Emma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | Link to this | Hansard source

I rise to speak on the National Health Amendment (Safety Net Thresholds) Bill 2019. Labor will support this bill which will reduce the PBS safety net thresholds from 1 January 2020. Labor matched the government's commitment to do so during the election campaign. That's what political parties should do—recognise and adopt good ideas from the other side. We urge the government to do the same with the health policies we took to the recent election.

I first registered as a pharmacist in 1998, so I have a longstanding interest in the Pharmaceutical Benefits Scheme. At that time, the PBS co-payment for a concession patient was $3.20 and it was $20 for general patients. But I'd like to go back a bit further and take a quick step back through the history of medicine access in Australia, because it matters. In 1919, with sick and wounded Australian service men and women returning from the Boer War and World War I, a program was necessary to provide veterans with access to life-saving medicines, and the Repatriation Pharmaceutical Benefits Scheme was established.

In 1944, a High Court challenge struck down the first attempt made by a federal government to legislate for a scheme to expand access to approved prescription medicines, such as antibiotics, free of charge to all Australians. It wasn't until four years later, in 1948, under Labor Prime Minister Chifley, that a limited version of what we now know as the Pharmaceutical Benefits Scheme began, offering free medicines for pensioners, and 139 life-saving and disease-preventing medicines free of charge for the general public. In 1986, the Hawke Labor government introduced a safety net threshold of 25 prescriptions in a calendar year for both concessional and general beneficiaries, which meant, for the chronically ill and other high-volume users of prescription medicines, that no individual or family would have to pay for more than 25 PBS prescription items in any calendar year. Fast-forward to 2019, and medicines are now the most common medical intervention in health care in Australia. In fact, over 80 per cent of Australians aged 65 and over, and 70 per cent of Australians aged 45 to 64, regularly use pharmaceuticals.

While we support this bill, we know that this bill won't fix the crisis in medicines' affordability that we see on this government's watch. The government's own figures show that many Australians don't fill prescriptions because they just can't afford them. According to the Australian Bureau of Statistics, 961,000 people a year delay or avoid taking prescribed medicines due to cost. Alarmingly, the rate of people skipping prescriptions is twice as high in the most disadvantaged areas as in the least disadvantaged areas, meaning that the cost of medicines is contributing to healthcare inequality in Australia and to worse health outcomes for those in more disadvantaged communities.

For many years, I was a specialist mental health pharmacist and chief pharmacist at Wyong hospital in my electorate on the New South Wales Central Coast, and I note that this month we're marking Mental Health Month. The minister can spruik listing PBS drugs, but if people can't afford them then some will delay or avoid filling a prescription—particularly the most vulnerable in our communities, such as those living with major mental health conditions.

I've been there in an outpatient clinic when a patient living with a major mental health condition has said to me, 'Which medication can I do without?' These are real people with major health concerns who need proper support, and they are having to make this decision which no-one should have to make: 'Which one can I skip? Which one can I delay?' People are sometimes taking medications every second day, or they might get one prescription filled this month and an alternative prescription filled next month. And we know what happens when people skip their medications. They get worse, not better. They present at our emergency departments with worse symptoms and need urgent care and often lengthy inpatient stays, particularly patients living with chronic diseases and major mental health conditions.

Last week, I visited the St Vincent de Paul in Wyong in my electorate, where my late father, Grant, was a volunteer. It was, for me, a chance to hear from them of the work that they do to assist many people in our community, particularly people in crisis. This year, to date, they have assisted 108 people with health care, including prescriptions. Whilst I am grateful, and it's commendable that organisations like the St Vincent de Paul Society and other charities and not-for-profit groups provide assistance and sometimes vouchers for medication for people in crisis who can't afford to have their prescriptions filled, this should not happen in a wealthy country like Australia.

And what has this third-term government done about this crisis? It's only made it worse. In the 2014 budget, the government proposed to increase the cost of PBS medicines by up to $5—even for concession patients; even for age pensioners—and to increase the threshold for the PBS Safety Net, which, as I mentioned earlier, was introduced to help people, particularly those living with chronic, complex conditions and families, to be able to afford medicines. This would have forced patients to pay $1.3 billion more for medicines and caused even more Australians to skip essential treatment. It was only Labor's opposition in the parliament that stopped the government from implementing this cruel measure. But Australians shouldn't forget that this Prime Minister and this minister were part of a cabinet that wanted to make medicines more expensive for every Australian, including vulnerable Australians, such as age pensioners, and that measure was on top of the government's appalling record of delaying PBS listings.

Last month, the PBAC made public their recommendations from the July meeting, which took the total number of drugs waiting to be listed by Minister Hunt to more than 60. These are drugs that have been recommended for listing by independent experts, the Pharmaceutical Benefits Advisory Committee, because they stack up on both clinical and costs grounds. This includes medications like Symdeko, which was approved in March by PBAC.

Symdeko is a life-changing cystic fibrosis drug which treats the most common cystic fibrosis mutation, extending life expectancy and improving quality of life. The minister made a promise to those with cystic fibrosis that they would have access to Symdeko on the PBS as soon as it was approved. Thankfully, it appears there is now some movement on this, with the government shamed into reaching out to the manufacturer following a Channel Nine news report. It shouldn't take a news report for the government to do the right thing and to do what the minister said they would do. I would like to quote from a letter from Nettie Burke, CEO of Cystic Fibrosis Australia. This is how she described the delay: 'Seven months of lung damage, seven months of mental stress and strain, seven months of a blame game, seven months of the best hopes and the worst fears exacerbated—years of hope dashed by seven months.' Nobody should be put in that situation.

We shouldn't be surprised, really. The government has form when it comes to delays like this. In a press conference in November last year, Minister Hunt confirmed that Flash technology would be available on the National Diabetes Services Scheme on 1 March 2019, stating:

… as of the first of March 2019 the continuous glucose monitoring program will be expanded both in terms of the range of people but also in terms of the options for devices. The Flash glucose monitoring will now also be included alongside the Continuous Glucose Monitoring.

Seven months later, there is still no word.

This government has made 120,000 people living with diabetes type 1 wait seven months longer than he promised they would. That's a significant amount of time for someone living with type 1 diabetes, because of the long-term consequences that can happen from poorly managed or mismanaged diabetes. The health minister likes to congratulate himself. He often likes to come into the chamber and appear in the media and pat himself on the back with every PBS listing. He is also accountable for every drug that he refuses to list, for those almost 60 drugs that we know that PBAC has recommended and that haven't yet been listed on the Pharmaceutical Benefits Scheme.

Australians who are sick deserve to have a medication which has been approved by the PBAC recommended as soon as possible. The government's recent budget updates show an underspend of $155 million on the PBS. We know there are people living with chronic complex diseases, we know there are people in crisis, and we know there are vulnerable people, particularly First Nations peoples or people living with major mental health problems, who can't access these medications. We know that there are people who are in crisis or who are in urgent situations and can't get the essential health care they need. We know this particularly affects people in regional and remote Australia. We know that people in regional and remote Australia have worse health outcomes than those living in major cities. This is something that the government either hasn't recognised or hasn't properly acted to fix.

The government shouldn't be propping up its budget surplus by underspending on the Pharmaceutical Benefits Scheme. This government does like to pat itself on the back about having a budget surplus, but the reality is that the surplus is built on underspends like this one, and like the $4.6 billion underspend on the National Disability Insurance Scheme. These underspends are arising because of maladministration by this government, preventing Australians—particularly vulnerable Australians, many of whom live in rural and remote Australia—from accessing the essential services that they so desperately need and that a government should provide.

The latest health spending data from the Australian Institute of Health and Welfare show that out-of-pocket costs are the highest they have ever been, with Australians spending a record $30 billion a year for their own out-of-pocket costs for health care. This is an increase of $920 million over the financial year—up three per cent. So while this government spends less on the PBS, Australians are spending more, particularly those who can least afford it. Out-of-pocket costs have never been higher and hospital waiting lists have never been longer than under the Morrison government. They need to stop the delays on PBS listings and start treating Australian patients with respect.

I mentioned at the beginning of my remarks that I first registered as a pharmacist in 1998 and I worked for almost 10 years at my local hospital in Wyong, on the Central Coast of New South Wales, as a specialist mental health pharmacist and as a chief pharmacist. I have seen people in crisis, particularly families and those who are desperate, have to come to an emergency department because they can't get in to a GP or they can't afford the gap payment. All of that compounds. They might be able to get in to see a GP—and often with families it's not just one child who is sick; there will be more than one child sick at the one time—and then they might end up with three prescriptions for antibiotics that they have to fill at the community pharmacy. It is very expensive for families to be able to get the essential health care they need. For this government to be propping up its budget surplus at the expense of Australians, particularly vulnerable Australians—many of whom are living in regional and remote Australia—is not fair. The government needs to act. It needs to properly acknowledge the crisis. It needs to act in the interests of all Australians.

As I mentioned earlier, October is mental health month. Last week we marked headspace day and we also marked 10/10 World Mental Health Day. I want to speak to each of those as a former mental health worker. The government's appointment of Christine Morgan as a special adviser to the Prime Minister on suicide prevention is commendable. The government's commitments in the election to increasing funding, particularly to services for young people through headspace or other programs, is commendable. But what we really need to see is real action and genuine bipartisanship in the area of mental health.

Before I conclude, I would just like to go back to the visit that I had with St Vincent de Paul last week. As grateful as people are for the support of charities and organisations like St Vincent de Paul, it shouldn't be their responsibility to provide support for people to access essential health care. Over 100 people in this calendar year have already needed to access help from the St Vincent de Paul service in Wyong, and those are just people seeking support with health care and pharmaceuticals. I've worked in community pharmacies, particularly in pharmacies that are open out of normal business hours, where people have come in who have had a voucher in order to have a prescription filled. That shouldn't happen. We shouldn't see people having to get vouchers from charities to be able to get the essential medicines that they need. It's not fair and it should not happen in a wealthy country like Australia.

Accordingly, I move:

That all words after 'That' be omitted and the amendment be circulated in my name with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House criticises the Government for:

(1) delaying Pharmaceutical Benefits Scheme listings; and

(2) trying to increase PBS co-payments for all Australians".

John McVeigh (Groom, Liberal Party) Share this | Link to this | Hansard source

Is the motion seconded?

Andrew Leigh (Fenner, Australian Labor Party, Shadow Assistant Minister for Treasury) Share this | Link to this | Hansard source

I second the motion.

Julian Simmonds (Ryan, Liberal National Party) Share this | Link to this | Hansard source

It's a great pleasure to speak in the chamber today on this bill, the National Health Amendment (Safety Net Thresholds) Bill 2019, without amendment, because this is why a strong economy is so important. This is why the government fights so hard to ensure that we have responsible economic management. A strong budget, a surplus or a strong financial framework are not ends in themselves; they deliver real on-the-ground outcomes to residents, to people who need them. And this bill certainly does that. In particular, it helps people and families, in a very important and coherent way, to tackle the cost-of-living pressures that they face. This bill will present significant savings, particularly for those on concession cards and those who have a chronic illness.

I appreciated very much the history lesson from the member for Dobell, but I think it's time that we as a chamber acknowledge that it is truly obvious that this government is the best friend that the PBS has ever had. This government is as committed as any government—or more committed—to make sure that the PBS remains a strong and important pillar of our healthcare system. The PBS may be over 60 years young, but it is currently supported like never before. The member for Dobell's speech, while giving some initial support to the bill in front of us, was concerned about medicine affordability. But this is where I struggle to wrap my head around it. Those opposite say they are concerned about the affordability of medicine, yet it's those opposite who stopped listing drugs on the PBS. That is such an important point to make, and we won't stop making it. The member for Dobell stood there at the dispatch box for her speech and talked about somebody who has waited seven months for a life-saving drug. Well, under Labor they simply would have kept waiting and waiting and waiting, until 'fiscal circumstances allow'. If we know anything about a Labor government it's that, given their management of the economy, fiscal circumstances would never allow them to restart listing drugs on the PBS.

In contrast, this government has listed over 2,000 new and amended drugs on the PBS, because we can afford to do it. I take umbrage at the way that it was characterised by the member for Dobell, and I know that, if the Minister for Health were here, he would do the same and point out that this argument that Labor members make about there being delays—in fact, I think the words the member for Dobell used were that the minister was 'refusing to list' some drugs that PBAC had recommended—is simply not true. We as a government have made a firm commitment to list those drugs on the PBS that have been recommended to us, and we have a track record of doing it. Over 2,000 have been listed. We have the strong economy, the strong budget and the strong record of economic management to show that we can do it.

Whenever a drug is recommended for listing, there is a period where there have to be negotiations with the manufacturer to ensure there is adequate supply and that the price is locked in to protect the taxpayers of Australia. But that is it. There is no refusal to list it. There is, in fact, a commitment to make sure that those medicines are listed as soon as possible—as soon as the negotiations can be completed between the department and those manufacturers—once the recommendation has been made. Let's not buy into the argument of those Labor members opposite when they say that that is not what is occurring, because our records show that it is. The new PBS drugs are being listed at an average of one a day—over 30 a month—to help particularly those with chronic illnesses.

Those opposite, including the member for Dobell in her speech, also want to scoff at the savings provided for in this bill. It just goes to show how out of touch they are with ordinary Australians who are struggling with the cost of living and for whom savings of between $80 and $100 provided for in this bill—because they can access the safety net sooner—are significant. Those savings will allow them to either better manage their cost of living or seek and purchase medication sooner. While the Labor members opposite scoff at those kinds of savings, they were quite happy to go to the recent election with a great, big, new retiree tax costing thousands of dollars for self-funded retirees, who were—exactly as the member for Dobell said—making sure that they were planning very carefully, when they purchased their medicines, to manage their cost of living. The Labor Party were very happy to go to the recent election with a great, big tax on retirees without a second thought, yet they stand in this place and scoff at the real savings that we are providing to help people with their cost-of-living pressures.

I would hope that an affordable, accessible healthcare system is something we can both agree on. The government has certainly made that commitment to the Australian people, and I'm certain it's an important reason that the government was re-elected in May. Our plan is to strengthen our world-class health system and guarantee the essential services that Australians rely on. As I said, an important part of that is ensuring we have good economic management to deliver it.

As part of our election commitment to the Australian people, we promised to reduce the safety net thresholds that apply to the Pharmaceutical Benefits Scheme. Under this government, with that responsible economic management, we have the budget to do it. It's the people that matter. Ninety-one per cent of scripts dispensed every year—the equivalent of $186 million—are to concession card holders, including seniors. As the son of two pharmacists myself, having grown up working behind the counter in pharmacies, I know firsthand the difference that quality, cost-effective medicines can make, particularly to older Australians. I saw firsthand how older Australians and concession card holders who were grappling with the cost of living were careful to time their purchase of medications and how careful they were to monitor their access to the safety net. Under this bill, they will get there sooner. Throughout all stages of life, most of us require medicines. Certainly we will have a family member who will understand that their illness has a profound effect on their quality of life. That's why I'm proud to be part of a government that is delivering this bill.

In some cases, medicines that Australians rely on would cost tens of thousands of dollars per year without the PBS. However, the PBS means that concession card holders pay a maximum of $6.50 per script and nonconcession patients pay a maximum of $40.30 per script. Patients receive free or reduced-cost scripts once they reach the safety net, which, under this bill, will be sooner. Twenty per cent of all scripts that are dispensed, the equivalent of $37 million, are free of charge because patients have reached a safety net—a safety net which they will get to sooner under this bill. That is because this government doesn't believe that financial circumstances should impact access to treatment.

My electorate of Ryan is home to over 39,000 families. Health care, medicines and affordable access to them are a priority. It's important to me, as part of the Morrison government, that we do all we can to ease the financial impact that is placed on families with a sick family member. The Morrison government can do that, because of our strong economic management. For instance, under this government, the bulk-billing rate in Ryan last year was over 613,000 visits—some 171,000 more than Labor's last year in government. That is because of our strong economic management. Unlike those opposite, who would increase the cost of living with their new taxes—which they certainly tried to do last May—we are helping Australians with their healthcare costs in a very real and tangible way.

The bill will reduce the PBS safety net threshold amounts for both concessional and general patients and their families and will come into effect on 1 January 2020. The impact on everyday Australians and their families in my electorate of Ryan will be significant. The number of scripts needed to reach the safety net threshold will be reduced by 12 for concessional patients, down from 60 scripts to 48 scripts. Reaching the safety net sooner will mean that patients receive free scripts or scripts at significantly reduced costs and this will reduce their out-of-pocket costs. The safety net threshold for general patients will reduce from the 2019 level of $1,550.70 to $1,486.80. This is equivalent to saving $100. As I said, Labor scoffs at this amount. It just goes to show you how out of touch they are with ordinary Australians working to make sure that they reduce their costs of living. With this bill we are looking to benefit 1.6 million concessional patients and 129,000 general patients across Australia.

Recently in this place I spoke about some of the recent PBS listings we have had. These have had a profound effect on those suffering from chronic illnesses, such as lung cancer, leukaemia, stroke and many more. Medications for well-known conditions that are suffered by many and that cause significant physical and mental pain as well—conditions like diabetes, cystic acne, high cholesterol, asthma and arthritis—have also recently been listed on the PBS under this government. I remind the House again that these listings simply stopped under Labor because they couldn't afford to do it. Since 2013 this government has listed more than 2,100 new or amended items—a total outlay of $10.6 billion. This is what good, strong economic management can achieve and the benefit it can have on people's lives. When sufferers of these chronic conditions and many other conditions reach the safety net they will pay less for their scripts and have fewer out-of-pocket costs.

This isn't just for people suffering from these well-known conditions; it is for many people and many Australian families, for example, when a couple is starting a family. Starting a family is incredibly emotionally and mentally challenging, particularly with the financial impact of treatments through an IVF cycle. Once the PBS safety net threshold is reached the co-payment rate for scripts for some costly medications associated with fertility treatment will be reduced. Allowing them to reach the safety net sooner is a way we can help families in one of the most stressful and challenging times in their lives.

It is at all stages of life that we rely on medicine. In Ryan we have a large ageing population. These individuals have in many cases spent most of their life living locally and helping make our community what it is today. As part of our promises to Australians we have committed to making sure that seniors and retirees in particular get more support. Assisting in their physical and mental health is important to the Morrison government. It's important to me as their local member. Reducing the safety net threshold will make sure that we look after Australian seniors and concession card holders in particular. To help achieve this we have committed $100 million to deal with the fear and loneliness that can accompany age that affect far too many senior Australians. The weekly trip to the chemist to pick up the scripts for the week is important for many older Australians, but it hits the hip pocket. Again, with strong economic management we can continue to invest in the PBS and continue to list new medicines—which Labor weren't capable of doing—to address the illnesses and conditions that are prevalent in older Australians, and we can continue to help them with their healthcare costs.

Not only are we investing in the PBS; I remind the House that we have increased hospital funding by 60 per cent since Labor left office in 2013—and not through new taxes and not through ripping money out of people's pockets, as Labor members opposite would have done if they had been successful at the last election. Through strong economic management we have invested more in our healthcare system than they were ever able to.

That is why—to circle back around—I'm confident to proclaim that this government is truly the best friend that the PBS has ever had. We are keeping it stronger than it has ever been to make sure that it remains a foundation pillar of our healthcare system, to ensure that people with chronic illnesses can access medications cheaper with less out-of-pocket costs and to make sure families are able to seek medical treatment that's ongoing, like IVF, in a way that is cost-effective for them. The Morrison government are ensuring that we are truly strengthening our world-class health system.

Anne Aly (Cowan, Australian Labor Party) Share this | Link to this | Hansard source

I think the member for Ryan mustn't be very proud of this policy, because he spent most of his time talking about Labor six years ago. But Labor is going to support this National Health Amendment (Safety Net Thresholds) Bill, as the previous speakers from this side have said, because it will reduce the PBS safety net threshold as of 1 January 2020. Labor did match this commitment during the election campaign. On matters of health and medications, I think it's important that we recognise good ideas and what's in the best interests of all Australians.

But, while we support the bill, there are a couple of points that I'd like to make. This bill, as much as it does and as much support as it has on both sides here, won't do much at all, quite frankly, to fix the affordability of medicines and the crisis that we've seen in the affordability of medicines under this government's watch, which, I might add, just to remind the member for Ryan, has been six years. To illustrate that point, I would like to relate a case to the chamber. In this case, I was doing a regular 'meet your member' at one of the local shopping centres on a Saturday morning. There was an elderly lady named Sue who waited very patiently to see me. When I finally got the time to see her, I sat down with her and I asked, 'How can I help you?' She started telling me about how she has suffered from chronic pain for the last decade. She was so emotional, so overcome with emotion, as she was talking to me that she broke down in tears. So I held her and I calmed her down and I said, 'That's okay; that's okay.'

The issue that she wanted to raise with me was the cost of her medications. She had tried so many different medications but the one medication that gave her relief was Panadol Osteo and, in 2016, this government saw fit to delist Panadol Osteo from the PBS. Since that time, this woman who suffers so immensely from chronic pain and who has tried everything that she possibly can to manage her pain has had to find the money to buy the level of Panadol Osteo that she needs. She's at a point where she simply can't afford it. She simply cannot afford to purchase the medication that she needs to give her the slightest bit of relief of her pain. That's what brought her to tears.

Osteoarthritis affects around 60 per cent of people over the age of 65, and people like Sue rely on good pain management to enjoy a quality of life that many people—and I'm sure most of us here—take for granted. That old saying that you never miss your health until it's gone rings really true. For her not to be able to afford the medication that she needs to give her that little bit of relief and to give her that quality of life that, as I said, we take for granted, I think, is a really sad state of affairs.

By the government's own figures, many Australians don't fill prescriptions because they can't afford them. Panadol Osteo, of course, is an over-the-counter drug, but we're looking at the number of Australians who can't even afford their prescription medicine. According to the Australian Bureau of Statistics, 961,000 people a year delay or avoid taking prescribed medicines due to the cost of those medicines. The rate of people skipping prescriptions is twice as high in the most disadvantaged areas. Five per cent of people skip their prescriptions in some of the least disadvantaged areas. In the most disadvantaged areas, it's around 10 per cent of people. What does that mean? It means that the cost of medication is prohibiting people from filling out their prescriptions and from getting the medications that they need for their health, for their wellbeing and for their quality of life is contributing to health inequality in Australia.

There's no other way to describe this other than as a crisis. This government is now in its third term, and rather than really look at this crisis for what it is—when you cannot afford medication, when you're choosing between food and medicine or between paying the rent and getting pain relief—in 2014, this government proposed to increase the cost of PBS medicines by up to $5, even for pensioners. My mum's a pensioner, and I know how much medication she has to take just to enjoy a quality of life that we take for granted, to be able to get some sleep, to be able to walk without pain and to be able to look after herself and live independently as she is so vehemently insisting on doing. I know how much it costs her just to be able to afford her medications, even though she is on a pension and even though she has a concession card. Increasing the cost of medicines by $5, even for pensioners, and increasing the thresholds for the PBS safety net would have forced patients to pay $1.3 billion more for medicines over four years. It would have caused even more Australians—people like my mum—to skip their essential medicines.

It was only Labor's opposition in parliament that stopped this government from implementing that measure. It was only Labor that kept this government in line and opposed this measure that would have seen PBS medicines increase by up to $5, including for pensioners, and see an increase in the thresholds of the PBS safety net. It was only Labor that stopped this government from doing this. Australians shouldn't forget that this Prime Minister and the current minister are part of that cabinet that wanted to make medicines more expensive for all Australians.

Last month, the PBAC made its recommendations public from the July meeting. That took the number of drugs waiting to be listed by Minister Hunt, the current Minister for Health, to more than 60. So there are more than 60 drugs at the moment waiting to be listed on the PBS. One of those drugs is Symdeko. Many members of parliament will know that I meet quite frequently with children suffering from cystic fibrosis and that I'm an advocate and a huge supporter of the cystic fibrosis cause. Symdeko is a life-changing cystic fibrosis drug. It treats the most common cystic fibrosis mutations and can extend life expectancy and improve quality of life for sufferers of cystic fibrosis, many of them children.

The minister made a promise to all of those with cystic fibrosis—to the children and to their parents—that they would have access to Symdeko on the PBS as soon as it was approved. It was approved six months ago. Six months may not seem long in our lifetime. I'm like anybody else who comes to October and November: we think, 'Where did the year go?' We say it every year: 'This year went so quickly. Where did the year go? Where did the week go?' Six months doesn't seem like that long at all, but I'll tell you: six months in the life of a child with cystic fibrosis is everything. To the parents of that child, six months is everything. To people who suffer with chronic pain, six months is everything. To people with life-threatening illnesses, six months is everything. It's just not good enough when this minister tells children suffering from cystic fibrosis and their parents that once Symdeko is approved they'll have immediate access to it and yet six months later they're still waiting.

Before I finish, I note that I have spoken before about continuous glucose monitors and I note that the government has made them available. However, I will raise this issue once more: once young people reach the age of 21, they are no longer eligible for the continuous glucose monitors. Again, I'm a big advocate for type 1 diabetes. What we're seeing is that, once people are over the age of 21, they no longer qualify for continuous glucose monitors unless they have a serious hypoglycaemic event that requires hospitalisation. The reports that I'm getting from the Diabetes Foundation and from advocates for type 1 diabetes is that young people are actually putting their lives at risk by purposely going into a hypoglycaemic event so that they can be transferred to the hospital and can qualify once again to get the continuous glucose monitors under the PBS, because they simply cannot afford them, particularly if they are studying or working part time and don't have wealthy parents who can pay for them. Young people are putting their lives at risk to get continued access to the continuous glucose monitors. I would urge the minister and this government, as a matter of urgency, to have a look at extending the regime and the access to continuous glucose monitors for people over the age of 21 so that we don't have young people putting their lives at risk.

Just to conclude, as I said, Labor does support this bill. We support anything that is going to make medications more available to the people who need them. We do this with a history of continuing to hold this government to account as it wants to increase the costs of medicine and shows tardiness on putting drugs onto the PBS once they have been approved by the PBAC. I would urge this government and this minister to look at those 60 drugs that have been approved. I urge the minister to be able to look children with cystic fibrosis and their parents in the eye and say to them that he did all he possibly could and used his position as the Minister for Health to get Symdeko onto the PBS as soon as possible, because every day that goes by is a day that these children and their parents are suffering and a day that that suffering is continuing needlessly.

Katie Allen (Higgins, Liberal Party) Share this | Link to this | Hansard source

I rise today to support the National Health Amendment (Safety Net Thresholds) Bill 2019 to lower the safety net threshold. I congratulate the Minister for Health, Greg Hunt, and I'm proud the Morrison government is delivering on yet another election commitment that will make a real difference to the lives of Australians and their families, in particular those living with chronic conditions like heart disease, asthma, arthritis and diabetes. These illnesses often mean patients are taking continual medication, sometimes dozens of pills a day for the rest of their lives. I know; I have many family members, and I'm sure many members of this House do too. But, unfortunately, compounding the problem, many require treatment for multiple conditions at the same time, and that results in the requirement for long-term medication. Understandably, these long-term illnesses can have a devastating financial effect on individuals and families, not just because of the cost of the medication itself but often because a person cannot work as a result of their illness. That's why I'm proud to support this bill today. The bill amends the National Health Act to implement our election commitment to lower the Pharmaceutical Benefits Scheme, or PBS, safety net threshold amount by 12 scripts for concessional patients and two scripts for general patients.

So why is this bill important? This amendment aims to help those who are the most vulnerable in the health system. These patients are often the sickest and require the most doctor's appointments. They are also the most at risk from financial pressures. I am proud that this amendment will help ease the burden on the most vulnerable patients in our health system. Currently 91 per cent of PBS scripts each year are for concession card holders, which shows just how important this amendment is and that we are supporting those who truly need it. By reducing the safety net threshold, pensioners and families will qualify to access free or further discounted medication much sooner. This will directly benefit around 1.6 million concessional patients—that's 1.6 million Australians—and a further 129,000 general patients who reach their PBS safety net each year. By allowing them to reach the PBS safety net sooner, patient out-of-pocket costs will be reduced, on average, by a further $80 each year.

This amendment is certainly not the only thing we are doing in the area of health. Our healthcare system is one of the best in the world, and that excellence remains a top priority for our government. There is much to be proud of. Our public health system provides care for everyone who needs it, and our private healthcare system provides choice for the consumer. Our healthcare system is unique in the world. Our strong economy means that we can make extra investments in our hospitals, and we have provided record funding for that purpose. What I'm really proud of is the fact that almost nine out of 10 Australians who visit a GP have no out-of-pocket expenses whatsoever, thanks to record Medicare bulk-billing.

Another very important thing that we should be enormously proud of is that we are continually at the forefront of medical breakthroughs and innovation as a result of stable and consistent funding from the coalition government. Our multibillion dollar investment in the Medical Research Future Fund is the envy of the world. I should know, having been a medical researcher myself and travelled overseas, where people have had a lot of interest in our Medical Research Future Fund.

The Pharmaceutical Benefits Scheme, which we're discussing today, is yet another complementary arm that keeps our population healthy, and it's not just for those who can afford it. The PBS already provides Australians with access to medications that would often cost hundreds of thousands of dollars. The Morrison government has already approved 2,000 new drugs on the PBS—that's 2,000 new drugs—which is something to be very proud of.

I want to highlight two tangible examples within our overall commitment to putting new medicines on the PBS. The first is life-saving drugs for cystic fibrosis and the second is life-saving drugs for lung cancer sufferers. As a paediatrician, I've seen the pressure that young families experience when a parent can no longer work and contribute to the household income, or, worse, if a child is sick and the parent needs to stop working to provide full-time care for their child. As a paediatrician, I've cared for many with cystic fibrosis. Unfortunately, no cures for cystic fibrosis are known and, consequently, several treatment methods are used for patient management.

While infants born with cystic fibrosis 70 years ago were unlikely to survive even past their first year, infants today are likely to live well into adulthood. It's one of the great success stories of medical research, and we are seeing people with cystic fibrosis now surviving into their fifth and sixth decade. Recent advances in the treatment of CF have resulted in patients living a fuller life, less encumbered by their condition, through proactive treatment airway infection and pulmonary rehabilitation. I'm proud of the recent announcement that the Minister for Health, Greg Hunt, has made to that end. However, families of patients still experience a massive burden of health costs with regard to disease management and its necessary treatments. This amendment is going to make changes to lower the PBS safety net threshold to ensure chronically ill patients, including those with cystic fibrosis, and their families, who also have other numerous medical burdens to consider in their day-to-day lives, are less encumbered by the financial burden that come to hand with such an illness.

Similarly, lung cancer patients will also reap the benefits of this safety net amendment. My mother died of lung cancer 25 years ago last week. It was hard watching her suffer without any hope. One of the medications that has just been placed on the PBS by the Minister for Health, Greg Hunt, would probably have saved my mother's life—she would still be with us today; she would have had the opportunity to meet her grandchildren. At the time, I remember we were so urgently wishing there was a treatment that was available. I remember the excitement when the treatment that is now available for people with metastatic lung cancer became available, but at the cost of hundreds of thousands of dollars for patients. I know that cancer sufferers are looking for that lifeline all the time, and to be able to have it listed on the PBS is something that we should all be proud of as Australian taxpayers.

I also remember at the time speaking to other cancer sufferers and their families about the impact that the cancer had on keeping their head above water, especially those who were the primary breadwinners in their family. Fortunately, new medicines are being listed each and every day as they become available on the PBS, and I'm proud to say that there are now cancer treatments that are available that are saving lives and protecting lives as we speak.

Earlier this month I actually hosted a community roundtable in my electoral office in Higgins to raise awareness about the impact of lung cancer. We've heard about the stigma that can be associated with lung cancer. A local patient, Jenny, told us how she often felt lonely and overwhelmed experiencing battling cancer. But she also told us about the stigma associated with lung cancer compared to the diagnosis of colon cancer that she had recently miraculously recovered from. She said the stigma associated with lung cancer was immense, because people assumed that she had smoked when she had not. She also reflected on the financial burden she felt during this challenging time. This amendment bill is a pragmatic approach to ensure that such patients are supported and eased of the financial burdens that exacerbate the challenges felt by facing either a life-threatening condition or a chronic illness. Such reforms are possible due to the government's strong financial management and will benefit countless Australians when they need it most.

More than delivering affordable drugs, the Morrison government is committed to investing in research to deliver better outcomes for patients. The Morrison government's recent $33 million investment into healthcare practices and interventions, focusing on those with or at risk of developing chronic conditions, is one such complementary and pragmatic preventative approach being undertaken by the government. Certainly many illnesses, disabilities and deaths experienced by Australians are caused by chronic conditions, including cardiovascular disease, some cancers, lung disease, diabetes and, of course, mental health. The funding for this initiative was provided through the Medical Research Future Fund's Rapid Applied Research Translation initiative.

The Medical Research Future Fund, introduced by the coalition government in the 2014-15 budget, is yet another example of a complementary policy introduction. It seeks to help understand vulnerable Australians and to provide groundbreaking preventative medical treatment to those in need. We are so lucky to have a world-class medical research group that is out there, trying to fight diseases and make better outcomes for patients. In conclusion, the Morrison government is delivering on its commitments in health and getting on with the job of supporting Australian families. This amendment bill is a pragmatic step to ensure that patients, in particular those with chronic illness, receive the support that they need without the financial stress. That is why I move to support this bill.

Mark Dreyfus (Isaacs, Australian Labor Party, Shadow Attorney General) Share this | Link to this | Hansard source

I rise to speak on the National Health Amendment (Safety Net Thresholds) Bill 2019. As has been made clear by speakers before me, Labor will support this bill, the purpose of which is to reduce PBS safety net thresholds from 1 January 2020.

Labor made it clear—certainly since not later than the election, when we matched the government's commitment to reduce the PBS safety net thresholds from 1 January—that we will support, and would support, this legislation when it was brought to this House. That's what responsible political parties should do. They should recognise good ideas when they are brought forward. They should recognise legislation that has beneficial effects for the Australian community and they should support legislation that has beneficial effects for the Australian community. It shouldn't be a matter of saying, 'That's a Labor idea; therefore, we won't support it,' which, regrettably, is something we hear constantly from those that are presently occupying the government benches.

We saw it today in the talking points that were leaked. These are, of course, the written instructions that go out like holy writ from the Prime Minister's office to government ministers telling them what they must say on each and every topic that might arise in the politics of the day. Unsurprisingly—I say 'unsurprisingly' because we hear it constantly inside this chamber—there were 34 references to Labor in the 14 or so pages of these talking points. That tells you a lot about this Liberal government. It tells you they're practically bereft of ideas themselves and all they can think of to do is attack Labor at every opportunity, and that's what passes for their idea of political debate.

But that is not enough for political debate. What we actually are looking for in this chamber, what the Australian community is looking for is engaged debate on policy, debate which actually weighs up the advantages to the Australian community of adopting particular policies, the costs to the Australian community of adopting particular policies and whether or not legislation that's proposed will, in fact, achieve the aims that it is stated to achieve. The idea that, when one side of politics comes up with a good idea, the other side of politics is prepared to adopt it, should not be regarded as an unusual idea. We would urge the government to adopt that approach to the health policies we took to the election on 18 May. But, of course, that's not what this Liberal government, which has now been in office for more than six years, wants to do. It actually, as its stock in trade, thinks that it's sufficient simply to attack Labor.

But let's return to this particular bill. Let's be clear: although this bill puts forward a desirable objective, it won't actually fix the crisis in medicines affordability that we have seen on this government's watch in the more than six years that they have fitfully governed. The government's own figures show that many Australians don't fill prescriptions because they can't afford to. That's a deeply distressing statistic to have to put before this House. The Australian Bureau of Statistics, the government's own agency, says that some 961,000 Australians every year delay or avoid taking medicines that have been prescribed to them by their treating doctor, and the reason that they don't go and purchase those medicines, or put off taking those medicines, is cost. That is a very sad state of affairs, and it gets worse when you consider how localised or in what parts of Australia this delaying or avoidance of taking medicines that treating doctors have prescribed is occurring. The rate of people who are skipping prescriptions from their treating doctor is twice as high in the most disadvantaged areas, at 10 per cent, as in the least disadvantaged areas, where the rate is only five per cent. That, of course, means that the cost of medicines is contributing to health inequality in Australia.

We want to see a health system that absolutely every Australian benefits from because they are holding a Medicare card, not because they are holding some particular kind of credit card. It's vital that health services, which include prescribed medicines, be affordable and available to every single Australian who needs those medicines. Unfortunately, when you look at what this third-term government has done about the crisis that's revealed by the statistics that I've just referred to, you can see only that the government has basically tried to make it worse.

You could start with what the government did in the 2014 budget right at the start of this government's period of more than six years in office. What happened in the 2014 budget was that the government proposed to increase the cost of PBS medicines by up to $5 even for pensioners and to increase the thresholds for the PBS safety net. The PBS safety net is vital for people who have chronic illnesses because, once you reach the threshold, which is already set at a fairly high level, you move to a lower rate of payment for prescribed medicines. What this uncaring Liberal government proposed to do in the 2014 budget was increase the threshold, which would have meant that more money would need to be spent by people with chronic illnesses before they were entitled to purchase their medicines at the reduced rate. It would have forced patients—and the PBS safety net, just to remind members of the House, is about people with chronic illnesses—to pay $1.3 billion more for medicines over four years. It would have caused even more Australians to skip essential medicines. It was only Labor's opposition in this parliament that stopped the government from implementing the measure that was in the 2014 budget, and every time members of the Australian community hear the current Minister for Health boasting about his supposed excellent record in relation to the provision of medicines to Australians they need to remember that this current Prime Minister and this current Minister for Health were part of the cabinet in 2014 that wanted to make medicines more expensive for every Australian. This Prime Minister and this health minister were part of the cabinet which brought a budget to this parliament for approval in 2014 that would have had the effect of making medicines more expensive for every Australian. That measure was on top of this government's appalling record of delaying PBS listings.

Let's pause for a moment to reflect on the fact that Labor introduced the Pharmaceutical Benefits Scheme under Ben Chifley. It was a great achievement. It has become, since then, a national institution which has benefited generations of Australians. The PBS is far too important to allow any side of politics, any political party, to seek the kind of cheap, temporary, partisan advantage that this grubby self-serving health minister seeks to engage in almost every time he stands up to answer a dorothy dixer in question time. Almost every time he does a press conference, we hear from him about how wonderful he is and how wonderful his government is now that he has been so generous as to list some further drug that has been recommended for listing by the Pharmaceutical Benefits Advisory Committee. No previous minister for health has sought to engage in that kind of self-serving behaviour. No previous minister for health has sought to say that it's because of his administration or because of his political party's orientation that these drugs, whatever they may be, are listed. This minister has taken it to a whole new level, because not only does he claim some personal credit for the government extending listings that are recommended by a committee which is intended to be non-partisan, bipartisan and disinterested in every sense and disconnected from drug companies—that's what PBAC is there for, to get separation from the drug companies, to get separation from vested interests and, particularly, to get some separation from political game playing—but this Minister for Health seeks constantly to engage in the seeking of partisan advantage by claiming that some special credit should reflect on him. And he engages in a nasty, untruthful comparison with his imagined version—because it is not a real version—of Labor's record over six years in office.

Let's just think about what has been the actual record of the government in delaying PBS listings. Let's look at last month when the Pharmaceutical Benefits Advisory Committee having made public their recommendations from the July meeting, which took the total number of drugs waiting to be listed by the current Minister for Health to more than 60. These are drugs that have been recommended for listing by independent experts—that's what the Pharmaceutical Benefits Advisory Committee is—and the reason the listings are recommended is that these are drugs that, finally, after clinical trials and after examination of their costs, stack up.

An example might be a drug called Symdeko. I heard the member for Higgins talking about cystic fibrosis drugs before. It's a shame to hear someone as knowledgeable about the health system as the member for Higgins merely reciting talking points that have been written for her by the Minister for Health's office. Her knowledge of the health system is far greater than his, I am certain, after her many decades of work for the Australian community both as a treating professional and as an academic. In particular, I refer to her work at the Murdoch Children's Research Institute. I've got the utmost respect for the knowledge and competence of the member for Higgins, and it is disappointing that she's been forced to just recite talking points provided to her by the Minister for Health. If we go to cystic fibrosis drugs, we can look at Symdeko. It's a life-changing cystic fibrosis drug. It treats the most common cystic fibrosis mutation, and that extends life expectancy and improves quality of life. The minister made a promise to those with cystic fibrosis that they'd have access to Symdeko on the PBS as soon as it was approved. It's six months since that was recommended back in March, and there is no word on when or even if the government intends to list it. Speaking with Ray Hadley on 2GB, the minister was asked by a listener about the delay in listing drugs that can help people suffering with cystic fibrosis. He said:

… I think it’s important that the cystic fibrosis community knows that, you actually wonder what keeps a minister up at night—this. It’s the new medicines and the new listings and getting them there …

Clearly, he's recovered his ability to sleep through the night, because he's actually asleep at the wheel when it comes to listing approved drugs on the PBS.

We have a minister who loves to pat himself on the back, a minister who loves to hold purpose-specific—drug-specific at that—press conferences, where he associates himself with a particular sufferer or the family of a sufferer and pats himself on the back every time the government finds the money through the Expenditure Review Committee or the budget processes to approve the listings that have been recommended by the Pharmaceutical Benefits Advisory Committee. If he's responsible for the listings, he's also responsible for every drug which he refuses to list—every drug which he sleeps through the night on and neglects to list. He needs to stop the delay on PBS listings and start treating Australian patients with respect. A good start would be to stop these grubby self-serving press conferences and claims for credit which he does not deserve.

Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

I rise in support of the National Health Amendment (Safety Net Thresholds) Bill 2019, because it's a very good bill. It gives a very good outcome to the health consumers of Australia—the taxpayers of Australia and people who need affordable medicines. We have a system that is the envy of other nations.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

Thanks to Labor!

Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

We're not arguing over who started it. We are talking about this bill and what we are doing. It is a good system. It wasn't brought in in the last six years, but it is a wonderful system.

Thousands of people get drugs for complex or common conditions that would bankrupt whole families in other countries. In fact, people in some jurisdictions just can't afford their regular medicines, let alone the expensive ones. Under the Pharmaceutical Benefits Scheme, as we know, when people go to fill their script and a drug is on the Pharmaceutical Benefits Scheme, hundreds of thousands of people only pay $6.50 for their script if they're a concession cardholder. Even though it might cost $80,000 or $300,000, they are paying $6.50. For non-concession cardholders, it's $40.30. What a wonderful system. People with cancer, cystic fibrosis and with all sorts of rare genetic diseases can get drugs that improve their condition out of sight.

There are 186 million scripts dispensed in the PBS every year. That's a frighteningly large number, but we managed to pay for it because we have been wise with managing our money. Of these prescriptions, 91 per cent are dispensed to people who are on a concession card. This bill enacts a change to the safety net. The safety net is the financial threshold over which you don't even have to pay the $6.50 or the $40.30. We're reducing that from 60 scripts for a concession cardholder down to 48 scripts. That will deliver quite a considerable saving for the individual concerned. If you're a non-concession cardholder, we are reducing the number of prescriptions of PBS drugs that need to be dispensed before you reach that threshold from 38 scripts down to 36 scripts. That's dropping from $1,550 to $1,486. If you were telling some friends of mine who live on the west coast of America that they only had to pay that amount of money for their prescriptions, they wouldn't believe the system that we have here.

As you know, we have a good record. This government, since 2013, has listed over 2,100 new drugs on the Pharmaceutical Benefits Scheme. We're all very familiar with the wonderful new drugs for ovarian cancer, for all sorts of cancers like melanoma, the treatment for hepatitis C, the treatment for cystic fibrosis and the new cardiac drugs—all these wonderful pharmaceuticals are available. They're cutting-edge drugs. All the immunological, immune modulating drugs and all the drugs that target specific genetic abnormalities in cancers are available. They're incredibly expensive, but we can deliver them to people who need them for the price that they pay—either $6.50 or $40.30. It's a wonderful system.

In the budget, we have, as the first cab off the rank, the Medicare guarantee. Everything that is really important in the health system can be boiled down to three tranches. We have the Pharmaceutical Benefits Scheme; we have the Medicare system; and we provide a co-contribution, or a rebate, for private health insurance, so that people can afford to hold insurance, take responsibility for themselves and not put a strain on the public hospital system. So we have a very good blended system here.

Many would remember that this wasn't always the case. There was a period when the finances of the nation were in a runaway deficit situation. It's on the budget record—and many quotations have been delivered in this House, stating what we all remember very well—that a lot of PBS drugs were delayed in their listing until the budget position allowed. But it wasn't when we were in control of the Treasury benches and balancing the budget; it was, unfortunately, with the former, Labor-led government. Because they hadn't controlled their budget spending in so many other areas, they delayed treatments. I know if they look back they would admit it; it's just a fact. But we have managed to balance our books. We have finally brought the budget back into the black. But, well before that, as I said, we brought in the Medicare guarantee and we brought in all these new wonderful drugs.

There are many more coming through the pipeline, but we have a system. The Pharmaceutical Benefits Advisory Committee is a group of highly professional doctors, scientists, pharmacologists and medico-economists that look at the safety and the efficacy of the drug and how well it works against the current therapy. It goes through a rigorous analysis. If the Pharmaceutical Benefits Advisory Committee makes a recommendation, the maker and the Australian government then negotiate a price. We are willing buyers of drugs and they are willing sellers, and general negotiation takes place. It is a sound system, because we have to deliver value for money and we are bulk purchasers of drugs. So not only is the science rigorous, but the financial side of the equation is also rigorous. We get a great deal for everyone in Australia who requires medication.

I am just so pleased that I was, by the lottery of life, born and live in Australia, because there are plenty of people that don't get the system that we have in this nation. So I would like to thoroughly recommend this bill to the House. It is going to cost the budget a considerable amount of money. The taxpayer will be paying $328 million more because of this safety net reduction. But it was a coalition commitment during the election to make medicines more affordable. We've delivered on our promises. We've delivered the drugs. We've delivered a balanced budget and we are delivering the best medicines for the people of Australia. I commend this bill to the House.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

At the beginning, I would just like to say that, in talking about health policy on the Labor side, I stand in the shadow of giants. Some of those giants were Ben Chifley and his government, who introduced in 1949 the PBS, which had been much talked about prior to the legislation being brought into the House—and the Curtin government, who during the war years, certainly recognised the need to help subsidise the cost of medications for all Australians. On the back of that legislation, we have been able to introduce fantastic health policies from then on, including our wonderful immunisation program, which has been the envy of the world. Following the Chifley government, we had many other great Labor leaders. The prime ministerships of Arthur Calwell, Gough Whitlam, Bill Hayden, Bob Hawke, Julia Gillard and Kevin Rudd developed health reforms for all Australians.

My career as a doctor started in 1972 as a medical student, and I well remember the talk of this new policy, Medibank, which actually revolutionised health care for Australians. Up until that point, medical costs had been a leading cause of bankruptcy in Australia. Medibank revolutionised health care in Australia, and I well remember when it came in and what a wonderful change it made for the ordinary Australians who, up until that time, had really struggled with health care. Of course, it was dismantled by the Fraser Liberal government, and then there were several iterations of partially-effective health insurance schemes by conservative governments. It wasn't until the onset of the Hawke-Keating government and the advent of Medicare that we in Australia really developed a universal healthcare policy that enabled all Australians to access fair and reasonable health care. It is important to note that part of that Medicare agreement led to a cooperative arrangement with the states, and also with private health insurance and the private health care industry, that enabled fair access to comprehensive health care for all Australians.

I started my private practice in the week that Medicare first started in Australia, in February 1984. Medicare revolutionised health care for many families in my electorate of Macarthur. I can remember seeing families who had not been able to have access to a paediatrician before because they couldn't afford the cost. It really did revolutionise health care in the electorate of Macarthur.

I am really pleased that my medical colleagues, the member for Lyne, David Gillespie, and the member for Higgins, Katie Allen, were able to speak in support of this bill, the National Health Amendment (Safety Net Thresholds) Bill 2019, and the amendment. But I do think it is a shame that they do not recognise that there has been a change in the last 10 years, and that health care for ordinary Australians is less and less affordable. That is one of the reasons why I'm in parliament.

It's fantastic to hear my very good friend and colleague the member for Dobell, who has worked in the public hospital system for a long time with some of the most disadvantaged members of our community. I know how much she recognises the way that health care in the last few years has really changed in Australia and that we are at great risk now of developing a two-tiered, American-style healthcare system where the poorest in our community get the poorest health care and have the most difficulty accessing it. We are seeing this already in the public hospital system with the collapse of the public hospital outpatient system, with longer and longer waiting lists and more and more difficulty accessing public hospital outpatient clinics for many people, and with greater gap costs for people accessing private practitioners, particularly specialists. The increasing gap costs are making visits to some specialists, such as ophthalmologists, ENT surgeons, cardiologists and neurologists, virtually unaffordable for many Australians. That is not to say that that is true for all Australians. Of course, people who have the financial ability can access specialists very quickly, and, through the private health system, can often access hospital waiting lists very quickly. But in the public hospital system we're seeing increasing gap costs for private consultations, and longer and longer waiting lists for public outpatient clinics. In fact, many hospitals don't have public outpatient clinics. For the paediatric ENT surgeons in my electorate, there is no ENT public outpatient clinic. I know at the Sydney Children's Hospital it's virtually impossible for a child to access a public outpatient clinic, so people are forced to see private practitioners and pay increasing gap costs. It makes it very difficult for the very poorest in our society to access top-notch health care.

I welcome any steps that address issues in affordability and access to health care. This bill in a small way does help people address medication costs. Through this legislation, once a patient reaches the safety net threshold their co-payments are reduced—for people not on concession cards they are reduced from $40.30 to $6.50 and for people on pension cards they are reduced from $6.50 to zero. I certainly welcome this reduction in the safety net thresholds for the PBS, but I must say that the government can and should be doing a great deal more to address the healthcare and medicines affordability crisis that we now know has occurred under their watch.

Don't forget the horrendous 2014 budget. This Prime Minister and members of his cabinet were the ones who wanted to introduce the GP co-payment and they wanted to introduce increased costs for concession card holders when getting medication. That was a horrendous and shameful budget. It really did a lot towards giving the okay for increasing the gap costs for a whole range of medical treatments. It was very shameful.

It really is a sad state of affairs when Australians are forgoing filling their prescriptions because they can't afford them. That's the reality that we are presently faced with. The government's own data confirms that this is happening in Australia in 2019. As more eloquently stated by the member for Isaacs, the shadow Attorney-General, the difficulty in affording medications is worse in the most disadvantaged electorates, so rural, regional and outer metropolitan areas are where these difficulties are occurring. That to me is really a travesty. The universal health insurance scheme that we have in Australia is about trying to make access to health care and medication more affordable for the poorest in our community, because of course the poorest in our community tend to be the sickest. The government are turning their backs on it.

I know that people have good access to health care at the North Shore Hospital, and they would certainly let you know if they didn't. In my electorate in outer metropolitan Sydney it's more difficult for people to access health care. I have on a number of occasions had to ring some of my specialist colleagues and ask them to bulk-bill patients so that they can have access to care. I contacted a neurosurgeon for one lady and a cardiologist for another. For a man who was going blind I contacted an ophthalmologist so that he could have his cataracts done. It's the reverse of what should be the case.

The government denies that there is a problem. I'm pleased to hear that some of the member for Lyne's colleagues who obviously are quite wealthy and live in the United States think that we have a good system, but I can tell you that a lot of people who live in outback New South Wales or even in outer metropolitan Sydney have real difficulty affording prescriptions and have real difficulty affording health care for their children. The government denies that that is the case and pretends that this very small move is going to make a difference to the everyday lives of many Australians.

We know that some of the most disadvantaged and the most vulnerable people in our society are being hit the hardest with health costs and that in the most disadvantaged areas the rate of people who are skipping their prescriptions is twice as high as it is in the least disadvantaged areas. There is no disputing the fact that the cost of medicines is contributing to the growing inequality in health care that we're seeing in Australia. When 10 per cent of patients are skipping their prescriptions in some of the most disadvantaged areas of our society we have a crisis on our hands. I'm not normally a catastrophiser; I'm generally an optimist. I think the majority of Australians do have access to pretty good health care. But we need to face the reality that many of the most disadvantaged are not accessing the quality of 21st-century health care that they should be in Australia. It's time we had a real look at our healthcare systems to see how we could better provide for the most disadvantaged. Many of those opposite do not share the same belief as me, and time and time again they've sought to make it harder for ordinary Australians to access the care that they need.

I have spoken in this chamber on a number of occasions about people being locked out of health care. We see that in public hospital waiting lists. For some of the surgical specialties—ophthalmology, ENT surgery, gastroenterology, endoscopies, et cetera—there are enormous waiting lists. And the waiting lists are worse in outer-metropolitan, rural and regional areas than they are in the inner-city areas. As I said at the beginning of this speech, we are at real risk of developing an American-style, two-tiered health system where those who can afford it have access to the very best of 21st-century care, and those who can't afford it are condemned to very poor health outcomes because they get very poor health care. We've been heading further and further down this path since the coalition government has been in power. Instead of taking the necessary steps to address this, those opposite have actually sought to make matters worse. Once again, it's the 2014 budget that comes to mind, with the increasing gap costs and the increasing out-of-pocket expenses for a whole range of health services. If they'd had their way, this government would have forced Australian patients to pay an extra $1.3 billion over four years to access the medicines they need. Thankfully, Labor's opposition in the parliament prevented those measures from being enacted in 2014 and stopped the government's attack on some of the most vulnerable in our society. We support this bill, the National Health Amendment (Safety Net Thresholds) Bill 2019, and it does reduce some of those costs, but I would stress the fact that the most vulnerable are falling further and further behind in health care.

I just want to say a little bit more about the PBS. The minister is very prone to crowing about his very special abilities to list drugs on the PBS. I know that the PBS for many, many years has been bipartisan. It acts on bipartisan advice. It separates the political arm from the enabling arm of the PBS through the PBAC. That's very important, so that the specialists involved in assessing these medications are able to give evidence-based reasons why they should or should not be listed. We know that there will be an absolute tsunami of new drugs being considered for listing on the PBS in the next few years. We know that because medicine is changing dramatically. It's much more data driven and there's much more technology in developing genetically targeted drugs. For example, there are some very rare diseases that now have genetic treatments that costs in the hundreds of thousands of dollars per year. We're all going to be faced with how to deal with this, no matter who's in power—and that's why the PBS is a very good, bipartisan system. It annoys me to see the minister crowing about his abilities when he's asked about this in question time on the floor of the House. The PBS is bipartisan. I will say that again: the PBS is bipartisan, and the minister should not be trying to politicise the PBS. It is absolutely shameful. Those on the other side who are involved in health care should know that and understand that, and I'm sure they do. I will call the minister out every time he tries to politicise our bipartisan PBS. We support this bill and the amendment, and I thank the House for its indulgence.

Josh Burns (Macnamara, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on this bill, the National Health Amendment (Safety Net Thresholds) Bill 2019. I want to echo many of the comments made by the previous member, who has spent a lifetime dedicated to helping others in his previous profession, and I know he still practices even though he serves in this place. It stands as a reminder of how lucky we are to have people who live to serve others and who live to heal others. I know the member for Macarthur is an outstanding representative of the medical field. It's a tough thing to come after him. Also the member for Lyne, who I have gotten to know over the last few weeks because we are serving on a committee on another matter together, has dedicated his life to the medical profession. It's a worthy profession. I can't say that I've had the same experience. My only job inside the healthcare profession was back when I was a pimply 18-year-old. I was a courier and I used to pick up blood samples from one hospital in Box Hill and deliver them to Peter MacCallum. It was just a small taste of getting to know and be a part of the health system. Even though I only did that job for a few months, there was certainly pride in working for our outstanding healthcare system.

Today we are obviously here to speak about the National Health Amendment (Safety Net Thresholds) Bill. As has been mentioned previously, the Labor Party will support this bill which reduces the safety net threshold from 1 January 2020. I think that we come to this debate with a basic premise that health care should be affordable and that the cost of medicines should not ever be a prohibitive factor for Australians. Ultimately, it comes down to the fact that the Labor Party have always believed that health care is a right and not a privilege and anything that we can do in this place to ensure that access to good-quality health care and good-quality medicines is absolutely essential.

Growing up, I had doctors in my family. My auntie was the family doctor, as was my grandfather. He also served on the head of hospital boards. One of the things that I never appreciated growing up was that good-quality health care and medical advice was only ever a phone call away. While many other people would have to go and book an appointment and hopefully get in to see their GP but often face a lengthy waiting list, my family were fortunate enough to just call and seek advice about whether we needed to seek further attention. It was, I think, one of the luckiest parts of my life. Both my parents worked hard, but having access to medical care was a crucial thing. It was something that I always appreciate now, especially as I've got a young daughter. Having to take her to the Monash one time at three in the morning was something that I certainly felt as a parent.

As I mentioned, we're here to support this bill. It is a bill that is, hopefully, going to make health care and medicines more affordable. On that premise, I think Australians are looking for more of that. They're looking for more of political parties saying: 'You know what? It's not about Labor; it's not about Liberal. This is about a good idea when we see it.' And we're here to back it. We're here to back the government. They have put forward this bill, and we think that it's worthy of support. But, by the same token, while we didn't get things right at the last election—and that hurts; no-one's here to say that the last election was where we wanted to be and, even though coming to this place is the privilege of my working life, obviously I would like to be sitting on the other side of the chamber talking about all the different reforms we are going to bring in—I do believe that the Labor Party brought to the last election some healthcare reforms that were going to make our country better, were going to make our country fairer and were going to reduce the cost of medicines and the cost of treatment, much like this bill sets out to do.

I'm just going to briefly touch on some of those reforms in the same spirit that we are treating this bill. The first one was, I think, the most significant piece of policy that the Labor Party brought to the last election and that we were proudest of and, if the government recognised it was a good idea and was willing to implement it, we would be the first to back it. That was our $2.3 billion cancer package, where $600 million was going to go to improving access and affordability of diagnostic imaging, with up to six million free cancer scans funded through Medicare; $500 million to cutting public hospital wait times for cancer treatment through a national partnership agreement with the states; $433 million to funding three million free consultations with oncologists and surgeons for cancer patients through the creation of a new bulk-billed Medicare item; and $125 million to cancer research. There would have been a guarantee that every drug recommended by the independent experts would be listed on the Pharmaceutical Benefits Scheme. Much like this bill, which seeks to ensure that medical treatment isn't a prohibitive factor for Australians, that, I think, is a policy that is worthy of support.

While we didn't win the election, we did come up with a plan to make treating cancer more affordable and to make sure that, if you had cancer, your job would be to worry about getting better and not worry about the cost of your treatment, the cost of your specialists and the cost of the medicines that you needed in order to make a full recovery. While we come today in this debate welcoming some reforms around the safety net thresholds, we would absolutely come back here and celebrate and work with the government if they were willing to support our cancer policy that we brought to the last election.

One of the other things I want to quickly mention is the proposed Better Hospitals Fund, where we had an extra $2.8 billion in funding for more beds and shorter surgery wait times over the six years. Hospitals in Victoria, my home state, would have been $635 million better off, including the Alfred Hospital in my electorate, which is one of our nation's finest medical institutes. I had the privilege of spending a bit of time with the doctors, nurses and researchers in the Alfred. It's quite a big medical research precinct in and around the Alfred, looking at ways in which we can find the next drugs, the next research and the next public policy health-saving measures to better the health and lives of Australians.

The other one is the Pensioner Dental Plan. The Prime Minister likes to talk about quiet Australians, but I think this policy would have made a huge impact on confidence and perhaps some of the neglect that many of our pensioners have felt simply by being hesitant when they're about to smile. That, I think, is something that we should never have in Australia. It is absolutely a medical right that Australians should have the confidence to have the ability to smile, to show off and to have healthy dental care. Our dental plan would have given you $1,000 worth of free essential dental medical care covered by Medicare every two years if you had an age pension or a Commonwealth seniors card. Over 185,000 older Australians would have benefited. We see too many Australians skipping dental care as a result of this.

These are just some of the measures that we brought to the last election. We say we're here to work together. We lost, and it hurt. While there are lots of arguments about who did what well and who did what not so well, I don't think any Australian would say that we don't become a better country by making medicines more affordable and by making sure the safety net thresholds are reduced. But I also think that Australians would say that we become a better country if, when you've got cancer, the medicines that you need in order to get better are covered by your government. If you are sick, you should focus on getting better.

While it is welcomed that the government has brought forward this bill to try and help alleviate some of the costs in health care, it hasn't always been a squeaky clean record when it comes to—

Opposition Members:

Opposition members interjecting—

Josh Burns (Macnamara, Australian Labor Party) Share this | Link to this | Hansard source

I'm getting interjections from my own side here! It hasn't always been a squeaky clean record when it comes to ensuring that Australians have affordable health care. You only have a look back at that famous budget in 2014 when the member for Dickson, the now Minister for Home Affairs, was the health minister. It was a different time. It was the budget where—while government members were celebrating over a cigar in the back lounge in the Senate—we found out that the GP co-payment was doing to be heaped upon Australian taxpayers and the Australian people, and that savings of over $1.7 billion would be brought about by pausing the indexation of the Medicare Benefits Schedule and the income threshold for the Medicare levy surcharge and the private health insurance rebate. Patients were expected to pay a $7 co-payment to visit the GP and to pay more for medication through changes to the Pharmaceutical Benefits Scheme that we're talking about today. There was $252 million of savings by raising the cost of certain medicines on the PBS—$252 million of savings by making medicines more expensive for Australians. So, while we welcome this bill, we do it with a sense of caution. We do it knowing that the government have form in this regard, that their instinct when they first came into government was not to make medicine more affordable but to make it more expensive and to bring in pretty harsh and cruel budget savings measures in order to bring down their cruel budget, which they celebrated over a big cigar.

I think today is a good step. It's a good step that this is about making medicines more affordable and that we in this place can say to the Australian public that, when we look at the PBS, we recognise that medicines can be a prohibitive cost and that we're here to fix this. But, on this side of the House, we also say that we're here to work together, we're here to make sure that medicine and health care are affordable for Australians and, if the government decides to recognise that this is not about politics but rather about good policy and wants to bring forward some of Labor's measures, including cancer treatment and dental plans and dental care for pensioners, then we stand ready to work with them.

I don't want to get too focused on the minister in my last minute in this contribution, but I would say that there have been instances where the minister has promised a big game on the PBS and hasn't delivered. The minister did make a promise to Australians living with cystic fibrosis that they would have access to Symdeko on the PBS as soon as it was approved and, unfortunately, we're now six months on and we are none the wiser on when the government intends to list it or when the government intends to put it on the PBS. So, while we say today that this bill is worth supporting and that we in the Labor Party do support better healthcare measures, we stand ready to work with the government and we stand ready to put forward and to look at some of the things we brought to the last election. And the minister should get on with the job of listing much-needed medicines on the PBS.

Fiona Martin (Reid, Liberal Party) Share this | Link to this | Hansard source

The National Health Amendment (Safety Net Thresholds) Bill 2019 will amend the National Health Act 1953 to implement our election commitment to lower the Pharmaceutical Benefits Scheme, the PBS, safety net thresholds for individuals and their families.

The amendments are needed to implement our 2019 election commitment to reduce the out-of-pocket costs for patients who are accessing PBS medicines. This bill will reduce the PBS safety net threshold amounts for concessional and general patients, and their families, from 1 January 2020. The changes to the safety net threshold amounts will enable PBS patients to reach the safety net earlier in the calendar year. The safety net threshold for concessional patients will be reduced by 20 scripts, from 60 PBS scripts to 48 PBS scripts, at the concessional co-payment level. This will reduce the concessional safety net threshold to an estimated $316.80 in 2020. Without this proposal, the 2020 concessional safety net threshold would have risen to an estimated $396. The safety net threshold for general patients will be reduced from the 2019 threshold of approximately 38 scripts to approximately 36 scripts. Without this proposal, the 2020 general safety net threshold would have risen.

Lower PBS safety net thresholds will benefit up to around 1.6 million concessional patients and 129,000 general patients, allowing them to reach the PBS safety net sooner, reducing their out-of-pocket costs. It will, in particular, improve access to PBS medicines for patients whose treatment requires a larger number of PBS prescriptions each year, such as people with chronic conditions including asthma, diabetes and high cholesterol. Reaching the PBS safety net enables a patient to access PBS medicines either at no cost or at a cheaper price for the rest of the calendar year. The measure will reduce prescription costs, saving the majority of patients approximately $80 per year. Lowering the concessional safety net threshold will benefit the holders of pension concession cards, Australian senior health cards and healthcare cards. It will also provide a benefit for gold, white and orange card holders under the Repatriation Pharmaceutical Benefits Scheme.

The measure to lower the safety net threshold was previously announced by the Prime Minister on 2 May 2019 as an election commitment and, at the time, was welcomed by stakeholders as a positive measure that would benefit patients. The safety net threshold amendment will cost $328.8 million over the current budget and forward estimates. Through the PBS, patients can access medicines that in some cases would cost tens of thousands of dollars per year for a maximum of just $6.50 per script for concession card holders or a maximum of $40.30 for non-concessional patients. Patients receive free or reduced-cost scripts once they reach the safety net. Ninety-one per cent of PBS scripts each year, or 186 million scripts, are dispensed to concession card holders, including pensioners and low-income earners, meaning they pay no more than $6.50 per script for medicines that without a subsidy would cost them much, much more than that. Twenty per cent of scripts for concession card holders, or 37 million scripts, are free of charge because patients have reached the safety net.

Since coming to government in 2013, we have invested $10.6 billion to list over 2,100 new or amended medicines on the Pharmaceutical Benefits Scheme. We are averaging 31 new or amended listings per month—approximately one per day. Many medicines would cost hundreds of thousands of dollars per year and would be out of reach for many, but, through the PBS, general patients will pay $40.30 per script, or $6.50 per script with a concession card. Recent new PBS listings include medicines for lung cancer that were costing patients $88,000 per year; for cystic fibrosis, $300,000 per year; and for arthritis, over $16,000 per year. Recent new PBS listings costing $67 million include Botox, which will have its current PBS listing extended to include adults with lower-limb focal spasticity following a stroke. More than 2,800 patients per year are expected to benefit from this listing. Without the PBS subsidy, patients would pay more than $5,400 per year for this treatment. In August, another key listing was Avastin, for relapsed or refractory glioblastoma. Around 890 patients with relapsed or refractory glioblastoma will benefit each year. Without the PBS subsidy, the $31,200 per course of treatment would have been borne by the patients. Avastin treats brain tumours that are resistant to previous treatment and it is very important to patients with relapsed or refractory glioblastoma.

Sprycel is for acute lymphoblastic leukaemia. The Morrison government is extending the current listing of Sprycel to newly diagnosed patients with Philadelphia chromosome positive acute lymphoblastic leukaemia. Without the PBS subsidy, around 88 patients might pay more than $51,000 each year for this medicine. Through the PBS, they will pay $40.30 or $6.50 per script.

Another treatment listed on the PBS is Actemra. This listing will directly benefit patients who have an inflammatory disease affecting the large blood vessels of the scalp, neck and arms. This charge could benefit an average of 852 patients per year and, without this PBS listing, patients like Alistair would otherwise have paid more than $10,200 for each course of treatment.

In Australia, one in 2,500 babies are born with cystic fibrosis each year. That's one every four days. Sadly, there is currently no cure. Kalydeco has been extended and added to the PBS listing and is now available to patients aged 12 to 24 months with cystic fibrosis. Kalydeco lessens the viscosity of mucous in the lungs, helping patients to breathe more freely. Without the PBS subsidy, patients might pay up to $300,000 per year for this medicine.

Labor stopped listing medicines in 2011 because they could not manage the economy. The 2011-12 portfolio budget statements explained that the listing of some medicines would be deferred 'until fiscal circumstances permit'. This included medicines for chronic obstructive pulmonary disease, endometriosis, IVF and asthma, among others. A strong economy ensures that the Morrison government is able to invest in essential health services. If you can't manage the economy, you can't manage health. The Morrison government's plan for strengthening Australia's world-class health system is providing Australians with access to quality medical care, record hospital funding, affordable life-changing medicines and breakthrough research for new drugs and treatments.

Medicare is funding at record levels. Almost nine out of 10 Australians who visit the doctor have no out-of-pocket costs with their GP. Bulk-billing is at a record rate of 86 per cent, up from 82 per cent under Labor. In my electorate of Reid, 93 per cent of GP visits were bulk-billed last year. That's over a million visits to the doctor in my seat alone. Hospital funding is up 60 per cent since Labor left office in 2013, and the Morrison government is providing an additional $31 billion for hospitals from 2020-21 to 2024-25, to employ more nurses, doctors and specialists, delivering in partnership with the states and territories, and offering more surgeries and medical services. If you can't manage the economy, you can't manage health.

Anne Stanley (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the National Health Amendment (Safety Net Thresholds) Bill 2019. Labor champions fair access to health care for all Australians, including protecting our most vulnerable from excessive costs in medicines and health care. While Labor supports this bill, it won't fix the significant issues that many are facing in this country, with escalating costs of health care. That number is clear: 961,000 people a year delay or avoid taking their prescribed medicines due to cost. Recently, in my electorate office, the public face of these numbers came to meet with me. They are a pensioner couple, both over the age of 70, who regularly make decisions about which one of them needs the pain medication more, because they can't afford the cost every fortnight of both medications. How is this reasonable in a country like ours?

We know that this is not the best way for them to manage their health. Being in constant pain will curtail the exercise which will ultimately keep them as healthy as possible. For our older Australians, this is just not fair. A first-world country where citizens cannot get the best care possible because the government refuses to support them—that's the path we are worryingly heading towards in Australia.

How many drugs have been recommended for listing on the PBS by the Pharmaceutical Benefits Advisory Committee and not listed? Unfortunately for people with cystic fibrosis, they can tell you that Symdeko still hasn't been listed. The health minister promised those patients and their families it would be listed as soon as it was recommended by PBAC. Well, Minister, it's been six months since it was recommended by PBAC and it has still not been listed by this government—another group of patients waiting, and more broken promises by the health minister. Cystic fibrosis destroys the lungs and the nervous system. It can't be cured, but it can be treated with drugs like Symdeko. It affects one baby born every four days. For the six months that these babies and infants, and their families, have been waiting, another 45 babies have been diagnosed with cystic fibrosis. It's time for the government to make good on their promise.

I also note the election commitment from this government, for people with type 1 diabetes, that flash glucose monitoring—or FGM—would be added to the National Diabetes Services Scheme. Type 1 diabetes is an autoimmune disorder, and it is not curable. Again, this typically affects children, and it is a lifelong disease. It is a leading cause of blindness, amputations and renal failure. It's time this government recognised the benefits of the flash and continuous glucose monitoring systems. Instead of pricking your finger upwards of 15 times a day, FGM and CGM machines place a small disposable sensor in the body and read blood glucose levels once every five minutes. It's like pricking your finger every five minutes for a blood sugar result without the pain, the calluses and the inconvenience.

FGM and CGM are proven to drastically improve control for people with diabetes, and greatly assist preventing the additional complications that drain our healthcare system. Baker IDI calculates the annual cost to Medicare of a person with diabetes at $3,468. For people with complications, that increases to a staggering $16,698. This government would end up spending four times as much, or around $13,000 more per year. An investment of around $2,000 per patient could avoid those complications and costs, both financial and social, and allow those patients to continue to be part of our society and have great jobs.

The health minister promised the listing of flash glucose monitoring on the NDSS as of 1 March this year. Has it been done? No, not yet. I hope this was not just an election promise. People with diabetes and their families are waiting for this promise to be kept. It is currently over seven months late, and it has been nearly a year since this promise was made. People under 21 with diabetes have access to that technology, but what about those who are over 21? In March, when the Minister for Health intended on listing flash glucose monitoring on the NDSS, 32 countries around the world had already subsidised flash glucose monitoring. Diabetes is a lifelong disease, and should be supported for all of that time. As I've already pointed out, better management means healthier people and a better budget bottom line.

As Maria Craig, a professor of paediatric endocrinology at the University of Sydney, wrote in the InSight + magazine from The Medical Journal of Australia:

Type 1 diabetes is not a choice or a lifestyle disease. I can't see a reason why Australia wouldn’t follow other nations in subsidising technology that is proven to improve the lives of people with it.

However, this government will only support people with diabetes to access constant glucose monitoring until they are 21. Even then, people with diabetes do not have a choice.

However, there are exceptions. If you have a history of multiple episodes of severe hypoglycaemia, you may be eligible. But, distressingly, there have been anecdotal reports of people deliberately triggering hypoglycaemic episodes because they can't suffer the alternatives. By doing so, people with diabetes are deliberately risking permanent damage or worse, with the possibility of complications such as kidney failure, blindness, heart failure and perhaps death.

The PBAC has recommended also more than 60 treatments to be listed on the PBS. I wonder why the government continues to stand in the way of patients accessing these much-needed treatments at costs which are more reasonable. And what is the result? Nine hundred and sixty-one thousand people skipping their treatments because they can't afford them—children, families, brothers, sisters, mums and dads skipping medication because they simply can't afford it. There are families who are dealing with chronic and potentially life-threatening illnesses, and they have to think about the costs associated with the treatment.

And this just relates to the cost of prescription medicines; let's not forget if you have to go to a doctor to get that prescription. Look at the government's record on the cost of a GP visit. Since 2013, when the government was elected, the cost of visiting GPs has skyrocketed, on average, by 36 per cent. In New South Wales and Victoria, the average has actually increased by 39 per cent. This doesn't include the $7 GP tax the government considered in the 2014 budget, a proposal that was rejected by Labor. Instead, this government then continued with the Medicare freeze, another way to introduce the GP tax by stealth. The figures are even worse when you look at the cost of seeing a specialist. The cost of visiting a GP since 2013 has gone up, on average, 36 per cent, but for a specialist visit the increase has been, on average, 58 per cent. This government has overseen sharp increases in fees that Australians pay to visit a specialist. This is on top of the blowout over the same period in the time that it takes to see a specialist in my electorate.

I am sure many of us in this place frequently see constituents who ask us how they can afford to see their doctors and treat their conditions. Recently I saw a gentleman who, due to a significant injury, is on Newstart. He needs regular specialist appointments to assist with his conditions but he can't afford them and pay bills and eat. What do you say to a proud man who breaks down in tears in front of you because he can't pay for the medicines or see his doctor? Australia's sick and chronically ill are delaying and avoiding Medicare services due to cost. That's the hard fact from the government's own experts, the Australian Institute of Health and Welfare. What do you say to a family whose young son, three years old, is diagnosed with cancer and who, to be able to support him and look after him, have to run a GoFundMe page so that those treatments can happen? It shouldn't happen in this country. Ours is a country that prides itself on its access to health services and medicines that are affordable. That needs to continue.

I sum up by saying this government has not listed 60 drugs on the PBS despite PBAC recommendations, it's introduced a GP tax by stealth, it's allowed costs to see GPs to spiral out of control, it's allowed specialist visit costs to spiral out of control, and it's prevented people with type 1 diabetes having fair and equitable access to constant flash glucose-monitoring systems. When will this government consider health as a priority, as most Australians do, and support our health system for better outcomes? The government must stop further escalation in the cost of medicines, treatments, medical devices and the accessibility of health care. Australians deserve better for their health and for the health of our country.

Daniel Mulino (Fraser, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support the National Health Amendment (Safety Net Thresholds) Bill 2019. This is an uncontroversial bill that represents election commitments made by both major parties at the last election. It will reduce thresholds in 2020 from where they would have been. As earlier speakers on this side of the House have indicated, this is a welcome measure.

But, as earlier speakers on this side of the House have indicated, when we discuss measures such as this which are uncontroversial and relatively narrow, in addition to noting support for the specific bill it's also worth noting the broader context within which the bill is brought to the chamber. It's an honour to follow on from speakers such as the member for Werriwa, the member for Macnamara and the member for Macarthur who have so well laid out that broader context. In particular, they've laid out the major contributions of earlier governments to health policy and health service delivery, such as the creation of Medicare and not just the creation of that framework but also over many years the funding of many services within that framework. They've also pointed out failings on the government side, such as the 2014 budget with its unannounced proposal that wasn't taken to an election for a co-payment and other proposals that were not acceptable to the community and which were blocked by the opposition and those on this side of the chamber.

Those earlier speakers on this side have also pointed out how those failings have actually continued since that now infamous budget. I just want to put on the public record a few facts about where we in Australia find ourselves today in relation to the provision of health services. These are some basic facts which I think should be very concerning to everybody in this place and which should create an urgency for much more to be done. In 2017-18, Australians spent $9.4 billion on medicines and pharmacy products not listed on the PBS. That's money coming out of the pockets of people who are already feeling that their household budgets are under strain.

In addition to this, the government's own figures show that many Australians don't fill prescriptions because they can't afford them. What burden can there be on people, on people's lifestyles, for them not to take drugs that doctors have recommended and that they need because they can't afford them? According to the ABS, 961,000 people a year delay or avoid taking prescribed medicines due to cost. I say again: these are drugs which doctors or specialists have indicated to people that they need and that people clearly want, but they're delaying taking them or not taking them at all because of the fact that they can't afford the out-of-pocket expenses. Importantly, the rate of people skipping prescriptions is twice as high in disadvantaged areas as in less disadvantaged areas. This shouldn't come as a surprise, but those figures should be on the public record in this place because that inequality is something on which this parliament should be taking action. It's something which a bill like this, a worthwhile bill, an uncontroversial bill, but a very narrow bill, completely fails to address in any way whatsoever. So that's really the broad context within which we are debating this bill. This is a small, positive measure, but health policy is lacking.

As earlier speakers on this side have said, we on this side acknowledge the result of the last election, but when you look at the offerings of the two sides in this area in particular the difference couldn't be starker. The difference couldn't be starker when it comes to the assistance that this side offered to those who can't afford needed drugs and the assistance for out-of-pocket expenses that would have been offered and the vision this government have and the very narrow vision that's being offered by those opposite.

Let's look at mental health. Again, just to draw on one particular area of health policy, Allan Fels has put on the record that he sees mental health as an area which is particularly underdone. In Australia, the total mental health budget is itself only 6.5 per cent of the health budget when the burden of disease due to mental health suggests this should be closer to 14 per cent. So there are clear economic costs in this area. Again, if you are looking at the funding of drugs, mental health is an area where that failure is particularly stark. Allan Fels looked at the impact of that not just on income inequality but across the age spectrum. He knows that there are still serious questions about our 'investment in young minds', as he puts it. About 11 per cent of spending on specialised mental health services in 2010-11 was towards child and adolescent services, yet zero- to 17-year-olds constitute almost 23 per cent of the population. I want to put on the public record that there are a number of very serious—and I would say urgent—health issues that need to be addressed currently but that are—

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

Order! The member for Fraser is interrupted.