Richard Di Natale (Victoria, Australian Greens) Share this | Link to this | Hansard source

I move:

That this bill be now read a second time.

I table an explanatory memorandum and seek leave to have the second reading speech incorporated in Hansard.

Leave granted.

The speech read as follows—

Australia is blessed with a world-class health system. Between our public and private hospitals and Medicare, we boast a system that is by world standards of high quality. It is also very efficient. Australia spends about 9.4% of GDP on health. This compares very well with OECD countries and is vastly more efficient than the United States, which spends over 17%.

More importantly our health system is highly equitable. Every Australian knows that if they get sick, they can go to a doctor. Thanks to high rates of bulk billing—82% at last count—most people who need to are able to see their GP free of charge. And if something more serious comes along, we have excellent public hospitals that are guaranteed to worry more about your general health than your financial health.

In some countries, where user pays is the norm, healthcare is much more expensive. Those with insurance can get treatment, though it may mean a fight with their insurance company. Those who lack insurance live in fear of falling ill and when they do must either suffer without treatment or skirt bankruptcy.

The combination of equity, efficiency and quality that we enjoy is a feature of our health system. But these three aspects are related. Because we have a single universal insurer in Medicare, it puts a brake on prices and keeps costs down. All Australians pay into the system with their taxes and use it for their healthcare needs, so its universality means ownership by all Australians. This creates pressure on government to ensure that the quality is of an acceptable standard. Although we read horror stories about emergency departments in the newspapers, by and large Australians can trust in their hospitals to look after them well.

In contrast, a two-tier health system run by a multitude of private health insurance companies has none of these advantages. Competition by insurance companies adds the overhead of multiple layers of administration into every medical service or procedure. A complex and opaque network of contracts can mean escalating prices. It can be more complex for consumers who have to check which doctor or hospital they can visit, what is covered, and how much of it is covered.

And what becomes of the uninsured, those on the bottom tier?

The Greens are committed to keeping this question in the realm of the hypothetical here in Australia. However, we have seen some worrying signs that indicate that Medicare as we know it is under threat. Firstly, there has been a lot of debate about adding a co-payment for all Medicare services as a way of reducing demand for primary health care services and thus to save money. Deliberately placing a cost barrier between patients and their GPs undermines all that Medicare is built upon.

Secondly, and not unrelated to the first point, is the potential for private insurers to enter the primary care space in force. Already, Medibank Private are trialling a system where they pay GP clinics to offer enhanced services to their members such as guaranteed appointments and after hours care. While this runs clearly against the spirit of the Private Health Insurance Act it appears to be within the letter of the law.

There is an important role for private hospitals as part of our healthcare system. Private health insurance is a choice that those who can afford it are free to make. But there is nothing to be gained by throwing open the doors to competing private health funds in primary care. Competition does not always mean lower prices. GP visits will become more expensive for everyone and if doctor visits become more expensive so will private health insurance. We do not want to start health care costs on this upward spiral. This undermines the single, universal system we prize so dearly.

In order to prevent this, this Bill, the Private Health Insurance Amendment (GP Services) Bill 2014, amends the Act to clarify that commercial arrangements between private insurers and GPs that create a two-tiered system are not acceptable. The Bill specifies in clear language that insurers cannot pay GPs for treatment of their members, nor can they pay to get their members preferential access to treatment.

Despite rhetoric we are hearing from the Government, health spending in Australia is not out of control and visits to the doctor are not to be discouraged. Medicare is fair and it is affordable. The Greens want to preserve both of these aspects of our health system.

I seek leave to continue my remarks later.

Leave granted; debate adjourned.