Jordon Steele-John (WA, Australian Greens) Share this | Hansard source

I speak today on the National Health Amendment (Supporting Patient Access to Cheaper Medicines and Other Measures) Bill 2024. The Greens will be supporting this bill. This bill will legislate the agreement reached between pharmacists and the Australian government in the Eighth Community Pharmacy Agreement. This includes freezing indexation of patient co-payments for PBS medications. For those with low-income healthcare cards, this freeze will remain in place for five years. For most of the population, prices will begin to rise again after only one year. This bill will also introduce a new additional community supply support payment, the ACSS, which will provide financial assistance for this pharmacists who are dispensing 60-day scripts.

The cost of healthcare is rising. In WA, less than 10 per cent of GP clinics bulk-bill all of their patients who are adults. The bulk-billing rate in WA has dropped by almost 17 per cent in just one year. WA has lost more bulk-billing GPs than any other state since 2023. Patient costs are now, on average, $41. Imagine needing to see your GP, wanting to see your GP, either because of the relationship that you've built, the more informal clinical setting, or the desire to fulfil what sometimes feels like a personal obligation to do whatever you can not to make the waiting times any longer in the emergency departments, even though your individual illness or condition is not the reason for the longer waiting time. Imagine wanting to do all of that and not being able to because you simply do not have that kind of money lying around because you're struggling to pay rent, pay power bills and buy food. That $41 can be the difference between actually having something for everyone in your family to eat and having to go hungry so that at least your kids can have something in their stomachs when they go to school. The last thing you need when you have paid often over $40 to see a GP is to then go to the pharmacy and see that the cost of your prescription has risen too.

This bill will go some way to addressing that but it does not go far enough. The Greens believe that the PBS should have sufficient investment to make approved medicines, drugs and treatment options accessible for everyone. Nobody should be prevented from getting the medicines they need because they don't have the money in their pocket. Nobody should be in a situation where they live in pain or they go into a health crisis or a mental health crisis because they don't have the money in their pocket. Of course it would take a lot of work and a lot of collaboration and a lot of thinking to achieve this goal, but surely it must be the goal. Surely, we don't ever want to be in a situation where somebody isn't able to get there meds and, because of that, has an accident, has to go into hospital, loses their ability to function, loses their life, lives in pain. There are many things in this life and in this world that are beyond the direct ability of a legislature to address, but the price of medicines isn't one of them. On this, we can and should do better. On this, we can and should strive together for a better balance, for a better way forward, for a better system.

This bill does not reduce the costs of medicine—and I think this is really important to make clear—it only prevents them from being subject to inflation. While the wages of Australians are not increasing at the rate of inflation, this is not effectively a price cut for average Australians. Every Australian deserves affordable health care. No-one should be forced to choose between taking a medicine they have been prescribed and being able to afford the other necessities of life. It is clear that the government needs to go further to address the cost-of-living crisis and to ensure that everyone can see a doctor and get a prescription, no matter their income.

It is also really important to recognise and acknowledge in the course of this debate—and I again want to put on the record that the Greens will be supporting this bill—that pharmacy and the PBS do not exist in a vacuum, either within health policy specifically or within broader Australian government policy. These systems are deeply interconnected, so the success or failure of initiatives like this are also dependent upon the success or failure of other systems and services that are in place. When we look across the nation and across the policy landscape at the broader Australian healthcare and mental healthcare system, what we see is a series of services and programs that are defined by their gaps and by the inequalities that they create and sustain. I want to go to a few of these.

Dental care: the Medicare system that we have in Australia, foundationally, is a credit to the nation and it is broadly supported, and resiliently supported, by the Australian community. To get a sense of just how much the Australian community support Medicare, I would advise anybody to pick up the phone and have a chat with Malcolm Turnbull, the former prime minister, and seek his view on how the suggestion of any cut to Medicare served him during the 2019 election.

But the system has gaps. We can acknowledge that Medicare fundamentally, foundationally, is a superb policy idea—a representation, if not a manifestation of a nation's sense of mutual duty—and we can also acknowledge that there are flaws. One of the biggest flaws in the Medicare system is that it does not treat teeth and the mouth as part of the body. Just think about that for a moment. Our Medicare system, our universal healthcare system, doesn't treat your teeth and your mouth as part of the body. That just doesn't make sense, particularly not in a context where we now know that the mouth and teeth are truly one of the key gateways to broader health of human beings and of community. Whether you're able to access good dental and oral health has a significant impact on the rest of your physical and mental health. Not only do we now conclusively understand the link between conditions such as heart failure, dementia and others and good oral health; we are also gaining a growing understanding of the link between mental health and dental and oral health.

In my time as the Greens health spokesperson, it has continually struck me as very odd that it has taken so long for politicians and policymakers to hear the community's calls and the evidence the community has given to the link between mental health and dental and oral health. There are many things in this chamber that would not be shared experiences between the senators in here and the parties in here, but I suspect one thing that might be a common experience is what it's like to experience dental pain, to experience an abscess or an ulcer or an untreated infection.

Many of the people in here have enough money to get that seen to via our overwhelmingly privatised dental system in Australia. But the reality for many, many Australians is that that is just not an option. In fact, when I recently went for a dental check-up, I was literally horrified to see sitting on the desk in reception a pamphlet. The pamphlet said: 'Struggling with dental costs? Why not access super?' Why not access your superannuation—to be able to get your teeth fixed, to be able to get an infection treated, to be able to get some basic restorative work, to be able to get the basic orthodontic care you might need? We are forcing Australians to dig into their retirement savings. And that is a position the government is happy with?

This is one of the strangest and most unacceptable gaps in Australian health policy, because we all have teeth. And we all have mouths; as much as sometimes I wish, at times, people in this place maybe didn't have them or maybe opened them less than they otherwise do. We all do have mouths and teeth. Why do we allow this absence to continue? And if you think about the pain that untreated dental care can often bring into your life, and the stress and the fear. It's not a hard thing for an infection to jump from your mouth to another part of your body. For anybody wondering, it can result in really serious flow-on health effects and really serious infections of the broader body. So is it any wonder that there is such a link between untreated oral and dental health and mental health outcomes? Is it any wonder that, when people have gone for so long without the ability to access preventive dental care and eventually manage to get teeth removed but are unable to receive access to or afford dentures or prosthetics, there is such a depth of shame that they live with because of the way that our society places such an emphasis on smiling and the quality of your teeth and your oral healthcare and connects them with a sense of morality and values based decisions? The connection that is drawn is that, if you have bad teeth, you are a bad person, and that's just wrong. That's so wrong, to say nothing of the fact that so many people fleeing family and domestic violence, as a result of the horrendous things they are subjected to, then have to live with the mark of that experience on their faces and in their mouths and are not able to access the restorative care they need. It's just wrong. We need to get mental health and dental health fully covered under Medicare.