.

Note the words 'controversial changes'. Also, the article identifies that it will hit the chronically ill, pregnant women, cancer patients and anyone who uses the system to help with their out-of-pocket expenses. Let us get this straight: the people who will be impacted on the most are the sickest and those people who can least afford it. The net payout for specialists will see out-of-pocket expenses increase from $88 to $94 and out-of-pocket costs for non-bulk-billing GPs will rise from $7.60 to $19.47. Cancer patients and new mums who rely on the safety net will once again have a greater out-of-pocket expense. At a time when you are really sick or having a baby, to have to have these exorbitant out-of-pocket expenses is unconscionable.

It is interesting to note that one of the most common complaints I receive in relation to private health insurance and medical bills is about the out-of-pocket expenses that patients incur. The safety net has assisted and will, to a certain extent, assist people who have large out-of-pocket expenses.

What this is doing is going to make it harder. And what it can lead to, too, is people getting sicker—because if you cannot afford to have the treatment what do you do? You go without it. Women needing IVF treatment and cancer people can face up to $15,000 out-of-pocket expenses, and cancer patients will have their out-of-pocket costs for lifesaving radiation treble, up to $12,000. These are figures I am taking from the Daily Telegraph, which is a paper that is generally supportive of changes that this government would introduce. I really think that the government needs to actually consult with a few people, a few organisations—maybe even consult with the AMA, because the AMA is not at all supportive. Brian Owler from the AMA was very, very critical of this change to the safety net.

Eric Hutchinson (Lyons, Liberal Party) Share this | Link to this | Hansard source

Of everything the government does!

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

I notice the member on the other side of the House very vocally supporting these changes. Well, I do not think they will support it back in your electorate, member for Lyons. I think that your constituents will be quite disappointed that you have supported these changes. Brian Owler said that the sickest and the most disadvantaged Australians will be hit the hardest by changes to the Medicare safety net arrangements. As a doctor, he knows. As head of the AMA, he knows the impact that these will have. Professor Owler said that the AMA opposes the changes because they wind back the safety net, and they are going to lead to increased costs to hospitals and health care.

Mr Hutchinson interjecting—

Tony Smith (Speaker) Share this | Link to this | Hansard source

Members will stop interjecting across the chamber.

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

It was really interesting. I listened to the member for Barker last night, and he was consumed with talking about efficiencies. Health care is not about efficiencies; it is about providing affordable health care. Those on the other side of this House are very much into efficiency but very short when it comes to looking after and providing services to people. These small government people believe that Medicare is something which should be removed, and as such they water it down to only support the most disadvantaged. This legislation is bad legislation. It is ill-thought-out legislation. It is legislation that has been developed without proper consultation. It is also legislation that we on this side of the House cannot support. But we do acknowledge that there is always room to look at changes around the safety net. But these are bad changes and they are done without proper consultation and they need to be condemned. (Time expired)

Eric Hutchinson (Lyons, Liberal Party) Share this | Link to this | Hansard source

Thank you so much for the opportunity to contribute to the second reading debate on the Health Insurance Amendment (Safety Net) Bill 2015. I will respond to a number of the points that the member for Shortland raised. I did not sense in her contribution, though, any real vigour for the case that she was prosecuting. It probably goes to the point. I will specifically try and direct my comments to my electorate—which is an electorate that, in terms of statistical areas, is a remote and outer regional electorate—and the benefits that the changes that are being proposed in this legislation will bring to communities around my electorate, but, more broadly, to the state of Tasmania.

The point I should make, first of all, is that this is responding to two independent reviews, that it involved broad consultation with a range of stakeholders and the public on its impact on provider-changing behaviour. I note the member for Shortland's comment that health care should not be about efficiency. In my world, I think we need to have efficiencies. We should in every sector of the economy, including health care, look for where there are efficiencies to be gained. This is exactly what this piece of legislation does. Those on the other side make much about the notion of fairness. This legislation provides more access to more people. I will go a little further into exactly who those people are and the reason why I chose to speak on this legislation in respect of my own electorate.

It will also reduce the inflationary effect on charges that occur within the current arrangements, which are indeed complex and which have been a hodgepodge of additions and changes over a number of years, by introducing capping across the board of those services that reach the caps. The benefit of these changes is, indeed, simplification of three systems, essentially into one system. This will have benefits not only for providers, who find this a very complex situation to navigate, but particularly also for consumers, who find it a difficult system to navigate. This is not only for those who reach the threshold; the benefits of this legislation will ultimately be for all users of the Medicare Benefits Schedule through the health system.

If we go back to first principles though, of course, we do want—and I think that all of us in this place support this notion—a universal health system that is accessible to all but affordable, particularly affordable for those most vulnerable within our community. The independent reviews showed that the EMSN—the Extended Medicare Safety Net—was indeed structurally flawed, that there had been considerable leakage of government benefits towards providers' incomes rather than reduced costs for patients.

Like everything, I guess, in this whole business of government it is always about balancing the important services that our medical professionals—be they general practitioners, be they allied health providers or others—with the costs that are passed on to patients. The highlighted point here in the independent review was that the leakages were overweighting the benefits to the providers at a cost to the patients and consumers. It also highlighted that around 55 per cent of these benefits were going to the top 20 per cent of Australia's most socioeconomically advantaged, with the least advantaged 20 per cent receiving less than 3½ per cent. That is where I will drill down a little further as time allows to the circumstances that exist within my electorate of Lyons.

The question might be asked: who will benefit from the changes that are being made and the simplification that is being introduced? The new Medicare safety net will indeed be one that is more progressive. The thresholds for people without concession cards are reducing—

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

Mr Speaker, I seek to intervene. I have a question I would like to ask the member.

Tony Smith (Speaker) Share this | Link to this | Hansard source

Is the member for Lyons willing to give way?

Eric Hutchinson (Lyons, Liberal Party) Share this | Link to this | Hansard source

As a newcomer I would defer to her experience every day, Mr Speaker!

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

Mr Speaker, I would like to ask the member for Lyons how many people in his electorate will be impacted by the changes to the Medicare safety net, and what he intends to do to have their voices heard here in Canberra.

Eric Hutchinson (Lyons, Liberal Party) Share this | Link to this | Hansard source

These are fine questions from the member for Shortland. If she intends to stay in the chamber, I will address those questions. As I mentioned, the reason that I chose to speak on this bill today is that the changes that are being made will benefit lower socioeconomic groups, particularly those in an electorate such as my electorate of Lyons.

As I was saying: who will benefit? The thresholds for people without concession cards are being reduced from $2,000 to $700 for singles, and $1,000 for families, and for concession card holders from $638.40 to $400. It is expected that more than 53,000 additional people will receive a safety net benefit under these arrangements. On the notion of fairness: I cannot quite grasp how that is unfair. For concession card holders, in particular, more than 80,000 more people will receive benefits than under the current arrangement. Member for Shortland, this is fair. This is good.

Ms Hall interjecting—

Ms King interjecting—

Russell Broadbent (McMillan, Liberal Party) Share this | Link to this | Hansard source

The member for Shortland will cease interjecting, as will the member for Ballarat.

Eric Hutchinson (Lyons, Liberal Party) Share this | Link to this | Hansard source

This will benefit, Member for Shortland, not the people in North Sydney; it will benefit the people in New Norfolk and it will benefit the people in Beaconsfield and it will benefit the people in Sorell.

The bill replaces, as I mentioned, all the existing Medicare safety net arrangements with one new Medicare safety net. The existing Medicare safety net arrangements include the extended Medicare safety net, the original Medicare safety net and the greatest permissible gap. The current arrangements are confusing for patients and make it almost impossible for them to calculate rebates. The existing Medicare safety net arrangements are complex and regressive and, as I mentioned in my initial comments, have an inflationary effect within those providers.

The new Medicare safety net has been carefully designed to respond to issues raised by the reviews that I have also mentioned, and there has been consultation with stakeholders and the public more broadly. It is expected that more than 53,000 non-concession card holders and 80,500 more people on concessional benefits will benefit. Unlike the extended Medicare safety net, the amount of out-of-pocket costs per service that count towards the threshold will have a limit. They will be capped. The amount of safety benefits paid per services after the singles or families threshold has been reached will also have a universal limit.

As I mentioned, the electorate of Lyons is, according to the statistical area, an RA3—it is an outer regional area of Australia—and an RA4. It is a mixture of those. Let us look at where the current payments are going—and I will quote these figures on a per patient basis, because I think that highlights it best. Under the current arrangements, $1,535 per patient is spent on those people living in RA1, major cities of Australia. For RA3, outer regional Australia, only $156 per patient under the current arrangements is spent. Per patient for RA4—I know, member for Ballarat, this is not something familiar to you; these are people living in regional and remote areas of the country—it is $55 per person. This is why this is important. This is why in the electorate of Lyons this will have benefit.

Just to demonstrate for those opposite who may not realise, if we look at the socioeconomic indexes for areas, the SEIFA data cube, admittedly from 2011, and the decile distribution—the member for Shortland will be interested in this, and I congratulate her on staying for the remainder of my contribution—in the electorate of Lyons there are 299 statistical areas, SA1s. Twelve areas have not qualified. But if we look at the deciles and we look at the first decile, which reflects the most socially disadvantaged people within our community, 70 out of the 299 reside in that first decile. Another 63 reside in the second decile, 62 reside in the third decile, 42 in the fourth decile, 31 in the fifth decile. I am halfway through. If we go to the other end, there are two that sit in the 10th decile, in other words, in those most advantaged communities.

By contrast, the electorate of Ryan, for example, is completely the opposite, where 170 out of 350 reside in the 10th decile, and there is only one in the first decile. This is the fundamental thing. The money, from these changes, will flow to those people in the most disadvantaged communities around Australia. That, to my way of thinking, unless I am missing something here, is a notion of fairness. If the member for Ballarat, the shadow minister, is standing up for those communities, like the member for Ryan or the member for North Sydney when a new one is elected, if that is what she is doing, because that is where the members of the AMA are advocating—that is fine by me. I have no issues with that at all. That is entirely up to her.

All the good doctors that I know—my old man was a GP many years ago; he is no longer with this—were people that committed their lives to, first and foremost, delivering good and proper medical services to those people. When my father died, one of the proudest moments that I remember was when people came up to me at his funeral and said that, for many years, they had paid him in vegetables and jams and those sorts of things. And let me remind the member for Shortland that he was no soft touch. It was only when he understood people to be in circumstances where they did not have the wherewithal to be able to pay that he did those things for. Those are the good doctors that exist around the country.

But this bill is about fairness for those who are least able to afford. This is about fairness. This is about more access for more people. This is about reducing the inflationary effect that exists under the current arrangements. It is around introducing capping across the board. The benefits of the changes will result in a simplification of three systems into one. It should be supported by those on the other side that supposedly stand up for the most vulnerable—but apparently not.

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

The bill we are debating today, the Health Insurance Amendment (Safety Net) Bill 2015, concerns the Medicare safety net. It is a bill which gives effect to a range of measures that were first announced in the 2014 budget, and here we are nearly a year and a half later. We have to ask ourselves why it has taken so long. Perhaps it is because the government has been so preoccupied with issues of their own, and has been so preoccupied within the health portfolio in dealing with the fallout from the disastrous GP tax, that they have not got around to other measures that were contained in that ill-fated budget.

Thanks to this bill, what we see is a cut to the Medicare safety net, which totals some $270 million. The new, so-called simplified safety net will hit the pockets of vulnerable members of the community, and I will explain exactly why. Before I do that, it is probably worth talking about some of the background of this because, as I said, the bill concerns the Medicare safety net—something not well understood, not only in this place but also in the general community.

The original Medicare safety net was set at around $440 from 1 January this year and it provides a rebate for Medicare card holders. It provides an additional rebate for out-of-hospital services when some of the difference between the Medicare benefit schedule fee and the Medicare rebate reaches the threshold in any given calendar year. After qualifying for this Medicare safety net, the Medicare benefit payable increases to 100 per cent of the scheduled fee, rather than the usual 85 per cent. For example, the scheduled fee for attendance with a consultant psychiatrist of more than 45 minutes but not more than 75 minutes is $183.65; the Medicare benefit payable to patients is $156.15—that is, 85 per cent of the fee. Once patients reach the original Medicare safety net, the benefit payable increases to 100 per cent of the scheduled fee rather than 85 per cent of the scheduled fee.

So that is the original Medicare safety net. There are two thresholds under the extended Medicare safety net: $638.40 for Commonwealth concessional cardholders, including those with a pensioner concession card, a healthcare card or a Commonwealth seniors card, and those who receive family tax benefit part A. The second is that $2000 safety net for all other singles and families. This extended safety net was introduced in 2004 and it covers about 80 per cent of out-of-pocket costs once the above-mentioned thresholds have been reached. Benefits are paid in addition to the Medicare rebate and in addition to any benefits that are received under the original Medicare safety net.

In 2009 Labor introduced changes to the extended Medicare safety net that allowed the Minister for Health via a legislative instrument to determine that specific MBS items have their extended Medicare safety net capped to a specific amount. This is an important point: it goes to the argument that Labor has not been active in this space and that Labor is not willing to put in place reasonable measures based on a fairness principle which help to constrain the growth in healthcare costs at the same time as meeting out-of-pocket cost pressures, particularly on the most vulnerable Australians—because in 2009 we did exactly that. Our decision followed two reports that highlighted excessive fees—one of those reports being commissioned by the former government—being charged by some doctors and other practices to take advantage of the extended Medicare safety net. Specifically, the benefit was capped on all obstetric services, some assisted reproductive technology services, cataract services, the item for hair transplantation and varicose vein surgery amongst other MBS items.

There is also a maximum permissible gap and this is the greatest permissible gap, or GPG, which predates the original Medicare safety net and the extended Medicare safety net. It is defined in section 103(3) of the Health Insurance Act and requires that the difference between the Medicare benefit schedule fee for an item and 85 per cent of the Medicare benefit must not be greater than a specified amount. In other words the GPG is a rule that sets a maximum gap dollar amount and it is indexed on 1 November in line with the consumer price index. In 2015 the GPG is set at $78.40. It is important that we have some context around the matters that are before the House today. I will go to some other context in a moment, but let's go to some specific issues within the bill.

The government is keen to point out that the bill lowers the safety net threshold for all patients—a point that was made just now in the house by the member for Lyne.

But the devil is always in the detail, because the bill does two things that the government has been very quiet about. Members opposite who have engaged in the debate have not actually pointed to the second thing that the bill does. First, it places restrictions on the out-of-pocket costs that contribute to a patient reaching the safety net in the first place. They like to argue that they have brought the finishing line closer to the starting line, but what they do not tell you is that they have increased the handicap. They have added additional weights on the racers so it is harder to get to the finish line in the first place.

Under existing arrangements, all out-of-pocket costs for out-of-hospital Medicare services count towards the threshold, with the exceptions of those issues that I raised earlier. But under the proposed changes restrictions are imposed on which out-of-pocket costs can accumulate towards reaching the safety net. What this means, in practice, is that the amount that counts to the safety net is equal to 150 per cent of the MBS fee minus the rebate, not the full out-of-pocket cost. So somebody who sees a specialist and is charged $150 previously had an out-of-pocket cost of $77.25 go towards the safety net. But under the new regime just $55.55 will go towards the safety net. This is going to make a huge difference over time, particularly when you consider that one of the greatest areas of usage for the extended Medicare safety net was GP consultations. The most common form of medical interventions that most of use is a visit to the GP. The second greatest, after GP consultation, for people accessing the extended Medicare safety net was specialist consultations.

On top of this, the amount patients receive back once they reach the safety net is also reduced. So not only is it harder to reach that finish line; the amount you get back is reduced as well. It will be capped at 150 per cent of the MBS schedule fee, less the standard MBS rebate. It is a double whammy that will impact on Australians who can least afford it. But there is another issue here, and I was expecting to hear about it from the member for Lyons over here, who is the son of a former GP and represents one of the most disadvantaged in Australia. Perhaps we will hear from the good Dr Gillespie on this shortly. There is a double whammy on this, and it goes to something that has not been uttered much in this debate. That is the impact of the Medicare rebate freeze. The impact of the Medicare rebate freeze is to ensure that over time people receive less and less from the Medicare system when they see their GP. We know that there is already an extensive gap between the scheduled fee and the Medicare rebate fee. I should put that another way: the Medicare schedule fee and the AMA recommended fee. In fact, the Medicare Benefits Schedule is about half the AMA recommended fee for a normal GP consultation.

So, if you think about the impact of these two strategies, what you have is low-income Australians—in fact, all Australians—being hit with a pincer movement. They are being hit with a pincer movement because on the one hand they are going to see less and less rebate from the MBS system for visiting their GP, and it is going to be harder and harder to reach the MBS safety net. And then when you do reach the MBS safety net you are going to get less back through the safety net rebate. So it is actually a double whammy, one that members opposite are not very keen to talk about for obvious reasons. I heard the member for Lyons in his contributions talk about the fact that in his electorate those on lowest incomes were going to be protected, that they were not going to be impacted by these changes. Well, I have got news for the member for Lyons: that is not what is going to happen. And I will explain why in a moment. But let us just assume for a moment that he is right. I know the demographics of his electorate in regional and rural Tasmania quite well.

I know that the practices that work there often are dealing with very fiscally tight environments. The economic viability of many of those regional and rural practices is challenged. So the only way that medical practitioners, be they GPs or specialists operating in the electorate of the member for Lyons, are going to do what he says—and that is protect the poorest and the vulnerable—is to cross-subsidise the costs within their practice. That is, they will pass on the growing costs of running a medical practice, whether that be in rural and regional Australia or elsewhere, to those people within that practice area who the GPs or the specialists believe can pay.

We know that will happen because we know that is happening right now. We know that it is happening right now, so the double whammy effect is actually a triple whammy effect for members such as those that we have just heard from. The only way the practices are going to be able to maintain their economic viability and protect—as the member for Lyne suggests that they will—those vulnerable members within those practices is to pass on additional costs to middle-income earners within his electorate. So, far from him being able to stand here and argue that they are going to be protected, we say with good evidence that that is not going to be the case.

We know that what it means in practice is that the amount that counts to the safety net is equal to 150 per cent of the MBS fee minus the rebate, so not the full out-of-pocket amount. Let us give an example. Somebody who sees a specialist and is charged $150 previously had an out-of-pocket cost of $77.25 go towards the safety net. Under the new regime, $55.50 goes towards the safety net. So we know that it is a double whammy. We know that it is a typical coalition trick, where they are giving with one hand and taking with the other. We know that the most vulnerable in our community are going to be impacted. We know that all members of the community are going to be impacted.

We are particularly concerned about the impacts that these changes are going to have on radiation oncology patients, on patients needing ongoing access to psychiatrists and on patients accessing certain IVF services. In particular, Labor is concerned that radiation oncology patients who had previously been bulk-billed will see significant new out-of-pocket expenses. According to one example, a patient with a malignant melanoma receiving radiation treatment could face new out-of-pocket expenses of some $7,400.

I ask you to contemplate this because we have experience in my own family of the impact on somebody once they are diagnosed with a disease such as malignant melanoma. They are no longer working. The income of the entire household is disrupted by this because the carer often has to give up their job to look after them well. So, at the most crippling time in the household's lives, they are going to be whacked with new out-of-pocket costs of up to $7½ thousand for radiation oncology.

This is just one example. I have cited in my contribution to this debate many other examples. Is it any wonder that the entire medical community is up in arms about these proposals? They add to the other misguided, misdirected and unfair health policy proposals that have been brought to this place by this government, and they should be rejected.

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

I am very pleased to be here talking about the Health Insurance Amendment (Safety Net) Bill 2015 because it goes to the heart of a very important part of the delivery of health services, and that is the Medicare safety net. I would just like to clarify a few things before the member for Throsby leaves. I am the member for Lyne, L-Y-N-E. The previous speaker from the government side is the member for Lyons, which is in Tasmania. I reside on the North Coast and the member for Lyons resides in Tasmania. There was a lot of argument put in there where Lyne, L-Y-N-E, my wonderful electorate, was pronounced 'Lin' and confused with Lyons. Just for the record, I have not spoken yet. I am now rising to speak for the first time.

This bill replaces all the existing Medicare safety net arrangements. As we know, there have been several iterations of the original Medicare safety net and the Extended Medicare Safety Net. This will roll them all into one Medicare safety net. There are changes; I will put on the record that there are changes. Whenever anything changes there are always people who are used to the current regulations and the current system, and if they are not in a public health institution it changes a lot of the economics of it. I understand that. The people who it will change the economics for as well are, obviously, the patients. But as we can see from some of the things I will bring to the table, there will be an increase in the coverage rather than a decrease in the coverage.

The main change is in the way that the Medicare safety net threshold is reached. It is changed by a new calculation, which both the member for Ballarat and the member for Throsby have outlined. There is a reason for why that has been changed, and that is what I would like to bring to the House's attention first of all.

The original Medicare safety net and the Extended Medicare Safety Net were designed as a safety net for the patients. They were not meant to be an open-ended lack of ceiling for medical and provider charges. There have been observations from previous changes that tried to address this, that the system had the phenomenon of a higher upfront provider fee reaching the threshold and then ongoing fees being picked up by the government purse.

Because of this very generous system, which was honest in its intent, some of the private providers—individual medical and surgical providers, or commercial providers—did not have that market feedback, because the purchaser was not going to bear the consequences of a higher fee. That is what the government observed in the reproductive technology space, before it changed the guidelines some years ago for the way it worked. So we do have to put a ceiling on what the government can pay—that is the existential problem that we find ourselves in. The government has a fiscal problem, and so we have to do this in a way that benefits most people. In that particular instance, we want the services to continue but we want people not to have high fees and to have a safety net.

Rather than having no incentive to control fees, which is what was observed—where we had the high up-front fees and the Medicare safety net picked up most of the subsequent gaps in fees—we are changing the way this is calculated to have 150 per cent of the Medicare fee, minus the rebate, going to the contribution to reach the Medicare safety net. That is significantly different, but the thresholds have been lowered. For people without concession cards, that threshold is being dropped from $2,000 to $700 for singles and $1,000 for families. And for concession card holders it is being dropped from $638.40 currently, down to $400.

Contrary to what the member for Throsby was alluding to, the department has worked out that it is expected that more than 53,000 additional people will receive a safety net benefit under these new arrangements. For concession cardholders in particular, 80,000 more people would receive benefits under that system than under the current arrangements. The number of non-concessional card holders receiving benefits will actually reduce. It is changing the mix of who would be attracting the benefit.

There are some other observations that have been collected, because the government is the ultimate payer for all of this and they have to look at costs. In my electorate of Lyne, we have a wonderful radiation oncology provision. We have the North Coast Cancer Institute, which has a couple of linear accelerators and specialist radiation oncologists as well as very large numbers of specialists both in the centre of Port Macquarie in my electorate and in the electorate north of me at Coffs Harbour in Cowper. The average per capita fee charged through the Medicare safety net now for an individual is $4.68, whereas in the metropolitan centre south of me in the Eastern Suburbs in Sydney the average is about $57 and on the North Shore area it is $59. So there is a difference in charging practices, and I might make some personal observations about why this is. It is not all about the phenomenon I mentioned at the start of this speech about medical fees chasing the safety net dollar. In a lot of metropolitan areas, many years ago, there were publicly provided radiotherapy centres and a lot of the complex stuff happened just in public hospitals, but with the expansion of the capability of the private sector a lot of the public sector providers have not expanded and the private sector has grown.

The economics of running private provision of health services, whether it is a private hospital, radiation oncology or complex IVF, are different to where the same technology is delivered in a public hospital, because in a public hospital or a public facility the state government is contributing to a lot of the capital works and to a lot of employment of the technical staff, and the superannuation payments and leave payments are all on the state government tab; whereas, if you are a private provider, you have to build your own facility, buy your own equipment, employ your own people and run it all out of the HPG grant for the equipment and the item number for the professional services. That is all bundled into staffing as well as the medical or surgical fee as well as running the facility. There are going to be greater fees; it is just a question of arithmetic and economics. What we do not want is what I was alluding to before, which was observed many years ago: where, because it was virtually open-ended—not totally but virtually—there was not that feedback between a medical fee and the patient bearing the cost of it, because there was this very generous open-ended Medicare safety net.

We have to be wise with our taxpayer dollars because there is a limited amount of them, and, when you make changes, some people will be very upset. It is a very difficult situation. But, on the balance of things, 53,000 more people accessing the Medicare safety net is a very powerful figure. It should make it more available and not less available. I will put on record now that I understand that for some people in some situations, depending on where you are going, through these changes there will be more out-of-pocket costs. But if that is the cost of keeping our whole system sustainable, it is an unfortunate consequence. It is really important that people have access to health care, and that is what the private providers are providing. In the public system, like we have in the North Coast, there is a significant wait. But to go to Newcastle, before there was the North Coast Cancer Institute, you could be waiting for many, many, many months for your radiotherapy and you would just be on a queue. Newcastle was overwhelmed with people coming from the Hunter and from the north-west of the state. So the North Coast Cancer Institute has filled that. But as I pointed out, a lot of the capital works was from government grants; the state government is contributing to it. But the fees that are charged on the Medicare Benefits Schedule and the other payments for the equipment and the building are supplementary to what they get from the state and federal governments out of other pockets of money. That is part of the reason the per capita draw on the Medicare safety net on the North Coast is vastly cheaper than what it is in the metropolitan centre where a lot of those other factors are at play.

Overall, it is a very significant change. We do want to get access to health care, particularly these very highly technical things. I do not want to second guess what every different situation is going to be, but when you look at it in total I think most people will have a more sustainable system, and more people will be able to access the Medicare safety net. I commend this bill to the House.

The DEPUTY SPEAKER (10:01): It being 10 o'clock, the chair will be resumed at the ringing of the bells.

Sitting suspended from 10:01 to 11 : 50

Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Link to this | Hansard source

I begin by acknowledging that today is Remembrance Day, and I give thanks to all of those people who served, died, suffered or made sacrifices so that we could all live freely and in peace.

In speaking on the Health Insurance Amendment (Safety Net) Bill 2015 I support the comments made by the member for Ballarat and the amendment that she has moved to this bill. Before I talk about the substance of the bill, for the benefit of anyone listening to this debate and who is not familiar with the safety net system we have in place, I just want to briefly describe it.

Medicare sets out a schedule of fees known as the Medicare Benefits schedule, or MBS. Medicare rebates 100 per cent of the scheduled fee for a general practitioner and 85 per cent for a specialist. The patient pays the difference between the practitioner's fee and the rebate. Frequently, fees charged by medical practitioners are higher than the scheduled fees. Presently, there are two safety nets for people with high medical costs: the original Medicare safety net and the Extended Medicare Safety Net. Once a patient qualifies for the original Medicare safety net, which they do so by reaching a threshold, the Medicare benefit is then increased from 85 per cent of the scheduled fee to 100 per cent.

That the original Medicare safety net is calculated on the gap amount being the difference between the Medicare benefit received and the scheduled fee is part of the equation. However, even once patients reach the original Medicare safety net and they are therefore rebated 100 per cent of the scheduled fee, if their practitioners charge more than the scheduled fee they will still have out-of-pocket expenses, which is the difference between the Medicare benefit and the practitioners' fee. Once an annual threshold of out-of-pocket costs is reached, patients qualify for the second safety net—that is, the extended Medicare safety net, or EMSN as it is otherwise known. The extended Medicare safety net covers 80 per cent of the out-of-pocket costs from this point onwards, although it is subject to some caps for specific MBS items.

With that explanation, I want to turn to the substance of the bill. This bill gives effect to the 2014-15 budget measure referred to as 'simplifying the Medicare safety net arrangements'. It effectively replaces two safety nets with a single safety net. Whilst the safety net would have a lower threshold for all patients, and therefore perhaps more patients will have access to it, the amount of out-of-pocket expenses that count towards it is also lower. The amount covered once patients reach the safety net would also be lower.

Although a simplification of the system would be welcome, the fact that these changes provide savings of almost $270 million over the next five years makes it clear that the government's objective is not just to simplify the system but to make cuts to the health system of this nation. The objective is also to use those savings made by the government in order to fund the coalition's Medical Research Future Fund. The government have put themselves in this position because, when they first announced the Medical Research Future Fund, it was to be funded by their GP tax, or the GP co-payment as it was referred to. As we all know, and as history now shows, the GP tax was rejected by Australians because it was unfair. So it seems that the government are now looking for other mechanisms in order to pay for the Medical Research Future Fund and, indeed, are looking for other cuts they can make to the health funding of the nation in order to do so.

It also makes little sense to fund research for future cures at the cost of deterring people from seeing their GP and possibly, in turn, making them sicker right now. It is the same argument that was used when we—I believe quite rightly—argued that increasing doctors' payments would simply put off the medical problem, in turn making it worse and ultimately making it a higher cost to society. This bill does a very similar thing. It effectively says that we are going to take away money today from people, who will not be able to afford certain treatment, and then in turn put that into future research, which might help society. But the truth of the matter is that it is asking one sector of the society to pay for the benefits that another receives.

If the government also believe that some practitioners are rorting the system by exploiting the lack of price sensitivity due to most of the costs after reaching the EMSN being paid by government, they need to provide evidence of that. When Labor made changes to allow caps on specific MBS items, it did so on the basis of two independent reports which made the case for change. We have seen no similar reports with respect to the changes that have been proposed by the government in this legislation.

In summary, this legislation abolishes the original Medicare safety net and the extended Medicare safety net. It creates a single safety net system, but it also cuts nearly $270 million of funding from the safety net—in other words, $270 million of funding that would otherwise go to Australians who are in need of health services. The truth of the matter is that those changes will affect thousands of Australians, and affect them for the worse. Although the bill lowers the safety net threshold for all patients, restrictions on out-of-pocket costs that contribute to a patient reaching the safety net are introduced, and the amount that the patients receive back once they reach the safety net is also reduced. Indeed, we have seen evidence that these changes will severely impact on oncology patients, on patients needing ongoing access to psychiatric treatment, and on patients accessing IVF services. For some of these patients, the costs are likely to increase by tens of thousands of dollars. These are not minimal increases; these are amounts of money that for some people will be out of reach. For those people, it may well be a choice between getting the treatment and not getting the treatment, and I suspect that in most cases, if they had a choice, they would want to get the treatment.

In turn, it also creates a medical system where people who can afford medical treatment will get it and those who cannot afford medical treatment in this country will miss out—a system similar to what they have in the USA and a system that we in this country, for the last 40-odd years, have been able to say is not the right way to go. We have a universal health system in this country which has served the Australian people very well and has ensured that all people, regardless of their income, have access to reasonable medical services in this country. This is starting to break down that system. For a Prime Minister who continuously talks about fairness and creates a perception that he understands the struggles of low-income Australians, this legislation goes entirely in contradiction to the perception that the Prime Minister tries to create. There is nothing fair about making it more difficult for lower income Australians to get the medical help they need, and all this measure does is to increase the widening gap between the rich and poor of this country.

Not surprisingly, the AMA, the Royal Australian College of General Practitioners and the National Association of Practising Psychiatrists have all come out with concerns about this legislation. They have good reason to come out with concerns about this legislation, because they know full well, as the front-line service providers, the impacts that it will have on their patients, and they know full well that people who might need psychiatric assistance will not be able to access it. We have seen it time and time again. We hear debates in this place time and time again about mental health issues in this country and how the costs of mental health are also escalating year by year. We are going to do nothing to reduce those costs by cutting out services or by making services more difficult to access by the very people who need them.

It is likewise with oncology treatments. I have spoken to people in my own electorate who found the cost of oncology treatment to be already excessively high. People have come into my office and talked about the possibility of going overseas to where health costs might be a little lower in order to access the treatment that they need. These are people who do not have spare money and people who are actually struggling to find the money they need just to pay for the services that they desperately need. To make things harder for them is, I think, one of the most heartless and cruel things we can do. Deputy Speaker, I am sure that you have come across such families in your own part of the world. The stress and trauma caused by some of these serious and severe illnesses is something that we would not wish upon anybody. Yet through this legislation I believe we are making their situation much worse.

It is also, in my view, bad public policy to bring in this legislation. I say that for this reason: not getting medical treatment when it is needed ultimately leads to more serious medical conditions later on. I do think there would be a doctor out there who would say that if you need to go to a doctor, do not worry about it; just put it off. The more you put it off the more likely it is that the situation or condition will deteriorate. When it does the costs of treatment become much higher. Indeed, if the situation deteriorates to the point where the person is admitted to hospital, again the costs escalate. It is not good public policy to have short-term savings which in the long term add to the health costs of the nation. It simply does not make sense. It may well be that this government, in order to create those short-term savings, is prepared to transfer the costs onto state governments which would perhaps wear the bulk of the costs with respect to the hospitals, or directly onto the families themselves. Again, in both cases, whilst it might get the government out of its budget mess, it does not do anything to reduce the overall costs to society of managing health in this country.

I see this legislation as simply another piece of the jigsaw of the Turnbull government's plans to dismantle Australia's universal health system that has served this country well for some 40 or 50 years. I say that it is part of the jigsaw because to date we have seen more than $60 billion cut from Australia's public hospitals, attempts to increase the costs of medicines through changes to the Pharmaceutical Benefits Scheme and the government's ongoing GP tax through its MBS freeze, which represents a cut of some $2 billion from Medicare. That is $2 billion through that freeze, so that doctors have no choice but to ultimately pass those costs on to their patients. So the patient ultimately pays, but it is a cut being made by the government. We have seen hundreds of millions of dollars cut from public dental health programs, mental health and Indigenous health programs. We have seen $370 million cut from preventative health programs around the country. Indeed, I have a letter in my office right now from concerned people in my electorate who are worried about the impact that $370 million cut will have to the front-line services they are providing in my part of the world. Again, these are real cuts which are going to have an impact on the health and welfare of the nation. This latest round, where we see another $270 million of cuts being introduced under the guise that it is about simplifying the system, is simply another part of the overall package of measures that this government has for reducing the health costs to government by cutting funding to health programs around the nation.

I will conclude on this note: there are few things in our country that people care about more than health. Indeed, when you talk to people about what matters most to them, the issues which inevitably come to their minds and which they refer to are health and education—and for good reason. Without having good health systems in place we cannot attend to the health needs of the people who need them. Without good health, life is made very difficult. It is likewise with education—if you have a good education it gives you an opportunity to get on with life. Cutting funds to health and education, I believe, is a retrograde step for any country to do. Indeed, we should be doing the opposite because if we do we will have not only a healthier nation but also a more productive nation. With these comments I repeat that I support the comments of the member for Ballarat. We do not support this legislation and we will be supporting the amendment put forward by the member for Ballarat.

Joanne Ryan (Lalor, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (Safety Net) Bill 2015. I note that it is a measure that was announced in the 2014 budget. Two years later, the government has finally decided to bring the amendment forward for us to consider.

It is important to reflect on the purpose of the Medicare safety net in any discussion around changes to the Medicare safety net. It was introduced in recognition that some patients need greater access to medical services—especially vulnerable groups, like those with serious and costly medical issues—at different times in their lives.

Having looked at why the Medicare safety net was introduced, I think it is fair to say that the member for Ballarat was very clearly suggesting that Labor has no problem with reforms in this area if they are going to be helpful but that in this scenario the government has gone about this by introducing a very blunt measure without clear justification. The introduction of the Medicare safety net was around particular groups of people who needed particular financial support to access high-end medical costs. The changes, therefore, need careful scrutiny. Labor has a problem, at the moment, with any evidence that that scrutiny has been careful. We have issues with the fact that we have not seen the evidence—nor have we seen evidence that these measures will address the issues, because it has not been fully explained.

At the time of the 2014 budget, the government argued that existing safety net arrangements were complex and difficult for both patients and practitioners to navigate and that this measure would simplify these arrangements. I am hearing a theme over the last two years: you say something is complex, you say you are going to simplify it and, before we know it, we have got a cut in front of us. So simplification has become a cut as far as this government is concerned, and I think this legislation today is another example of that. Again, it is a cut, the savings of which will not go back into the health system from this government—not in any meaningful way that is going to support patients and Australians in our health system.

I stand with my colleagues on this side to oppose this $270 million cut that has not been explained properly nor has evidence been presented to justify or rationalise it. Over the last few days, we have seen that theme come through. Prime Minister Turnbull has a knack of adding complexity when he claims to be simplifying things. We have seen that this week with cuts to the family tax benefit supplements being proposed under the guise of simplifying things at the same time as we are having a tax debate with a suggestion of a 15 per cent increase to the GST. The Prime Minister says that that will be fair, because in the process there will be compensation built into the system. So we are going to take cuts to the family tax benefit under the guise of simplification, talk about a 15 per cent GST rise and have a compensation process put in place—simplification? What we end up with is a complex system.

We are seeing a government that is confused: confused about what its ends might be and what the reasons for these cuts are. They are confused, because they continue to talk about deficits then introduce cuts and, all the time, they are stripping funds away from important areas like the health system. So simplifying things is the rhetoric; complexity is what we end up with.

Whilst acknowledging that the new Medicare safety net has lower thresholds for all patients, this bill restricts out-of-pocket costs that can accumulate towards the threshold and thus restrict the benefit payable once patients reach the safety net. The bottom line is that we are looking at a $270 million cut per year and, in the end, the people who will bear the brunt, or the cost, of that are patients. Again, it is a cut dressed up as simplification.

It is not just Labor saying this; specific concerns about these changes have been raised by fertility groups, radiation oncologists and psychiatrists, especially those providing psychotherapy services. We are hearing from those stakeholders specific examples: for instance, a radiotherapy patient with a malignant melanoma is facing new out-of-pocket costs of $7,000—this is where we get down to the human element where simplification is actually adding complexity; a radiotherapy patient with prostate cancer could face new out-of-pocket costs of $8,000; victims of sexual abuse and people with serious mental illnesses no longer have access to psychiatric services and are being priced out of that process; and IVF private patients, who currently face out-of-pocket costs of $4,000 per cycle, could now face the full cost of treatment, if these changes proceed, which is likely to be $10,000 to $15,000 per cycle.

We need to look carefully at the human cost of what these cuts will deliver and, when we look at those costs, it is natural to ask, 'What is the justification, the rationale, behind this? Where is the evidence that this is a good idea? Where is the evidence that it's going to make things simpler? Where is the evidence that it's going to improve the system?'

The sector, like us, are concerned that the government's changes could adversely affect some of the most needy—those with chronic illnesses, pregnant women, cancer patients. What is being exposed with this legislation in front of us today is that the glamour of the new Prime Minister and his government is fading, just like his predecessor. He is ignoring the health experts. He is ignoring the sector. You could go so far as to say that it is just another example of trying to Americanise our health system—a demonstration that the substance has not changed of this government, just the style.

Labor will not be supporting the $270 million changes to the Medicare safety net, because of the impact such a move will have on people in the community. If I look at my community in the electorate of Lalor—and remember that this was a 2014 budget measure that was brought in, the budget that was a cut-and-slash budget without thought or care for the people on the ground. If we put it into that context, there wasn't a huge amount of commentary on this measure when it was originally announced, because of course we were all very concerned about the other health measure—the GP tax—that was going to impact, particularly in a community like the one I represent. Remember: it was the biggest broken promise from before the last election.

In that context, when you look at this piece of legislation, you have to look at the impact of all of the things that this government has tried to do and what its agenda has been in the health space. In my community in the electorate of Lalor, the notion of the GP tax was extraordinarily cruel.

The electorate has 95 per cent of GP consultations, which are bulk-billed, and what has been exposed over time is that this government was hell-bent on a GP tax, but is really hell-bent on reducing bulk-billing rates in this country, and reducing the neediest's access to a doctor without out-of-pocket expenses. We know that that is still the intent, because we know that this government has not reversed the indexation freeze on the Medicare rebate, and until actions like that start to come from this government, we know that there is still intent on the same long-term agenda.

What are the impacts in my electorate of this potential change? In the electorate of Lalor, chronic illness is high. We have high rates of obesity, high rates of diabetes and high rates of heart disease. Chronic illness is high, which means the impacts of these will be high on those people. And we have a lot of low-to-middle-income earners, people who have worked hard all their lives, and perhaps have not been able to afford the highest health care, and they will now be further penalised through these proposed changes.

The government needs to go back to the drawing board on this piece of legislation. This government, that is the Abbott government dressed up as the Turnbull government—less lycra, probably; more leather, possibly—has the same insidious intent when it comes to Australia's health system. That is what this is demonstrating today. The measures from the 2014 budget that have been put in a cupboard are now being wheeled out, and this time they are being wheeled out with Mr Turnbull at the front. This legislation demonstrates clearly that the government has not changed, and I stand with my Labor colleagues to oppose it because, as the member for Makin said not a few minutes ago, it is a government that is still hell-bent on short-term savings and ignoring the long-term costs. It is a government that wants to make changes that are cuts, which are clearly slashing the health budget in this country without any thought to what the long-term health costs will be.

We know that if people are not going to the doctor, if people are not seeking the health care they need in the early stages of illness, that the costs go up and up, and of course they become extreme once someone reaches hospitalisation. We have a government hell-bent on short-term savings, not providing a rationale for the changes that they seek to make nor a rationale or explanation as to how these changes will solve an issue that they say they found but have not provided evidence for. I say to those opposite: 'Show us the evidence that this is needed. Show us that this $270 million cut is needed. Show us that it will help with the supposed issue, and show us the evidence that these changes will address those issues.'

The member for Ballarat has been incredibly diligent in her role in opposition of taking the forensic view of the changes being proposed by those opposite to our health system. In her work, she has exposed that, time and time again, we have seen changes being proposed to our health system that will undermine the basic universal nature of our healthcare system, that will undermine particularly low-income people's ability to access the health care that they need. This is just one more example of that today. Labor will suggest amendments, and we stand opposed to the Health Insurance Amendment (Safety Net) Bill 2015 as it stands and as it was brought to this chamber today. I know that people in my community are now very wary of any changes this government tries to make to health, because they are feeling on the ground the impacts of the changes they have already made by regulation—the GP tax through the backdoor. They are feeling those changes now as local doctors move to change their business model to ensure that they will still be in business to see patients in response to the indexation freeze. This government has a trust issue when it comes to the health space, and I think the people of Lalor will support Labor's opposition to this piece of legislation.

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

I rise to speak on the Health Insurance Amendment (Safety Net) Bill 2015. This bill is the result of the Abbott-Turnbull government's infamous 2014-15 budget. Who could forget it? Who could forget that budget? I remember the booklets being handed around in Moreton before the election—the Real Solutions booklet, with the photo of the coalition's frontbench; Malcolm Turnbull sitting in there smiling. That budget completely repudiated what was in the Real Solutions booklet, and the promises made by the leader of the coalition—surely the most blatant case of false advertising that anyone has seen.

Lionel Hutz would have more chance of arguing the false advertising case against the Abbott-Turnbull government than when he sued against the movie The NeverEnding Story. It is unbelievable—all the promises contained in the Real Solutions booklet were completely thrown out by the 2014 budget, and this piece of legislation is a direct result of it.

It is put forward by the government as a potential saving of $270 million. Of course, if there is a saving to the government it must also mean that there will be a cost to someone else. That is the reality of economics. We know with this government that the cost is always to be borne, sadly, by those in Australia, who are the most vulnerable, and this legislation before the chamber is no different.

Medicare is one of the great legacies of the late Gough Whitlam, and I particularly acknowledge him today, on the 40th anniversary of his dismissal by the Queen's representative Kerr. Medicare, introduced by the Whitlam Labor government in 1975, was originally called Medibank and was renamed Medicare when it was reintroduced by the Hawke Labor government in 1985. In the nine months after Medibank/Medicare was implemented on 1 July 1975, the staff increased from 20 to 3,500, and 81 offices were opened. Medicare today is accepted and loved by all, particularly on this side of the chamber, as Australia's universal healthcare scheme. It ensures that all Australians can access our world-class healthcare system.

The savings from this bill arise from changes to the Medicare safety net by the Abbott-Turnbull government. The Medicare safety net can be a confusing system to navigate, so I will just give a brief description by way of background. I want to preface this brief description by taking people back to a Four Corners interview on 6 September 2004 with the then health minister, a bloke called Tony Abbott. The interviewer, Ticky Fullerton, asked:

TICKY FULLERTON: Will this Government commit to keeping the Medicare-plus-safety-net as it is now in place after the election?

TONY ABBOTT: Yes.

TICKY FULLERTON: That's a cast-iron commitment?

TONY ABBOTT: Cast-iron commitment. Absolutely.

TICKY FULLERTON: 80 per cent of out-of-pocket expenses rebatable over $300, over $700?

Tony Abbott replied—and this should be underlined and put in bold:

TONY ABBOTT: That is an absolutely rock solid, iron-clad commitment.

That was the minister for health, as he then was, in the lead-up to the 2004 election, when the member for Adelaide was elected, on a tough day for Labor. Medicare was a big issue in that election campaign, but we saw the health minister make that rock-solid, ironclad commitment, and then—by March the next year, I think it was—he did a backflip. So he had form. We should have realised, when it came to the 2013 election, that the commitment that was made before the election was not going to be something that he would hold true to. And we saw that with the 2014 budget.

There are currently two safety nets in operation: the original safety net, which applies to all Medicare card holders; and the extended safety net, which has two limbs, one applying to concession card holders and families eligible for family tax benefit part A, which has a lower threshold than the second limb, which applies generally to all Medicare card holders. The two safety nets operate quite differently. Under the original safety net, once the threshold of $440.80 has been met, the patient would receive 100 per cent of the schedule fee for out-of-hospital services. Under the extended safety net, once the threshold of either $638.40 for the concessional threshold or $2,000 for all other Medicare card holders is met, then 80 per cent of out-of-pocket costs will be covered. At present, all out-of-pocket costs for out-of-hospital Medicare services contribute to the safety net threshold. I repeat: at the moment, all out-of-pocket costs contribute.

Under this cruel bill, the out-of-pocket costs that contribute to the threshold will be capped at 150 per cent of the MBS schedule fee. On first inspection, this bill appears to be the patient's friend. But the devil is in the detail. It does decrease the safety net threshold and, ordinarily, that would create savings for the patient, but, because this bill also places restrictions on the out-of-pocket costs that contribute to the patient reaching the safety net, this makes the task of reaching the threshold more difficult for the patient. These changes will have a huge impact on thousands of patients in Moreton—from Chelmer to Kuraby, from Fairfield to Oxley, from Annerley to Willawong and every suburb in between. Sadly, the amount that patients receive back from Medicare after they reach the safety net will also be reduced.

The Australian Medical Association, not exactly a left-wing organisation, are very well placed to comment on the effects of this bill and how it will impact on their patients, and they have criticised these cruel Turnbull changes. Professor Owler, the President of the AMA, has said:

The new Medicare Safety Net arrangements, together with the ongoing freeze of Medicare patient rebates, mean that growing out-of-pocket costs will become a reality for all Australian families, including the most vulnerable patients in our community.

Professor Frank Jones, the President of the Royal Australian College of General Practitioners, another organisation that has direct connections with the implications of this bill, said:

… coupled with the indexation freeze, the legislation will actually increase the cost of care to vulnerable groups. Safety net thresholds will increase by CPI annually while rebates are frozen.

Both of those organisations—the College of GPs and the AMA—have noted how this bill will impact particularly on the most vulnerable. It is revisiting the tactics of the 2014 budget.

This bill will particularly impact upon radiation oncology patients: cancer patients who are undergoing radiation treatment—surely people at a most difficult time in their lives. Those patients have more than enough to deal with without being exposed to more out-of-pocket expenses. By way of example: a patient with a malignant melanoma—which is sadly a reality in Queensland—who is receiving stereotactic radiation treatment could face further out-of-pocket expenses of $7,400. A patient with prostate cancer undergoing volumetric modulated arc therapy treatment could face further out-of-pocket expenses of $8,000. A patient with breast cancer undergoing radiation therapy through a private provider could face a 200 per cent increase in out-of-pocket expenses. These are not incidental amounts that these patients will be faced with. Patients will be slugged with these extra costs at the very worst possible time in their lives, normally also while they are unable to attend work. The last thing these patients need is further stress, wondering how they are going to pay for the treatment that they hope will keep them alive.

Another sector of the community that will be impacted by this bill is patients undergoing IVF. Australia has been at the forefront of IVF research since the 1970s. It has brought joy to many, many households across Australia. The first IVF birth in Australia was in June 1980. It was only the third IVF birth to occur anywhere in the world. I think it was in Adelaide actually, from memory. I would have to check.

Kate Ellis (Adelaide, Australian Labor Party, Shadow Minister for Education) Share this | Link to this | Hansard source

I was just a baby myself.

Jason Clare (Blaxland, Australian Labor Party, Shadow Minister for Communications) Share this | Link to this | Hansard source

It was you!

Kate Ellis (Adelaide, Australian Labor Party, Shadow Minister for Education) Share this | Link to this | Hansard source

It wasn't me.

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

There are now more than 10,000 babies born through assisted reproductive technologies each year in Australia. It is estimated that patients who currently pay only $4,000 per IVF cycle—still an expensive decision—will now be slugged with a bill of between $10,000 and $15,000. This is also at a difficult and stressful time in their lives. That is a huge increase in cost, particularly when couples often go through more than one cycle of IVF. That increase could be crippling to a young couple trying to start their family. Imagine their stress if the IVF cycle is not successful. Not only will they be terribly disappointed by their failure to conceive; but there will also be the knowledge that in order to have another chance to conceive they will have to face those huge costs again—another expensive roll of the dice. The President of the Fertility Society, Associate Professor Mark Bowman, claims that this bill will result in 1,000 fewer babies being born every year and an increase in sets of twin, triplets and other multiple births.

The Royal Australian and New Zealand College of Psychiatrists also has concerns about this bill. One of their concerns is that people with serious mental illnesses will no longer have access to psychiatric services. They are also concerned that sexual abuse victims, who are currently the subject of the Royal Commission into Institutional Responses to Child Sexual Abuse, will also not have access to psychiatric services. Psychiatrists and psychotherapists have warned that these changes will lead to an increase in the incidence of suicide among this vulnerable patient group. There is much at stake for this group of patients and the groups I have mentioned. It is not just about the extra costs of the service.

The existing arrangements provide that all out-of-pocket costs for out-of-hospital Medicare services will count towards the threshold. This bill will restrict the out-of-pocket costs that will contribute to reaching the threshold, making it harder to get to that threshold. Then, once the threshold is reached, there will be further caps on what will be covered. This is a cruel policy. The purpose of the safety net—the very essence of what the safety net is about—is to ensure that when a person faces a large amount of out-of-pocket health costs in one year they will be protected.

This purpose underlines the basic principle of Medicare—that every Australian should have access to the highest quality of medical care, regardless of their capacity to pay. That is what Whitlam was about when he introduced the bill in the first place. I know Fraser overturned it, but then the Hawke government brought it back in and it has been accepted by John Howard and by every Labor Prime Minister, obviously, but even by Tony Abbott. But now they are even undermining that universal healthcare principle. The most vulnerable patients are the ones that will suffer because of this legislation. Those with cancer, couples undergoing IVF, people with serious mental illnesses and victims of sexual abuse are the ones who will be hit hardest by the financial impact of this bill.

This government was elected on the promise of 'no cuts to health'. That was the commitment given by the leader of the coalition before the last election. That promise did not last past their first budget, and now we are seeing it made even worse. There was the GP tax, $57 billion in cuts to hospitals; and now this $270 million in 'reforms' to the Medicare safety net. This bill is nothing short of a cut to public health. In real terms it will mean massively increased out-of-pocket costs for some people—and, as I said, particularly those who are most vulnerable.

I know from my constituents that people value the Medicare system and care about protecting it. Just yesterday one of my constituents posted on my Facebook page this comment:

As an older woman, I say leave us alone. My husband is fighting cancer.

We both paid our taxes, medicare levies, and for 54 years my husband struggled to pay for private health. Why? Cos he believed, like many in our age bracket, that we were protecting our family's welfare.

You have no idea of 'struggle'.

This bill will hit the most vulnerable in our society the hardest. For that, I condemn the Abbott-Turnbull government. People battling with cancer treatment deserve more. People struggling to start a family with the assistance of IVF need to be considered, particularly with the benefits that will come to our society as birth numbers decrease. People who are victims of sexual abuse and people suffering from mental illness do not need this.

Could this bill be any more cruel? I ask the health minister to reconsider this piece of legislation and I ask the Turnbull government to reconsider this bill. I will not be supporting it.

Kate Ellis (Adelaide, Australian Labor Party, Shadow Minister for Education) Share this | Link to this | Hansard source

I rise today not just to speak against the Health Insurance Amendment (Safety Net) Bill 2015, but also to urge everybody to stand up against this legislation. I urge those members opposite to not blindly follow their executive in walking down this pathway which will lead to cruel outcomes for the Australians who rely upon our health system and who will face the consequences if this piece of legislation is allowed to pass.

We have heard that this is about finding savings; it is about finding savings in our multibillion dollar health system. The government has brought forward this piece of legislation because they seek to find what on paper is $270 million in savings. That is the bottom line when you look at it in black and white. But we know that in finding those savings they will be impacting the lives of thousands of Australians, they will be impacting the families of thousands of Australians and they will lead to cruel and short-sighted consequences of this legislation, which we must stand up against.

I would urge those members opposite to have a look at what the consequences of this bill passing the parliament would be. I note members before me have spoken in detail about a range of different consequences. I would like to particularly focus on the impact on one group of Australians that the passing of this bill would have—that is, the group of Australians who rely upon access to IVF in order to have the families that they have always dreamt about.

What we are talking about is the impact of this bill on thousands of people. We know, for example, that the use of assisted reproductive technologies, such as in-vitro fertilisation, has steadily grown in Australia. According to the most recent Australia and New Zealand assisted reproduction database, 12,000 babies were born in 2012, following assisted reproductive treatment in Australia and New Zealand. That is 12,000 babies and 12,000 families.

We also know that, according to the Harvard Medical School, one study of 200 couples seen consecutively at a fertility clinic found that half of the women and 15 per cent of the men said that infertility was the most upsetting experience of their lives. Harvard also noted that many individuals who experience infertility experience emotions common to those who are grieving a significant loss. They are struggling with the loss of the ability to procreate. Frustration, anger, despair, loss of self-confidence and loss of self-worth are common emotions, and this can put pressure not just on those individuals but on the relationship in the first place.

We know this because of Harvard research but we also know this because every one of us in this place represents couples who have sought IVF in order to have their families, in order to get the children that they have dreamt about. I know through constituents that I represent, through local residents and also through friends who have accessed IVF just how stressful that experience can be. From speaking to them I know about the pressure, the emotional strain, the anxiety that is put on couples who want nothing more than to be able to have the baby that they will love and cherish but have been unable to do so.

The piece of legislation currently before the parliament would mean that these couples could see the cost of a cycle of IVF increase from $4,000 up to $10,000 to $15,000 per cycle. That is according to the Fertility Society of Australia. We know that this would put inordinate financial strain on many parents who are desperate to have children. Members opposite should consider: if you are going to rise in this place, if you are going to speak in support of this bill, if you are going to use your vote to support this bill and blindly follow your minister and Prime Minister as they seek to find $270 million in savings, you should be prepared to stand up and explain to the couples that you represent, to the parents who are desperate to have a child that, because of your actions in supporting this legislation, those families may have to make the sacrifice of trying to scrounge to find $10,000 to $15,000 in order to access a cycle of IVF, that those families may have to deal with not just the emotional stress, not just the anxiety of not knowing whether or not a cycle is going to be successful but also the financial burden, the additional pressure that comes from knowing that, if that cycle is not successful, they may not be able to afford trying again. Members opposite, if you are prepared to stand up and support this bill, you should be prepared to look those would-be parents in the face and say you are willing to sacrifice their dreams of having a family because this is a government too lazy to do the work to find more sensible savings. You should be prepared to take responsibility for the fact that many families may not ever be able to access a cycle of IVF because of the financial burden. That is something that members opposite must absolutely consider if they are even contemplating supporting this bill.

We know the financial considerations. According to the Fertility Society of Australia, one in six couples in Australia and New Zealand suffer infertility—that is one in six of the constituents that I represent and one in six of the constituents that every member of this parliament represents. IVF private patients currently face out-of-pocket costs of around $4,000 per cycle. We know that success rates vary dramatically. Many couples need multiple cycles of IVF. The emotional strain builds up but the financial burden also builds up. At the same time, there will be many individuals for which IVF will not be successful, and these families have to deal with the grief, the stress and the sense of loss that comes with that as well as, if the government has their way, the out-of-pocket expenses, which can skyrocket as a result of this bill.

I give this information because, as with any legislation, it is important that every member of this House has a look a the real-world impacts of the bills that we are debating. It is not acceptable for members of this parliament to just blindly line up behind their minister and not accept personal responsibility for the consequences of this bill for Australians who want nothing more than to have a child, who want nothing more than to be able to access IVF in order to build the families that they have dreamt about. We know that bulk-billing IVF clinics are not widespread. We know that many couples turn to private IVF as their only option. It is each and every one of these families that will be impacted as a result of this piece of legislation.

If that were not bad enough, the government has simply not even bothered to do their homework to justify why these cuts are necessary. When Labor was in government, we made changes to the safety net. We are not for a moment coming into this parliament and trying to argue that the safety net is perfect or that we do not need to look at making changes, but we absolutely come into this parliament and say that you have to do your homework and make sure that you know what the consequences of those changes would be. When Labor made changes to the safety net, they were supported by two independent reports—thorough studies of what the situation was and what the situation would be as a result of the changes to the safety net. This government comes into this parliament and proposes this legislation which would impact families trying to access IVF, which would impact cancer patients across Australia and which would impact patients who desperately need access to a range of psychiatric services. They do so without having done any of the independent studies; without having gone out and made the case; without having laid out what the consequences of this bill would be, who would be impacted and by how much they would be impacted.

I say that, as a parliament, we need to stand up and say, 'That is not good enough.' As a parliament we need to stand up and say, 'We will not deny Australian families access to IVF services when the government is too lazy even to do their homework and to outline what the impact of that would be.' As a parliament we must stand up and say, 'It is not good enough to rip away people's dreams of having a family when we have a minister who cannot even make the case and who cannot even stand up and outline the data about what the impact of these cuts would be.' This is lazy legislation; but, worse than that, it is legislation which will impact on some of the Australians who most need access to our health system and who would be denied as a result of this.

We know that the Australian Medical Association is opposed to these changes. Their president has said:

The new Medicare Safety Net arrangements, together with the ongoing freeze of Medicare patient rebates, mean that growing out-of-pocket costs will become a reality for all Australian families, including the most vulnerable patients in our community.

We know that the Royal Australian College of General Practitioners has also warned about the impact of these changes, especially in the context of the government's GP tax and through its ongoing freeze of Medicare indexation. The president of the college, Professor Frank Jones, has said:

… coupled with the indexation freeze, the legislation will actually increase the cost of care to vulnerable groups. Safety net thresholds will increase by CPI annually while rebates are frozen.

Some may argue that the government have not had a chance to make the case and to look at what the impacts would be. So desperate is their need to find this $270 million in savings that they need to get this piece of legislation through, without having done the simplest of homework. But those who try to argue that should consider that this is not a new initiative. This is not from this year's budget. This is legislation that stems out of the 2014 budget that this government introduced. Since 2014, the government have had the opportunity to look at what the impacts would be and to make sure that there were not going to be any negative consequences for the Australian families who need access to the health system the most. They have failed to do so. They have failed to make the case, because this is a government that is so arrogant that they think that they can just make a decision and not even consider who it will be affecting and what the consequences of it will be.

I want to make it very clear to this parliament, as many of my colleagues have outlined, that we are deeply concerned about the impact this legislation will have on cancer patients. We are deeply concerned about the consequences that we know psychiatrists across Australia have pointed out. But we are also deeply concerned about the fact that this is a government that would wander into this parliament and introduce legislation which will have a profound impact on whether Australian couples have children, whether Australian couples can make the families that they have dreamt of. We are deeply concerned that they would do something so massive, without having done their homework, without having produced the data and without having made the case.

I urge each and every member of this parliament: if you are not prepared to stand up and say directly to the parents who need access to IVF that you are happy for them to be slugged $10,000 to $15,000 for each and every cycle of IVF that they may need, then you need to stand up and vote against this legislation. It is as simple as that. If members are prepared to support this legislation, they are prepared to support one of the cruellest sacrifices that this parliament could make Australian families do.

We know that this is a government who looks for savings and who looks to rip money from the Australians who need it the most. But is this a parliament that is going to support us ending the dream of Australian couples to start a family, because the government is too lazy to do their homework, to come up with considered policy and to make sure that they find $270 million amongst the multibillion-dollar health system, without ripping it directly out of the pockets of the patients that need it the most? I urge each and every member of this parliament to stand up and vote against this legislation.

Julie Collins (Franklin, Australian Labor Party, Shadow Minister for Regional Development and Local Government) Share this | Link to this | Hansard source

As we have heard from so many speakers, on this side, particularly, the Health Insurance Amendment (Safety Net) Bill 2015 is really a bill that came out of the government's 2014-15 budget measures and is really about looking for savings. It is about how we can cut money out of the health system, rather than how we can improve health services for Australians and make some savings while we are at it. We do have some serious concerns, as people on this side have outlined, about the impact of these changes on thousands of patients.

The Medicare Safety Net and the Extended Medicare Safety Net are important parts of the health system in Australia, because they are for vulnerable people who have chronic illnesses, who are suddenly diagnosed with a particular illness, or who have some injury or accident and in that particular year their health costs blow-out and their out-of-pockets are really high. This is about ensuring that they can access health services and are not actually having to make the very difficult decision to say, 'I cannot have this health treatment because I cannot afford it.' That is what the safety nets are there for. That is why they were introduced. They are there to protect vulnerable people who have a particular illness, a chronic illness or an injury or who have had an accident in a particular year and may not be able to afford access to health services during that 12-month period that they reached their safety net or their extended safety net.

I know many constituents in my electorate to have met this Medicare Safety Net or the Extended Medicare Safety Net from time to time; I know other constituents in my electorate who regularly meet it every single year, because their out-of-pocket costs are very high indeed. Interestingly, the Senate did a committee report recently on out-of-pocket health costs in Australia. They are a really serious issue. The Australian Institute of Health and Welfare estimates that in Australia, in 2011-12, $24.3 billion was paid in out-of-pocket expenses by patients, by Australians. That is an average of $1,000 per capita in Australia. So every Australian at the moment, on average, is paying about $1,000 in out-of-pocket costs for health care at the present time.

The Medicare Safety Net, of course, is mostly for out-of-pocket hospital expenses that have an MBS item—going to visit your GP, your specialist or your consultant. What the government is trying to do with this bill is just make a saving, as I said earlier, but the consequences of this saving and the people that it will affect are those people that need the services the most. As we have heard, they are patients who have been diagnosed with a cancer or a malignant melanoma, they are radiotherapy patients who have been recently diagnosed with prostate cancer, and they are victims of sexual abuse. They are also people with serious mental illnesses who will no longer be able to have access to psychiatric services. And, as we have heard so eloquently from the member for Adelaide before me, they are IVF patients who will face much higher costs if these changes go through the parliament. At the moment, out-of-pocket expenses are around $4,000 a cycle of IVF. That could go up to $10,000 to $15,000 per cycle, depending on where they are and the types of fees charged by their consultants.

This legislation will impact on some very vulnerable people. As an example, for radiotherapy patients who have been diagnosed with some cancers: we are talking about additional out-of-pocket costs of $7,000 to $8,000 per patient. When you have just been diagnosed with a particular cancer and you are trying to seek radiotherapy, the last thing you want to think about is how you are going to pay for the radiotherapy that you need to extend your life or, hopefully, have your tumours shrink, have your tumours go away and be able to have a very full and fulfilling life. The $8,000 per patient for radiotherapy is a very significant amount of money.

As I said, the Medicare safety net was introduced to assist and support vulnerable people so that they could access health services without having to worry about how they are going to pay for them. The country that we live in, Australia, is about a fair go for everyone, and I am sure that nobody in this place really wants people to be making decisions about their health based on what they can afford to pay. It is not the Australian way and it is not what Australians genuinely would support in the community.

These measures, as I said, were part of the 2014-15 budget. That budget also tried to make other health savings. You need to look at the health system in totality when you talk about better access to health care, better services for Australians and making savings. As we have heard, the issue with this bill is that the government has been lazy about the way that it has gone about it. The government is just trying to make a saving without looking at the impact on the broader health system or at other ways in which the Medicare safety net could be adjusted to provide some of those savings.

Of course, it was in the 2014-15 budget that we saw the GP co-payment proposal come from the government. Not once, not twice but three times we heard from the government that the GP co-payment was going to be introduced. It was only through pressure from people on this side standing up—like we are standing up in this debate today—and saying, 'No, we are not going to support that', 'That is not okay', 'The Australian public will not agree to this,' and, 'The Australian public never voted for this,' that we actually managed to get the government to back down on the GP co-payment. The reason, of course, that we had problems with the GP co-payment was that it was again about restricting access to health services that people need. It was about vulnerable people who may be making decisions about accessing health services based on whether or not they can afford it. That is not the Australian way, as I said previously. It is not the Australian way to say to people, 'You can only access health services if you can afford to pay for them—if you are wealthy enough.' That is not the country in which we live in today, and it should not be the country that we live in into the future.

Of course, with the freeze on the Medicare rebate for seeing a GP, we still have a GP co-payment by stealth from the government. We still have GPs in Australia with notices in the GP clinics saying that they may have to increase their charges or charge a gap rather than bulk-bill patients. They are saying that, because, of course, the government has frozen the rebate for three years, even though we know that health costs will increase over that period. We have had the AMA and GPs all over Australia coming out and saying that this will have an impact on patients accessing health services. They are still telling stories, of course, of when the 2014-15 budget first came out and a whole heap of people cancelled their appointments at the GP because they thought that the GP co-payment was already in place. So we know that it will have an impact on people accessing critical health services that they may indeed need.

We also know that primary health care is one of the cheaper ends of the health system. We know that if people see appropriate primary health carers at the correct stages of their illness or disease that can actually stop the hospital admissions that may occur. We know that we may be able to save more money further down the track by having patients seen on time and by getting doctors to see their patients. What we do not want in this country is those patients saying, 'I'm not going to access the GP, I'm not going to go to my specialist and I'm not going to go and have this radiotherapy treatment, because I cannot afford the out-of-pocket costs,' and that is what some of the changes in this bill will do. Some of the changes in this bill will see out-of-pocket costs increase for patients right across the country, particularly in those areas of radiotherapy, psychiatric services and IVF.

Last time we were in government, we made some changes to the Medicare safety net. We did look at some of the excessive charging that we thought was happening with consultants, and we did look at some changes to the Medicare safety net and, indeed, the extended Medicare safety net. We made some decisions based on evidence. We had two reports to us before we made those decisions. We had two reports looking at the consequences of the decisions that we were making, and that is not the case with this bill. The government are merely saying, 'We want to make savings in health system, so we are going to just cut some things and put caps on them in the extended Medicare safety net, because we can and because we want to make savings in the health portfolio.' That is the only reason the government are proposing these savings. They are not doing it because they want to provide better health services for patients. They are not doing it because they think that there is some systematic issue in the health system. They have not provided any evidence to suggest that that is the case. Certainly, to date, I have not seen any evidence at all from the government about why they are going down this path.

We have not had the health minister explain properly to people why the government have made the decisions about these particular services that we are talking about and why they have made the to decisions to cap what gap payments can be. We have not heard anything from the minister other than, 'We have to make savings.' The minister has not gone out and done her homework about why the Medicare safety net and the Medicare safety net need adjusting. She has not done her homework in terms of access to health services. She has not done her homework in terms of the consequences to some of these patients who may need critical care—either for radiotherapy patients or IVF patients that want to have a family. She has not looked at what impact this will have on those patients and those services.

The IVF issue, as the member for Adelaide talked about, is a really critical one for those couples who need IVF support to have the family that they dream of and to have the family that, for many years, many of them have been trying to have. It is traumatic and very difficult for couples to go through IVF cycles. Imagine going through those cycles of treatment knowing that every time you do so your out-of-pocket costs could go up from the current $4,000 to $10,000 to $15,000. It is a very significant impost on those couples who are having to make those difficult decisions about their families and their future families. They are very difficult decisions indeed—as I said, they are already under a lot of strain and no doubt are already emotionally in a difficult place trying to make those decisions.

This bill has not been thought through properly. This bill should not be supported. It is one of those government changes in the 2014-15 budget that tried to make massive cuts to the health system in Australia without the consequences for patient care being thought through. The government did not think about the consequences and the effect of the decisions that they were making in terms of the greater Australian community. They were not thinking about those people who have chronic conditions, those people who are ill—the elderly, those people who have an accident or an injury who might need to access health services in a particular year with the extended safety net and the Medicare safety net. As I said, there were various proposals for GP co-payments and there is the current GP co-payment by stealth. All we have seen from this government is a whole heap of savings in health. We have not seen any suggestions about how they are going to improve access to health services in Australia; all they do is talk about sustainability and what they mean by 'sustainability' is cuts. That is all they mean—cuts, cuts, cuts and more cuts. They are not talking about improved health outcomes for Australians, they are not talking about better access to health care, they are not talking about people being able to access health services when they need them and access health services in a way that will stop them having to impose further costs on the health system. They are not looking at preventing hospital admissions or any preventative health measures that could be in place. All we have seen from them is cuts. They just want to continue to cut—they want more out-of-pocket expenses for patients, for Australians, particularly for those Australian who are already sick and vulnerable and who already require additional assistance from government in many cases through the safety net and the extended safety net.

There is no way that I and members on this side of the House can support the bill, although I understand we will be referring it to a Senate committee so that some of the people who will be adversely affected by the bill—some of the experts and clinicians, some of the consultants and specialists in these areas—can put evidence before the Senate and before the parliament in the hope that those on the other side might listen and might look at other ways of making savings in health that improve access to health services and make savings at the same time. They could do some work and get some evidence and that is why we are going to refer the bill to a Senate committee—to see if some of that work can be done by the Senate given that the government does not seem to want that evidence before the parliament before the bill is voted on. I am proud to support the amendment but not the bill.

Andrew Giles (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (Safety Net) Bill and in particular in support of the amendment by the shadow minister, the member for Ballarat. I am proud to have been here listening to my colleague the member for Franklin outline exactly why this bill should be rejected and the proposals contained in the amendment should be supported. I am proud to be standing with my Labor colleagues against changes that would adversely affect vulnerable people often at a particularly vulnerable time in their lives. The member for Franklin stressed the main theme here, which is that there may well be a policy case for change but the changes in this bill do not meet that challenge. The evidence has not been brought to bear. The evidence is not before us. This is particularly important in respect of this bill because the provisions contained within it cannot be assessed in isolation from the wider challenges in health care—wider challenges compounded by the attitude of this government through both of its budgets.

This is an opportunity to look at the Labor approach to health and the Labor approach to policy reform more generally. This government has a new Prime Minister who is very keen to talk up reform, but he is very reluctant to talk about what this reform is in aid of. We see this in the tax debate, where mellifluous sentences are strung together and there is much grandiose rhetoric but no real sense of what it is all in aid of—it is reform for reform's sake. Similarly we see 'sustainability' as a weasel word in the government's approach in respect of health—in respect of health generally and specifically in respect of some of the challenges this bill is said to respond to. We hear a lot about sustainability, which is of course code for cuts—cuts being the lazy approach to reform. There is a lot of talk about sustainability but no talk, really, about ensuring appropriate access to health care, much less talk about the real challenge here, which is improving the health and wellbeing of Australians.

I guess this lazy ideological attitude to public policy reform goes to the heart of the debate on this bill. As the member for Franklin very eloquently and effectively set out, we see assertion where we should have evidence—assertion in the place of evidence underpinned by a deep ideological preference for the private over the public. While it is important to acknowledge that there is a policy case to have a rethink about how the safety nets operate, there is much more work to be done if we are to take the government and the Minister for Health at their word on the intention of this legislation. These are issues that are so important to the people I represent. Universal health care is the most significant issue raised with me by my constituents, many of whom signed petitions in response to the various proposals of this government to introduce a GP tax. Universal access to health is of vital importance to the communities I represent and this legislation fundamentally damages that great principle, the foundation stone, of the modern Australian social compact. We should be slow to take government members at their word about this simplification process and in respect of some of the equity arguments that have been advanced in support of the bill. The reasons go to the detail of the bill, but also to its proper context.

We cannot see this legislation in isolation. It has to be considered in respect of this government's overall attitude to health. I talked briefly about the various proposals we saw for a direct GP tax, which has now been replaced by the GP tax by stealth—the rebates freeze, which represents a $2 billion cut to Medicare. And this sits with a $60 billion cut to public hospitals—that is a $60 billion cut, along with deep cuts to vital preventative health programs, along with the abolition of vital agencies such as the Australian National Preventive Health Agency, and along with cuts to public dental programs, cuts to mental health, cuts to Indigenous health, attempts to increase the cost of medicines—I could go on. But we are seeing a systemic attack on universal health care in Australia. This was exemplified by the recent attack by the minister on the principle of community rating; an exemplar of the privatise-at-all-costs, social Darwinist attitudes that underpin the deep policymaking preferences of those opposite.

In essence, we are talking here about cuts to the very notion of universal health care; the preference being—unstated, of course, and unargued for, unfortunately—to privatise health care in Australia. These were not arguments put to the Australian people before the election. In fact, the opposite arguments were put by the former Prime Minister in the Griffith by-election. These are not arguments which are advanced in the context of this debate. But this deep ideological suspicion of Medicare informs so much of the government's attitude. Liberals have been consistent in opposing universal health care in Australia for 40 years. Initially, they were up-front about this: they were up-front about it in the seventies, which saw the dismantling of Medibank; through the eighties, Prime Minister Howard was very up-front about his views on Medicare. Since then, Liberal party members have stopped talking directly about these views, but by their actions they give the lie to their stated commitments to Medicare. They are less honest about their views about Medicare and universal health care now—but, as we have seen over the last two years, this does not change the substance. This does not change the effect—the effect in this place but also, more importantly, the effect on people's lives and the potential effect on health care outcomes, driving us towards an even less equal society.

While all the talk of sustainability fills the rhetoric of government members, let us not forget for a moment that our universal health insurance scheme provides us with healthcare costs that are relatively low by OECD standards, while providing universal coverage. And obviously, there are major contrasts with economies like that of the United States in that regard. There are real fears that this approach to health care could lead to higher healthcare costs, for all the talk of sustainability. And this is not to consider the vital role that our universal healthcare system has in maintaining an effective social wage, in being a vital bulwark against inequality, both in an economic and in a broader wellbeing sense.

Looking at that context, I turn to the bill itself. I note that right across the healthcare sector we see very, very strong opposition and deep concern about the provisions in this bill. Strong comments such as those that have been made by Brian Owler of the AMA should be taken seriously. Of course, no-one here is suggesting that stakeholders should individually drive any reform process. But when concerns are voiced so seriously, they deserve to be taken on board. That has not been done. As well as the AMA, a variety of specialist bodies have also spoken out to express their concern. It may well be that these concerns could be addressed by a proper reform process. I think it is useful to reflect on the 2009 process considered by the former member for Gellibrand, Nicola Roxon, when she was Minister for Health and Ageing, where an evidence case was built in response to a stated problem. Here we have nothing of the sort. And, while simplification is generally a good thing in public policy—and clearly our rebate system and the safety nets that attach to it are complex and difficult to understand—simplification is not an end in and of itself. A single safety net is, I believe, a fine aspiration—but surely it is a means to providing effective access to health care at lower cost, and to health and wellbeing for all Australians, particularly in light of the sorts of circumstances we dealing with here, when individuals are faced with extraordinary, one-off events that can impose great financial pressures at very difficult points in their lives.

Again, let us think about the first principles that underpin this: we are trying to provide that form of insurance and, in doing so, maintain the principles of Medicare and the principles of universal health care which just about everyone in this parliament espouses, at least on paper. And, when we are mindful of these first principles, let us also think about the adverse consequences that we believe could arise from this bill, that have not been adequately dealt with by the minister or government members, maybe unintentionally, but which are adverse nonetheless. We have very serious concerns about these impacts. At a general level, we are concerned about the introduction of restrictions on the out-of-pocket costs that contribute to a person reaching the safety net, and about the reduction of amounts received back after the safety net is reached—noting, of course and only to be fair, the lowering of the safety net threshold. But let us be clear about this: some patients would be reaching the safety net sooner, but that is would be in the overall context of a $270 million cut, which makes it very clear that savings are to be made—that is, the savings claimed by restricting out-of-pocket costs that can accumulate to reaching the safety net and additionally by placing further caps on what is to be covered. There may be good reasons for some of these caps—I am sure there would be—but that case has not been founded in evidence. It is merely something that we are asked to take on trust. That is something we should not do with this minister or with this government.

Going beyond the general to some of the specific areas of concern that were touched on by the shadow minister in her contribution, very effectively and in some detail, and by the member for Franklin before me: we should not treat lightly the impacts on specific cohorts of patients; particularly, as I said earlier, at vulnerable points in their lives. I think about radiation oncology patients, and I think about those accessing psychiatric and IVF services, and I will touch on them briefly. These are important matters that deserve reconsideration by the government, through—ideally—acceptance of the amendment moved by the member for Ballarat, or through the Senate committee process. What we are really talking about here, stripped of the rhetoric, is a cut giving effect to cuts of $270 million to the safety nets through the abolition of the current safety nets and their replacements. These safety nets exist to serve a simple and important principle. It is all very well for the minister in her second reading speech to talk about the problems and the current arrangements, which this legislation is said to attend to. She is right to say:

The current safety nets are complicated and confusing.

But this is not the whole story, quite far from it. The shadow minister, the member for Ballarat, has said that Labor does not say the present arrangements are perfect and nor do we resist reform in this area, especially to improve targeting one of the issues purportedly this bill is to deal with. But we take a considered and respectful approach to this challenge—as we did under former Minister Roxon in 2009, as this government continually refuses to do and as our proposed amendment would provide for.

In the time remaining to me I will touch briefly on the specific areas of concern that I believe warrant a proper response. The member for Franklin ended her speech in touching on the issue of couples and individuals accessing IVF. Again, we need to take very seriously the concerns that have been raised by fertility services providers when they suggest, reasonably at face value, the costs per cycle could more than triple to between $10,000 and $15,000. This is a matter that we should give very serious regard to and think about the circumstances of those people considering IVF and how we should restrict access to that. These are debates that we should have through the front door not through this sort of default system. There have been some serious concerns raised by psychiatrists on the potential impacts on the patients they provide vital support and care for. The commentary of their professional leaders touch on issues like the cohorts of potential patients like the victims of child sexual abuse, which is a matter that is of importance and concern to all of us in the context of the royal commission. I suspect these impacts may be unintended consequences of the legislation but they prove the point. Similarly, radiation oncology patients who were formerly bulk-billed would be very seriously affected and their household budgets stretched—huge stresses and huge strains on people who are at a very, very challenging time in their lives.

In wrapping up, Labor accepts that there is a case for review, there is a case for change, but it should be founded in the evidence, it should be founded in first principles, and it should also be founded in a broader discussion about our approach to health. These provisions cannot be isolated from the broader settings of health policy and the broader decisions of this government, but this bill—through its hasty introduction and lack of consultation—will compound difficulties in the health system rather than alleviate them. The bill should be rejected and the amendment of the member for Ballarat supported.

Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

I think Australians are rightly proud of our health system. Labor's reforms in government saw 11,000 more doctors, 26,000 more nurses, and more doctors in the bush. It was Labor that built Medicare, it was the Hawke and Keating governments which sustained it and supported it, and we had to rescue it when we came to power in November 2007. Under the stewardship of the member for Warringah as the then health minister, bulk-billing rates were as low as 67 per cent. We attained record GP bulk-billing rates of over 82 per cent by the time of the fall of the last Labor government in September 2013. We invested more money. We invested $20 billion extra in our hospitals and that funding would have continued up until 2020 but for the election of the coalition government.

I do recall seeing that blue book with the smiling visages of the member for Warringah, the member for Wide Bay, and the now Prime Minister, the member for Wentworth. They were smiling sweetly about their plan, the dog-eared plan—the blue book. It looked a bit crusty by the end of the campaign. It was going to set out what they were going to do. When I had a look at this particular legislation, I thought: 'What were they actually going to do on health?' So I pulled out and dusted off the Fiscal Budget Impact of Federal Coalition Policies, which was released a couple of days before the election. I went to section 5.0, Coalition's Health Policies. They were going to strengthen GP practice—well, that has really gone down very well with the GP co-payment proposals in various iterations and the 'GP co-payment by stealth' as the President of the AMA, Brian Owler, talks of. They were going to double practice incentives and invest in regional and rural teaching infrastructure, and a whole range of things such as investing in medical internships and boosting front-line health care and research.

I wonder how that front-line health services boosting is going on with the $60 billion in cuts to health and hospital services. There were a whole range of things. I went down from 5.1 through to 5.17 and the Net Budget Impact—Health Policies as $344 million out to 2016-17. I went through it again to see if I could find a GP co-payment in there anywhere, or a change to the safety net in terms of Medicare, and I could not find it anywhere. In fact, it is not to be found anywhere because the coalition, before the 2013 election, said absolutely nothing whatsoever about this. In fact, the member for Warringah, the then opposition leader, was very quick to say there were going to be no cuts to health, no cuts to education, no cuts to pensions. So the people trusted the coalition when they came to power that they would support Medicare, that they would not make front-line health services harmful and that they would not undertake cuts in relation to hospitals and the kind of care that Australians expect. Why? Because under the previous Labor government we had invested in medical workforce training, shorter times had been achieved in terms of waiting times for emergency and we brought in a Growing Up Smiling package, a kids dental package which was a revolution in terms of what it was going to do. But this government coming to power seemed to break all of that. We had the disastrous budget in May 2014, where they said that Medicare was lacking in sustainability in the health service. They then undertook cut after cut after cut but they did not direct it towards the system, or the sector whatsoever; they directed it towards a future fund.

Research is good. Who could seriously argue that putting money into a medical research fund is a bad thing? Of course we think it is a good thing. We ultimately supported it. But this government undertook cuts everywhere and, in the end, did not put any money back. We saw more than $60 billion cut from Australia's public hospitals. There was an attempt to increase the cost of medicine for every Australian, including through the unfair changes to the Pharmaceutical Benefits Scheme.

Labor are very proud of the Pharmaceutical Benefits Scheme, because we built it; we founded it. The Pharmaceutical Benefits Scheme has been helping millions of Australians each year with the cost of essential medicines. We are very proud of it and we support it. We championed bulk-billing rates. We got them to record highs. We were helping to keep the health costs of Australians lower and helping working families nationwide. But the coalition came into power not saying anything about what they were going to do in terms of the changes they made in the May 2014 budget. They have made it much harder for families to get the kind of health care they need. Families are forced to use their credit card rather than their Medicare card.

What are the government doing here? What are they arguing? They are arguing that the Medicare safety net is primarily utilised not by low-income earners but by middle- and high-income earners. Through this legislation, although the government is introducing a new Medicare safety net with a lower threshold for patients, there are restrictions on some out-of-pocket costs that accumulate towards that threshold, and the benefits payable once patients reached the safety net are also restricted. Why are they doing that and on what basis are they doing it? Is there any empirical evidence whatsoever to support this? How will this enhance the health of the country and the health of families? Will it help in terms of their health costs?

We know that if you take $270 million out of the government contribution towards the health system someone will have to pay. It will be families who will pay. They will pay more. Legislation for family tax benefit cuts came before the chamber yesterday and will be looked at I think today or tomorrow. The impacts on the family tax benefit part A supplement leave 14,715 families in Blair hundreds of dollars a year worse off and the cuts to the family tax benefit part B supplement hit 13,041 families in Blair.

When we made changes to the Medicare safety net in 2009, we did so based on empirical evidence, based on reports done by the Centre for Health Economics Research and Evaluation. We released those reports and, on the basis of empirical data, we looked at what would best make the system sustainable and what would best help families. So we are not opposed to better targeting and making changes; we are opposed to making it harder in the name of simplification. The government is proposing to simplify Medicare safety net arrangements, and that was indeed the theme of their 2014 budget.

You have to look behind the rhetoric to see the impact. This simplification results in an adverse impact on thousands and thousands of patients. It does the three things I mentioned before. It lowers the safety net threshold for all patients, which in and of itself sounds good, but it restricts the out-of-pocket costs which contribute to the patient reaching the safety net and it reduces the amount the patient receives back once they reach the safety net. So on the surface it looks fine, but there is a sting in the tail.

Speaker after speaker on this side of the chamber have talked about the impact on radiation oncology patients—those suffering from cancer, whether malignant melanomas, prostate cancer or breast cancer. The government is simply not listening to the sector. It is certainly not listening to the AMA. My colleagues on this side of the chamber have quoted Brian Owler, President of the AMA, on numerous occasions. As he has said, the new Medicare safety net arrangements, together with the ongoing freeze of Medicare patient rebates, mean that growing out-of-pocket expenses will become a reality for all Australian families, including the most vulnerable patients in our community. The AMA is not an affiliated union to the Australian Labor Party. The AMA is an organisation that is very independent and that is quite prepared to give both sides of the chamber a hit up the chin if it wants to. It is quite prepared to tell both sides they have got it wrong. This is not, as the government suggests, about taking away from wealthy families. In fact this is going to have an impact, as the AMA said, on the most vulnerable patients in our community. It does not have the support of the Royal Australia College of General Practitioners either.

This will have a big impact on my electorate, where bulk-billing rates have hovered between 88 per cent and 92 per cent in the last year or two. So will the GP co-payment by stealth that has been inflicted by this government. That will rip $1.3 billion out of Medicare over the next four years. The amount that we are talking about today is a small amount but it will have an adverse impact on families. If there is a rebate freeze, it will have an impact on the profitability of GPs. A study done by the AMA and the Medical Journal of Australia has found that by 2017-18 the shortfall will leave GPs $8.43 worse off, forcing many doctors to charge patients who are currently being bulk-billed, and resulting in increased gap payments for other patients. On top of the freeze the government is imposing there is another whammy on vulnerable families. In relation to the GP co-payment, which they were talking about before, they could not work out whether it was going to be $7 or $5—there were various iterations. According to the data, it would have had an impact of about $4.7 million on families in the Blair electorate.

The legislation before the chamber is not good legislation. It will have an adverse impact. Let us look at the current arrangements. Under existing arrangements, all out-of-pocket costs for out-of-hospital Medicare services count towards the threshold. Once a patient reaches the extended Medicare safety net, 80 per cent of their out-of-pocket costs are covered for out-of-hospital Medicare services.

This is not good legislation. The government should have a look at itself and withdraw the legislation. That is why Labor is opposing it.

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

Order! It being 1.30 pm, the debate is interrupted in accordance with standing order 43. The debate may be resumed at a later hour.