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's cuts to Medicare.

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

In Mr Turnbull's very first economic statement, he went after cancer patients and patients with chronic disease. Now, in his very first budget, as confirmed here at question time, he is after kids' teeth. There is quite literally no group of Australians, no matter how weak, no matter how poor, no matter how sick, that this Prime Minister will not attack when it comes to health funding. Why? Because the Prime Minister who promised so much is so weak that he cannot even consider serious tax reform, and he is forced by the extremists in his party and the Nationals to once again attack the weak, attack the sick and attack the poor by now attacking kids dental care.

Just when you thought that, after $60 billion in health cuts in their first two years—including a $57 billion cut from hospitals, which has been confirmed by Treasury; the GP tax; and prescription price hikes—they could not possibly get any worse, Mr Turnbull showed that, when it came to health cuts, Tony Abbott was a wimp. He went where even the former Prime Minister refused to go. In his very first economic statement, he attacked cancer patients and others with chronic conditions with his $650 million of cuts to bulk-billing incentives for pathology and diagnostic imaging. Now driven by the extremists in the Liberal and National parties, he is going to use his very first budget, as confirmed in question time today, to attack the Child Dental Benefits Schedule.

Labor's $2.7 billion dental program has provided one million Australian children with affordable dental care over the past two years. Many of these are children whose parents have never previously been able to afford dental care for their kids. Labor initiated the scheme, following alarming reports from the Australian Institute of Health and Welfare that 42 per cent of five-year-olds and 61 per cent of nine-year-olds had experienced decay in their baby teeth and 58 per cent of 14-year-olds had experienced permanent tooth decay. More than half of all Australian teenagers have permanent tooth decay. Why? Because in many cases their families could not afford to go to see a dentist. This was a shameful outcome in a country as wealthy as Australia, with a health system that in all other respects is the envy of the world.

So, in our 2013 budget, we announced a scheme to provide eligible children with up to $1,000 in dental treatment every two years to ensure that their teeth get checked and they do not suffer these terrible dental problems later in life. It has been an outstanding success. That is not my description; that is the verdict of this government's own health department. In its report released earlier this month—which, for some strange reason, the government has never sought to publicise and never put out a press release about!—it said:

In particular, the Panel noted the success of the CDBS—

the Child Dental Benefits Schedule—

in targeting the oral health of young Australians at an age where preventative measures can be most effective. It supported the right of every child to access dental treatment from both the private and the public sectors. The Panel agreed that it would make clear recommendations to Government to ensure the ongoing success and effectiveness of the CDBS.

However, the report did have some criticisms to make—not of Labor's scheme but of this wretched government that has sought to undermine the scheme by in fact hiding it from parents.

Think of all the times in the last few weeks you have seen a TV ad for the Prime Minister's catchphrase. Think of how many times you have seen that on a bus shelter and think of all those millions of dollars wasted on promoting a meaningless phrase by a Prime Minister who has proven to be anything but agile and innovative, let alone exciting. How many times do you think the Child Dental Benefits Schedule has been promoted on television or bus shelters anywhere in this country? Not once. How many times do you think the kids dental scheme has featured anywhere in this government's advertising program? Frankly, not once.

In fact, in the entire time it has been in existence under this government, it has been promoted in a single mail-out to family tax benefit recipients. No wonder that, when the government's review made 10 recommendations to improve the scheme, five of them—that is right; half of the recommendations—were telling the government to do more to promote it. Here again, I quote from the panel's report:

The Panel agreed that the CDBS has been poorly promoted, and noted that the current eligibility notification did not provide readily recognisable advice of an entitlement.

The plot here is so transparent it would have been knocked back by a reality TV program. They refuse to publicise the scheme; then they claim that it has not met the target because no-one knows about it; and then, when their own department says it is a success, helps a million kids and should be promoted more, they bury the report.

I am here today to tell every single member on the government benches that, if you thought the backlash in terms of the GP tax was a bit too hot for you to handle, what do you think is going to happen now with every single dentist in the country rallying behind this scheme and telling their patients? What do you think is going to happen? I have to feel a bit sorry for the backbench because they probably only found out about this happening in the same way the dentists did: they saw stories in the newspapers saying that this scheme was for the axe.

You would think that the backbench, after the GP tax, after the hammering they are getting on pathology and diagnostic imagery, after the cuts to hospitals, after seeing all of this month after month and after seeing that they are going to privatise Medicare payments in Western Australia—the paper up there has that front and centre—would be going to the health minister and saying, 'What are you doing? Having been hammered so much on health, having undermined Medicare and made it such an election negative, why on earth would you go after the Child Dental Benefits Schedule in the months leading up to an election campaign? Are you absolutely crazy?'

If you were a backbencher on the government side you would be shaking your head about why on earth they would go after this scheme. If you come for this program, which is providing, for the first time, affordable dental care for hundreds of thousands of kids, Labor will again stand in your way and we will have millions of parents standing there with us.

This is far from an isolated attack on dental care by this government. In its very first budget, the government ripped $390 million out of dental programs. There are more than 400,000 Australians today on public dental waiting lists, waiting to get their teeth fixed. In the 12 months prior to the Liberal government's first budget, those waiting lists started to fall significantly as a result of Labor's investment in public dental. That means thousands of people getting their teeth fixed and thousands of people no longer in pain—able to eat, talk properly and have good oral health—until this government came along and slashed that funding. What a joke!

We had the Prime Minister here saying, 'We want to support public dental better by cutting the successful child dental benefit scheme,' after slashing the public dental scheme and increasing waiting times on public dental. Really, you have got to be kidding! Then those opposite ripped some $225 million from Labor's programs to build dental clinics in regional Australia and in nursing homes. The Liberals and Nationals, who claim to represent regional communities, ripped money out of Labor programs to improve dental care in regional Australia. Because too many health cuts are never enough for the government, they backed that up again in the 2015 budget by ripping another $125.6 million from the Child Dental Benefit Schedule itself.

Now, once again, the government has the teeth of Australia's kids in its sights, confirming yet again that the Liberals only ever see health as a source for budget cuts. This confirms that after just six months on the job the member for Wentworth has been even more of a disaster for the health of Australians than the member for Warringah. He took Tony Abbott's $57 billion of cuts to hospitals and entrenched them in the budget. He took Tony Abbott's GP tax and added another $2.1 billion of his own in cuts to primary care. He has gutted crucial health workforce training programs by $595 million and ripped another $146 million out of prevention. Now we hear that he wants to come after the Child Dental Benefits Schedule program. We will stand in his way. Only Labor cares about the health of Australians. Only Labor cares about Medicare. Only Labor will defend, strengthen and protect it.

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

Congratulations to the shadow health minister for the beautifully read speech and congratulations to the person who wrote it. But, in reality, if she actually visited a dental surgery she would know that in this country we are getting little more than a lube and an oil check for those dental checks. That is one of the great challenges with Labor's model. The reality is that Labor's great idea of free dental has banned the use of bridges and other advanced dental techniques that are needed to fix the very teeth that the opposition health spokesperson is talking about. What is the point of having a Labor-designed dental scheme that bans the use of bridges and other important developments, such as crowns, for a child's teeth? How do you look an Aboriginal child in the eye and say, 'We're quite happy to scrape your teeth and to give you a fancy mouthwash and a floss, but if you need a bridge or a crown, sorry, that is not provided by the Commonwealth'? That is patently ridiculous. We need a dental scheme that will look for those with the most serious oral conditions and look after them.

I have already told you this week about Tasmania, where, if you have the effrontery to have a job, you are banned from dental health care. I can see Tasmanian members in this chamber now, and I have visited those cities where a young woman with an entry-level minimum-wage job with a mouth full of oral cavities is told, 'You are not eligible for state Labor support.' That is appalling. I can confirm for those listening in the gallery that our $155 million campaign, the national partnership agreement for dental care, is locked in place for 178,000 Australians. On top of that, there are the $200 million transfers to all states and territories, signed off last November.

We know that there is only one party in here that has an absolute inability to work with private dentists, and it is not this side. We know that there is one side of politics in here that ripped away the Medicare Chronic Disease Dental Scheme from those who needed it the most, and it was not this side. Let us be absolutely clear—

Opposition Members:

Opposition members interjecting—

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

I hear the accusations of overcharging. I do not think that there is any part of the health system that does not have a bit of overcharging, and if it occurs we will act and we will prevent it. But let us get one thing clear: 'Do we treat the poor or do we treat the sick?' is the ridiculous question that Labor asks itself. If you have some money in your pocket, you are not eligible for dental care, and that is a complete disgrace. If you are sick, you deserve care; I do not care what you are earning. And if you are sick, you deserve dental care; I do not care what you are earning. But the Labor Party rule that out completely. They think that a floss, a shine and a pick at kids' teeth represents dental care. You have no idea how the dental scheme works. You would not even know the visiting hours in hospital. There is not a single person over there with a shred of health economics knowledge. When you have that, come back and engage in this debate in a serious manner. Right now, all you care about is cost; we care about effectiveness. You care about cost; we care about value. You care about cost; and we care about the utility of health care.

Sometimes the system has to change. Sometimes you have to find a better way of doing it. Sometimes this great chamber has to move away from the ridiculous and puerile idea that if you are cutting or ripping then it cannot become a better system. Of course it can, but there is one caveat: if you remove money from the system, you put it back in a more efficient way. What did Labor say? I remember very well that the shadow spokesperson for health, who was in the chamber a few minutes ago, said on Sunday, 27 September 2015:

In government, Labor worked with the medical profession to improve the quality and safety of Medicare, and where savings were realised, they were reinvested back into the health system.

Let us just fast forward to 6 January of this year:

Some of those savings did go back into the health Budget, not all of them.

That is right. This side is just as guilty as any political party of trying to find sensible savings to maintain one of the greatest health systems in the world. Sometimes you have to admit that $1 spent in one part of the health system could be slightly better spent somewhere else. But Labor do not get that, do they? Their notion is that the minute you touch something, goodness me, there might be a low-income Australian who cannot walk straight in, see their GP and be bulk-billed, where 80 per cent of them are, or go and get some diagnostic radiology and pathology, where 87 per cent of those services are bulk-billed. Let's hold on for a second: most people earning double the minimum wage are getting free health care, free diagnostic radiology and free pathology. This party has the effrontery to come in here and occupy time in this valuable chamber complaining about a one per cent change in bulk-billing and taking back some savings out of what is fundamentally two corporate providers of private pathology.

Listen to these flimsy heroes over there. They have barely one single serious connection with the private health sector, but listen to them jumping up and supporting major pathology corporates when it suits their political state of mind. They had no problem when they were in government ripping half a billion dollars out of pathology and boasting about it. They boasted about it! The minute that we try to do something that will drive better efficiencies in pathology, suddenly the Australian Labor Party are the great heroes of the corporates. It is wonderful to see the transition—they are pretty quick on their feet.

In reality, this mob over here, in six years of government, where the rubber really hits the road, never came up with anything that fundamentally improved the health system. What did they do? Eleven increased or new authorities. What were the fastest-growing things in health under their government? Water bubblers, executive toys, executive chairs and pot plants, because those guys could not wait to furnish the new bureaucracies here in Canberra that were going to transform the health system. But, if you were working out in Gundagai or down in Mungindi, you barely saw a change. You never saw a change in quality numbers, you never saw a change in specialist numbers and you never saw an improvement in access to care.

But they came up with plenty of Medicare Locals. That was pretty impressive, wasn't it? There were layers and layers of bureaucracy, health authorities talking about how to make a better health system and lots of fancy graphs and pie diagrams—you are very good at that too. You kept the government printer busy, that is for sure. But in reality, if you were on the front line, sitting down there in the Mater hospital, trying to see young kids who have a squint and hoping to get them on an unbelievably long state waiting list, Labor offered you nothing at all. If you had serious cavities in your teeth and you happened to have a job, Labor offered you nothing, because you were not poor enough. This extraordinary situation where Labor were rationing health care according to income was appalling.

Last of all, Labor nickelled and dimed private health cover, when before every election they said they would not—and, of course, 40 to 50 per cent of Australians saw their premiums going through the roof and wondered why. We get one chance in this world to get the health system right. This is one of the few nations utterly paralysed in the health debate, because this is the last political frontier where Labor are not collapsing in on themselves. This is the last topic of politics where Labor can talk to Australians and be given at least some credit that they might be able to run the system, but people who really know health know they cannot.

People who really know the system know that Labor are so wedded to not touching the fee-for-service bulk-billing system that they do not talk about any other topic. We cannot even get them to talk about hospital management. We cannot even get them to talk about diagnostic imaging and radiation oncology, where, under the public system, it is almost half as efficient as the private system. I know Labor are prepared to go down there and open the plaques and stand there for photos, but, at the same time, they are funding completely ineffective state hospital systems that are seeing patients at half the rate, and people are waiting twice as long to get treatment.

There is a serious side to all of this. It is not just about the billy banter from Young Labor and Young Liberal going on for generations. Ultimately, it is about a senior Australian who is diagnosed with cancer. At that moment, you really the test the system. How long will it take under a Labor process to get your first CT? What is the time to treatment for a poor Australian? The party on the other side, the Australian Labor Party, have never worked to reduce those times whatsoever. They have never made a strong private alternative for Australians, because they do not want to know that there is a private alternative.

Too many people have died too early because they were not able to get time to cancer treatment down. We need to get them seen quickly, with more specialists and with the best treatments. You do not do that by simply allowing costs to escalate. You do it by constantly looking around the health system, doing a flyover and asking what we can do better. I do not pretend to have all of the answers, but this country would be a fair bit better off if this place here could have a constructive debate, instead of these appalling motions going on and on about defending Medicare when it is utterly clear that, when Labor are in government, they do not.

Matt Thistlethwaite (Kingsford Smith, Australian Labor Party, Shadow Parliamentary Secretary for Foreign Affairs) Share this | Link to this | Hansard source

Forget all the bluster and rubbish from the member for Bowman. I am going to give you the voice of the Australian people when it comes to their beliefs on Medicare and what this government has done. This is an email that I received in January this year from a constituent, Terry of Matraville. He writes: 'I had to go to Medicare for a simple expenses claim. When I entered, I expected a separate desk for each organisation. I asked someone where Medicare was, and she said, "Line up." The queue had about 20 people in it, so I decided to go home and try on the phone—without success, as the system was overloaded and would not take any more calls. I went home as I have bad knees and I cannot stand for any length of time.'

This email perfectly highlights this government's approach to Medicare. Terry had to go home and could not access Medicare services at the local Centrelink office, because two years earlier the Abbott government closed our local Medicare office in Eastgardens. They closed the office and merged the service with Centrelink. They said, 'Don't worry, there will be separate services when you come to Centrelink.' There are no separate services; people have to queue for one service. That is the result. Making life harder for people is what this government does.

They are doing this because, let's be frank, the Liberals and Nationals do not believe in Medicare. They never have and they never will. They see it as an intervention in a market. They see it as contrary to their conservative philosophy. They do not support Medicare. They want to water down Medicare and reduce its coverage. In the case of doing that, the Australian people are suffering.

Let's look at what they have attempted to do with Medicare since they came to government. In 2014, in their first budget, they tried to introduce a Medicare co-payment so that people would have to pay to visit their local GP. Never mind the fact that the actual effect of the Medicare co-payment is to increase overall health expenditure, because you are actually discouraging people from going to visit the doctor when they are sick—particularly people on low and middle incomes, and pensioners, who cannot afford the co-payment, so they do not go to the doctor and they get sicker and sicker. By the time that they have to go to hospital, it becomes acute care, which is much more expensive.

That is the approach that the Liberals took to Medicare in their first budget, but they could not get the co-payment through the parliament. What did they do in the wake of that? They continued the GP rebate freeze. They continued to freeze the rebate that goes to GPs when it comes to Medicare. In effect, they were introducing a co-payment through a sneaky, backdoor method, forcing GPs to charge a co-payment and to water down the universality of Medicare.

Now we have learned that the government plan to allow private health insurers into GP practices. Again, they are trying to end the universality of Medicare. They are continuing with this campaign to dilute Medicare. Just before Christmas we had the government introducing $650 million worth of cuts to bulk-billed pathology and diagnostic services. So patients, including cancer patients, will now pay up-front for MRIs, CAT scans and X-rays. Remember what I said at the beginning: they are making life harder for Australians and watering down and undermining Medicare. That is this government's approach to universal health coverage.

Their latest attack is quite despicable because they have determined that they are going to attack children by cutting the children's dental health scheme. The purpose of this scheme is quite simple. It is to provide dental health care for kids who have decay and holes in their teeth, whose teeth need fixing and whose parents cannot afford a trip to the dentist. The government scheme subsidises those children. It is a means-tested payment. So it is targeted to those families that cannot afford dental health care. A million children in this country have accessed the scheme, and what is this government's approach? They are going to cut it. What did the minister say when she was questioned about this? She said, 'There may be a better way to target funding.' That is code. That is Liberalspeak for, 'We do not believe in universal health care. We do not believe in Medicare. It is an intervention in the market and it is against our conservative values.'

The government have also cut $57 billion from the hospital budget. We are seeing the effects of that in my community, with cuts to the Prince of Wales Hospital. The government do not believe in Medicare. They have cut and watered down Medicare, and Australians will suffer.

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

I am really relishing this opportunity to talk about the hypocrisy of those on the other side when it comes to Medicare. They think they own Medicare because Gough Whitlam turned up with it. But who has increased spending and made it a more efficient system over the last few years? Let's start with the opposition's story about privatising Medicare that is designed to scare people. They think privatisation is some bogeyman that is coming. I might just quote the author of the Medibank and Medicare introductions in 1968. When he was talking about the privatisation of the nuts-and-bolts delivery of Medicare services like the back-of-house computer systems and tap-and-go technologies, John Deeble said:

It won't necessarily alter Medicare because it's the structure of Medicare—what money you get for what service—that matters, not who does the running of it.

That is what is happening here.

Business innovation happens all the time. Even Brian Owler, neurosurgeon and head of the AMA, made comments in the press last year that there needed to be some modernisation of the Medicare system. You can use tap and go in a coffee shop, but if you are trying to get your money from the Medicare system it is much less efficient. What is happening is that the marionettes here are responding to their puppetmasters in the Commonwealth Public Service Union who think their jobs might be threatened if there is a more efficient way of delivering the nuts and bolts of Medicare.

Let's look at the opposition's story about cuts to funding. I have looked at the papers for the forward figures for 2017-18 and there is a 21.5 per cent increase in Commonwealth funding for public hospitals. That is almost a one-fifth increase. That is $3.3 billion extra. To me, a cut means less next year then you had this year. But that is an increase. Going forward, payments to the states will be indexed to CPI. That is on the record. That is not a cut; that is an increase. The opposition are trying to drum up a scare campaign. That is all they can do. They will not take responsibility for the budgetary situation they left the country in. When we try to fix it, they try these emotional, scare based tactics. That is what they do. They run an emotional argument. They do not run a logical argument. We are all used to it, but some people in the press swallow it hook, line and sinker and do not question it.

Let's look at the dental system that the previous speaker spoke about. They mentioned the word 'children', as though that will pull on heartstrings. I can tell you what happened with the childhood dental scheme. It was criticised. The Chronic Disease Dental Scheme that the Labor Party dumped was actually delivering dental care. They replaced it with the childhood dental scheme. What happened? You had buses driving around the country and turning up outside schools, such as in my electorate, and getting all number of kids in, as the previous speaker said, for a wash, lube and oil change. Basically they got their teeth cleaned and had a couple of X-rays taken. The scheme used up all the money available and then said, 'Go down the road to the dentist.' So the kids turned up down there and there was no money left. It was the biggest scam. It was marketed as a breakthrough for kids, but there was not much actual dental care delivered. They just got a check, a clean with a high-speed brush and a lot of X-rays. All the money was used up. If they had cavities or needed other work, there was no money left to treat that. There was no way that complex stuff for people with really bad teeth was going to get done. The reality is that it was a failed scheme.

Not only that but we have increased funding to public dental schemes through the state agreements—$155 million was enough to treat 178,000 patients through the hospital dental scheme. In 2015-16 it was $200 million. We are delivering common-sense changes to the whole Medicare system. None of this emotional, scare driven campaign makes sense.

I cannot go without saying something about the scare campaign that we are cutting bulk-billing. Pathology and X-ray services got an incentive to increase bulk-billing rates, but that is the only bit that has changed. That is an efficiency. Bulk-billing continues— (Time expired)

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

The Turnbull government is obsessed with destroying Australia's universal health system. We see that through its $60 billion cuts to hospitals, the four-year freeze on Medicare rebates for GPs, the $650 million cuts to Medicare rebates for pathology and diagnostic imaging, cutting health workforce programs by $595 million, e-health and health prevention programs also cut by $146 million, the $1.3 billion hike on essential medicines, and now we also see the attacks on the child dental benefits scheme. After already cutting $125 million from the scheme—this is a $2.7 billion program implemented by the last Labor government—the Turnbull government now plans to abolish the scheme altogether. It is clear from the Prime Minister's response in question time today that that is what they have in mind.

This is a decision that will remove access of 3.4 million eligible children to a scheme that gives them $1,000 in dental care over two years. It is a program that, to date, has supported one million Australian children with dental services. The President of the Australian Dental Association, Dr Rick Olive, says about the cuts: 'This is bad policy, which the ADA is flabbergasted to hear about.' He went on to say that ending the child dental benefits scheme 'will significantly disadvantage children from low-income families, who we know have greater oral health needs'. South Australia has the highest child dental scheme uptake of all the states—38.4 per cent of eligible children used the scheme. In actual figures—in raw figures—87,000 South Australian children accessed this scheme. South Australia and Tasmania have the highest numbers of eligible children, reflecting the high disadvantage in parts of those states. Put simply: cutting the child dental benefit scheme would be another cruel cut which would hit the poorest and most disadvantaged the hardest.

Let us look at some of the other cuts, and I refer to the hospital cuts as well. The AMA's Public Hospital Report Card 2016 says about the cuts to public hospitals that 'waiting times have not improved and no progress has been made towards access and treatment targets'. We go on to the Diagnostic Imaging Association, who say about the cuts to their services: 'We are concerned that many Australians who don't know they have a treatable condition will now put off or choose not to seek a diagnosis because the up-front and out-of-pocket costs are likely to be prohibitive—an average $134 to $214 up-front and $14 to $94 out of pocket. These are conservative estimates.'

Those quotes peak for themselves. It is not just Labor who is concerned about these cuts; it is the professionals who work in the industry—such as the CEO of Primary Health Care Limited, when he talks about bulk-billing incentive cuts for pathology providers: 'Pathology providers no longer have any capacity to absorb further funding cuts without charging fees or reducing access to services. Australians don't want a co-payment by stealth.' They have had their payments frozen for 20 years, and yet this government is trying to bring in co-payments by stealth.

This government wants to destroy Australia's universal Medicare services and take us to a US-style health system where those who can afford treatment get it and those who cannot miss out. In recent times I have received numerous emails from people in my electorate who are concerned about the proposal to do away with Australia's Medicare system. People have woken up to the fact that that is what this government wants to do, and it is doing it by stealth, one step at a time. The reality is the government wants to do that for two reasons: (1) because it has never supported the universal health system that we have, and (2) because it wants to balance its budget mess on the back of the poorest people in this country. It has shown that it wants to do that by cutting family payments, by cutting education funding, by pushing university degrees to up to $100,000, by cutting legal aid, by cutting funds to pensioners and by cutting front-line services to the community. All of these cuts, every single one of them, hit the most disadvantaged in our community the hardest, and that is why Labor will oppose these cuts right through to the election and ensure that we do our best to protect the services that the Australian people need.

Nola Marino (Forrest, Liberal Party) Share this | Link to this | Hansard source

A responsible government recognises the need to keep Medicare sustainable—it has to be sustainable—and that is why we are taking sensible, fair and responsible measures. They have to be responsible. The period of the previous Labor government saw an absolute explosion in health costs. Since 2007, Commonwealth expenditure has grown by 46 per cent. Again, we have seen billions and billions in debt and deficit from the previous Labor government as a result. The pressure on the budget from Medicare, the PBS and public hospitals has been absolutely unrelenting, driven in part by the ageing population, chronic disease and higher costs. It has also been driven by increasing expectation. As medicine becomes more advanced it also becomes both more complex and more expensive. We can perform procedures today that a few short years ago would have seemed a bit like science fiction. We have a raft of new drugs that treat disease better and faster, but each one costs a small fortune to develop and get onto the market.

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

A large fortune.

Nola Marino (Forrest, Liberal Party) Share this | Link to this | Hansard source

A large fortune to get them onto the market, as the member for Herbert says. Chronic disease conditions that we once just lived with we now treat with surgical correction. For example, the growth in knee and hip replacement surgery has been exponential. Of course we should develop new techniques and new medicines, because this improves the quantity and quality of life for all Australians, and, in many cases, our work benefits the entire world. However, all of this improvement comes at a cost, and that cost never goes down, because once we start fixing one disease or condition another one takes prominence. It is a never ending issue, but one that must be managed.

Between Medicare, aged care and the Pharmaceutical Benefits Scheme, the Commonwealth processes over $42 billion worth of payment transactions every year. Ten years ago the MBS was costing $8 billion; today it is $20 billion and in 10 years time it will be around $34 billion. In 2013-14, 275 million Medicare services were provided free to the patient. This will cost the taxpayer more than $12.8 billion. In 2013-14, more than four out of five GP services were provided free to the patient, in spite of what those opposite say. That is more than 80 per cent. In 2014-15, Australians accessed more than one million MBS services every single day. This is the first time that this level has been reached in the history of Medicare.

In spite of Labor's scaremongering and hyperventilation, Australia enjoys a high and growing bulk-billing rate. That is how it is. It is Labor's failed management of expenditure growth that has left us where we are today. The coalition is spending more money on health, but it is doing so in a responsible manner by managing and addressing the ever-growing costs. Developing a plan to manage spiralling health costs is a long-term job that requires tough decisions. Labor's plan was simply to spend and ask our children and our grandchildren to foot the bill. They were putting health budget growth on the national credit card. That is exactly what Labor were doing. It is unfair because it asks our children and our grandchildren to pay for the health outcomes of today's generation. That is exactly what those opposite were doing.

When the former Treasurer, the member for Lilley, was asked about the debt limit, he responded by saying—as you do—that that will be someone else's problem, just like he would have passed on the current generation's health bill to the next generation. Despite the hysterical allegations—

Opposition members interjecting—

We can hear the caterwauling across the chamber—it would appear that the shadow spokesperson acknowledges the problems, as she did in an interview this year, when she said:

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

Those were the comments by the shadow spokesperson, Catherine King, on 22 February 2015. She said:

There is no area that is going to be exempt—

(Time expired)

Justine Elliot (Richmond, Australian Labor Party) Share this | Link to this | Hansard source

The government went to the last election promising no cuts to health, but that turned out to be just another broken promise. That is exactly what they have done and it is exactly what they keep on doing. There have been so many cuts to health. In fact, in their first two years they have announced $60 billion in health cuts already, including $57 billion in cuts to hospitals, a four-year freeze on Medicare rebates for GPs and the very harsh $650 million in cuts to Medicare rebates for pathology and diagnostic imaging. They are doing all this with just one objective: to destroy Medicare and our universal health system. They did it under the previous Prime Minister, Mr Abbott, and they are doing it now with Prime Minister Turnbull. Nothing has changed with the new Prime Minister. The harsh cuts are still there. But something has changed a bit: they are, in fact, getting worse. His cuts are adding to the previous cuts. He accepted all the cuts by the previous Prime Minister and now, on top of that, there are more cuts. In fact, in his very first economic statement, Prime Minister Turnbull took all of the previous Prime Minister's cuts and added another $2 billion in cuts, making health care even less affordable to millions of Australians.

It is very important to note that many choices by this government really hurt regional areas. I often say that National Party choices hurt. The Nationals have already made the choice to unfairly cut the age pension, family payments, regional jobs and health services. In health, some of those choices have been incredibly cruel. Some of the cuts have been very harsh, particularly the cuts to bulk-billing in pathology and diagnostic testing. The Turnbull government announced last year that it would scrap bulk-billing for these important procedures. The $650 million in cuts over four years to vital bulk-billing services means that people just cannot access bulk-billing for these specific services. That means that patients will have to pay for procedures like Pap smears, blood tests, X-rays and ultrasounds, and that makes health care less affordable for those who need it the most: the sick, the struggling families and the elderly. The changes unfairly target the very frequent users of pathology services—those who are the most sick.

Patients being treated for cancer and other serious conditions could be forced to fork out thousands of dollars up-front to pay for MRIs, X-rays, CAT scans and mammograms as a result of the government's harsh cuts. We know that Australia has the world's highest diagnosed rate of melanoma. A typical patient diagnosed with melanoma who was previously bulk-billed would face up-front costs of around $1,500 and would still be left with out-of-pocket costs of up to $400 after receiving their Medicare rebates. A patient with suspected breast cancer faces up-front costs of about $550 for mammograms and ultrasounds and would be left $300 out of pocket, even after receiving all the Medicare rebates.

As we have stated many times on this side of the House, Labor will fight these very harsh attacks on bulk-billing. We will continue to fight all of these unfair and cruel measures. We will defend Medicare and we will always defend the people who rely on it. The cuts to pathology and diagnostic imaging are some of the harshest and they are hitting regional areas very hard. We will always remember that National Party choices hurt, and these cuts are really hurting.

Now it appears that the Liberals and Nationals are moving their health attacks to the area of kids dental care. How harsh is that? We are very concerned at reports that the Child Dental Benefits Schedule will be the next victim of the government's cuts. Indeed, the Prime Minister confirmed it today in question time. Labor's $2.7 billion dental program has provided a million children with affordable dental care over the past two years. The parents of many of those children have never been able to afford to take them to a dentist before. The scheme provides eligible children with up to $1,000 in dental treatment every two years. This is a great scheme, and it came under attack from day one by those opposite. In last year's budget, the government ripped $125 million from the scheme. We know what is going to happen now: they are going to cut it altogether.

Another real concern with the government is how they want to go further and allow private insurers into Medicare. That will really be bad. It will mark the end of Medicare and universal health care and will create a two-tier Americanised health system, in terms of accessing GP services. The fact is that the Liberals and the Nationals always look for ways to make health care less affordable for the people who need it the most. In contrast, we will always fight for Australians to be able to access decent, affordable health care. We will fight to defend Medicare. In regional and rural areas, locals know that National Party choices hurt. One of their harshest choices has been to cut all of those health services in the country. They continue to make cuts to hospitals and diagnostic and pathology tests, and now we are seeing cuts to children's dental care as well. There are often more health needs in the country, and the National Party is making the cuts that will impact families in the bush most harshly.

Michael Sukkar (Deakin, Liberal Party) Share this | Link to this | Hansard source

Quite frankly, this is groundhog day. For 30 years, whenever the Labor Party has been desperate, the catch cry has been: 'Cuts to Medicare! Cuts to health!' The reality is quite different to the constant scare campaign that we have heard from Labor for 30 years. Effectively, for 30 years the Labor Party has said that we are cutting health and we are cutting Medicare. No wonder the Australian people just do not believe it anymore. Ten years ago the MBS, which forms a very crucial part of our health system and of health funding, was costing $8 billion. Today it is costing $20 billion, and in 10 years time that will have grown to $34 billion. So for 30 years, effectively, Labor has said we are cutting health expenditure, yet it keeps rising and rising year on year.

Today is all about an absolutely naked grab to get a headline in an area that Labor view as being a political strength for them: the health space. But we will never ever apologise for casting our eye over the health system. The $20 billion in MBS is not our entire health expenditure, but we will not apologise for casting our eye over every single line item of expenditure to try to make it as efficient as possible and as fit for purpose as possible. Surely we can agree in this House that any money we can save and reinvest into other more important parts of the health system is a good thing. The reality of productivity and efficiency with an ageing population is that we will need to squeeze out more services for every single dollar. How could anybody argue that it would not be wholly responsible for this government to cast its eye over every form of expenditure to see where efficiencies can be found? Importantly, those efficiencies will be reinvested back into the health system. That is something we are committed to.

The member for Bowman highlighted earlier that the shadow minister for health has spoken about Labor's time in government, and about how not all savings that were made in health were reinvested into health. We have a proud record on this side in this parliament of making sure that every single dollar is reinvested in some way, shape or form. One great legacy of this government that I think will be remembered for many years to come will be the Medical Research Future Fund. Every single dollar that will be invested into the Medical Research Future Fund will come out of savings in health, and that research will be the thing that drives the health outcomes of the future. Yet the Labor Party was very lukewarm on the Medical Research Future Fund. They were dragged there kicking and screaming and ultimately supported it. But it needs money, and you must find it somewhere. Importantly, on this side of the House we will support the Medical Research Future Fund and make sure it has the capital that it requires to find the cures of the future.

This is quite an extraordinary MPI today because it is ill defined. I am not even sure that the hearts of members opposite are really in it, when we look at the particular issues that they are raising. We have bulk-billing for pathology at about 87 per cent. The $500 million being referred to by the Labor Party raised it from about 86 per cent. So we have seen a one per cent rise in the bulk-billing of these pathology services, and every single dollar subsidised by the government there goes to two large corporate providers. The Labor Party have no principles on these issues. They are just trying to get their headline out there: 'Cuts to Medicare! Cuts to health!' I know that is what you do in an emergency. In every single emergency you go to the playbook—'Cuts to health! Cuts to education!'—no matter how tenuous that is. But I do not think the Australian people believe you, because the statistic I started with has shown that expenditure in health increases year on year. We will always make sure that we get the best bang for our buck, because we do not have the luxury, like the Labor Party, of coming into office with surpluses, with big amounts of money in the bank. We, unfortunately, inherit disaster from the Labor Party. It is incumbent upon us to fix it, and we will.

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

The one thing that the member for Deakin and I certainly do agree on is that this debate has something of the semblance of groundhog day, because, day after day, members on this side of the House have to stand to defend universal health care in Australia. Every time there is a Tory government we get this relentless attack on universal health care. They did not like it from the start. They did not ever want it to be part of this agreement. They fought it during the seventies and through the eighties, nineties and 2000s, and we are here in 2016 having those same old arguments.

I can understand the member for Deakin being stuck in this sort of groundhog day feeling, because it was his friend the former Prime Minister of Australia who stood before the cameras on the eve of election night promising the nation, promising us all, that there would be no cuts to health. He said there would be no cuts to health, no cuts to education, no cuts to pensions and no cuts to SBS and ABC! All these promises were subsequently broken, of course, and we on this side of the House know that all of those promises were, as we suspected at the time, a lie.

From the moment of the first budget of this government, it was abundantly clear to all that this government could only ever see health as a source of savings in a budget. There is no sense that you would ever invest in a preventive health scheme that might have some long-term health benefits for the nation. So it is little wonder that this week we get the grim news that the government is going to go after the Child Dental Benefits Schedule. This is a program that has been found to be quite successful. This is has been found independently of Labor; it is not just us on this side of the House saying that this is a successful scheme. More than one million kids have had access to a dentist and have taken part in a preventive oral health scheme that we know has long-term benefits down the track for all aspects of health.

It is not just—as some members opposite have glibly described—some kind of scrub and clean. It is hard to imagine that they would dismiss a dental scheme for Australian children so lightly, but that is exactly what has happened. This was not a scheme that was just plucked out of the air. The Australian Dental Association, for example, played a really critical role in the development and implementation of the Child Dental Benefits Scheme. They, like anybody who had been involved in that scheme, understood that this was a valuable investment in the oral health of future generations.

Preventative health is such a fundamentally important part of the Australian health scheme. That is why not only a tax on the Child Dental Benefits Schedule has been shocking; the announcement that this government would also rip out $650 million from diagnostic imaging and pathology tests that people are using is shocking. Detecting disease early is a really critical part of leading a healthy life. In particular, it has been a big issue for a lot of women in my electorate. They have spent decades encouraging women to front up to get regular mammograms, to have regular Pap smear tests and to ensure that they have the very best of health care. The financial barriers being put up now will ensure that those decades and decades of good work on that front are about to be undone.

Making preventative health an unaffordable part of Australia's health care is just nuts. It is just crazy, silly, short-sighted and, indeed, wasteful. It is a really wasteful spend. When you make cuts to preventative health then you are, in fact, wasting valuable dollars.

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

In 2010 when I was a candidate, Queensland X-Ray wanted to put a PET/CT into a private setting away from the hospital grounds. The reason was that PET/CT is high-end imagery and is radioactive, but it is essentially outpatient work. In Townsville the hospital is at Douglas and parking is difficult—although people in big cities do not understand this—so they were going to put it at one of the Mater facilities in Bayswater Road right in the heart of town. So, whilst your loved one was having a PET/CT scan, you could do the shopping at Castletown or in Woolworths at Hermit Park and you could get on with your life.

The state government and the Labor Party objected to it and said that if we were going to get one—which we did not need—it should go in at the hospital. The problem around this was that Queensland X-Ray was prepared to put it in with a federal government input of only $2 million. To put it in at the hospital would have cost $9 million. So, when it comes down to health, when it comes down to the system of health, what happened was that Queensland X-Ray went ahead with it, then Queensland Health put in another one at the hospital. Firstly, Queensland Health were saying that we did not need one, so we got one through private enterprise, then Queensland Health, using the taxpayer dollar, put another one in our hospital. This is the problem with health. This is the problem with overspending in this area. When it comes to health, no matter what the system is, no matter where you go in this system, after a time can you look at the system and ask: can it be improved, can it run faster, can it run differently, can it run more efficiently? As the member for Bowman has already said, if we can find efficiencies in one area of health, we put it back into others.

When it comes to computerisation and technology, the speed with which we can do things is absolutely amazing. Since the microchip was invented there are only two areas where you will find that more people are employed as a result of the microchip. One is in computer shops and the other is in the public service. The public service has actually increased in size from the 1970s to now, even with the multitude of digitalisation and ICT that goes into these things. It is not because they are perceived as lazy or anything like that. There are reasons for the increased employment in both areas.

People's lives change and work is increased with every Labor government. Dealing with any government department today requires patience as public servants battle to handle the myriad of requests which complicate lives. Every member here understands what is going on when they deal with complaints about the public service, or complaints about Medicare or Centrelink or any government department. You have to have the patience of Job to stay on the phone. But that is not the fault of the public servants. That is the fault of inadequacies in the system that lets qualified and hardworking public servants stay in menial jobs when we should be simplifying methods where we can and shifting those highly trained public servants into areas where they can assist the clients, our constituents, the people in our cities. If we are to streamline more of the easy stuff and save money with innovation and digitalisation, we can provide better services all over.

We have a budget in deficit. We have an opposition fixated on saying no to everything that we bring into this House to save money. We have the member for Ballarat coming in here and decrying the issue of dental care. This is the same Labor Party that cut the Chronic Disease Dental Scheme. This is the same Labor Party that said, 'If you've got a mouthful of fillings and you've qualified for this you have until December 31 to get this through, otherwise you will have to wait 12 months before you can get anything under the new system.' This is the same Labor Party that moved those people. Essentially what they do is give you a wash, a scrape, a floss and a polish and then they send you off.

This MPI is a joke and it should be seen as that. We will get on with the business of government.

Craig Kelly (Hughes, Liberal Party) Share this | Link to this | Hansard source

There being no further speakers, the time for the discussion has concluded.