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 Prime Minister’s failure to abandon his 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

We had the Prime Minister, immediately after the election campaign, claiming that he had learned his lesson in the election when it came to health and Medicare. He said he would do more to reassure voters about his commitment to health. But in the two months since the election absolutely nothing has changed. As the Prime Minister confirmed in question time yesterday, he has not reversed a single one of the cuts to Medicare or to health care generally. Either the Prime Minister lacks the authority to lead his government or he has not learned his lesson at all, because a Prime Minister who had learned his lesson when it comes to Medicare would not be continuing with the six-year freeze on Medicare rebates. A Prime Minister who had learned his lesson on Medicare would not be continuing with the cuts to Medicare bulk-billing incentives for pathology and diagnostic imaging. A Prime Minister who had learned his lesson on Medicare would not be continuing with the cuts to the Medicare safety net. A Prime Minister who had learned his lesson on Medicare would not be seeking to increase the cost of prescription medicines. And a Prime Minister who had learned his lesson on hospitals would be funding them properly.

The fact is that this Prime Minister's claim that he has learned his lesson on Medicare is as believable as the claim of the former Prime Minister, the member or Warringah, at the last election that there would be no cuts to health and no GP tax. The Australian people know that when it comes to Medicare you cannot trust the Liberals. Just as with the former Prime Minister, the decisions that this government have made to gut healthcare spending, to force people to pay more for health care, to abandon sensible healthcare reforms and to privatise the Medicare payment system will be a millstone around their necks for however long their tenuous grip on government remains.

The government's Medicare freeze, in particular, has entered its second year, and it is clear to everyone that it is bad policy that will force Australians to pay more every single time they see the doctor. That is clear even to the health minister, who was put into witness protection during the election campaign after she said that she does not really like the freeze and that she 'would like to lift the Medicare rebate freeze but Treasury and Finance won't let me'. There is a gaffe if you want to talk about one.

New data this week shows that more than one in four Australians already has to pay to see a doctor and when Australians do pay to see a GP then on average that visit costs around $35; that is the gap payment. We know that those costs are a significant barrier to care for many Australians. Nationally, one in 20 Australians already skips seeing a GP because of cost. Unfortunately, those figures are much higher in some areas. In Tasmania, south-eastern New South Wales, Murrumbidgee and here in the ACT, one in 14 people delays or avoids seeing the GP due to cost. In country Western Australia it is one in 12, and in the Murray Primary Health Network in northern Victoria one in 11 people delays or avoids seeing a GP due to cost. As the Australian Medical Association and the college of GPs have said repeatedly, that figure will get worse if the Prime Minister's freeze on Medicare rebates stretches into what the rural doctors have called an 'ice age'. We are already seeing evidence of that in general practices around Australia. In my own electorate, the Springs Medical Centre has advised its patients that:

Over the past two years … government support for General Practice has significantly reduced.

Unfortunately it is no longer sustainable … to maintain fees at the current levels. To do so would seriously impact on our service quality …

As a result, that practice will now charge even concession cardholders up to $30 every second consultation.

Up in Queensland, in my colleague Cathy O'Toole's electorate of Herbert, the Latitude 19 Health on Magnetic Island has been forced to make a similar decision. They advise:

Due to Medicare restrictions and cuts, we have had to make a difficult decision to become a mixed-billing practice and we are unable to bulk-bill everyone.

Down in Tasmania, in the electorate of Denison, the Grosvenor Street and Collins Street general practices posted a note:

Due to the Medicare rebate freeze we will be changing to private billing for all patients.

On the morning before the election, the Prime Minister claimed that no-one would pay more to see a doctor as a result of the Medicare freeze. If you want to talk about a lie during the election campaign, well there is a big one for you. In practices in Ballarat, Herbert, Denison and around the country, patients who were previously bulk-billed, including concession cardholders, are now being charged—and that is in the second year of the Prime Minister's Medicare freeze; imagine the impact after six years! Unfortunately, it is the most vulnerable in our community who are hardest hit. With growing health inequality in this country, the question has to be asked: why does this government want to make it worse?

Of course, this is not the only cut to Medicare that this government has imposed. The Prime Minister confirmed during the election campaign that it is still his intention to increase the cost of prescription medicines for everyone, including concession cardholders. We already know, from data and from pharmacists across the country, that compliance is a major issue when it comes to medicines and that cost plays a very significant role in that.

We also have cuts to pathology and diagnostic imaging. On 1 October the government is set to cut all Medicare bulk-billing incentives for pathology. The regulations to do this, according to the government's own timetable, are due to be tabled this month. The result of the Prime Minister's decision will be that some of the sickest people in the country—the Australians with chronic conditions; the Australians who need blood and other pathology tests—will be forced to pay more for them. This, alongside the decision by the government to reduce bulk-billing incentives for diagnostic imaging as of 1 January next year, will mean that patients being treated for cancer and other serious health conditions will pay hundreds, and in some cases thousands, of dollars up-front for diagnosis and ongoing treatment. These are this government's decisions on health!

And then, of course, there are public hospitals. Despite the government's eleventh hour deal to get them through the election, the reality for our public hospitals is that they are in trouble. They are barely keeping up with demand, and the pressure this is placing on our dedicated nurses, doctors, other health professionals and all of those who work in supporting them is taking its toll. Basically, instead of increasing public hospital funding, the government has locked in the status quo until 2020.

The government's continued public hospital cuts mean that hospitals are being funded at a level that is simply not sustainable, and its abandonment of funding and targets for emergency department waiting times and elective surgery is having an impact. With the government's Medicare freeze and cuts to pathology and diagnostic imaging, the pressure placed on public hospital emergency departments is only set to grow—and if the Prime Minister thinks that the states and territories will quietly sit and wait until 2020 for this to get resolved then he is a fool.

We also have the government's decision to continue to count the cut to the Medicare safety net in its budget figures. We know from the Senate report on this legislation that there are many concerns about the way in which the government is intending to go about it—and it is a cut to the safety net. The College of General Practitioners said that they had:

… significant concerns that the proposed changes will leave all patients with greater out-of-pocket costs.

The Private Mental Health Consumer Carer Network said that they had significant concerns about the measures, in particular the serious associated risks to the lives of those sex abuse victims—something they raised through the course of the Senate inquiry—noting that the measures would 'severely interfere with their real chance of recovery'. The Royal Australian and New Zealand College of Psychiatrists also said it was:

… very concerned about the impact that the proposed new Medicare Safety Net will have on vulnerable people with mental illness who require long-term intensive psychotherapy.

But the government is far from learning the lesson of the election. As the AMA president said earlier this month, we are seeing exactly the same health policies from before the election, and many of them—all of them, I would say—are bad health policies. All of the cuts to Medicare remain. Far from learning the lesson on Medicare, the government is showing it has no idea when it comes to Medicare.

And what is this government backbench doing? What are those brave souls on the backbench, who have discovered that in toppling a former Prime Minister they actually have some power, doing? What is activating them at the moment? Are they going to the Prime Minister saying, 'We are really worried about what is happening to health care in this country and the cuts that are impacting on our constituents'? No. They are bogged down in squabbles about superannuation for wealthy Australians, watering down race discrimination laws and trying to scuttle same-sex marriage. Well, if the government backbench will not stand up for Medicare, this side of the parliament definitely will—every single day.

The test of this Prime Minister on health is absolutely clear: if you have truly learnt your lessons of the election, you will unfreeze the Medicare Benefits Schedule, drop the decision to increase the price of prescription medicines, get rid of the cuts to pathology and diagnostic imaging, properly fund our public hospitals and drop your plans to slash the Medicare safety net—and, while you are at it, stop pretending that you were not planning to privatise the Medicare payments system and tell us what you are going to do to improve delivery. (Time expired)

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

I wish the member for Ballarat well in getting up the question time order so that she can put questions to me and the team during question time. I see that she has been the reserve question two days in a row, and I know that is that a tough position to be in.

There are a lot of mistruths—and I do not like to say the word 'lie'; it gets thrown about too much in this place. But I want to take those listening to today's broadcast directly to Leigh Sales, 7.30 and the Leader of the Opposition. Leigh Sales asked the Leader of the Opposition, 'Can you put your hand on your heart and look Australians in the eye and say that the coalition has a policy to privatise Medicare,' and he would not and he did not. I refer everyone to the broadcast.

After the Leader of the Opposition had refused to answer that question, Labor went into bat with its union mates—not on the building sites around Australia; we are dealing with that through the ABCC—robocalling elderly Australians late at night and then sending fake texts from fake accounts based on a fake proposition about something that was never going to happen and will never happen. This was even after the Prime Minister stepped out and made very clear that every element of Medicare that is being delivered within government by government will continue to be and that there is nothing in our approach that has ever been inconsistent with that. In spite of that, the scare campaign went on.

It is disappointing, because it is actually not about what patients and families and people who voted recently want to hear about. What they want to hear about is our plans for the health system. What they should consider is Labor's record versus ours.

Ms Catherine King interjecting—

Now the member for Ballarat keeps talking about cuts, and I say this: no government has invested more into Medicare than the Turnbull government. No government has overseen a higher bulk-billing rate than the Turnbull government. The Turnbull government is currently investing about $23 billion a year into Medicare. That will increase by $4 billion over the next four years. There were 17 million more bulk-billed Medicare services last year under the Turnbull government than during Labor's last full year in office—17 million more bulk-billed services.

There are things that we say in this place, but the thing that I will not allow to go past on this occasion is the suggestion that we are going to put up the price of prescription medicines and make it harder for Australians to access medicines. The shadow minister and the Leader of the Opposition were in parliament when a previous Labor health minister refused to sign drugs for mental health, asthma and other conditions onto the PBS, because what you cannot pay for you cannot deliver. That Labor health minister was caught out, because, as we know, Labor cannot manage money. They can talk the big talk, but they cannot manage the dollars. On this occasion a Labor health minister decided that they were not going to list medicines.

We have spent $4.5 billion on listing medicines in the last three years. We have listed three times as many medicines as Labor did in government.

Ms Catherine King interjecting—

Deputy Speaker, I sat quietly and listened to the member for Ballarat—

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Ballarat will listen.

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

I do not mind if she ignores me, but I do mind if she interrupts me. We have spent $4.5 billion in new listings. Every time you meet a patient in the pharmacies or the general practices around Australia you hear about how the listing of new medicines has made a difference to their lives, like the most recent one, something called Bydureon for type 2 diabetes, which is a once-weekly injection instead of a confusing regime of shots.

We know that the first place in the world to list Keytruda for melanoma was Australia. We know that we could because we know how to manage the dollars responsibly and invested a billion dollars, so we are the only jurisdiction in the world that offers cures for hepatitis C to every single Australian without fear or favour, everywhere in every circumstance. Now the reason why we need a sustainable Medicare, the reason why budget repair matters for Medicare and the reason why you can always trust a coalition government when it comes to managing the dollars responsibly and managing the health system responsibly is demonstrated by these things—by the fact that we can to that. But at the same time, the figures that I have just given you about bulk-billing underscore the fact GP bulk-billing is higher—at 85.1 per cent—than it has ever been in our history, because we know that we are continuing this investment.

Ms Catherine King interjecting—

The member for Ballarat continuous to interrupt. As I said, I do not mind if she ignores me, but I do mind if she interrupts. They ran around in circles like Chicken Little during the campaign saying, 'It's happening already. It's happening already. Doctors are stopping bulk-billing.' Well, the figures belie that. And we know that with these strong and sustainable bulk-billing rates, we will continue to see that. However, it is not just about that. Our reforms to health are about more than that: they started long before the election, they are continuing and they will land in a place that ultimately is very, very good for Australian patients. Our healthcare homes, a new model of remunerating doctors for general practice—

Ms Catherine King interjecting—

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Ballarat will listen in silence.

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

Our healthcare homes are something that was actually advised to Labor in 2009 but they ignored. So they could have done this but they did not. Doctors are coming to the table with a plan, with implementation and with ideas, and we are having a really positive discussion. Remember that the reforms that we are going to make in the delivery of health will be done in partnership with clinicians. That has been my determination every step of the way. It is not just about the bureaucracy. It is not just about things being done at a level that only looks at one side of the discussion. It is about recognising what is good clinical practice. It is about recognising that good clinical practice engages the patient, as our healthcare homes model will. It will engage the patient in their own care.

Consider our reforms to mental health—almost $100 million more was added during the campaign for something that is a huge priority of the Prime Minister, that matters to every Australian, that sees a stepped care model available depending on where you are on the steps of treatment, that will see patients no longer discharged into a vacuum, that will join up the acute hospital setting with the primary care setting and that will wrap that care around the patient in a way that our mental health practitioners and the community sector tell us has not happened till now and is broadly welcomed, particularly in regional Australia.

I want to come back to Labor's record because we have not seen a Labor government for a while. We want to know what Labor did. So this is what they did. When they were in government they cut over $6 billion from Medicare and medicines. I have just talked about the $4 billion that we are adding over the next four years. They cut $6 billion. They were actually the first ones to introduce a pause on Medicare indexation. You know how they did it. They attacked doctors' wages. A previous health care minister—I am not going to name her; she is still in parliament—actually said, 'Doctors make enough money. They can suck it up.' That is what a previous Labor health minister said. This coalition health minister says to doctors, 'We want to work in partnership with you. We know it's tough. We are dealing with Labor's debt. We are dealing with a fiscal situation and we want to work in partnership.' A previous Labor health minister—and I wonder if this shadow minister says the same thing behind closed doors—said, 'Doctors earn enough. They can suck it up. Let's not worry about that.'

So that is what Labor did. We are talking about diagnostic imaging and pathology. Labor cut $1.4 billion from diagnostic imaging and pathology. Labor took out a billion dollars a year from Medicare for dental services and they put it in a means-tested scheme where it only helped a third of the kids. The member for Sydney has gone very quiet on that because she has actually recognised that what we have done is introduce the first sustainable public dental scheme that will make a difference at every level.

Labor cut billions from the private health insurance rebate. That previous minister for health said, 'You know where I went to for my savings? I went to private health.' At one stage the private health insurance premium went up 30 per cent almost overnight and that Labor minister for health was proud of it. Talk about attacking patients. Talk about attacking families. Talk about not recognising how to build a sustainable system. There is plenty more. Labor broke a $57 billion promise on hospitals. They talked about it and talked about it, the member for Ballarat tried to get questions up everywhere she went and then all of a sudden during the campaign the Leader of the Opposition just stopped talking about it. The shadow minister stopped talking about it. Suddenly it evaporated. It was their promise and they broke it.

We have a Medical Research Future Fund that will build to a billion dollars disbursements a year. That is a fantastic addition to actually find the cures for the future. What did Labor do in government? They tried to take out $400 million but then everyone caught them out, so they sneakily put it back. They waged war on future cures to diseases when they did that. They took money out of medical research. Shame, Labor, shame. They cut $1.6 billion from aged care funding without fixing the problem. They talked the big talk on mental health, but they actually wrote a road map to nowhere. We are working on the problems of everyday Australians. (Time expired)

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

I think the minister has just confirmed to everybody who is listening that they have indeed done nothing since the election. Nothing has changed since the election. Nothing has changed since Malcolm Turnbull, the Prime Minister, said that he had learnt his lesson. Only days after the election, he actually said, 'We have to do more to reaffirm the faith of the Australian people and our commitment to health and Medicare.' That is what the Prime Minister said just days after the election.

What have we seen since? We have not seen anything since the election from the government because the Australian people know that this government cannot be trusted when it comes to health policy in this country. They know they cannot be trusted to look after Medicare and to keep Medicare in public hands. They know this government cannot be trusted. They know it because everything this government has done before and since the election shows that this government is not committed to better health outcomes for Australians and they are not committed to keeping Medicare in public hands. Two months on we are still waiting for the Prime Minister to convince Australians that he is serious about what he said prior to the election and just after the election.

We all remember the election campaign, where they were so worried about Medicare and the fact that people understood what their plans for Medicare were that he had to get out the corflutes—and they were very reminiscent, actually, of the Gonski corflutes, and they will probably go the same way: they cannot be believed, just like the Gonski ones. Remember when he signed this corflute about Medicare just before the election. And what have we seen since the election?

This government has done nothing at all to restore Australians' faith in the Medicare system whatsoever—nothing. It has not taken off the rebate freeze on GP visits. We still have GPs in this country going round and talking to patients, putting up signs in their surgeries, saying that people will have to pay to go to the GP because of this Medicare freeze. This freeze is scheduled to be there for a long time, and this bulk-billing situation is going to get worse over that period if this government continues to do nothing. We have people on low incomes, people on concession cards and healthcare card holders who will be in a position where they are going to have to make a tough decision about whether or not they can afford to go to the doctor. Not only are they going to have to make a decision about whether they can afford to go to the doctor but, because of this government's plans, they are going to have to make a decision about whether they can go to the chemist afterwards and pick up their prescription. That is what you are doing to the Australian people—to low-income Australians and Australians on healthcare cards.

Mr Laming interjecting—

You seem to think it is funny. You seem to think that this is not real. It is real, and it is happening out there. We have already heard that one in 20 Australians do not go to a GP now because of the cost. Already we can hear this. Already it is happening, and you actually have done nothing about this. You are making it worse, and you do not intend to resolve this issue, clearly.

It is not only the freeze and the cost of prescriptions but also diagnostics and blood tests. People with chronic illnesses on a low income are going to have to pay up-front to get their blood test at their local clinic. They are going to have to pay up-front to find out whether or not they are getting better and to get their test results.

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

They'd never let you in a hospital. You wouldn't know how it works.

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

Clearly they do not know how it works over there. Clearly they do not understand how people on low incomes are forced to make these decisions. Clearly they do not understand what it is like to live on a low income and be in this position, because it is real, and you are making jokes about what is actually happening to people in Australia.

What you need to realise is that it is actually cheaper for you to fix them earlier. It will actually be better for you to treat people sooner and to give them the medication they need. But not only are you doing all this; you are still cutting money out of hospitals. In my home state of Tasmania, we have the bowel kit and bowel cancer test. Last week we had a GP on the radio saying category 1 patients are taking up to 12 months to get the tests they need if they have had a bowel cancer test come back saying they need further investigation. This is category 1. These are people that need to be seen within 30 days, and they are taking a year. Do you understand what you are doing to people? Clearly you do not, and clearly you do not care.

This government and this Prime Minister are not serious when it comes to improving health outcomes for Australians. They clearly do not understand the impact of their decisions. They would rather give a $50 billion tax cut to companies in Australia, including $7 billion to the big banks, than look after ordinary Australians. (Time expired)

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

Before I call the shadow minister, this is a free-ranging debate but the general rules do apply and, if we have a free-for-all across this chamber, I will be evicting people.

David Gillespie (Lyne, National Party, Assistant Minister for Rural Health) Share this | Link to this | Hansard source

One thing that people get really cynical and angry about is when their leaders mislead them. And what have we seen in this last election campaign? The very misleading Mediscare tactics of sending texts out days before the election, telling people that the coalition government is going to privatise Medicare. Nothing is further from the truth—take a snippet of information about IT support and turn it into a massive great scare campaign.

Another failed scare campaign is the so-called $57 billion cuts out of hospital funding. In the campaign—and before that in the last COAG deal—the opposition had to withdraw that. In the last COAG agreement, there was another $2.9 billion for hospitals. So in fact, with regard to the member for Franklin's quite emotional speech there about the situation in Tasmania, since 2013-14 there has been a 29½ per cent increase in hospital spending.

I know why they have brought this out. Whenever things are going badly there, they wheel out the regular emotional argument. I know they have problems in the Senate, with senators that have caught the attention of the Australian public. Whether they are doing it for that reason alone or because they are bereft of other positive ideas, this whole MPI is suggesting that there are cuts. The total spending on health in the last term of the previous Labor government—I can tell you; I looked it up—was $61.9 billion in the 2012-13 budget. Then in 2013-14 it was $64½ billion, and the next year $67 billion, and the next year $69.1 billion, and in the last budget the total health spend was $71.4 billion. In the Medicare spending there have been 17 million more bulk-billing episodes—$23 billion per year, and $4 billion over the next four years. When you are going to discuss cuts, you actually have to have the figures to back it up, not an emotional argument. It is the old chestnut of the ALP's argument: they have an emotional argument rather than a factual one, and people get very cynical when you actually point out the facts and figures.

Here are a few other facts. I have mentioned hospital spending, but on pharmaceutical benefits, in the last term of the coalition government and just after, there has been another $4½ billion worth of drugs put onto the Pharmaceutical Benefits Scheme, whether it is drugs for ovarian cancer, the diabetes drugs that were just announced, hepatitis C drugs, or melanoma and other cancer drugs. That is $4½ billion. In primary care and mental health, there is an extra $1½ billion. So the facts and figures just do not add up.

We have a lot of rural health initiatives. We have a commitment to developing and delivering an integrated rural training program and appointing a rural health commissioner. Courtesy of your advocacy, Mr Deputy Speaker, we have a cancer centre being delivered in Dubbo. Instead of hundreds or thousands of people travelling hundreds of kilometres, they will be getting first-class cancer care in Dubbo. I congratulate you on your efforts there, Mr Deputy Speaker. We have committed $11 million extra to the Royal Flying Doctor Service. All of this is focused on delivering rural, regional and remote care.

As I mentioned, we have a good track record on the Pharmaceutical Benefits Scheme. In aged care we have got extra funding. Most recently we have announced Health Care Homes, an initiative for people with chronic diseases. It will mean that care for people with complex, multifaceted illnesses will be focused in one place rather than being disparate and disjointed. It is an initiative that was actually proposed during the period of the previous Labor government, but they did not even follow their own advice. It is a great initiative and great that it is actually coming to fruition. (Time expired)

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

It was only four days ago that I received an email from a local doctor in my area which said:

It appears that they—

'they' being the Turnbull government—

haven't learned anything from their narrow victory.

He was talking about the cuts to Medicare and to health generally. That was his summation only four days ago. It was Labor that built Medicare, and it will always be Labor that will fight to protect it. It is because of Labor and because of Medicare that we have one of the best health systems in the world. Despite the Prime Minister's hysteric denials that this government and this Prime Minister are intent on dismantling Medicare, Australia's universal healthcare system, we know that they are simply following in the tracks of every other coalition government before them.

If you want to know what this government is doing, Mr Deputy Speaker, just look at the facts. This is the government that cut $50 billion of funding to hospitals. It made three attempts to increase a GP co-payment: first it was $7, then it was $5, then it was $20. When it could not do that, it froze the GP Medicare payments for six years, knowing that doctors would have no alternative but to charge a GP co-payment, possibly up to $20. This is the government that wants to cut $650 million from pathology and diagnostic imaging incentive bulk-billing payments. This is the government that wants to cut around $1 billion from the Child Dental Benefit Scheme. It is the government that wants to increase pharmaceutical costs by some $5 on top of the $37 that many people already pay.

Members opposite—including the Minister for Health and Aged Care only today—cry foul over Labor's Medicare campaign. The facts speak for themselves and they are very clear: when the government cuts public funding of government services and transfers that responsibility to the free market, that is privatisation, clear and simple, and that is exactly what this government is doing.

Of course, we also know that this is the government that set up a Medicare privatisation taskforce. You do not do that unless you have intentions of privatising services currently being delivered by Medicare. It is a government that also paid $5 million to PricewaterhouseCoopers and tasked the Productivity Commission to advise the government on how to privatise essential services, including Medicare. So when members opposite cry foul, perhaps they should turn around to their own government and their own ministers and ask them: what are you really doing and why won't you come clean about what your intentions are here?

The reality is—and the research from the Australian Institute of Health and Welfare shows—that people in rural and remote communities generally experience poorer health, higher rates of most chronic diseases and shorter lives than people from metropolitan areas. That is because they are generally more disadvantaged, have poorer access to health services and have to travel greater distances to access those services. The incidence of chronic disease, cancer, injuries, mental health issues, dental health issues and obesity are all much higher in regional and remote parts of Australia than they are in metropolitan areas. Yet, under this government, what we have seen from the latest statistics is that the GP numbers in those areas are actually declining—that is, we have fewer GPs per 100,000 people in rural and remote areas than we had previously. The government's health policy is simply not working, and it is particularly failing people in regional and remote Australia.

Members opposite might try to deny the reality, but again I go back to the local GP services in my area, who claim that they had to cut the after-hours services to people in the local area because of the cuts to the practice incentive payments that they were receiving. I note that the cost of after-hours GP locum services has gone up from $90 million five years ago to $195 million in the last year. Those are costs that are blowing out because of the misguided policies of this government, who would do far better, as previous speakers on this side have already pointed out, by spending the money wisely and properly. It will actually save them money in the long term.

The last comment I want to make is about the Health Care Homes trials. Again, this is a program we would generally support, but it is not going to work if you do not give the doctors more funds, and instead do the opposite and freeze their Medicare payments.

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

I think people in the gallery must be getting quite used to health debates where both sides of politics just complain about cuts by the other side. It is simply unsatisfying, I think, for people listening to this debate. More tragically, Australia really is one of the few nations where we have this deep partisan political divide over health care. We are almost unable to talk about significant improvements in the quality of health care because there is an abject fixation on the quantity of funding. I think that may seem, quite superficially, a reasonable place to start—how much money we are spending on health—but ultimately, when you are talking about the user experience in health, it is about the quality of the money spent and whether it is directed appropriately. It would be very helpful if we could rely on both sides of this chamber, at some point in this three-year term, to engage meaningfully in that debate. I could spend my next four minutes talking about how they cut money and how they froze stuff. Of course, there is a litany of these descriptions that can be attributed to both sides of politics, but that is not going to help us get anywhere.

Ultimately, we need to turn to the smartest minds in health policy and say to them, 'What will take us forward?' As a former GP, with respect, I would certainly appreciate it if my payments were indexed every year; I would be very happy for that to occur. But some greater good needs to be considered, and that is the sustainability of the system that provides those services.

Now, both sides are guilty of this, so before we get into simply regurgitating the ministerial talking points let's just remember that ultimately the fee-for-service approach is increasingly becoming difficult to sustain high-quality care with. If it is simply focusing on how many item 3s, 23s, 36s and 44s you can bill in eight hours in a cowboy practice in an inner city where you are seeing 80 patients a day then, honestly, time is a very significant proxy—an inverse proxy—of quality of care. I want to see the GPs who are doing the serious work with chronic disease, seeing 20 or 30 patients a day, acknowledged and rewarded. But you cannot if you simply let Medicare rip with overservicing in areas where it is all about the speed. Unless you have an honest conversation about that—me and you—an honest conversation about rewarding quality, then we will simply have these debates forever and a day.

It was Francis Peabody back in 1920 addressing the Harvard Medical School who said that the key to caring for patients is quite simply the care of the patient. So how do we penetrate and say what the best possible user experience is? I would have to say that even you over there across the political partisan divide have to confess that we need to look at the new models that are going to deliver quality—the healthcare outcomes start there. There are 360,000 nurses enrolled, 200 practices across seven PHNs and we are just going to say, 'Enough of the alphabet soup of health authorities!' We do not measure ourselves simply on how much money we spend—how many pot plants we can put into multi-high-rise buildings full of non-service-providing bureaucrats providing data we never use! That is not improving health, although it is spending more money. It is not just about the quantum. It is about the effectiveness of the spend.

With respect, it was Kevin Rudd, with so much promise, who talked about running the show nationally but controlling it locally. But in the end it was funded by debt and completely out of control. He came to the states and said, 'Look, we'll swap the 40-60 federal-state funding split to 60-40, but we are going to do a smash and grab,'—or should I say, 'A grab-and-smash tactic'—GST and take 30 per cent of your GST to do that change,' meaning the Feds put just one disappointing per cent more into the hospital mix. They smelled that a mile away and that is why at the end Catholic Health Australia and the COAG reform council said, 'Look, you made barely two per cent difference in the rate of people being seen in A&E in a reasonable period of time but you let the OR rates blow-out.' The chance of seeing a GP blew out. Stephen Duckett, your age-old ally said it himself. He said it was an alphabet soup of new authorities, tonnes of data and no changes in access to community care—no changes. In fact, a blowout in residential aged care.

Just be honest with yourselves: you were no better at running the show. But we can together work to make sure money is spent better. That has to be the objective here. Sure, we do not control many levers here in the federal government but we need to work with states to do it better. Stop funding corporate health and start devolving responsibility; let the regions of our great states have more say in how they employ, how they fund and how they deliver health services. Call it a Medicare Local, call it a PHN—the future is giving support to general practitioners and private direct primary healthcare providers to do their job better. It is not about buying more three-by-three tents. It is not about standing outside fairs and saying, 'Please, grab an apple or come for a walk.' Ultimately it is about taking the sickest, most stratified, high-need patients and giving them the care they need—the wraparound care they need. Together, I secretly believe both sides of this chamber can achieve that noble goal.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

It is interesting to hear the speaker opposite talking about overservicing. Try talking about overservicing to the single mum who works part-time, relies on her penalty rates—which is a debate for another day and which they want to cut—and who has three kids. One gets the flu, it goes around in the family and she has to visit the doctor three to four times in the next fortnight, paying the co-payment. Try telling her that is overservicing.

Or try telling the pensioner in my electorate who suffers from chronic diabetes and a heart condition and who has to visit a doctor weekly that he has to be asked to pay a co-payment. Try telling him that he is being overserviced. These are the conversations that I had in the lead-up to the last federal election in the seat of Hindmarsh. There is no doubt that this 2016 election was fought on the issue of protecting our exceptional Medicare system. We built this system back in the Whitlam days. It was taken away by the then Fraser government and then we reinvested in Medicare and created a good universal health system for all Australians.

Twenty per cent of my electorate is over the age of 65, therefore this was a crucial issue and a crucial discussion that we had at the last election with my constituents. There was a loud message from them, and I said this last night in this place. The message from those people was, 'Do not tinker with Medicare.'

Now, I know the Turnbull government's incredibly poor election result; you see the new members that are here, and my seat as well. But this furphy about some lies about Medicare—let's look at the facts. Let's look at the history and go back from 2013 when Mr Abbott was the Prime Minister, and their first budget. There was an attempt to bring in a co-payment through legislation through this House. What happened was that it was rejected in the Senate. It was rejected and it was rejected. It was rejected three times. Do those opposite think the Australian public are stupid? That they do not remember these things and they do not know these things? Therefore, the seeds were planted in the Australian public's mind that there was something wrong with this government's position on Medicare.

Not only that, because they could not get it through, thanks to Labor's opposition, they then tried to bring it in through the back door by having a freeze on doctors' payments. We know if you put the freeze on doctors' payments that in some of the clinics in my electorate—in some of the inner western suburb clinics and the one that I visit on a regular basis and which my family has for many years—you go in there, they start at eight o'clock in the morning and they are there till eight o'clock at night.

I talk to my doctor sometimes and I say, 'You need a break.' He says, 'I can't have a break. Who's going to look after these people?' It is a lower socioeconomic area—a lot of migrants with English as a second language, lots of young mums and unemployed people. These people need health services, and if they also have an ailment or a chronic health issue it is even more important that we look after these people and ensure that they can visit a doctor. If they do not visit a doctor, their illness—their diabetes or blood pressure—will get worse. And a couple of nights in hospital will cost the government and the budget bottom line far more than what you are trying to save through this freeze on their payments.

Health is a fundamental right for a nation like ours—in fact, all nations—and it should be one of the goals that we all set. We should have a universal health system. When people need to see a doctor, the services should be there for them and they should not have to think of their hip pocket.

We can talk about these furphies—text messages et cetera—but the Australian public did not need a text message to know what the government was up to. The seeds of doubt were planted in 2013—and more seeds were planted and flourished at this election because the Australian public knew they could not trust the Turnbull government on Medicare and health.

Cutting Medicare bulk-billing incentives for vital blood tests and imaging scans is another issue. In the 2015-16 Mid-Year Economic and Financial Outlook the Prime Minister cut $650 million from Medicare for vital tests and scans. This was in spite of the overwhelming evidence that the former Labor government's incentives were achieving their aim of maintaining an increase to bulk billing— (Time expired)

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

Scare campaigns are some of the most dangerous thing in our political discourse, and Labor's fabrications about Medicare were some of the most potent in the recent campaign. I had many people come up and talk to me in May and June, armed with the falsehood they had seen in Labor's leaflets, to berate me for what they believed the Liberals would do to Medicare. Some people had been woken in fright on this issue—although, to be fair, that was because Labor was robo-calling pensioners late into the night. Shameful behaviour! I was very happy to talk to everyone who raised concerns over Medicare because, once I had explained the truth of the matters, most people readily saw the gaping holes in Labor's arguments.

The facts are as follows. The Turnbull government is committed to ensuring that all Australians have access to affordable, universal health care by building a healthier Medicare. The Turnbull government is currently investing about $23 billion per year into Medicare. This will increase by $4 billion over the next four years. There were 17 million more bulk-billed Medicare services last year under the Turnbull government than in Labor's last full year in office. No government has invested more into Medicare than the Turnbull government. No government has overseen a higher bulk-billing rate than the Turnbull government. We are undertaking budget repair to protect Medicare. There are no plans to privatise Medicare, and its payment systems will be delivered in house.

Every element of the health budget has grown since the Liberals came into power. Let's look at the figures and compare them to the 2013-14 year: health, $71.4 billion, an 11.6 per cent increase; Medicare, $22.7 billion, a 13.6 per cent increase; hospitals, $17.9 billion, a 24.9 per cent increase; Pharmaceutical Benefits Scheme, $10.4 billion, a 9.8 per cent increase; additional primary care investment, including mental health, $1.5 billion, an 11.7 per cent increase; and aged care, excluding Department of Social Services, $17.8 billion, a 25 per cent increase on 2013-14. Overall, the number of Medicare services increased to 384 million in 2015-16, or more than one million per day, at a total cost of $21,107,750,246, an increase of nearly $1 billion on 2014-15. The overall Medicare bulk-billing rate also increased by 78.2 per cent in 2015-16, up from 77.6 per cent the year before.

These are not just the views of the Liberal Party—because we believe in consultation and discussion. We know that they are also supported by independent experts such as the AMA. In June this year the AMA President, Michael Gannon, declared that 'there is absolutely no evidence at all that the Liberal Party has any desire to privatise Medicare'. I have long held an interest in this area. Bennelong is home to all levels of medical supply chain—from small business pharmacies and GPs through to the Australian headquarters of some of the world's largest pharmaceutical companies. So it is one of the areas in which I have been most involved, and I know the fantastic effects of Liberal policies in relation to the PBS.

On this front, we have undertaken important budget savings that have enabled us to list triple the number of medicines on the PBS than Labor did, at a cost of $4.5 billion over the past three years. The total Commonwealth investment in health will grow by over $71 billion in 2015-16. This will increase to $79 billion within four years. The PBS is a critical tool for helping people get access to the world's leading medicines, which they deserve, fuelling medical investment in Bennelong. But, more importantly, each of these new medicines will make a life-changing impact to a person's livelihood and, in many cases, it will save their lives and add to their quality of life.

The Labor scare campaign was so far off the money that it would be laughable had there had not been so much at stake. The Liberal Party is the only true friend of Medicare. I congratulate our Minister for Health for what she does to keep Australia— (Time expired)

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

People listening to this debate could be forgiven for thinking that we are somehow caught in parallel universes here. Members opposite are stuck in the Medicare denial phase, having lost seat after seat after seat in the last election, which was fought very much on this issue around access and equity in health, an issue that members opposite had failed to grasp. The member for Bowman recounted how this was all about people abusing a system—oversupply, overservicing of areas.

We on this side of the House have no trouble in believing the studies that have been done year after year alerting us to the growing inequality in our communities in accessing quality health care. It is no surprise to members on this side of the House. Those opposite might note that we have grown in number quite substantially since we were last here. Each of us were out there campaigning with our community members on what it means to them to have access to quality health care, a universal healthcare system that was designed by Labor. The member for Makin made the point earlier that it was Labor that created Medicare. It is Labor that will always stand up to protect Medicare, because we get what it means to have universal health care. We get what it means to make sure that every single Australian, regardless of their wealth, regardless of their postcode, has access to quality medical advice and assistance when they need it.

It is regrettable that members opposite swallowed the Prime Minister's dummy spit on election night. It suggests that no lessons have been learnt by members opposite. It suggests that you subscribe to the Prime Minister's view that: 'There is nothing to see here. We are not really continuing to slash Medicare.' We knew that happening throughout the election campaign. The Prime Minister has had eight weeks to reflect on some of the lessons he might have learnt from that election period. Yesterday in question time he had an opportunity to come to the dispatch box and point out what cuts he has taken off the table. But what did we get? Absolutely nothing. Actions always speak louder than words in this House.

In my electorate of Newcastle, people are suffering with regard to access to doctors. Indeed, GPs in my electorate are increasingly worried about the impact on the health of our community members. They are worried about their ability to provide the quality medical advice and assistance they have always been able to provide. It is not unusual to hear about this. Constituents are coming to talk to me about the signs that are appearing in GP clinics. I suspect everybody on this side of the House has seen the signs that doctors have put up in GP clinics referring to the Medicare freeze by this government.

And let's not pretend here. I have heard some interjections by those opposite that this was Labor's freeze in the first place. Labor did have a temporary freeze for a period. That came off, and this government put a new one on. Not only did they put a new one on; they extended it. So this is your freeze that you have to own totally. Our doctors have signs in their clinics saying that the GP freeze means they will not be able to bulk-bill as many patients as they currently do. In order to remain open and provide a service, they are having to increase their prices, which means an increase in out-of-pocket expenses for people coming through the door. There are gap charges of anywhere between $20 and $40 to see a doctor in my community. That is a financial obstacle that prevents large numbers of people in my community from accessing medical advice and assistance when needed, as needed, as is their universal right—which you should be supporting. (Time expired)

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

Here we are in the first week back, and what a disappointment the Labor Party in opposition are proving to be. In this matter of public importance debate they are continuing with the same disgraceful 'Mediscare' campaign that we saw at the last election. It should embarrass every single one of them. During an election campaign, it is one thing to stand up and make statements and argue back and forth, or to put things out in brochures, but it is quite another thing to send out text messages, to send out what is in fact a fraudulent document that creates the perception that it is from an official source, from Medicare, and that pushes the lie that the coalition is going to privatise Medicare. Every single member on that side of the chamber should hang their head in shame over that campaign. But what they do? They come in here and wear that deception like a badge of honour. Every single one of them should be disgraced. Whenever they are talking about health policy or Medicare, the first statement they should make is to apologise—apologise for misleading the Australian public. That continues here today with this MPI on so-called cuts to Medicare.

Let us look at the truth and expose what is just another Labor deception and untruth. In 2012-13, the last year of the Labor budget, total health spending was $61.9 billion. If you listened to Labor, you would think that we have cut that spending this year. In fact, in this current financial year health spending is $69.1 billion—over $8 billion more than it was in Labor's last budget. How is that a cut when we are spending $8 billion more? What about over the forward estimates? We will raise spending on health to $79 billion. At the end of this three-year term, spending on health will be $79 billion compared to Labor's last year in government, when it was $61 billion. That is close to a 30 per cent increase. When you spend more money, when you spend billions of dollars more, it is an increase. Yet Labor comes in here pretending that health spending is being cut.

As for Medicare spending, we have seen it go from $21 million in 2014-15 to $23 billion this year. Over the next four years it will go up to $27 billion. Another $4 billion increase is going into Medicare over the forward estimates. Yet we have Labor continuing to perpetuate this untruth that Medicare spending is being cut.

What about the actual number of services? We know, if we compare this year to the last year of the Labor government, that there have been 17 million more swipes of the Medicare card—that is, 17 million more services provided by Medicare. We have bulk-billing rates at historic highs in this nation, yet we hear Labor member after Labor member going on and on about cuts.

The thing is, we would like to put more into health care. I am sure we would all like to put more into health care, but the money has to come from somewhere—

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The time for the discussion has concluded.