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

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

The Government attacking Australia’s health care system.

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

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

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

Just when you think there could not possibly be anything further the Liberals could do to attack Medicare, they prove you wrong yet again. On the front page of today's West Australian newspaper it is revealed the government has a secret plan to privatise Medicare and the Pharmaceutical Benefits Scheme. So, after two years of trying to kill Medicare, now the Liberals are trying to sell it off. This is a direct attack on Medicare services which could jeopardise the patient data of every Australian and the jobs of some 1,400 staff at centres all around the country. This idea, from the same failed commission of audit that gave us the GP tax, that told us we should merge the Organ and Tissue Donation Authority with the National Blood Authority—something I think the government has now finally ditched—would mean that Medicare services would be delivered for profit, not with the best interests of patients in mind. It would mean the most critical, confidential and intensely private health details of all Australians potentially being sent overseas.

Once again this is a case of the government seeing these services which are so vital to all Australians as nothing more than a source of savings. This is the Prime Minister going where even Tony Abbott feared to tread. This is the Prime Minister proving that, no matter who the leader is, the Liberals only ever see health as a source of budget cuts and will always look to make health less affordable for those who need it most—the sick and the poor. In his very first economic statement the Prime Minister took all of Tony Abbott's cuts to health, and then added an extra $2.1 billion to make health care even less affordable to millions of Australians. He took Tony Abbott's $57 billion in cuts to hospitals, his billions of dollars in cuts to preventive health and public dental programs, his GP tax and added another $2.1 billion of his own.    He gutted crucial health workforce programs to the tune of $595 million, ripped another $146 million out of health prevention and took another $650 million out of Medicare by slashing bulk billing incentives for pathology and diagnostic imaging.

The people who will pay for these cuts are the patients, in up-front costs of hundreds and even thousands of dollars that even after the Medicare rebate is paid will see them hundreds of dollars worse off in some cases. This decision to abolish Labor's incentives—incentives that were absolutely working in pathology and diagnostic imaging—will force many pathology clinics and diagnostic imaging practices to abandon bulk billing and begin charging patients for scans and tests. And patients charged these fees must pay the entire amount up front and then claim back the rebate later. These costs are not inconsiderable. According to the Australia Diagnostic Imaging Association, patients would have to pay up to $93 up front for an x-ray, $396 for a CAT scan, a minimum of $85 for a mammogram and up to $186 for an ultrasound. For those unfortunate enough to need a PET scan, the up-front cost could hit $1,000. That is before you get the rebate back, and you have to pay it up front. But patients with serious conditions never need just one scan. Australia has the world's highest diagnosed rate of melanoma and a typical patient diagnosed with melanoma would be referred for a PET scan and an MRI scan of the brain, a total of $2,660 to $3,130 up front and gaps of $260 to $725. A patient with suspected breast cancer who was previously bulk billed faces up-front costs of between $282 and $554 and will still be left $29 to $302 out of pocket after receiving all of the Medicare rebates. Patients will eventually get rebates from Medicare, but they could still be left with hundreds of dollars in out-of-pocket expenses— that is, of course, if they have been able to find the money up front in the first place.

For many of the patients who are now bulk-billed, these sorts of costs are simply unaffordable. People who skip appointments may get lucky and find their condition has not deteriorated, but the odds are that those who do miss important scans will get sicker, require even more extensive treatment and end up costing the health system much, much more. And heaven help those who do end up in hospital, because, as I pointed out earlier, this government has cut $57 billion out of our public hospital system—$57 billion in hospital cuts is such an overwhelming figure it can be hard to focus on what its impact might mean for our hospital systems. Now, thanks to the work of Labor senators on the Senate Select Committee on Health, we know that for just one state, Victoria, it is the equivalent of closing two major hospitals and dropping 23,000 elective surgeries every fortnight. The Queensland health department has estimated its share of the cut is the equivalent of 4,500 doctors, nurses and allied health practitioners. And these cuts will be repeated in every state and territory, with tens of thousands of elective surgeries cut, hospital beds closed, waiting lists blowing out and thousands fewer doctors, nurses and other health workers. No wonder even the Liberal New South Wales Premier Mike Baird has declared the cuts to be unsustainable and a kick in the guts.

But the changes went much further than just ripping out the funding, because at the same time the government also tore up a series of agreements years in the making and agreed by governments state and federal, Labor and Liberal, to not only place hospital funding on a secure basis but also use that funding to drive real reform that would not just improve patient care but do so in a way that made our hospital system much more efficient and eliminated waste. The benefits delivered by the agreements went beyond hospitals—better care in primary care, better prevention care and better dental care, as well as placing hospital funding on a secure footing. They were, in short, the most significant health reform since the introduction of Medicare—negotiated yet again by a Labor government in cooperation with the states and territories, and the Liberals have literally thrown them out and said, 'It's not our problem.'

In just the last few hours, it seems that even those premiers and chief ministers clinging to the hope that somehow the government's floating of the GST might be the answer have finally seen the light. Of course, state leaders are desperate for money for their schools and hospitals. They are telling the truth when it comes to what this government has done. But increasing the price of everything by jacking up the GST and the cost of living is simply not the answer.

It is now very, very clear that this was never about funding schools and hospitals. It was just a massive tax transfer from companies and high-income earners onto low- and middle-income earners. There was never anything in this for schools and hospitals, and the premiers and chief ministers now understand that this is not a government that cares about properly funding our schools and hospitals. The government has today cancelled a special meeting of the Council for the Australian Federation to discuss this crisis. No wonder even Liberal premiers are saying these cuts are unsustainable and simply amount to a massive cost-shift onto both patients and the states.

The growth in hospital costs will not magically be lowered as a result of these cuts. In fact, the latest evidence confirms that they will have a real impact on patients and healthcare outcomes by increasing emergency department waiting times, increasing elective surgery waiting times and reducing the number of hospital beds across the country.

Not content with cutting hospital funding, the government then attacks bulk-billing by slashing rebates for pathology and diagnostic imaging, and of course continuing its freeze on rebates to general practitioners, ensuring that even more people will head to already overstretched and underfunded emergency departments—because when you are a parent with a sick kid who needs to see a GP or get an X-ray and you cannot afford the fees, where do you go? You go to the emergency department of your local public hospital—the same public hospitals that are about to lose $57 billion as a result of decisions that this government has made.

So, while the government has changed leaders, essentially the health policy remains exactly the same: to cut health costs and to shift costs onto patients by attacking bulk-billing and Medicare at absolutely every turn. And now, after two years of trying to kill off Medicare, the government is trying to flog it off. Today's revelations confirm yet again that only a Labor government can be trusted to defend Medicare and that Medicare will never be safe under the Liberals, regardless of who their leader is.

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

It is a pleasure to speak on the matter of public importance today and to punch a few holes in the rather ridiculous argument from the member for Ballarat. We get used to hearing this nonsense in here, but it worries me when people listening to the broadcast actually believe what the opposition say the costs of, for example, scans and pathology will be. The member for Ballarat does not know. No member of the Labor Party and no member of the Liberal Party either actually knows what the charging practices of doctors, diagnostic imagers or pathology providers will be from day to day in any location across Australia.

What we did say, and we defend it, is that by trimming a bulk-billing incentive we bring back the spend in pathology and diagnostic imaging to where it should be. But we do not touch the Medicare rebate itself. The Medicare rebate for every single one of these procedures remains the same, but you would not think that from listening to the member for Ballarat. You would think that we had gone into the MBS, changed the numbers and written them down, and made life deliberately difficult for patients. In fact, every day in the Health portfolio, it is patients we think of first; they are front and centre. We think of their needs and we think of the system that we have to build that is sustainable for them.

There has been this massive huffing and puffing, this scare campaign, over Medicare. While the Prime Minister was explaining that we are having a look at the technology around the payment system—the Minister for Human Services also explained that very well—there were screeches coming from the opposition front bench: 'Just rule out that you're privatising Medicare.' I can of course rule that out. This has nothing to do with privatising Medicare. Medicare is the system invested in by taxpayers that remunerates doctors for the procedures that they do on behalf of patients, the procedures I have just been talking about. You go in to diagnostic imaging, you have a scan, Medicare pays your doctor the Medicare rebate and then your doctor decides what they may or may not charge you. Pathology is a good example. The bulk-billing rebates that we have taken away mean it goes from $1 to $3 per service. So how the member for Ballarat can conjure that up into hundreds of extra dollars in costs for patients, I do not understand. What I do know is that it scares people, it upsets people and it is completely ridiculous.

As for looking again at Medicare, which was what the newspaper article the Leader of the Opposition tried to wave around in question time was about—and, yes, our editors get a bit excited about headlines, and maybe that is what happened—why would you not look at a payment system that was designed around the same time Medicare was, in the 1980s, and work out how you can bring it into the 21st century?

Now, maybe Senator Doug Cameron—I actually like Senator Cameron—is not in the digital age. I am sure his children are; I know mine are. They absolutely all get it. Everyone in their twenties gets it. Soon we will not be carrying around bags and wallets and cards. We want to be able to do things on the move. We want mobile platforms. We want a payment system that is quick, that is responsive and that perhaps lets us interact with our own private health data and maybe gives us permission to pass it on to third parties. That is the world we live in: cloud based, computer based, information sharing.

Of course, when it comes to privacy, when it comes to keeping your information safe, the laws are there; those regulations will always remain in place. Senator Cameron said he was very worried that multinationals would get hold of our data. I do not know if he banks with any of our major banks. I do not know if he does business with any multinational corporations. I am sure that our children in their twenties, as I talked about, would remind him that we live in a digitally interconnected world, and it is not really a bad thing to be doing business with people who can make your life easier, who can add value.

There is another point to make about this ridiculous scare campaign about privatising Medicare, and that is: if you are investing in the best possible health system for patients, why would you not work out how to make the back-of-house stuff as efficient as possible? Why would you not want to keep all of your money for the front of house—for the services that are provided by doctors to patients, by nurses to hospital patients and by allied health professionals, GPs and mental health nurses? That is where the money needs to go

It needs to go where it makes the lives of patients, carers and consumers better. It does not make sense for any government not to consider how we might reinvest in a clunky payment system and bring that money to bear where it can do the most good.

The member for Ballarat talks a lot about hospital funding, and sometimes she is joined in that by some state premiers, but at least one Labor state Premier has very positive conversations with me about working together. I know that when it comes to health spending it does not make sense to play politics—that does not make sense when people are not well. When people interact with the health system they want a system that cares. They want someone that understands that that system should be built for them for the long term. So we are working together. I am having really good conversations with state ministers about the next health and hospitals agreement, but I can tell the member for Ballarat this: it will not be like the last health and hospitals agreement. Kevin Rudd as Prime Minister was so desperate to sign up that he added layer upon layer of funding to the states. Did it improve performance in public hospitals? Sometimes here and there—maybe a bit. It was patchy. What it did do was give a very helpful revenue stream to state governments.

What we need to say and what we should say on behalf of the taxpayers whose money we are responsible for is that if we are co-investing on their behalf in the state public hospital system, if we do not have any drivers over the cost of that system we need to make sure that we build into those agreements and arrangements a recognition that prices cannot keep rising at the rate that they are. State health ministers understand this. Actually, previous health ministers understand it as well. The member for Ballarat, like me, works in the health portfolio. Previous Labor ministers have well and truly understood this point. I am a bit surprised that we had pathology rolled out as an example today, because it was Labor that took $550 million out of pathology because it knew that that was where expenses were rising at a rate that was not sustainable for the health system as a whole. Previous health ministers all recognised this. In fact Nicola Roxon said, 'Without reform and a careful and methodical approach the system will cannibalise itself, because in health there is a continuous clamour for more and more funding with no regard to where the money comes from.'

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

Wise words.

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

Wise words from a previous health minister. Even this health spokesperson said, late last year:

… the opposition would be kidding itself if it did not recognise there were challenges in the budget and that savings needed to be found. There is no area that is going to be exempt.

So the health spokesperson has recognised what every single health minister knows—that is that it is in the interests of patients to make the system as sustainable as possible.

Earlier today, we had the member for Sydney—another health minister—talking about the Trans-Pacific Partnership, rather uncomfortably, because I do not think a lot of her Labor unions actually like it. She said that Australians are very determined to protect the PBS. You want to make sure that the PBS, the price of medicines, is sacrosanct in the TPP. I can assure her that it is. I had lots of conversations with the minister for trade and the Prime Minister to make sure that is the case. The member for Sydney talked about new medicines. Hello! Access to new medicines is not possible in a health system that is not sustainable. If you look at where the spends are across the system, doesn't it make sense to look at how we can make the necessary investment and savings so we can have access to new medicines.

The member for Ballarat quite rightly mentioned melanoma, a disease we have far too much of in Australia. It is treated by a drug called Keytruda, an innovative immunotherapy. We would not have been able to list Keytruda, at $100,000 a patient, if we had a system whose costs were spiralling out of control, if we did not have to make the tough decisions, if we did not have to make this saves that we have announced.

By the way, where are those saves going? Into the Medical Research Future Fund—not where Labor put them, into the budget bottom line—because we know that the cures for cancer, the health of all Australians, depends on these innovative techniques and treatments. I mentioned the drug Keytruda. I should also mention the $1 billion investment the government has made in curing hepatitis C. We are the only jurisdiction in the world to say, 'Everybody, everywhere, we want you to have access to treatments.' That is pretty much 12 weeks of tablets, not the awful interferon based hospital therapies that made so many people so unwell. Without fear or favour wherever you are, in the prison population or homeless on the street, you should have access to this. It is $1 billion spent in MYEFO. Everyone talks about the saves. Sometimes it is a good idea to look at where we spend the money and how we invest it for the health of all Australians, how we keep the dollar as close as possible to the patient to make the most difference in the patient's life.

Stop scaremongering, Labor Party. Have a sensible debate and talk about what you are going to do, what your policy might be. We had no ideas in 2015; we really need some good ones from you in 2016.

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

It is now well accepted, at least by all of those on this side of the House, that Australia, which was once known as country of the fair go, as the land where people could pull themselves up by their bootstraps, indifferent to the circumstances of their birth, with the support of the government and the great opportunities this country would bring to them, and make good of themselves. But we know that inequality is growing. It is growing right around the region and right around this country. In fact, in the middle of last year the OECD published a report, which found that inequality in Australia is growing, as it is right throughout the OECD countries, and that it is in fact a drag on our national growth and eroding our social cohesion. It found that in Australia the top 10 per cent held over 45 per cent of the country's wealth and that the gap was going. That is a point that should be of great interest to all those National Party members and regional MPs opposite. The OECD found that in the city you were 20 per cent more likely to be in the top and wealthiest people in the country, as opposed to those people in the regions and in the country.

With growing inequality it is all the more important that we have a government that is dedicated to providing a decent health system. We already know that gaps in access to healthcare services and that health inequality are greater between city and country, and as we will learn tomorrow when the Prime Minister and Leader of the Opposition address this parliament on progress on closing the gap we will learn once again that we are not making sufficient progress on closing the gap in health outcomes between black and white Australia.

Against this background, why on earth would anybody who gives a toss about a fair go, which is seriously committed to addressing inequality in this country, do this government is doing to the health system of this country.

The member for Ballarat has gone through the long list of cuts that this government is attempting to visit upon the Australian people. The member for Ballarat went through the $57 billion worth of cuts to our hospital system, and we are seeing state premiers of Liberal and Labor persuasions saying that if something is not done about this our hospitals will fall over.

In my state we are already seeing the beginning of hospitals without doctors, something unthinkable a decade ago. There are hospitals without doctors, because they simply cannot afford to ensure that they have the full complement of staff.

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

Name one!

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

The member over there, the member for Bass, has asked me to name one. What about Bega?

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

No doctors in Bega hospital? That's ridiculous. How can there be no doctors in Bega hospital?

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

And, if the member really wants to entertain this dialogue, we will give him a full list: $1.8 billion worth of cuts to general practice; the proposals to increase the cost of medicines; the proposals to increase the costs of blood tests, X-rays and MRIs, which we learn will cost the average patient up to $60 a presentation. If this is what it means to be 'agile', I want to be standing for something different. If this is what 'agile' means, it is not what we are for. On this side of the House we stand for Medicare. We stand for a decently funded hospital system.

We learned today that the new government led by the new Prime Minister has not discarded their ferocious plans to attack Medicare, because we find today that there is a proposal to privatise Medicare. This will put the livelihoods of between 5,000 and 10,000 hardworking Australians at risk. I would have thought the member for Bass over there—who always has a lot to say—in an electorate like his, with such high unemployment, would be going into bat for the employees of Medicare, but he cares about something far less than that.

The only thing more ridiculous than the idea that we are going to privatise Medicare is the idea of putting the embattled Minister for Human Services in charge of such a proposition. Have you ever heard of a more ridiculous proposition? Those on this side of the House are going to fight until our last breath to ensure that we have a well-funded public hospital system and a Medicare system that is fit for the purpose of dealing with health inequality in this country. (Time expired)

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

I am pleased that the member for Throsby—the gift that keeps giving—raised unemployment in Bass. At the time of the 2013 election, unemployment in Bass was 8.6 per cent; right now it is 6.6 per cent, after two and a bit years of this government. So thank you for bringing attention to that, Member for Throsby; yet another own goal.

While the shadow health spokesperson spreads yet more misinformation and scare campaigns, Minister Ley, the member for Farrer, and the Tasmanian health minister, Michael Ferguson, are working to clean up Labor's health mess.

Ms King interjecting—

I know that no-one does feigned indignation like the member for Ballarat, but the problem for her and Labor is that the Australian people have very long memories. They know that, when it comes to spending on policy priorities, Labor consistently over promised but underdelivered—on the NBN, on defence, on health, on education, and on too many other policy areas to mention. They know that the member for Ballarat flutters in the wind when it comes to health policy. One day the shadow spokesperson acknowledges the problems in our health system; the next she denies them. Consider a Sky News Agenda interview on 22 February 2015, when the member for Ballarat said: 'The opposition would be kidding itself if it did not recognise there were challenges in the budget and that savings needed to be found. There is no area that is going to be exempt. We have to look across the board.' The Australian people see this inconsistency clearly.

She should also reflect on the fact that the Australian people have long memories. They know, for example, the true pain of Labor's deep cuts to the private health insurance rebate. People in my electorate of Bass are amongst more than 10 million Australians who have some form of private health insurance. They know that during six years of Labor and Labor-Greens government the attacks on provide health insurance policyholders were relentless. Cutting funds, means-testing—and this is despite 5.6 million of those people with private health insurance having incomes under $50,000 a year. Three point four million of those people have incomes less than $35,000 a year.

Labor broke promise after promise on health insurance, putting the sector under significant pressure and creating uncertainty. And the member for Ballarat has the audacity to talk about records on health spending. With the Labor-Greens government health spending hit a record low. Patients and health funds are left to pick up the pieces. What happened to Kevin Rudd's promise in 2008 to 'end the blame game'? He said he would take over hospitals by 2009, yet hospital costs today are growing, because of your mismanagement, at three times the rate of GDP.

The Australian Institute of Health and Welfare report in 2013-14 showed that health expenditure in Australia under Labor and the Greens fell from 43.7 per cent nationally in 2003-04 to 41.2 per cent in 2013-14—the lowest in a decade. Australians know it was the Labor Party that introduced the freeze on MBS indexation when they were in government. In fact, when Labor introduced this measure that they are now arguing against, the then health minister Tanya Plibersek said: 'Doctors earn enough money to bear the federal government's controversial freeze on MBS rebates. I understand GPs have all sorts of expenses in running their surgeries and employing staff and so on, but the average billing from Medicare is more than $350,000 a year.' I can go on with example after example of health mismanagement at strategic and tactical levels under the Labor and Labor-Greens government.

The John L Grove centre in my electorate of Bass was opened with much fanfare before the 2013 election. The Giddings Labor government accepted $4.7 million in federal funding from Julia Gillard to build the centre, and then the state government put no money in the budget for its ongoing running costs. I found out in 2014 that this new centre was about to close but, thankfully, through my advocacy former Prime Minister Tony Abbott and I were able to announce last May that the coalition would provide $10 million to secure the John L Grove centre's future to mid-2017.

I say again to the Labor Party: spare us your sanctimony, your hypocrisy and your feigned outrage. Join us in optimising our health system to eliminate waste and afford the new drugs we need for the future. Labor created this mess. It is the Turnbull government's intention to fix it.

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

Few things matter more to people than access to an affordable, quality and professional health service. Indeed, without good health you have very little else and very little else matters. But the Turnbull government simply does not seem to understand that. As the member for Ballarat has already pointed out, since coming to office the coalition government has cut almost $60 billion of health spending. Every state Premier acknowledges that and every state Premier has made the point that it will impact on the services they are able to deliver in their state. Some state premiers, in particular the Premier of New South Wales, are saying that some of the GST that they were talking about ought to go specifically to funding health across this nation.

Indeed, it is because of the cuts to health expenditure by this government that we are seeing an absolute shifting of costs from the federal government to the states. Not long ago I met some GPs in my electorate. They were being threatened with cuts to their practice payments, which meant they were going to have to cut their after-hours services; and that in turn was going to send more people to the public hospital up the road. That is exactly what is happening across the country, and that is why today the Premier of South Australia has made that point once again, saying that the $4 billion-plus in cuts that South Australia will lose could result in hospitals being closed.

The fact is that this government made cuts from the health budget not only before the current Prime Minister came into office; since then, we have seen another $2 billion in cuts, with $650 million being cut from pathology tests, from diagnostic testing and from other health prevention programs.

We have also seen $595 million in cuts to the health workforce. In answer to a question on notice that I placed, the minister responded to me only two weeks ago that we currently have in this country nearly 4½ thousand doctors on temporary visas—2½ thousand of them came in the last 12 months—and another 2½ thousand nurses and midwives. That is the sad state of workforce planning in this country when it comes to the health system. Again, what we are seeing from this government is simply more cuts. It just does not make sense.

I refer to Bloomberg, whom the Minister for Agriculture also referred to today. They say Australia's healthcare system ranks No. 6. The US health system ranks 44th out of 51 countries—yet this government is trying to take the Australian healthcare system down the US path. The reality is that not only does the US spends 8.5 per cent of its GDP on health, as opposed to Australia's six per cent; but it gets a much worse health outcome, and life expectancy in that country is much lower than life expectancy in Australia. That proves that our system, publicly funded as it is, is working well for the people of Australia. It is a system that we should not be trying to tear down; if anything, we should be trying to support it.

The sale of Medicare has been raised again today. That does not surprise me one iota. We know that the government wants to get rid of Australian Hearing as well, another terrific service that has served the people of this country for five decades. We know that this government has no interest in protecting the jobs of Australians. We see that in the cuts across the public sector. We see it in our research institutions, which have been decimated. We see it across the private sector, where the manufacturing sector and industry more broadly has had hundreds of millions of dollars in cuts. We have seen it in education and now we are seeing it in health.

These are the jobs of real Australians, real people who are providing services to people across the country. When it comes to jobs in the health sector, none are more important, because when you have a family member who needs health care, you want to know that you can go and get the service that they need. Sadly, those services are slowly disappearing. I get emails and people coming into my office on a regular basis who are having difficulty accessing services that they need urgently and desperately. It is all because of this government's cuts to health funding across the country, which in turn are flowing on to private services and the public systems in the states.

Medicare has served this country well for the last four decades. It is a universal health system that we should be proud of. It is a universal health system that has met the needs of this country. This government is now trying to destroy it. That is what will happen with the first step that the government has talked about today. (Time expired)

John Alexander (Bennelong, Liberal Party) Share this | Link to this | Hansard source

Thank you for the opportunity to contribute to the debate on this matter of public importance. The management of our public health system is most definitely a very important matter. Australians demand the best possible health service, where their interactions are in lock-step with the best available processes and technologies. This is, of course, in the government's best interests as well because, between Medicare, aged care and the Pharmaceutical Benefits Scheme, the Commonwealth processes over $42 billion worth of payment transactions every year.

Consumers nationwide have enjoyed a shift to 'tap and go' payment systems as our cards and mobile devices are enabled to manage an ever greater variety of transactions. As a result, the health department is looking into ways to digitise transactions as part of our commitment to embrace innovation and offer the community the best options available in response to changes in the digital economy. The government will engage business innovation and technology experts to arrive at the best and most efficient solution. So, of course, at this stage the government has not made any decisions on this as the work continues.

But why let the truth get in the way of a good scare campaign? So here we go again with another inept attempt by Labor to scare consumers that a change to 'tap and go' payments will somehow be a negative for them. Our Medicare system should always be evolving. That is our duty to the constituents who elect us to represent them in this place. Commonwealth spending on Medicare is certainly evolving—more than doubling from $8 billion in 2004 to $20 billion today. Yet we raise only $10 billion from the Medicare levy. Ten years ago the Medicare levy covered 67 per cent of the cost of Medicare, but it now covers only 54 per cent. That is why this government is conducting a once in a generation review of the Medicare Benefits Schedule. And this is why it is vital for the sake of future generations that this government is always looking for better ways to deliver medical services to Australians and to provide the best quality services for each important taxpayer dollar spent.

The MBS review is looking at more than 5,700 Medicare items, with the goal of ensuring that we have the most effective modern clinical system. It is vital that as a government we are always looking at ways to identify and reduce waste and inefficiencies in the system whilst protecting the integrity of our world-class health system. The review is led by clinicians and supported by allied healthcare practitioners and consumers. The pause on indexation of MBS rebates will remain while this work continues through the MBS Review Taskforce and the Primary Health Care Advisory Group. The minister has made it clear that she is open to a future review of the indexation pause as the work on reform progresses.

In contrast to this calm and methodical approach to policy development is what we saw from those opposite when they occupied the government benches. At the 2007 election Labor promised a plan to fix hospitals and, if it was not achieved by mid-2009, a referendum to be held to seek to take financial control of Australia's 750 public hospitals. In 2008 the Labor government promised to 'slash elective surgery waiting lists'. History tells a different story: bureaucracy ballooned while public hospitals, private health insurance, dental and other areas faced funding cuts. Some $1.6 billion was cut from public hospitals and $3.5 billion was cut from private health insurance, forcing up premiums for 10.6 million Australians with hospital cover.

An area particularly close to home for me is that of the government's support for life-saving medicines being made available to consumers through the Pharmaceutical Benefits Scheme. The coalition government has more than doubled the number of new and amended drug listings on the PBS to 913—worth almost $3.4 billion in total since October 2013. This is compared to Labor's paltry 331 listings during the last three years of their term in office. Labor signed a memorandum of understanding with Medicines Australia in May 2010 to provide 'policy certainty' to the sector in return for additional savings of $1.9 million over five years. Within months Labor had turned their back on this agreement, denying patients timely access to new medicines that had been independently assessed by the PBAC as being safe and cost-effective. (Time expired)

Rob Mitchell (McEwen, Australian Labor Party) Share this | Link to this | Hansard source

Isn't it great to hear those opposite with their impassioned speeches about how exciting this government is? It is an exciting time to be alive, according to the peacock Point Piper prince, the Prime Minister. Let us have a look at what is going on here today. What we see is that every single state and territory is suffering because of Malcolm Turnbull's decision to tear up the hospital funding agreement. The Prime Minister is leading a government that is systematically attacking Australia's healthcare system and putting Australians' health at risk. The $57 billion cuts to health funding mean that more patients are being forced into overcrowded public hospitals. For the Turnbull government and its view of the Public Service this means staff cuts in Medicare and the Department of Health. On the front line it means fewer doctors, nurses and other health staff. It means cuts to elective surgery, hospital beds closing and waiting lists blowing out.

Not content with cutting hospital funding the government then attacked bulk-billing by slashing rebates for pathology and scans and by freezing the rebates to GPs, ensuring that more people will head to the overstretched and underfunded emergency departments. Cuts to health funding mean massive costs being shifted to the states, medical centres and patients. It means additional stress for Australians who may not get the medical attention they need at the time it is required.

Managers of bulk-billing medical centres in my electorate tell me about the struggle to provide services to our communities. For regional areas in particular it is already difficult for medical centres to attract and retain doctors. I was amazed to hear that an overseas qualified doctor with permanent residency in Australia has greater restrictions put on their ability to work in medical centres than someone with temporary residency.

A medical centre in my electorate was forced to close down its after-hours service between 4 pm and 9 pm because of the doctor shortages. Where do these patients go? They go to the hospital, putting more pressure on already strained hospital resources. What happens when, with the cuts from the Turnbull government, a hospital is forced to close? Patients then go to the next available medical centre or hospital, increasing the pressure on those locations until they break. With local medical centres being forced to close due to doctor shortages, what outcomes can we expect?

We need to support our community medical centres and ensure that they have the staff and the procedures in place to meet their needs. Medicare is so understaffed that the delays in assessing provider numbers mean that one medical centre I spoke about earlier, which helps 130 patients each day, will be forced to reduce the number of patients being seen. This means that medical care for people in our community will be compromised. We are entering the cold and flu season. To have to close down a bulk-billing medical centre at its busiest times—after hours—is unsustainable. In the real world this is when most workers and employers are likely to seek medical attention.

The Prime Minister spoke about Medicare during question time today. It is pretty clear that he has given the house a lick of paint before he puts it on the market. How about we put some money into staffing Medicare to ensure that it is able to support GPs and medical centres—the front line of Australia's healthcare system? Instead, this government directly attacks Medicare services. It is putting personal patient data and the jobs of more than 1,400 Australians at risk. Selling Medicare means that its services will be delivered for profit, not for the interests of Australian patients. It means that the most critical, confidential and intensely private health information of Australians could be sent overseas. It is the Turnbull government making health care less affordable. This is the Turnbull government trying to make a buck out of Australia's healthcare systems.

Today's revelations confirmed yet again only Labor can be trusted to defend Medicare and Medicare will never, ever, ever be safe under the Liberals, regardless of who the leader is. This discussion today is backed up by Premier Mike Baird, that great socialist man in New South Wales. He also said that these cuts from his Liberal mates are 'a kick in the guts' and mean that the healthcare system in New South Wales is 'simply unsustainable' and said, 'The states do not have the capacity to meet the healthcare costs on their own.' Even Jill Hennessy has warned that these cuts will have a massive impact on Victorians who are sick and need healthcare treatment, because you simply cannot pull $17 billion out of a healthcare system and expect there not to be any consequences. This government has continued changing leaders but is failing Australians where it matters most—our healthcare system. (Time expired)

Kevin Hogan (Page, National Party) Share this | Link to this | Hansard source

I grabbed a piece of paper on my way here, just to look at federal government's spending on health. It might be enlightening for the other side to listen to this, because in the financial year 2014-15 the federal government, in the area of health, spent $67 billion. The estimate for 2015-16, and we are just over halfway through it, is $69 billion. That is an increase of $2 billion of federal government spending on health.

You might ask: what after that? Will cuts happen, then? No, they will not. The estimates and projections for 2016-17 go to $71 billion. Projections for 2017-18 are $74 billion. For 2018-19 the projections for federal government spending, on health, are close to $77 billion. In 2018-19 we get to $77 billion. You might say to me, Mr Deputy Speaker Broadbent, where are we from last year? That was $67 billion. I know you are a very intelligent man, Mr Deputy Speaker, but I will tell you anyway. That is an increase of $10 billion in spending, on health, by the federal government. So let us lay out those facts and projections at the start of this. As a federal government we are increasing funding on health—as we should—every year and are budgeting to do so over the next five years.

I would like to take this opportunity as well to talk about spending on health in my local community. In the 2013 election I promised $4.5 million for the upgrade of the Ballina hospital. It will have a new operating theatre and some new imaging equipment. We have funded other health related ancillary services, like the Dementia Outreach Service. I recently announced infrastructure funding for Tresillian, which is a family care centre in Lismore, to help young families with babies and their health needs. We have increased funding for aged care and related health services. There have been millions of dollars—just in my community—announced in the last two years.

I know you are aware, Mr Deputy Speaker—as are most people in this House—of the scourge of ice in our community and the health issues it has created. We have increased funding to that area—from very little, if anything—by $300 million that we announced with the National Ice Taskforce. There is more in my local community. In 2013 the Labor government promised $3 million for redevelopment of the Casino emergency department. They made that promise six or seven weeks before the election. We did not.

I went to Casino after the election. I saw that the emergency department badly needed an upgrade and I lobbied the then health minister. We even matched that promise. There is a new triage area. There are two new resuscitation bays. There is a new ambulance entry. There are four new treatment bays. The waiting area was relocated, because they needed more privacy for people who presented to the emergency department.

As the local member I have a lot to do, as I should, with the Primary Health Network for our region. It is a great operation. We are giving them increased funding. In fact, we are giving them much more autonomy on how they spend money on health resources in our region. I had the pleasure, recently, to open a new headspace facility in my community. Mental health, as we know, greatly needs increased services. There is increased demand there as well.

So we are increasing funding for the health sector of our community—as we should. My wife is a nurse at the local hospital and I am very conscious of the good work they do. This federal government will increase resources to those areas that need it.

Lisa Chesters (Bendigo, Australian Labor Party) Share this | Link to this | Hansard source

I have to confess, when I saw it on the front page of the paper today, I thought, for a moment, it was April Fools' Day. I thought it had to be a joke. Surely, how could this government go after Medicare and how could this government trust and involve the disgraced Minister for Human Services in this process? This government is so classically liberal it is hard to determine how on earth the Australian people could get behind them at the last election. But they did. And we are now here, today, learning exactly how much this government cares about Medicare.

They have tried over and over again, in this term of parliament, to kill off Medicare. They have tried to bring in a GP co-payment and force our doctors to be tax collectors, force them to collect $7 per GP visit—$2 for their own administration and $5 to be passed on to the government. That failed. It failed because doctors and patients in the Australian community said 'no'. For the first time in many years we saw the AMA fire up and become one of the most militant and strongest unions we have in this country. They stared down their mates in the Liberal Party and said: 'We reject your GP co-payment and what you are trying to do to Medicare.' Then we saw the cuts to hospitals. There is a reason our hospitals are crying out against this government.

In my own electorate of Bendigo they cut $34 million from Bendigo Health—and $40 million from hospitals in total. That is from some of our smallest hospitals—the Kyneton hospital, the Heathcote hospital, the Castlemaine hospital—who are saying to me, 'We're actually better off not seeing patients, then we'll break even. But the moment we start seeing patients we start going broke, because this government cut the operating budget and they are not paying their fair share to our hospitals.'

It has not stopped with the previous Prime Minister; it has continued under this Prime Minister. Malcolm Turnbull has brought back the exact same cuts as the previous Prime Minister. That only confirms one thing: this is a Liberal agenda. This is a Prime Minister that is purely and simply pursuing the Liberal agenda. We have known that, since the creation of Medicare, they will do anything to outsource, cut or sell off this public institution that ensures that Australians have universal access to health care. Why are they so opposed to ordinary Australians having decent access to Medicare? Why do they want to deny people in our community access to good quality health care through our Medicare system? These are questions that Australians have asked themselves for generations. Why do Liberals not understand it is something that Australians want? We are very happy to fight an election on this issue because when health is at the top of the priority list people do not look to the Liberals for answers; they look to Labor for the answers.

Then came today's great announcement that they are going to fatten up parts of Medicare and sell it off to the market. You can forgive for a moment the shock of the CEO of Australia Post who has been angling and saying Australia Post could help the government deliver some of these services. Australia Post, as we know, is a government entity, and the CEO was keen to talk to the government about how a government entity could support other parts of government in delivering services. But this government has completely bypassed Australia Post, an Australian government entity, and it is talking about going straight to the market. They are so obsessed with selling off public assets and public services that they have gone straight to the market and today in question time could not even a rule out whether overseas companies could bid for that contract.

The last thing Australians want when they are looking for support with Medicare is their public health care records going overseas. Australians hate the outsourcing. They hate Australian jobs going overseas, particularly when it comes to their public service, and the government needs to rule that out. The government needs to be honest with the Australian people. It needs to stop going after Medicare. It needs to reinvest in Medicare. It needs to put the funding back into health care and actually stand up for the institution.

For 20 years I have been asking people to sign a Medicare petition, Save Medicare. That trend is going to continue because this government does not seem to understand. (Time expired)

Ann Sudmalis (Gilmore, Liberal Party) Share this | Link to this | Hansard source

Sometimes when I sit in this chamber and listen to opposition speakers I wonder if we are all living in the same universe. The perception of reality is so completely different it seems that their perception is not only rose coloured, it is fractured as if they are looking through a kaleidoscope. Do not get me wrong, I like some of those opposite. But, really, what are they looking at when they check expenditure proposals from their side?

I would like to begin my contribution by likening the national budget to an apple tree. Our revenue can be seen as the apples on this tree, available for consumption by the states for federally funded programs and, unfortunately at this moment, for paying off national debt. In the past, at the end of the last coalition government, though not recently, the whole of the apple crop—or the money, the national revenue—could be spent in Australia or on foreign aid or on hospitals, schools or tax cuts. Now a big chunk of the apple crop has to be allocated to paying back debt—to the tune of almost $12 billion a year.

Those opposite have this really weird understanding of the apple crop. You cannot keep allocating apples—or money—to projects beyond the number of apples that you actually have on the tree. In Reality Land outside the House—not the bubble of illusion that exists with those opposite—each of us in this room has a budget. It may involve a mortgage, electricity, fuel, rego, food and living costs. We stick to our budget or we face bankruptcy. What on earth makes those opposite even considered that the national budget is exempt from the same process of living within our means?

Each of us knows that health has absolutely no chance of being a revenue-producing industry. It is by its very essence a support expenditure for our citizens. It is crucial that every dollar we spend in this portfolio is having the greatest effect on health outcomes, not just spreading dollops of cash into programs with no benefit to the patients. This is not just a current need; this is a future need. We on this side of the House recognise that well-spent and well-allocated dollars are the aim of a responsible government. In the past there were some members on the other side who also recognise this fact. Almost a year ago—and a couple of us have already quoted this—the opposition said about itself that it:

… would be kidding itself if it didn't recognise there were challenges in the budget and that savings needed to be found.

'There is no area that is going to be exempt,' …

'We have to look across the board.'

For the shadow minister for health, that is exactly what we are doing. I remind those opposite that trying to create a sustainable health system, including a sustainable Medicare, is not just a policy direction adopted by a conservative government; we are actually responsible for better economic management.

Let us just do a quick review of some of the most significant initiatives introduced by Labor to try to make health sustainable. During the Rudd-Gillard-Rudd years waiting times for elective surgery increased and the bureaucracy associated with health grew but—do you know what?—not the front-liners in the hospitals. Private health insurance went right up and dental services were cut. From the 2006-07 financial year to the 2011-12 financial year there was a 27 per cent increase in departmental staffing, very few of which were actually on the front line. In the 2011-12 and 2012-13 financial years $403 million was retrospectively cut from the health budget due to parameter miscalculations. Okay, we need a new abacus over there.

I have to remind those opposite that private health insurance is not the domain of the rich, so making cuts to anything that relates to that hurts many people who just want to take out health insurance to take them through their retirement years. We all know that in every region in Australia many city areas have a growing number of older Australians. By natural circumstance, this means there will be a much higher demand on our health system. If we do not work out a sustainable strategy now, then my children, their children and the grandchildren of those opposite—in fact, the whole of our next generation—are going to be seriously disadvantaged as they age.

We are not just representing the people of today; we are representing the Australians of the future, and we are duty-bound to get an economy that is sustainable so we can invest in our health resources, we can sustain Medicare, we can keep our community healthy, we can have services that mean something to our community and our doctors can be trained. For those opposite who said, 'We've got a shortage of doctors,' I hate to tell you this, but it takes about 10 years to get a doctor qualified and into the system. So leaving it to a last-minute announcement is not cool. We really have to work hard to make this a sustainable health system.

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

The time allotted for this debate has expired.