Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Hansard source

The bill before us is a bill amending the Private Health Insurance Act 2007 to pause the income thresholds that determine the tiers for the Medicare levy surcharge and the rebate on private health insurance at 2014-15 rates for three years. We know this is part of a wider plan from the government to pause all increases across the board across various elements of legislation. We will be supporting this legislation. We on this side have actually looked at the budget very carefully and we had determined that there were elements of savings that should be supported, and this is one. So before there is any confusion in the chamber about what the position of Labor is on this point, and before we hear any strong contributions be urging us to support this very important piece of legislation, I just want to make it clear at the start: we are supporting it. However, in supporting the bill, we want make it very clear that we think that this is a context and we want to talk about the context in which this particular piece of legislation is brought forward.

I cannot help but remember when we as a government brought forward the legislation in 2012 to introduce means testing to private health insurance and heard the portents of disaster, the allegations and the accusations that reverberated around this chamber that that would be the introduction of a means test—a means test that we thought was fair and necessary to be scrupulously looking at budget issues across our system. We brought forward the means testing to this place and we heard debate here that said that this would be 'the end of private health insurance in our nation'.

The bill was sent to the Community Affairs Legislation Committee to consider the impact of introducing the means test—the means test that we are looking at today in terms of freezing the rates. In those hearings we had across the country streams of witnesses were brought forward to us saying that introducing a means test into the private health insurance sphere would be completely negative; that we would not see any further progress in private health insurance in this nation; and we would see queues of people at all the public hospitals across the nation because they were being forced out of private health insurance by this outrageously—and I use the adjective which I hate, but it is a direct quote from Hansard'draconian' piece of legislation that the evil government was imposing on the community. In fact, I draw people's attention to some of the comments that were being put around at that time. In the other place we had quotes by the opposition health minister of the time quoting from analysis. He said that they predicted that:

… in the first year, 175,000 people would withdraw from private hospital cover and a further 583,000 people would downgrade their private cover. Over five years, they predict that 1.6 million Australians would drop cover and 4.3 million would downgrade their cover.

I think it is important in this debate, where we as a considered opposition are supporting the government in this process to effectively look what is happening in our medical system across the country and in particular in private health insurance, that we have a look at what the reality was as a result of the 2012 changes. It is a fact that those portents of disaster that were put in this chamber just did not happen. The number of Australians with private health insurance continues to increase. In fact, it is at its highest level ever and continued to increase in spite of that change. So Labor at that time was able to introduced changes that improved the budget bottom line by more than $20 billion without gutting Medicare and without hundreds of thousands of people that were supposed to be going to cancel their claims cancelling their claims.

However, one of the deep concerns that I raised at the time of that debate—and I continue to raise—is that I am unsure and continue to be unsure about the confidence that people in this country have in private health insurance. I am concerned that people do not understand their own cover. I believe that there continues to be confusion in that area. I am not going to go into that debate now, because it is not of automatic relevance to this process, but I think it is an ongoing discussion for us. We support private health insurance. We support the fact that that is an integral part of our health system. However, I am deeply concerned and continue to be that, while people talk a lot about their cover and talk a lot about private health insurance, there continues to be some lack of knowledge in the community about exactly what their cover includes. It continues to be an issue. We have raised this at times certainly with Medibank Private while they still continue to be able to come to Senate estimates and we can talk with them. That may not be the case for much longer—and that is a piece of government legislation that the opposition will not be supporting. We have raised this consistently in terms of people understanding exactly how the system works and operates. One thing at this stage when we are freezing the rates of increase is that there could be an element of explanation required for the wider community to make sure that they know exactly what is happening and exactly how the process is going to operate.

Apart from my general concern and I think everyone's concern about the impact on the community of freezing the rate, one of the things that does worry me is that this, yet again, has been proclaimed by the government as savings that will be 'harvested' but will not be going back into the wider Medicare or wider medical system.

We know that the reason the government have put forward consistently for all these changes, the reason for all these savings, is the lack of sustainability of our current health system. We have heard statements made in this place and others about the dire state which our health system faces at the moment and into the future. These are facts that have been continually questioned, most recently in Australian Institute of Health and Welfare studies which do not reveal a crisis or a lack of sustainability in our medical system. Nonetheless, the government continue to say that they need to make these savings to ensure that our medical system continues to operate. However, the savings out of this measure to freeze rebate rates are not being returned to our medical system across the board; they are going to the Medical Research Future Fund.

Labor strongly support medical research. Look at our history; you will see that we have strongly supported medical research. However, this fund is one that we are still trying to understand. We are still trying to understand how this Medical Research Future Fund is going to operate.

We know that there are a whole range of savings measures proposed that are impacting on our health system. There is the $7 GP tax for every single person that goes to visit their GP—and, as we have found out through continually asking questions, it is not limited to savings that will be made by the government when they harvest all the $7 paid out by people going to see their GPs; it also relates to the pharmaceutical savings that are there, by increasing the amount of money people have to pay. But also, as we have found out and as has come out in quite a few contributions recently, the fact is that the new GP tax will not just be on visits to the GP. We know that it is going to be applied every time anyone accesses medical imaging services or any kind of testing.

Through the Senate Select Committee on Health and evidence from the Australian Diagnostic Imaging Association, information has come out which is extraordinarily confronting in this context, because one of the areas where people often do use private health insurance—and complain about the lack of the return—is when they are going through the complexities of having medical tests. Documents tabled by the Australian Diagnostic Imaging Association showed that previously bulk-billed patients will now face up-front costs of up to $1,263 for liver cancer diagnosis, $1,326 for thyroid cancer diagnosis, $2,207 for liver metastasis diagnosis and $712 for breast cancer diagnosis. These are deeply concerning figures that have been put out, and people have had to look at their own circumstances to see how they would cope with this kind of impost in terms of their own medical costs when they are desperately seeking services.

Those are the kinds of savings the government is talking about. But all of those savings, rather than going back into the medical system—which the government has described as being unsustainable and a danger into the future—is all going into the Medical Research Future Fund, and we still do not know how it is going to operate. What we do know, and we found this out through Senate estimates, is that not a lot of consultation went on to establish what this medical research fund will look like, how it will operate and who will be deeply engaged in it. If we are talking about savings, significant savings—not as significant as the means test that we introduced in 2012 in the budget but, nonetheless, significant savings, which we are supporting in this case alone, in this particular process; we are not supporting the others—we should know, we should have some certainty about, where the money is going and how it is going to benefit the community.

One of the things that did concern me is that through the Senate estimates process we found out that medical research bodies, including the highly regarded National Health and Medical Research Council, which is one of the bodies that have the greatest knowledge of and expertise in research needs in Australia, were not consulted on how this new medical research fund is going to operate. They were not deeply involved in the process when it was actually announced to the community.

Subsequent to that decision being in the budget, subsequent to the decisions about the savings that are apparently desperately needed in the medical system, subsequent to all those decisions being made, maybe now the government will actually work on engaging more people across the board on the area of medical research. It is a passion that we all share. It is not a contest—that my knowledge and support of medical research is bigger than your knowledge and support of medical research. It is a fact that we as a nation do respect medical research and do feel that there should be funding of the medical research industry so that we can continue to celebrate advances and the professionalism of medical researchers in our nation, such as the kind of work that is done in my own state, at the University of Queensland. I know that Professor Ian Frazer's ears have been burning for years as we praise his work! Only recently, on Saturday, President Obama pointed out when he was at the University of Queensland the work that Professor Ian Frazer has done, through that wonderful organisation, on Gardasil and other vaccines to fight the horrors of cancer.

We all know that there needs to be continuing support for medical research in this nation. What we on this side of the chamber do not understand is how that will occur. The government puts forward arguments for what the value of the savings will be from this measure and other measures at the same time as the debate goes on about the need for those savings to improve our wider medical system.

The proposal put before the community is that all that money that is gathered in this way will go into this medical research fund for which we have no detail, for which we have no plan, for which we have no actual knowledge about what that will do to benefit us as a community or what all the savings will do to prop up—using the government's own language—the current medical system. In this savings measure, we are concerned about that.

We are also concerned generally that the government is putting in danger—and I use that term quite considerably—the ongoing health of Australians in the kinds of savings it is purporting to put forward in the areas of the GP tax and also, as I pointed out, the whole area of medical imaging, which, again, will impose a cost on people that may affect their own decisions about their health. This is at a time when we have said for many years that we are encouraging people to take ownership of their own health, to actually take notice of their own symptoms, to learn about their own symptoms and to seek help at the earliest possible time. Consistently, the message over the last few years has encouraged people in Australia to understand their own bodies, to actually take ownership of their health and to use their medical system effectively and personally so that people can actually have the kind of health system that we all expect and we all deserve.

One of the other important things in our health policy over many years—a shared policy among governments of all flavours—is that we do want to ensure that people can trust the health system and know that they will receive good service, the best service they can possibly get no matter where they are.

As I said, we will be supporting this particular proposal because we do think it is a savings measure that we can understand and can actually point out to the community the way it will operate as it goes forward. It is also important that we actually do accept that the health system that we have is sustainable. We are not in a crisis in our health system. Certainly, this is not my own opinion—I would never pretend to have that professional knowledge—but I do think that we should take some notice of organisations such as the Australian Medical Association.

We know that the government, when they are in government and also when they were in opposition, have been very open to advice and information provided to them by the AMA. In fact, the AMA has been crucial to the development of health policy from the current government. We know that the Australian Medical Association President, Associate Professor Brian Owler, has talked about the Australian Institute of Health and Welfare's report, which I mentioned earlier, about the sustainability of our health system. Professor Owler said at the time:

The AIHW's report really makes a mockery of the government's claim that health care spending is out of control.

He went on to say:

There is absolutely no need for them to introduce the GP co-payment.

I am actually making that comment in this debate on the issue of the Medicare levy surcharge and the rebate on private health insurance rates because I believe that the government has put forward the argument for this change in line with all the other changes they put forward in the health budget on the basis that there is this crisis in health care and that our current system is not sustainable. We reject that proposal.

However, we believe that in looking to see where we can have the most effective delivery of service and the most effective budget decisions, pausing the income thresholds that determine the tiers for the Medicare levy surcharge and the rebate on private health insurance is something that we will support. It will provide some savings to the budget, which we hope will actually go to improving the whole of our health system—though we remain sceptical at best about the operations of this research fund for which we are yet to see detail or plan.