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

The original question was that this bill now be read a second time. To this, the honourable member for Hindmarsh has moved as an amendment that all words after 'That' be omitted with a view to substituting other words, so the question before the House is that the words proposed to be omitted stand part of the question.

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

Before I get fully into this bill, the Private Health Insurance Amendment (Income Thresholds) Bill 2021, I want to make a few comments about Australia's health system. I know that every member of this House will accept that Australia has one of the best health systems in the world bar none. We can go back as far as the pandemic of 1917, and the national response to that grew into other responses for improved health care, especially across the regions.

I've told this story many times, but probably not to this House. In regional areas I represent, as many Liberals and Nationals do, the number of incidences of women dying in childbirth pre-Second World War and just after was in the high double-digit percentages in regional areas. In the cities, it was in single digit numbers, and low single digit numbers. The response from local government councillors and state members at the time—I dare say, inspired by their federal members—was to say, 'We need particular care for the women in our regions,' and they introduced a system of bush nursing hospitals. On the introduction of those bush nursing hospitals, driven by local government and state government and community, who then raised money for their hospitals, those figures came all the way down to the national figure of women who died in childbirth. How did this come to my attention? I was speaking to a farmer in my electorate, one of nature's absolute gentlemen who has now passed away. He was talking about his first mum and second mum and third mum. I was a bit taken aback because of the conservative nature of the area and the family, and divorce certainly wasn't it. He'd lost two of his mums in childbirth—two, in that one family—so it made me go back and inquire as to the nature of this. It's been part of the system where Australians have always responded when their backs were to the wall or they had a need.

I believe in this case with COVID, while there'll be argy-bargy between both sides about who's done what and when they did it and how they did it and who should be blamed and who should not be blamed we are still running one of the best health systems in the world. We're a very wealthy nation per capita, and we're able to respond on behalf of our many, many communities. Australia is a nation of communities. We love to see ourselves as this one broad community, but we're a nation of small communities, and those communities will always band together in times of trouble, in times of fragility, in times when they're faced with a worldwide pandemic like we are today.

This very day in Victoria we are living through it again. There will be encumbrances, disruptions and fatigue for many people across Victoria and for those that have suffered over this last 18 months across the nation. We identify with you. We're not standing in your shoes. We haven't experienced exactly what you have. Our disruption is minimal. As a parliamentarian, my disruption is minimal compared to yours—the restaurants who bought all the food last week and have had to throw it out, all the people that made preparations and plans, and had hopes for the next few weeks, who have had to change their plans completely and all the people running around now, trying to make sure that they've done the right thing by the health system with their vaccinations. To those that are struggling in deciding whether to take the vaccination or not, or which one, I certainly identify with you too.

If I can just stay on the health issue, there will be people today in Victoria who, after a directive that if they are not vaccinated they can't work in certain areas, will be resigning their positions, and I feel for them too. Each one is making personal but sincere decisions about their future and their families' future and how it is to be handled.

When we say we have the best health system in the world it's because of the strategic nature of the changes that I think Stephen Duckett made whereby if you do not have the means to pay for private health insurance you will still be covered in this nation. If you're in trouble, you can ring for help. You can ring triple 0 in Victoria and you will get help. You will be hospitalised and you will be cared for because of the national system that we have. But the wealthier you become in this country, the greater the amount you pay for your health care. That's the Australian way. We have always done it that way. Does having private health care give you priority for elective surgery? Probably. But if you need that care in any emergency situation you will be looked after. You will be catered for. You will be cared for.

In so many countries in the world people cannot afford to get sick. Every parliament that I have been in since the Howard parliament has been the greatest friend of the Australian healthcare system. We as a nation should be thankful every day for this system that looks after our elderly, that looks after our most vulnerable, that looks after those that are in trauma, however that trauma comes, and that swings into action immediately we have any sort of threat to our society, be it bushfire, flood or pandemic, and is able to ramp up its service delivery to a nation in need. So, of course, we pay tribute to all of those who have contributed through the pandemic. We honour them and we thank them for what they've done and what we're calling on them to do again in Victoria.

There have only been three cases of community transmission today, which is a blessing. Let's hope there are none tomorrow and then none the next day, and state governments around the country will be able to relieve their restrictions on how people can move around the nation, because, until we have that freedom to move and begin to move, we cannot sustain the economic wellbeing of this nation. If some are completely constricted in their ability to move, everybody suffers. We need the opportunity to be able to not just move goods but move people, because people are the greatest wealth that this country has.

The national healthcare system has stood the test of time, from its introduction in 1970 until now, with all the changes that have been made. Is it expensive for government to run? Yes, it is. Is it contributed to by the broader community through private health insurance? Yes, it is. Is it supported by others who, under government direction, have to pay part of their wage in taxation that goes directly towards our healthcare system and, therefore, supports those who cannot support themselves? Yes, it is. I don't quite have the words for how important it is that a family knows that, if their child gets ill, the public health system will run in behind that family and care for that child, and it'll be the best care in the world, from the world's best specialists in every area of our health system. And, Deputy Speaker Mitchell, you know better than I do how important that is on the ground not just for the patient but for the parents, for the grandparents and for the broader family and for communities, who have great expectations.

If you live in a regional area, you're not going to have the broad benefits of living in a city in this nation; we accept that. But we do then overlay that with the Flying Doctor Service, we do then overlay that with very strong and large regional hospitals and then we put extra money into making sure we get the services out to the people.

This legislation makes private health insurance simpler to understand and more affordable for Australians. The government reforms have delivered the lowest average premium changes in 20 years, just 2.74 per cent in 2021. And wouldn't it be great if we could hold that even lower over the next two years so that families that do have private health insurance can have confidence in their own ability to gain access to hospital when needed? It would only be better for this nation if more people who had the funds were able to reduce the pressure on the public healthcare system by taking out private insurance, because that makes such a difference to the pressure on our hospitals. Even if you have private health insurance, you still may be treated in a public hospital because that particular public hospital may be where the best specialists are for the problem that afflicts you or your family.

So we still ask people to make a contribution, and what the Australian government is doing through this legislation is trying to make it easier and more affordable for Australians to have that confidence of being able to buy and support themselves through private health insurance. On the other hand, we're asking the private health insurers to make a contribution to the nation, as well, by streamlining the services they have and finding ways to reduce costs. We're keeping the pressure on the private health insurers to make sure they're delivering the best service that they can, from the premiums that they are given, for real value for the Australian people. And, whether it be in hip replacements or knee replacements or the equipment needed for that, there has to be genuine oversight and pressure put on so that those particular items do not burst out in costs which then comes back on to health insurers but then comes back onto those people investing in health insurance.

So the best healthcare system in the world, the best public healthcare system in the world, and the most generous governments of the day that support private health care. I remember having this conversation with Prime Minister Howard back before the 1996 election campaign. The changes he brought in then are still resonating with the Australian people today and supporting the Australian people today. This is another very good reason why the best place to be in the world at the moment is this great south land.

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

I rise to speak on the Private Health Insurance Amendment (Income Thresholds) Bill 2021. Importantly, the reforms outlined in this bill continue the current pause on the annual indexation of income thresholds for another two years, allowing for annual indexation thereafter. The pause provides stability for consumers and stakeholders regarding the operation of these important private health insurance incentives while a detailed study into the effectiveness of their operation is undertaken.

The bill amendments continue to secure the future of private health insurance by continuing to incentivise high-income earners to financially contribute towards their own healthcare costs or pay the Medicare levy surcharge and continues to incentivise customers to purchase and maintain private health insurance cover. This bill will further promote Australians' freedom of choice when it comes to health. It is designed to support the sustainability of private health insurance and, accordingly, is intended to promote individuals' access to health services.

The Morrison government has already delivered the most significant reforms to private health insurance in over a decade. The government's reforms have delivered the lowest average premium changes in 20 years, of 2.74 per cent in 2021. The government is committed to improving the affordability, value and attractiveness of private health insurance, particularly for younger Australians. It is demonstrating this through further reforms to private health insurance. The Australian government is investing $30.6 million over four years to continue to make private health insurance simpler and more affordable for Australians. This is in line with the Morrison government's commitment to delivering an even better post-COVID-19 healthcare system.

We should be ambitious for our healthcare system. A dream for an even better healthcare system is why I served on a local hospital board, Cabrini Hospital, before coming to this place. Cabrini is the only hospital in Higgins and it is a not-for-profit private hospital. As I said in my first speech, our healthcare system is already undoubtedly one of the best if not the best in the world. In fact, rankings worldwide show we're No. 2 in the world, and that is no mean feat. It is a unique and effective blend of public and private, where the private sector provides innovation and choice and the public sector provides a safety net for all. In our two-tiered system, the private health sector acts as both a complement and a substitute for the public health system. We take the best from the European system, which is more socialised, and the best from the private system in the US. We have a very good system which provides a good, high-quality baseline level of health as well as choices and options for those who wish to pay more for flexibility and accessibility in their insurance.

As a member of parliament representing a vibrant younger electorate and as a mother of four young adults, I know how important reforms to ensure a successful private health insurance system are, particularly for the young. The Morrison government is working hard to make sure our nation's private health insurance is simpler and more affordable. We on this side of the House are firmly committed to strengthening and simplifying private health insurance and making it more accessible. Our community rating system depends on these tenets.

The 2021-22 budget improves the sustainability of and access to the private health insurance system. To this end, we've included five initiatives.

Firstly, we will modernise the private health insurance prosthesis list by aligning prices paid by insurers more closely with public hospital prices to improve affordability. I cannot stress enough how important this major reform is and how welcome it is to the sector. The minister for Health, Greg Hunt, has worked very closely with the different players in the sector to make sure that we deliver an outcome that is going to be well received by everyone across the sector.

Secondly, we will improve the private health insurance rebate modelling capabilities through better data and behavioural insights. By using the most up-to-date evidence and insights, ultimately we'll provide more value for money for consumers.

Thirdly, we will optimise the private hospital default benefit arrangements by funding an independent study of the current settings, to ensure that access to and the cost of private hospitals is optimal for consumers. Fourthly, we will apply greater rigour to certification for hospital admissions, to resolve disputes between insurers and care providers when patients are hospitalised for care normally delivered out of the hospital—and I know how this issue does keep boards up at night.

Fifthly, and importantly, we will continue the income-tier thresholds for the Medicare levy surcharge and private health insurance rebate for two years to 1 July 2023 and undertake a review to ensure that the settings of these important incentives support affordability of private health care. The bill means that, for the next two financial years, the private health insurance rebate income thresholds remain unchanged at $90,000 for the base single policy and $180,000 for the base family policy until 30 June 2023.

This progress continues on our second wave of reforms to private health insurance, implemented over years. It is indeed a complex set of negotiations that the minister for health has pursued and delivered. We've already increased the age of dependents able to stay on a family policy, to encourage younger people up to age 31, and also people with a disability, to maintain their private health insurance.

I'd like to provide an example of how this legislation has helped people in my electorate. A Higgins constituent waiting for public-listed appointment for his epilepsy had a serious, life-threatening fit when he was overseas in Chile. This was because he'd been a patient at a children's based public hospital and had not yet transferred his care to an adult based public hospital. This young man had been waiting for a long period of time in the public health system. He'd finished university and was in the first year of his job. Private health insurance wasn't one of his financial priorities. It's very understandable for young people, when they're getting their first pay packet. But, as a result, he waited longer than was necessary for an appointment. He ended up not getting the medication adjustment that was needed, and he had a seizure. That young man happened to be my son. So I was delighted to see that this legislation would apply to him and that he would be able to be brought under our family private health insurance until the age of 31. As a mother, it gives me comfort that he'll be able to have private health insurance and continue to have choice and opportunity and access to a quicker appointment to make sure his epilepsy is kept under control.

We also know that research shows that individuals who've been introduced to private health insurance have a higher likelihood of renewing their insurance in the future, and I'm hopeful that my son will get used to having his private health insurance and enjoy the benefits, and that, when he gets to the age of 31, he'll be at an age where he wishes to invest in his own health future through private health insurance. We know that our community based rating system relies on the young engaging in a private health insurance scheme.

We've also expanded funding for at-home and community based mental health care, so insurers can pay for non-NDIS services such as payments to mental health nurses and subscriptions to mental health apps. We know the explosion of mental health apps that are now available. It means that people can access them in their homes, remotely, in rural areas and across the suburbs and cities of our country. Mental health apps are a welcome addition to the digital health technology that is exploding around the world. This helps to make it easier for people to access mental health apps, particularly when they may feel they don't want to leave their front door in order to get help.

We've undertaken consultation for expansion of home and community based rehabilitation, to encourage a shift from hospital to home and community based care when it is appropriate for the patient. This is something that I have been a great champion of, through my medical experience in my past profession. Patients do want to be treated in their home, and, if they can get home quicker after being hospitalised, that is something we should continue to support and welcome. In fact, as a paediatrician, Hospital in the Home was pioneered at children's hospitals right across this country and is now being taken up with enthusiasm by the adult sector and, as we can see, the aged-care home sector as well. People want to be in their homes. They want to be supported by the flexibility that home provides for them, and they do have a sense of wellbeing being at home rather than being in a hospital setting.

We've invested $2.4 million for actuarial studies of private health insurance incentives, including lifetime health cover and risk equalisation, to investigate where the incentives to take out and maintain cover are, to encourage insurers to help patients prevent illnesses and so that hospitalisations are at the optimal level. The transparency of out-of-pocket costs has been improved thanks to the Medical Costs Finder website. The website will be enhanced through an investment of $17.1 million, with the Medical Costs Finder tool to collect, validate and publish individual medical specialist fees. I was at the launch of this just before COVID, and I think this has been incredibly welcomed both by consumers and by the medical healthcare system right across Australia.

Since these reforms have been implemented, over 465,000 young Australians have received an aged based discount of up to 10 per cent on their premiums. Over 13,500 policyholders have benefited from improved access to higher benefits for psychiatric care through the government's mental health waiting period exemption, allowing people to upgrade their mental health services without serving a waiting period. Over $160 million in benefits have been paid to achieve this end. An additional 35,000 policyholders in regional areas have received a total of $3.1 million in benefits through improved travel and accommodation to facilitate access. The results speak for themselves.

The act makes provision in relation to the setting and annual indexing of private health insurance income thresholds used to determine government funded rebates announced that may apply to consumers with eligible cover and the Medicare levy surcharge income thresholds and rates. The Medicare levy surcharge is levied on Australian taxpayers who do not have private patient hospital cover and earn above a certain income. The private insurance health rebate is an amount that government contributes towards the costs of singles' and families' private health insurance premiums. The rebate and Medicare levy surcharge are income tested, and that is as it should be. The act describes how annual indexation of private health insurance income thresholds is calculated using an indexation factor. Additionally, it specifies the private health insurance income thresholds for both singles and those in the family status. The act also specifies the formula for applying indexation across the income thresholds each financial year.

The coronavirus pandemic has shown us all the importance of our world-class health system. Indeed, Australia's health system continues to be one of the best in the world. I know Australians knew that before the COVID pandemic, but you can bet your bottom dollar they certainly know it now. Continued investment and reform by the Morrison government into private health insurance proves our commitment to affordable and flexible options for all Australians when choosing private health insurance. This bill goes even further to support Australian families still recovering financially from the height of the COVID-19 pandemic and lockdowns, and my heart goes out to those in Melbourne and Victoria who are actually working through the problems that they deal with in lockdown. This bill reflects the hard work of the Morrison government to ensure the improvement of our private health system is as an accessible, affordable and fair system for all Australians. I commend this bill to the House.

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

I rise in support of the Private Health Insurance Amendment (Income Thresholds) Bill 2021. In Australia we have a very hybrid system of health delivery. We have a large public health system through state-run public hospitals. We have the Medicare system, where people get a payment which can be up to zero dollars if they are bulk billed or where they get the cost of their medical care as an outpatient to general practitioners and specialists subsidised by the Medicare system. Then we have another arm, which is the Pharmaceutical Benefits Scheme, which is the envy of many First, Second and Third World countries, where the government subsidises the cost of drugs that are approved to go on the Pharmaceutical Benefits Scheme which are proven to be effective and cost-effective and to deliver a quality-adjusted life-year benefit to the recipients. It's a very high threshold, but the scheme is respected around the world, because in Australia we get the benefits of some amazing, cutting-edge drugs that cost people in other countries—in North and South America, Europe and Asia—hundreds of thousands of dollars.

Part of the success of the hybrid system that we've got is the private health insurance rebate, which keeps a lot more people engaged in private health insurance who are young or who have fixed low income—perhaps income support from the government through the age pension—and would otherwise struggle to maintain private health insurance. But the whole system relies on a certain number of people taking up private health insurance. The analogy I always make is with car insurance. If the only people who held car insurance were ultrawealthy people or people who are likely to have a car crash, you can imagine that car insurance wouldn't work very well. We have compulsory third party. We have lots of competition. Pretty much anyone with a car has got a minimum level of insurance. That's why it's important in our hybrid system to keep the private health insurance system affordable and viable. We have done a lot of reforms to make sure that is the case. One of them is the rebate system. It is a tiered system based on declarable income, and it is working. The indexation of it went into a freeze sometime ago, but this bill enables that freeze of the rebate levels and the thresholds to remain the same.

As well as that, people should realise that we have done so much to reform private health insurance. We have introduced simplified clustering of products, into gold, silver and bronze, so that people can make headway in deciding what level they will choose. We have had reforms around the Prostheses List, which was good in intent but was being disruptive and counterproductive because some entities were charging the full cost for prostheses yet receiving them at a much lower price. There was quite a large price differential between the public hospital prices for prostheses and the private hospital prices. We've done lots to increase affordability of private health insurance and the involvement of young people in private health insurance, by extending the time that young people can remain within their family's cover. Historically you could remain within that cover until you were no longer dependent, but now you can remain within it until just over the age of 30. To cover for mental health, for young people there is a 10 per cent discount for private health insurance.

We've done other things to reform the health system that people are probably now realising the true benefit of in the COVID world—it has changed everything. Telemedicine has been reformed and is now part of regular practice. It has developed efficiencies for both patients and the health system. In the Pharmaceutical Benefits Scheme a reform went through—not in this last budget but in the budget before—which was an extra appropriation so that there is leeway to get more new drugs onto the PBS. Old drugs drop in price because they've been around for a long time and their patent has expired, and there are competitor drugs. This reform has allowed it to be a much quicker process to get new drugs onto the Pharmaceutical Benefits Scheme.

But, if we didn't have the private health system, which is underpinned by private health insurance, our public hospital system would be overwhelmed. Everyone knows about waiting lists. In my electorate, in the last figures I saw a couple of years ago, 48 per cent of people in my electorate, the wonderful Lyne electorate, had private health insurance of some type. I have the oldest demographic in the country, I might add, and we know a lot of the health activity and economic costs are tail-ended. It's in your senior years where most of the big costs in your health expenditure as an individual and your family happen. There's a big bit at the beginning when you're first born, with obstetric cover, but then when you get into the replacement things like hips, knees, joints, cardiac surgery, cancer treatment, it's all weighted to the end. If we didn't have those people covered by health insurance, that would all be bundled onto the public health and hospital system. It is a hybrid system. Our waiting lists that are way too long in many public hospital systems would be much longer if it wasn't for the ability of people to take control of their own health and take out private health insurance.

The amendments continue to secure the future of private health insurance. We incentivise people with high incomes, who can afford it, to take out private health insurance; otherwise, there is a Medicare levy surcharge to be paid. It's a bit of carrot and stick. Like I said, private health insurance must remain viable and that's why the prostheses list changes and reforms are in place. That's why we have young people staying in through their family cover. When I started my early post-university and employment career, private health insurance was more affordable. Everything was more affordable a long time ago, but these days people are trying to get rid of their HECS debt, pay their taxes, pay their high rents, which are incredible in the city. It's really quite scary the amount of money that young people now pay for rent in metropolitan cities. All of those things mean that often the first thing that falls off a young person's budget, because it's so far in the distance, is private health insurance; a lot of young people are dropping out of it. I have a lot of pensioners in my electorate who agonise over whether they'll keep their private health insurance going, and the rebates for them is a really big deal. The other thing is, those young people who choose to drop off, which means there are fewer healthy people lowering the overall cost of the system, we need them to stay. So that's why some of these figures, the lowest premium increase for ages—2.7 per cent, less than three per cent—have been a really good outcome.

The Medicare levy surcharge is levied on people who have a taxable income threshold currently of $90,000 for a single person and $180,000 for a family policy. They're being frozen for another two years, from July 2021 to July 2023. The indexation amount that has been pre-determined across those three tiers will stay the same until that same time. These are really important issues because we want to have a stable, reliable, health system which, as I said, relies on all those arms. It is very important this bill passes to maintain that sustainability. I commend the bill to the House.

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

I rise to speak on the Private Health Insurance Amendment (Income Thresholds) Bill 2021, and I wish to contribute to the debate. During this debate I've heard members on both sides of the chamber telling people to get injected with COVID vaccines. I believe that unless we are a qualified medical doctor we have no position to tell anyone to take any medical treatment or not to take any medical treatment. All that we should be doing is advising that COVID vaccinations are provided free—that is, they are paid for by the taxpayer out of government revenue, or should I say currently borrowed government revenue—and you should consult with your doctor to make an informed decision. It should not be up to us as members of parliament or anyone else without the medical experience or qualifications or knowledge to be making recommendations as far a drug goes.

What also has concerned me during this debate has been the perpetuation of the myth that, somehow, someone who is so-called fully vaccinated is immune and is totally safe from the COVID virus. We know from data from the USA that that is simply not true. So far, the US data from their Centers for Disease Control—firstly, they note what they call a breakthrough infection, they note that the number of COVID-19 vaccine breakthrough infections reported to the CDC is likely to be an undercount of all SARS-CoV-2 infections among fully vaccinated persons. So they acknowledge that data they print is likely to be an undercount. That data shows that, so far, there have been 1,758 people hospitalised in the US specifically because of COVID infections. They have been so-called fully vaccinated. Of that number, 366 people have died in the USA who were so-called fully vaccinated. So the idea that being fully vaccinated gives you some sort of complete protection is a furphy. Yes, the evidence shows it gives you some protection, but it is not 100 per cent protection.

Another furphy being perpetuated is that, somehow or other, high rates of vaccination in a population means that you can open up. Again, let's have a look at what the evidence is showing. From Forbes magazine:

Countries with the highest vaccination rates—including four of—

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

Order! Member for Cunningham, are you seeking to speak?

Sharon Bird (Cunningham, Australian Labor Party) Share this | Link to this | Hansard source

I'm just wondering about the relevance rule on debating bills. To my colleague, the member for Hughes: it's actually on private health insurance.

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

The member for Hughes is reminded that it is about private health insurance.

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

On the point of order, this is a subject that was widely debated by many other speakers earlier in this debate, and I believe I am totally able to raise these issues as they have already been raised through this debate. I'm quoting from Forbes magazine:

Covid Surges In 4 Of 5 Most Vaccinated Countries …

Countries with the world's highest vaccination rates—including four of the top five most vaccinated—are fighting to contain coronavirus outbreaks that are, on a per-capita basis, higher than the surge devastating India, a trend that has experts questioning the efficacy of some vaccines …

It notes:

Of the Seychelles, Israel, the UAE, Chile and Bahrain—respectively the world's five most vaccinated countries—only Israel is not fighting to contain a dangerous surge in Covid-19 infections.

It goes on:

Controlling for population, the Seychelles and Bahrain, alongside other highly vaccinated countries like the Maldives and Uruguay, recorded the highest number of daily coronavirus cases worldwide.

So the idea that there is somehow a great correlation between high rates of vaccination and opening up your country and having low rates of COVID infection is simply not borne out by the evidence.

Also, coming back to what has been discussed by other members of parliament during this bill, about recommending that someone should or should not have a medical treatment in this country—with many treatments, of course, covered by Medicare—I think we should note what a few doctors are saying. A Dr Damian Wojcik of New Zealand said only in the last couple of days, and I quote directly, that, in the five months to March, 4,434 deaths have been reported to the US adverse reporting system. This is more than the total combined number for all vaccine deaths in the preceding 10 years. It is 113 to 165 times the number of deaths than the annual flu vaccine. He went on—again, a direct quote:

By way of comparison, the attempted rollout of the swine flu vaccine to 19 million Americans in 1976 was halted immediately after 50 deaths and … 500 cases of severe paralysis.

He said that one would anticipate that, with this data, there would be an 'immediate halting of the COVID vaccination program, but it seems not'. He said some would say this is the 'price we must pay' to end the pandemic. To this he would say, and again I am quoting Dr Damian Wojcik:

… not on my watch, not in my patients. My patients are living persons with names and families, not laboratory rats to be sacrificed in a global vaccine experiment.

Professor Peter McCullough, MD, MPH, FACP, FACC, FAHA, FNKF, FNLA, a professor of medicine from the US, stated only a few days ago, 'I can no longer recommend the vaccinations to any individual.'

Now, I don't know with these doctors are right or whether they are wrong. But I do know that I do not believe in the concept of ignorance is strength. We should be able to debate these doctors' views, not vilify them, not criticise them. We must look at the evidence calmly, with clear heads, and look at the data. Unfortunately, that is not happening in our society today, and we are all the poorer for it.

I'd also note that, when it comes to the fantastic Medicare system that we have in our country—probably second to none anywhere around the world—the sanctity of the doctor-patient relationship is absolutely critical to its success, and I have been greatly concerned that we have state government chief medical officers that have violated the sanctity of the doctor-patient relationship. Nowhere have we seen that more than in the state of Queensland, where they have criminalised a doctor for prescribing hydroxychloroquine to a sick patient. That is the current state of play for a doctor in Queensland who looks at the evidence, studies the evidence, speaks to doctors overseas, sees the success that they are having with hydroxychloroquine as a treatment, understands that many countries around the world have that in their protocol, looks at the 29 early treatment studies of treatment by hydroxychloroquine, sees that 100 per cent of those studies report a positive effect and that the random chance of that happening is 537 billion to one. That's the random chance of it being an effective treatment. But, if a doctor in Queensland, using his ingenuity and his research and his skills and his ability, thinks, 'This treatment would be best for my patient,' there is legislation in place that threatens to send that doctor to jail.

That is a violation of the sanctity of the doctor-patient relationship, and it goes against the principles of everything that Medicare stands for. We must do this on the evidence, on the research, on the data, on the science, not on the emotion and the politics because that is where this decision has come from. So I call on the Chief Health Officer of Queensland and the chief health officers of all states to look at the science, to look at the evidence, especially when it comes to early treatment, and to remove their bans from allowing doctors in this country to prescribe hydroxychloroquine. That is fundamental to the promise that we in this federal parliament give to all Australians with our Medicare system. I thank the House.

Josh Wilson (Fremantle, Australian Labor Party, Shadow Assistant Minister for the Environment) Share this | Link to this | Hansard source

I'm happy to make a contribution to this debate on the Private Health Insurance Amendment (Income Thresholds) Bill 2021 and to do so in support of the second reading amendment moved by the member for Hindmarsh. These are some relatively minor but welcome changes in relation to the indexations that are part of our private health system. Private health funds form part of our health system as a whole, which has always been a hybrid model. We have private and public health in this country, and together the public health system, at the foundation, and then the private health system on top of that seek to deliver three things to the Australian people. At the very top of that list is quality of care. I don't think there's any doubt that, in all of our lives, the building block of wellbeing, the foundation on which our ability to be at our best and to pursue our lives, our interests and achieve our potential, is good health. As far as public goods go, in my view, it's what comes first. When you think of the great public goods like education, our environment and public health, I think most people would agree that health is what you need to achieve first and foremost. So you want the best quality of care, and Australians have a right to expect that.

It's entirely reasonable that people have choice in their health care. In the most dire circumstances, emergencies, essentially the system takes care of you. If you have a bad accident, you will be collected in an ambulance, you will go to emergency and you will receive the kind of high-quality care that's available in the Australian hospital system. You probably won't know too much about it and you won't have to make a choice. But there are other kinds of health care where choice is relevant, and people should be able to make some choices with respect to their health care. The private system does enable that. Then of course there's the issue of cost management. It's not just cost management for individuals, but cost management for the nation and the system as a whole. Someone, such as a primary school student when they first understand the health system and its public and private components, might be forgiven for thinking that the public part is the only part that draws on the public purse, and the private part is essentially paid for by the individual. That's not the case. We support, with Commonwealth assistance, those who choose to have private health insurance in one form or another. The cost picture, the cost to Australia as a whole, is made up of and the costs are drawn from both the public and the private system.

It's interesting to note that, again, someone might think that if you had a system with a higher private-to-public mix then that would draw a smaller amount from the public purse, but there's actually evidence to the contrary. I think the United States is the best example of that. The United States has a significantly less universal form of public health than we have in Australia, and yet government expenditure on health in the United States is considerably more than it is here. So, I think there's not much doubt that our health system, as it has evolved, is a comparatively strong one, and people who've travelled to other parts of the world may well have had some experience of that. For it to remain strong, we need to keep tending to it. We need to keep looking at the various settings and costs and the way in which it changes over time, because health care is one of those areas of life that is changing all the time. There are new pharmaceutical treatments, new diagnostic treatments and new forms of surgery. It will come as no surprise when I say that most of them are at the cutting edge. The more innovative ones come with an appropriate price tag attached, and that's something that needs to be managed.

The pandemic has allowed us to see various aspects of our life in Australia under the magnifying glass, as it were, and that includes our health system. When decisions were taken in March and April last year to prepare for and manage what could have occurred if the virus had really got off the leash in Australia, one of the decisions made was to stop certain kinds of hospital procedures, to essentially free up capacity in our health system and in our hospital system in particular for what might have been a more dire form of infectious spread in Australia. That meant cancelling elective surgery, and I think people understood the logic of that. For some private health providers, though, it put them in a very difficult position, because their model is dependent on providing services that are paid for by the people who go and have the elective procedures that are covered by their insurance. My understanding is that, in some cases, private hospitals not surprisingly gave indications that they might need to shut down a little bit more comprehensively than the health authorities were anticipating. Health authorities were hoping that everything would go dormant as far as ordinary healthcare activities were concerned and would be there ready and waiting for what might have happened if the virus had really spread throughout the Australian community. When the private health providers gave some indication to government that they might shut down a little bit more seriously than that, that was an issue. It was certainly true in Western Australia and I expect it was in other jurisdictions. But that was an issue that needed to be managed, and government had to find a way to encourage that private capacity to remain online. At that stage we were looking at ICU capacity and ventilators. I remember a conversation in WA when we were briefed about how many ventilators were available, and at that stage there were perhaps only a few hundred. They were trying to bring more online, because we know at the very acute part of the COVID-19 disease it is the provision of oxygen and a ventilator that can keep you alive.

I do note that in what may have been phase 2 or phase 3—it's hard to keep track, really—at some point around April or May, all of us were dealing with the issue of cruise ships and shipping based infection. It seems like a long time ago now, but we had the Artania in Western Australia, a ship that had a significant infection issue for both passengers and crew. I think it was the Joondalup private health facility that was essentially put aside to deal with that, to be the dedicated facility for the passengers and crew who needed to be treated who were coming off the Artania. That whole healthcare exercise was seen through with an extraordinary degree of success. It was controlled. There was no infection outside of the hospital. I don't think that any of the healthcare workers were infected, and all of the people who needed care were provided with care. Many of them, I think, German and Italian citizens, were ultimately able to fly home, and the crew were able to in some cases fly back to the Philippines and in some cases be returned to the ship. That was an instance where our private health facilities or capacity was marshalled and drawn upon in a sensible and well-organised way to deal with that particular aspect of the pandemic. It's those kinds of things that we're likely to need to draw more on in the future. As we're seeing right now with the circumstances in Victoria, nobody can be sanguine about the progress of this pandemic, its future, how it will develop and what other challenges we will see.

What has been clear is that when we think of health care it's not just the high-end medical expertise that is crucial; there are a lot of things involved in delivering health care that are in that practical or logistical category that probably aren't that different from many other areas of life. It's about anticipating what may occur, stocktaking the resources that you have—human capital, equipment and, in the case of hospitals, obviously beds, ventilators, oxygen machines, PPE, pharmaceuticals, all of these kinds of things—and then there's the scheduling and administrative side of it. We are seeing at the moment some aspects of that administration being examined because they haven't delivered what we may have expected, and we cannot have a situation where we're not able to say how many people have been vaccinated within a particular cohort. We must be more effectively proactive in reaching out to ensure that vulnerable cohorts are vaccinated, and certainly we must be able to have, pretty much at the tips of our fingers, the details as to how effective those programs have been. We can't have a situation where, as I understand, the responsible minister in Senate estimates today just simply isn't able to give some numbers about people in certain categories of aged care, whether it's aged-care residents or aged-care workers or people in residential disability care. If you're not on top of that kind of detail, it speaks to the administrative competence or the administrative solidity that is underneath our vaccine program.

We need to be able to, using all the resources that we have—our public system, our private system, doctors and nurses, public servants in the relevant health departments—to identify what should be occurring. Obviously frontline workers should be vaccinated. People in residential aged care should be vaccinated. Their carers should've been vaccinated. That should've occurred already in almost all of those categories. We're discovering now that it isn't the case, and we're seeing some of the consequences.

The numbers today are encouraging. I think we all saw 11 infections yesterday and some of the statements made by Victorian Health with a lot of compassion and concern and trepidation about what might be ahead, so to hear today that it's only three gives us some hope. And we can take hope from the way the Australian community has responded through the 17 outbreaks and lockdowns to date, because, however difficult they have been, we have managed to get to the other side. But we should learn the lessons when these things occur. This has shone a bright spotlight on some things that I think have surprised all of us. We expected that you wouldn't have aged-care workers working across multiple sites last year. That apparently changed, and then it apparently changed back, and it's very hard to understand why that's the case, not least because we know the consequences of that. And it's not on the aged-care workers; the only reason aged-care workers do that is because they're paid a pittance. They're not properly supported and remunerated in the vital work that they do, and they have no choice other than to work in multiple centres.

This bill makes some minor but important changes to our health system as a whole—obviously the private health aspect of it, particularly in relation to the indexation of certain income thresholds, and we support it on that basis. Obviously I support the second reading amendment that's been moved by the member for Hindmarsh.

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

The debate is interrupted in accordance with standing order 43. The debate may be resumed at a later hour.