Sharon Claydon (Newcastle, Australian Labor Party) Share this | Link to this | Hansard source

It is with pleasure that I rise to speak on this bill before the House, because, whilst we may have a new Prime Minister in this parliament, the bill we are in fact debating here today, the Health Insurance Amendment (Safety Net) Bill 2015, is certainly further proof that, despite a new face, there are many things that remain the same. Here we see evidence of that same unfair, callous approach that has existed since this Liberal government was elected and certainly in this area of health.

The bill implements the unfairness that originated with the 2014-15 budget. It gives effect to those budget measures. 'Simplified Medicare safety net arrangements' was very much a theme, if I recall, of that budget as well as this government's general approach to the health portfolio. When we talk about simplifying measures, what that really meant was cuts to the safety net of some $270 million.

We have seen cuts across every part of the health system in these last two years. The Abbott-Turnbull government has taken more than $60 billion in cuts from Australia's public hospitals, including some $155 million from hospitals in my region. It includes attempts to increase the cost of medicines for every Australian, including unfair changes to the Pharmaceutical Benefits Scheme safety net. It includes $370 million in cuts to the preventive health programs, programs that we know are vital to getting Australians' health back on track. There is the abolition of the Australian National Preventive Health Agency and Health Workforce Australia. Those are two huge issues that are looming in this nation that this government has taken the razor to.

There is the government's ongoing effort to implement a GP tax in one guise or another. This is, I believe, the fourth reincarnation of what has always been a very bad public health policy that this government simply refuses to put to rest. So let's try GP tax version 4 now, through the perpetual freeze of the MBS, which represents a cut of some $2 billion from Medicare. We are of course seeing cuts of hundreds of millions of dollars from public dental health schemes, another incredibly critical service that people in my electorate of Newcastle have voiced their concerns about to me on many occasions. There are cuts to the general practice training programs and there are cuts to mental health—and, most alarmingly, cuts to Indigenous health programs.

How this government intends to meet its close-the-gap targets is a mystery to most people outside of this parliament. If there is a failure to meet those targets, you can rest assured that my colleagues and I on this side of the House will be holding this government to account.

The cuts are really deep and they are at every level of health. The bill before us today, the so-called 'simplified' safety net, involves abolishing the existing original Medicare safety net and the extended Medicare safety net. Labor is opposing this bill, because we have serious concerns about the adverse impact these changes will have on thousands of unwell and vulnerable Australians.

While the bill does lower the safety net threshold for all patients, restrictions on the out-of-pocket costs that contribute to a patient reaching the safety net are introduced, and the amount patients receive back once they reach the safety net is also reduced. In particular, Labor is concerned about the impact these changes will have on: radiation oncology patients, patients needing ongoing access to psychiatrists, and patients accessing IVF services. I would like to spend a little time now highlighting some of the concerns I have around detrimental impacts that these changes will have for radiation oncology patients—people with cancer.

Radiation oncology patients, who had previously been bulk billed for elements of their treatment, will now see significant new out-of-pocket expenses. Cancer is an issue that touches so many Australians. In my region of Newcastle and the Hunter we have quite high rates of cancer. There are very few families in my electorate who are not touched in some way by this disease.

If you look at the rates of prostate cancer, for example, there are about 20,000 Australian men diagnosed every year, including 1,200 in the Newcastle and the Hunter region. Around 3,000 of those men die from prostate cancer every year, including about 160 in the Hunter. That is a lot of men to be losing on an annual basis.

When we look at the melanoma rates, there are around 11,000 Australians diagnosed with melanoma every year, including 600 in the Hunter-New England region. It is the second most common cancer in the Hunter, behind prostate cancer. There are very high rates in our communities. We have way above average rates of melanoma. Indeed, the Cancer Institute New South Wales figures show the Hunter ranks fourth highest in the state.

And then, of course, there are the disturbing figures around breast cancer. Five hundred and fifty women are diagnosed with breast cancer in the Hunter each year. It is the third most common cancer in the Hunter. These patients are now forced into increased out-of-pocket expenses. According to one example, a patient with a malignant melanoma receiving stereotactic radiation treatment could face new out-of-pocket costs of some $7,400. A patient with prostate cancer receiving volumetric modulated arc therapy could face new out-of-pocket costs of some $8,000. Similarly, a patient with breast cancer being treated by private providers might see a 200 per cent increase in their out-of-pocket expenses for radiation oncology. These are massive imposts on people who are very unwell, feeling especially vulnerable and already have so much to deal with.

Due to the debilitating nature of these illnesses—not to mention the incapacitating effects of the treatments that people have to undergo—many cancer sufferers are unable to work and earn an income for prolonged periods of time often extending into remission. Having to come up with thousands of dollars to meet extra out-of-pocket costs is not something that anyone experiencing cancer should have to undertake.

There is barely a week that goes by in my electorate where I do not have an invitation to attend a fundraiser for a family who are doing it tough and trying to raise money to complete their medical treatment. There are examples of morning teas, trivia nights, film screenings and, increasingly, crowdfunding. That is before these additional cuts come into play. That is before these additional out-of-pocket expenses kick in. It is an enormous financial burden already for people undergoing prolonged treatments for cancer.

I have an example of a young man in my electorate suffering terminal brain cancer. He is not eligible to go for a disability support pension. There is no financial support available for him while battling this illness. Additional thousands of dollars to add to an already hefty bill is the cruellest of cuts from this government. These are people who do not have a treasure trove of savings to call on. Nobody makes plans for a cancer diagnosis; it is a very unexpected matter for most people to have to deal with. This additional burden, as I said, is just one of the cruellest consequences of the bill before the House today.

Health professionals agree that the impact of the changes proposed in this bill will negatively impact their patients. The Australian Medical Association is opposed to these changes. The President of the AMA, Professor Brian Owler, 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…

The Royal Australian College of General Practitioners have also warned of the impact of these changes, especially in the context of the government's GP tax through its ongoing freeze of Medicare indexation. The college's president, 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.

Concerns have also been raised by the Royal Australian and New Zealand College of Psychiatrists. Cancer groups and others have also raised consistent concerns about the thousands of patients that will be adversely affected by these changes.

Breast Cancer Network Australia Chief Christine Nolan said:

Many women are dismayed to learn that despite paying years of private health insurance premiums, they cannot claim for radiotherapy costs from their private health fund unless they are in hospital during their treatment.

These women must rely on the Medicare Safety Net to maintain their costs for radiotherapy at a reasonable level. Breast Cancer Network Australia is concerned about any proposed changes to the Safety Net that may increase treatment costs and add to the financial burden of a breast cancer diagnosis.

In these last few minutes I would like to take a look at some of the detrimental impacts these cuts will have on patients needing ongoing psychiatric care. Psychiatrists, especially those providing psychotherapy services to very vulnerable patients, have warned the government of the very serious impact on patients they care for. Dr Shirley Prager, the President of the Association of Practising Psychiatrists, has said:

I am very concerned about the impact the new Safety Net proposals will have on patients who need long-term ongoing mental health treatment as these patients will find their health care with a psychiatrist increasingly unaffordable. If the new Safety Net is legislated a significant group of high need patients who require consultation with their psychiatrist more than once a week will lose the appropriate level of support provided by the current Safety Net arrangements. Many of these patients are poor and unable to work as a consequence of illness, and the intensive psychiatric help that they urgently need to re-build their fives will be lost under the new Safety Net.

Dr Prager has also said:

I believe that patients who need to access a psychiatrist in these circumstances will suffer significant and increased financial hardship, or may, very frequently, be forced to give up much needed treatment to the overall detriment of their own personal health and well-being. The consequences are potentially disastrous.

Again, in my region, many people have revealed, for the first time, through the Royal Commission into Institutional Responses to Child Sexual Abuse, the terrible trauma that they have experienced in their lives. They are now seeking some assistance in their healing process; those people are reaching out for our help. The cuts that we see in this legislation before the House tonight really go to denying those people the very treatment they need to complete the healing process.

Chris Hayes (Fowler, Australian Labor Party) Share this | Link to this | Hansard source

Once again, we are seeing some of the core values of the Liberal Party well and truly on display as they continue their relentless attack on disadvantaged Australian families. We probably should not be all that surprised, given that in the lead-up to the 2013 election—maybe that is not the right way to say it—or rather on the night before the 2013 election, remember the promise made: there will be no cuts to health. They did go on to say there will be no cuts to education and a number of other things as well, about which many people around here have had their head down ever since. But the truth of the matter is, having said that, they formed government and, in doing so, one of the first things they did was slash $60 billion from the Australian health budget, from Australian hospitals. They cut straightaway. It was not just the opposition who were jumping up and down about that. The leaders of Liberal state governments wasted no time. New South Wales Premier, Mike Baird, said, 'This was a kick in the guts to all Australians.' This is not something that should be seen as a government-versus-opposition issue; this is something that should be seen as an issue of great importance.

This legislation is of such great importance that I would have thought, on a piece of legislation like the Health Insurance Amendment (Safety Net) Bill 2015, the government would offer more than three speakers. Only three speakers were brave enough to come into the House and try to defend their position on this legislation before us today. They are taking $60 billion from Australia's public hospitals and $370 million from preventative health programs, and they are imposing an ongoing development of their GP tax through the MBS freeze, which represents a $2 billion cut to Medicare. This is hardly consistent with what they said the night before the election: 'There will be no cuts. Trust us.' I think the Australian population's view of politicians' promises has probably been largely gauged through the rather black joke that has been played on them by this government. The bill that is before the House tonight, if passed, will give effect to that first and most infamous Liberal budget of 2014 and their budget measure to 'simplify the Medicare Safety Net arrangements'. This will cut approximately $270 million from the Medicare Safety Net.

At a time when we should be looking at healthier lifestyles in this country, we now have a government, and certainly a health minister, that is instead working to do the complete opposite. Under the existing Medicare Safety Net arrangements, there are two safety nets: the Original Medicare Safety Net and the Extended Medicare Safety Net. The Original Medicare Safety Net provides an additional rebate for out-of-pocket hospital services when the sum of the difference between the MBS fee and the MBS rebate reaches the threshold in any calendar year. From 1 January 2015, the annual original safety net threshold is $440.80. The extended safety net provides for additional rebates for Australian families and singles who incur out-of-pocket costs for Medicare-eligible out-of-hospital services. There are two thresholds under the Extended Medicare Safety Net which are indexed by the CPI on 1 January each year. From 1 January 2015, the annual Extended Medicare Safety Net threshold is $638.40 for Commonwealth concession cardholders, pensioners on concession cards, health care cards, Commonwealth senior cards and people who are on family tax benefit A.

By the way, there are 17,000 people on family tax benefit A in my electorate. I have often said that my electorate has much to be proud of in terms of being the most multicultural electorate in the country. The colour, the vibrancy and diversity of it is something that we have many, many celebrations for, and it is something that we can all revel in. But there being 17,000 families in family tax benefit A is probably indicative of the fact that my electorate is not rich. My electorate has a high degree of disadvantage. As a matter of fact, my electorate also has a very high degree—it is overrepresented, in fact—of families living with disability. So this is something which very much goes to them. In addition to those thresholds I just spoke about, there is a $2,000 threshold for all other singles and families.

Under the Liberal government's proposed new arrangements, there will only be one safety net. It will be called the Single Medicare Safety Net and it will be for out-of-hospital services. Under the Single Medicare Safety Net, it will be $400 for singles with a concession card or families with a concession card; $700 for singles with no concession card or families receiving family tax benefits part A—like those 17,000 families I spoke about in the electorate of Fowler—and $1,000 for families with no concession card. Leaving concession card holders aside, the average household income in my electorate is a tad over $50,000. So, again, that paints the picture: my electorate is an area of significant need. It is regarded as a low socioeconomic area. These thresholds will now clearly impact on many families and on many families of great need. This is a direct attack on them, particularly as, on the night before they entered the ballot box at the last federal election, they were told that there would be no cuts to health.

The new Medicare safety net will be at a lower threshold for all patients. But it is of concern, quite frankly, that it will restrict the out-of-pocket costs that contribute to a patient reaching the safety net. The threshold amounts will be reduced. What patients receive is going to be very much impacted. A great change is going to be foisted upon the chronically ill, pregnant women, cancer patients and anyone who is in the medical system and using it extensively. Over 800,000 Australians will be slapped with higher medical bills and out-of-pocket expenses worth over $600 a year, after receiving the standard Medicare rebates. This is not including the out-of-pocket costs for non bulk-billed GP visits, which will rise from $7.60 to $19.45 and will not be covered as out-of-pocket expenses.

In particular, Labor is concerned about the impact that these changes will have on radiation oncology patients, on patients needing the services of psychiatrists and on patients accessing IVF services. For instance, a patient with a malignant melanoma receiving stereotactic radiation treatment could face new out-of-pocket costs in the vicinity of $7,400, while a patient with prostate cancer accessing volumetric modulated arc therapy could face as much as $8,000. Similarly, a patient undergoing breast cancer treatment through a private provider might see a 200 per cent increase in their out-of-pocket expenses for radiation oncology. Significant concerns in relation to fertility services have also been raised by various providers, with some reporting that patients could face costs of between $10,000 and $15,000 for an IVF cycle, which is above the current average of $4,000.

Under the existing arrangements, all of the out-of-pocket expenses for hospital Medicare services count towards the threshold and, once a patient reaches the threshold of the extended Medicare safety net, 80 per cent of their out-of-pocket expenses are met. However, under the changes which are part of this bill, the amount a patient will receive will be capped at 150 per cent of the MBS schedule fee, which, quite frankly, is significantly less than the standard MBS rebate. These growing out-of-pocket costs will become a reality for many Australian families, including those most vulnerable individuals in my community. When you are living on around $50,000 a year and raising children, you do not expect to be kicked in the guts—as Premier Mike Baird referred to it—on matters of health and education—matters that really go to your normal day-to-day life. Sure, there are many other things that can be argued in this place. But when it comes to the most vulnerable, the last thing you want to be doing is making decisions as to whether or whether not you access medical services, particularly when there are kids involved.

This brings me back to what I said earlier: only three people on the government's side have decided to stand up in here and support and justify this legislation. Only three people were brave enough to get the call from their whip to say, 'This is a duty that you must deliver upon.' While my electorate has significant pockets of disadvantage and many, many challenges, the truth is that many of the people over there represent very similar electorates. Are they going to go back, look people in the eye and say, 'When I had a chance, I didn't do anything about stopping this. I just went along with the wave of $60 billion cuts to education not knowing that this was going to impact on people of need in my electorate'? There comes a day of reckoning for this stuff. This is not a game for economic rationalists. Here we purport to represent, openly and honestly, people in our communities. We bring their concerns here and we stand up for their rights and their liberties; we stand up for their families. What I can see here is that there is only one side standing up for Australian families and Australians who are looking after their families in respect of health, education and many other things. In respect of health, there is only one side here that is standing up to these cuts.

I am sure that this is one of those issues where the numbers will be crunched and this will go through, but this is a piece of legislation that should be remembered. This is an issue that every member in this place—the whole 150 of us that have the honour of serving our electorates—should have a view on. It should not just be left to Labor MPs to come out and say how it is going to affect people in our electorates. The government have the majority here; as I say, they can crunch this through, and they probably will. But they also need to look people in the eye and tell them, 'When we had a chance, we proposed doing nothing about protecting the interests of families when it comes to health.'

This will have a deleterious impact on health in our communities. It will cause people to decide whether they will access their doctors, in the full knowledge that there will be out-of-pocket expenses involved and that they may have to sustain those expenses. That is the last thing we want Australian families to have to do. People do a great job looking after their families, and in turn those families are the backbone of our community.

This legislation is all about communities—it is all about how we support our communities. Labor does not support this bill and will call for it to be referred to the Senate Community Affairs Legislation Committee to provide the opportunity for all stakeholders to express their opposition to these proposed changes.

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

It is always a great honour to follow the Chief Opposition Whip, the member for Fowler. It is good to be with the member for Hasluck—he recently had a promotion, and that is a good thing for the country. He made a bit of history. We all hope that his wise counsel is heard in the health department and in the health ministry, because the truth is that the Abbott-Turnbull government's record on health has not been very good at all. From day one, from their first budget, we have seen an assault on Medicare—$60 billion of cuts to public hospitals, to doctors and nurses; $2 billion worth of cuts in preventative health and health flexible funds, things like drug and alcohol counselling. This is at the same time as the government runs an ad campaign on ice addiction, the problem with that ad campaign being that there is no hotline number, there is nowhere to ring, there is nothing to do. It simply makes people aware that there is this terrible problem in our communities. They are doing this pea and thimble trick because while they are running this ad they are cutting drug and alcohol counselling. We know what they did with the GP tax, which was of course a cascading tax—$7 every time you went to the doctor, $7 every time you got a scan or a blood test. It was a cascading tax: seven times seven times seven times seven. We know that they have cut money in Health Workforce, in preventative health care. This year alone we have 3,000 nurses graduating but they cannot get graduate positions in this country. It is a terrible waste of human potential—and a terrible waste of Commonwealth taxpayers' money in educating them in the first place.

Ms Scott interjecting—

I have got the bite from across the chamber. I knew that eventually one of them would own up and try to defend this government's miserable record of destroying Medicare, hammering Medicare, ripping apart Medicare. The Health Insurance Amendment (Safety Net) Bill is just another instalment. What does it tell us? It tells us that this government has not changed one bit on health. There is a new salesman, and he describes to us everything about health—here are all these options, here are the benefits of one and the detriments of another. That is what we get every question time—Lord Muck, the Prime Minister, at the box telling us all the positives and negatives of every argument but never owning up to what the government is actually doing. If you look at what the government is actually doing in this bill, it is a game of three card monte. It is like all these kinds of games you might play in politics—but the person that they are trying to game is the citizen, the health care consumer. Here we have a health care safety net bill that cuts the safety net by $270 million. Who is that going to affect? As the member for Fowler told us, it is going to affect people on low incomes—poor people, not just in Labor electorates but in electorates all over the country and especially in rural and regional Australia where we know health care is not only very important but also harder to access because of the tyranny of distance in this country.

What we have here is a so-called simplified safety net. Whenever you hear the word 'simplified' or 'deregulation' and a few of those words, you know who is going to suffer—it is the patient, the person who is supposed to be protected by the safety net and by Medicare. There are a lot of those people in my electorate—people in outer metropolitan South Australia and people in country South Australia. The Rudd and Gillard governments responded to this challenge by having a reform program—we sought agreement with the states and we put in place case-mix arrangements with activity-based funding arrangements for public hospitals, but one of the most important things we did was look at the rates of cancer and the treatment for cancer, and we acknowledged there was a problem. In my electorate, if you wanted treatment, if you needed to get into a chemotherapy bed, you had to drive all the way into the city, whether you were in Elizabeth or in Riverton or in Kapunda, my home town—I am giving the member for Hasluck a bit of a geography lesson about South Australia—

Ken Wyatt (Hasluck, Liberal Party, Assistant Minister for Health) Share this | Link to this | Hansard source

I have family there.

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

He has family there, which is good—he is welcome any time in the Barossa Valley. He can come and visit me; he can drop by. If you go north of there, into Grey, to Redhill or up to Burra, or further up, you will understand just how long people have to drive to get chemo—it is hours and hours in the car to go to Adelaide. We saw that this was a problem and we fixed it. We put chemotherapy beds in places like Clare; we put chemotherapy beds in Gawler. When I was at the opening of the Gawler beds, there was a chap there who had to have blood transfusions for a very rare health condition and he said to me: 'If I could not go every day to the chemo bed in Gawler, I would probably be hospitalised in Adelaide.' That would have been the consequence. So we did not just make investments to stop people having that two-hour drive in the car; we also made those investments to keep people out of hospital—to make sure they get good treatment which will keep out them of hospital. And that is a saving. Every time you keep someone out of a hospital, it is a saving to the taxpayer and, most importantly, to that individual. It keeps them out of acute settings. We know that the more people are in acute settings, the worse it can be for them, and the worse the outcomes.

We on this side were all about making prudent and sensible investments that made health care better in this country. And that is what you have to do, Mr Deputy Speaker: if you want to keep people out of acute settings, you have to spend money up front. It means you have to actually treat GPs with trust and with professionalism, and treat them with dignity—because GPs are at the front line of this stuff. If we want to deal with diabetes, if we want to deal with some of these other things, then we have to make sure that GPs feel valued and we have to make sure that they do not feel undervalued. I have done tours in my electorate going around to GP clinics and talking to GPs: doctors feel very, very aggrieved by this government. And it is not just about the cuts to the GP rebate—cuts which are devastating for clinics out in the country and for clinics in outer suburbs; they are absolutely devastating for bulk-billing. This is just the GP tax regurgitated and put onto doctors—they have put the hammer onto doctors. We have recently had some matters—money sought, returns to Medicare, some issues with claiming of Medicare—that were used in the papers to try and blackguard every GP in the country, implying that GPs are all out to take advantage of the Medicare system. Frankly, that is a serious problem for this government. If you look at Australian Doctor magazine, or any of those magazines, doctors feel very, very undervalued by this government. And it is a serious problem because doctors are the front line—for this government or for any government—in dealing with chronic disease. We know that if diabetics go and see the doctor, and if they go and see the podiatrist, they are much less likely to have amputations—which, sadly, we have a great deal of in this country, and they cost us a great deal of money. I cannot really impress enough upon the government the arrangements we need to make, and the investments we have to make in preventive care. And that means valuing doctors.

This bill, the Health Insurance Amendment (Safety Net) Bill 2015 Bill, claims to be a simplified safety net—of course it is nothing but. It is a cut. It is a $270 million cut, on top of all the other cuts, and on top of the tax on Medicare. That is what it is. It is a brutal attack. And it belies all of this government's smooth talking, and its easygoing nature. As I said before, the Prime Minister, like Lord Muck, is coming in and describing every problem in glowing terms, and telling us about what the options are on every single issue, and talking about having a national discussion. That is all well and good. But it is not good when you are launching attack after attack from the Commonwealth benches on Medicare, with the hostility to universal health care in this country. There is absolutely no doubt about it; it is just that the hostility now is masked—masked behind a smile, behind smooth talking, behind fine oration, and behind—sadly—good men like the member for Hasluck. Behind their reasonableness is harshness and viciousness. How else can you explain raising the out-of-pocket costs for a person with a malignant melanoma by $7,400? That is a real thing that this bill is going to do. Or, for a person with prostate cancer who needs volumetric modulated arc therapy—I do not know what that is, but it does not sound pleasant—their out-of-pocket costs are 8,000 bucks. For women with breast cancer, patients will find a 200 per cent increase for their out-of-pocket costs for radiation oncology. Brian Owler said about this bill:

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.

President of the Royal Australian College of General Practitioners, Professor Frank Jones, 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.

And what are the consequences of this? Well, for the average IVF cycle, IVF patients could face costs of between $10,00 and $15,000.

All of this is serious stuff. It should not be masked behind fine oratory, or a smile, or knifing a prime minister in the middle of the night and replacing him with someone who is all smiles and all reasonableness. That is going very well at the moment—apparently—but beneath the surface are all these cuts: the same vicious agenda on Medicare, the same vicious agenda on tax—which we will see shortly—and the same vicious agenda on incomes and penalty rates. All of these things are still bubbling away in the community. People hope they will go away. They hope that this government is going to take some new approaches. But that is not what we have seen with this bill this week. How many days in are we, with the new Prime Minister? I have lost count. It is not very long though, since the Prime Minister was replaced—because of popularity. And I have no doubt that the story behind the coup will eventually come out—the viciousness, the betrayal, the backstabbing—will come out and be revealed. The plotters will be there. All I am saying is true. And we all know that the Abbott-Turnbull government will become something else when the popularity diminishes. If that is the way you are going to judge a prime minister, if that is the way you are going to do it, then we know what will happen next. We know what will happen next to the member for Wentworth. It will be the Abbott-Turnbull-Morrison government. We could get a chocolate wheel and just spin it, and get a new defence minister, a new industry minister, a whole new set of ministers on the National Security Committee. But the one thing that will remain is their hostility to Medicare, their hostility for ordinary people being treated with dignity in our community. That is the one thing that you can say will remain, no matter what the personnel changes are in this government. The one thing that will remain is the hostility, the viciousness towards Medicare and universal health care which is a mark of our national character and our decency as a nation. That is the truth.

Debate adjourned.