Anne Ruston (SA, Liberal Party, Assistant Minister for Agriculture and Water Resources) Share this | Link to this | Hansard source

I table a revised explanatory memorandum relating to the bill and move:

That this bill be now read a second time.

I seek leave to have the second reading speech incorporated in Hansard.

Leave granted.

The speech read as follows—

HEALTH LEGISLATION AMENDMENT (IMPROVED MEDICARE COMPLIANCE AND OTHER MEASURES) BILL 2018

SECOND READING SPEECH

The Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018 amends the Health Insurance Act 1973, the Dental Benefits Act 2008 and the National Health Act 1953 to implement measures announced in the 2017 budget to support the integrity of Medicare through improvements to the recovery arrangements for debts owed to the Commonwealth. These changes save $103.8 million over four years for reinvestment in Medicare.

The bill also makes amendments to the Health Insurance Act 1973 to clarify that the jurisdiction of the Professional Services Review extends to corporate medical practices which contract rather than employ individual practitioners.

The amendments are supported by my compacts with the Australian Medical Association and the Royal Australian College of General Practitioners. These compacts reflect shared principles that support a stronger, sustainable health system, including improved compliance processes to ensure Medicare overpayments are detected and recovered.

Compulsory offsetting and garnishee

While the majority of practitioners claim Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and dental benefits appropriately, some practitioners do not. Some practitioners claim incorrectly, are found by the Professional Services Review to have engaged in inappropriate practice or are found to have engaged in fraudulent claiming, and are required to make a repayment to the Commonwealth for incorrect claims.

However, only some practitioners who have a Medicare debt agree to enter into arrangements to repay the debt. Over $50 million in compliance debt is currently outstanding and some of these debts are worth over $1 million. Those that refuse to agree to a repayment arrangement are currently still able to claim benefits through Medicare, including receiving significant payments directly from the Commonwealth for bulk-billed services.

These amendments will allow for future bulk-billed claims to be reduced or offset by up to 20 per cent, to repay their debt to the Commonwealth. For those practitioners who do not bulk-bill, the amendments will allow garnisheeing of other funds owed to the practitioner who holds the debt, including funds held in bank accounts and income from employers. An offset or garnishee arrangement will only apply if all rights for review have expired and the practitioner does not agree to a repayment plan within 90 days. These new arrangements will start on 1 July 2018.

These changes will ensure that more practitioners repay their debts, allowing this money to be reinvested in new services under the Medicare Benefits Schedule and new listings on the PBS to ensure Medicare continues to provide more support to Australian patients than ever before.

No patients will be affected by these changes. Where practitioners engage in inappropriate practice, or claim incorrectly, they are responsible for the repayment of any excess Medicare payments, even if the rebate was paid directly to the patient or the person who incurred the expense on their behalf.

Improving the consistency of administrative arrangements across the three Acts

These amendments will reduce inconsistencies in record keeping requirements among different professional groups.

For the first time, allied health practitioners will face the same rules as doctors and be required to keep copies of referral documents for two years, and all practitioners will be required to keep copies of documents that were created as a condition of claiming the item.

The bill also addresses an anomaly where pharmacists are required to keep copies of prescriptions but not to produce them to substantiate claims.

Amendments will also apply compulsory administrative penalties on unpaid debts to dentists and pharmacists so they are treated the same as other Medicare practitioners.

These changes will ensure that instances of suspected incorrect billing can be investigated properly and any overpayments can be identified.

Professional Services Review

The Professional Services Review currently is able to review officers of organisations based on their influence over their employees' billing practices. Practitioners are increasingly employed as contractors. These amendments clarify that the jurisdiction of the PSR extends to officers of organisations that engage Medicare practitioners as contractors.

Organisational billing

The current legislation places all of the liability for Medicare claiming against an individual practitioner, except in clear cases of fraud. This reflects the old business model of single-doctor practices. However, in contemporary practice there has been an increase in the role of practices, corporate entities and hospitals in the billing of MBS services on behalf of individual practitioners.

The amendments will introduce a scheme where if there is an employment or other contractual relationship, the practitioner and their employer (or other related party) will each be responsible for the repayment of part of the compliance debt.

This change represents a significant shift, moving to a fairer distribution of the responsibility for getting billing right, and is supported by key stakeholders, including the AMA and the Royal Australian College of General Practitioners.

These new shared debt recovery arrangements will start on 1 July 2019. This will allow further time for consultation on the detail of the proportions to apply to the practitioner and employing or contracting organisation, which will be set out in regulations.

Deborah O'Neill (NSW, Australian Labor Party, Shadow Assistant Minister for Innovation) Share this | Link to this | Hansard source

I rise to make a contribution to the debate on the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018. Labor is the party of Medicare. We invented it and we will always protect it. It's our universal public health insurance scheme. It's the heart and soul of our healthcare system, and it's the envy of many other countries around the world. It ensures Australians can access life-saving treatment when they need it without worry. More than 20 million of us access Medicare services every year, including GP visits, vital tests and scans and hospital treatments. Without a doubt, it's one of the most important programs the Commonwealth government delivers. It's fundamental, not just to our health system but to our economy and to our society. That's not to say it's perfect, but, of course, with a program this size there will always be problems and there will always be improvements that can be made.

Labor is always up for sensible improvements. This government bill implements a 2017 budget measure to improve the Medicare Benefits Schedule compliance and debt recovery practices, and it will result in an estimated combined saving over the forward estimates of $103 million. That money should, of course, be reinvested straight back into Medicare in a transparent way, rather than returned to the budget bottom line, but that is an issue I will return to later. This bill amends three acts, the Health Insurance Act 1973, the Dental Benefits Act 2008 and the National Health Act 1953. These technical changes will, hopefully, enable improved compliance by better targeting unusual business billing and improving the consistency of administrative arrangements.

I want to say at the outset that the vast majority of medical and allied health professionals that bill Medicare for services to their patients do the right thing. But we also know that there are increasingly commercial interests at play in some areas, so compliance is something we have to improve. Only 40 per cent of Medicare debts are currently recovered, meaning there's over $50 million in outstanding debt. There's obviously a need for some action in this space. These changes clarify that the Professional Services Review, which investigates Medicare and PBS compliance concerns, has jurisdiction over corporate medical practices that contract health providers as well as practices that employ providers, and the providers themselves. It introduces compulsory offsetting and garnishee provisions for providers who do not voluntarily agree to repayment plans within 90 days. At present, these providers are still able to claim full Medicare benefits even when they owe significant debts. Where a compliance debt is issued, both the employer and the contracted provider will be responsible for part of the debt, reflecting their shared responsibility for accurate billing.

This bill also makes record-keeping requirements consistent across different health professions. In particular, allied health providers will be required to keep copies of referrals for two years, just like doctors. Pharmacists will be required to produce prescriptions to justify queried claims, and dentists and pharmacists will face the same administrative penalties on unpaid debts as do other Medicare providers. Further detail will be set out in regulations, and the new arrangements will start on 1 July 2019. But, for now, I can say Labor will support this bill.

Like I said, we are always willing to support sensible improvements to Medicare. What we don't support is this government's overall approach to Medicare. It took two Labor governments more than two decades to shape and embed the Medicare that we know today. Many Australians today take Medicare for granted, as if it was always there. It's great that they have that attitude. That is exactly as it should be. Australians should be able to rely on Medicare whenever they need it, without worrying and without a second thought. But let's never forget that the conservatives opposed Medicare every step of the way. Labor had to fight hard to set it up, and we continue to fight hard to protect it.

We know that you cannot trust the conservatives with Medicare. They drone on constantly about their rock-solid commitment to it, but we know the truth. They have revealed it over decades. They hate it. They have tried to take it out many times. They want to dismantle it. They just don't believe in universal health care as Labor do. They dream of and implement wherever they can mechanisms to echo the American health system, where it's every man, woman and child for themselves, where people increasingly have to rely on private means to access basic health care, where people die or suffer for years because they cannot afford to see a doctor or go to a hospital and where you have to get out your credit card, rather than your Medicare card, when you visit the doctor. That's the Americanised model that the Liberal-National Party seek to inflict on this country. Hating Medicare is in their DNA. They might behave themselves for a while, because they know how much the Australian people value Medicare. Australia certainly sent that message out loud and clear at the last election when the government was plotting to outsource parts of Medicare to the private sector. Labor, of course, staunchly and vehemently opposed that move.

In the two years since that election, the government's been very busy trying to rewrite that history, pretending that it didn't happen, pretending that Labor made up its efforts to outsource parts of Medicare to the private sector. But that is a reality. It's a historical reality that the government will pretend didn't actually happen. Its defence is utter nonsense. This government was actively planning to outsource the Medicare payment system to a corporate player—one of the four big banks, perhaps, or maybe a private health fund? If we'd let them get away with it, it would have been the beginning of the end for Medicare as we know it. The government dropped its plan because Labor's tireless efforts to highlight the damage that it would have done to our health system pulled them back from the brink of implementation. It was because the Australian people agreed it was a terrible plan and punished this government for it. Eventually, as we all know, the Liberals, true to their DNA, will have another crack at Medicare. They'll come up with another scheme to undermine it, weaken it or to sell off parts of Medicare.

They've got so much form with their attacks on Medicare, over so many periods of their government. Remember, on the arrival of Mr Abbott, their first effort at the $7 co-payment. That was just a few years ago. That was an unprecedented attack on the universality and the accessibility of Medicare. It was effectively an attempt to end bulk-billing. Then too, it was Labor, it was the parliament and it was the Australian people who ultimately stopped the government going down that dark road. As is so often the case, we helped save the government from itself. The plan that they were attempting to implement revealed what's really in their hearts: to attack Medicare at every opportunity.

When they couldn't get their $7 co-payment through the parliament, they went for an alternative strategy: a freeze on indexation, which impacts every single doctor delivering health care in this country today. That freeze was implemented by this government on the fees that doctors receive and health professionals receive for the services that they provide. That freeze stuck while all the other costs of running a small business—that is what our doctors do; they have costs such as electricity and all of those costs that are attached with running a business, all with rising rents—all continued to rise. The freeze that this government implemented is still in place today. Again, under intense pressure from Labor, from doctors pushing and from the public pushing, Minister Hunt was forced to announce a fall in the freeze as recently as May 2016; but he still hasn't actually lifted a single element of it. Some elements will finally come off on 1 July, delivering GPs a paltry 55c increase in their rebate. It won't put a dent in soaring out-of-pocket costs in the health sector.

While the government continues to try to tell the Australian people that they love Medicare, other elements of the freeze that they have underway will remain in place until 2020. That's six years of slugging doctors and ultimately patients with that cost, simply because they want to access the healthcare system. The rebate freeze has saved this government billions of dollars, and they're banking the savings right now. Those are billions of dollars that should have gone to providing health care for Australians, but this government took those billions out. Meanwhile, we know that the latest Medicare data shows that the cost of seeing both your GP and your specialist is at a record high, and that is directly attributable to these Liberal cuts. The gap has expanded for Australians who simply need to get to a doctor, get seen and hopefully get well. For those who find themselves unwell and who have to go to a specialist, the cost of getting to a specialist has just grown and grown. The Liberal freeze is a key reason for that increasing gap.

The first three months of 2018 are pretty instructive. Australians paid an average out-of-pocket fee of $38.44 to see a GP. It is up to nearly $47 in some states and territories. The national figure has risen nearly $4 from $34.53 at the end of 2017. Out-of-pocket fees to see specialists have soared even higher. They were up to an average of $87.62 in the March quarter. That's up from $71.75 in the last three months of 2017, up nearly $16 in a quarter. In some jurisdictions the average out-of-pocket cost of seeing a specialist has now soared to well above $90. That's far, far too high. I can tell you that from doorknocking in the seat of Robertson, where we have a fantastic candidate, Anne Charlton. We were out doorknocking in Wamberal, right near Terrigal, and we were meeting great Australians who've served this country in many ways across the years. I remember an encounter that Anne and I had with a woman who said she'd been able to manage her health care very well for all of her life but was at a point, for the first time in her life, where she was simply unable, despite owning her own home and having had financial stability all of her life, to access health services. That was on the watch of this government and its action around Medicare. So every time those opposite say, 'Nothing to see here; we support Medicare,' remember the facts: an attempt at a $7 co-payment and a freeze that's still in place.

Ninety dollars in out-of-pocket costs to see a specialist is far too high. Meanwhile, the government is out there trying to trumpet a static GP bulk-billing rate as some kind of great achievement. How out of touch can you get? The Australian people are far too smart to fall for the kind of spin that this government is trying on them. They know that the cost of going to the doctor has risen. People feel it in their pocket every time they have to go to the doctor. What about families with children? I've got three. It was always: one would get an ear infection, the second would get one and then the third one, and it would all be one day after the other. For families, multiple visits to doctors in the course of one week are common. The cost of that—the out-of-pocket cost—has expanded under the watch of this government.

The Australian people will not fall for any of the nonsense that's promulgated by this government about their love for Medicare. Sadly, the consequences of five years of Liberal-National Party government under Mr Abbott and Mr Turnbull, both of them, are that Australians now are delaying going to their doctor. They are delaying going to their doctor simply because they can't afford it. The freeze has had a terrible impact on the health and wellbeing of this nation. Official Bureau of Statistics figures show that one million Australians delay or avoid seeing their GP each year due to cost, with another 1.7 million Australians skipping specialist appointments. About the same number don't fill a prescription because of cost. Older Australians fare the worst, with one in eight telling a Commonwealth fund that they've got problems getting health care because of cost. Only patients in the US, obviously no role model when it comes to universal care, fare worse than older Australians.

There have always been challenges to Medicare's universality, such as difficulty in accessing services for Aboriginal and Torres Strait Islanders, as well as the challenges—very big challenges—for people in regional, rural and remote Australia, but in recent years out-of-pocket costs have become a very significant barrier to access. Medicare statistics show that 10 years ago Australians paid an average out-of-pocket fee of $21 to see a GP. Increased in line with inflation today, that cost would be around $26. The same is true for specialists. Ten years ago Australians paid about $44, equivalent to around $54 now. But the problem is that the costs under the Liberal-National government are much, much higher than that. The Liberals make a laughable claim that Medicare has never been stronger than it is now, on their watch. What a load of rot! Whether it's making Medicare more expensive, cutting public hospitals or putting health insurance profits before patients, the conservatives can never be trusted on health.

At the last round of Senate estimates, officials said the government's latest budget was trying to bend the curve of Medicare—bend the curve of Medicare, right? That means basically they're trying to cut. That was what we found out at Senate estimates in this building just a few weeks ago. The government wants to bend Medicare, all right; they want to bend it till it breaks.

In stark contrast, the Leader of the Opposition in his budget reply speech in May announced the first round of Labor's new investments in Medicare, and it's a significant investment in MRI machines, which are so vital for the diagnosis of complex medical illnesses. Unlike other services, MRI scans only get the Medicare rebate if they're performed on an eligible machine. The licence system is anachronistic. It worked pretty well until 2013, given that the last Labor government granted 238 licences. Unfortunately, the current government has totally neglected MRIs, granting only four licences. There were 238 MRI licences from Labor and four licences in the five years that they've been in government. This is a woeful record and it goes again to the facts about this government, their attitude to Medicare and their cavalier attitude to the health and wellbeing of Australians. Access to Medicare MRIs is very patchy, and many Australians travelling long distances experience significant wait times to access an eligible machine. It's too long to have to wait.

This government's assurances about health are worthless. While there's $190 million in savings from the MBS review in the 2018 budget, there's just $25 million in new MBS listings, which means another net cut to Medicare. They are taking money out of the health budget hand over fist. They cut Medicare. They cut hospitals. They do everything they can to prop up the private insurers. Labor will have much more to say about this government's treatment of Australians' health in times to come.

Sue Lines (WA, Deputy-President) Share this | Link to this | Hansard source

It is sad to say that I am old enough to remember life before Medicare and life after Medicare. I might talk a little bit about that later on. I'm a passionate advocate of Medicare, having experienced both systems. Labor will support the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018. As Senator O'Neill outlined, we're more than willing to support bills which look to improve and streamline how Medicare functions and, indeed, to ensure that money expended is returned to Medicare, although we haven't got that commitment. We know that the savings at this point are not going back directly to Medicare, which is really where they should go, because the savings are being derived from new measures.

The Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018 will amend the Health Insurance Act 1973, the Dental Benefits Act 2008 and the National Health Act 1953 to implement parts of a 2017 budget measure on Medicare compliance. I was a bit surprised and shocked to read that, currently, we are recovering only about 40 per cent of the Medicare debts, which means that there's about $50 million of outstanding debt. If this measure sharpens up that statistic, it will be a very good measure. Hopefully, this bill will improve the recovery arrangements.

It will also clarify the Professional Services Review—the PSR, as it's commonly known—which investigates Medicare and PBS compliance concerns. It will have jurisdiction over corporate medical practices that contract health providers as well as over practices that employ providers and over providers themselves. I think that's particularly important in an ever-changing medical model where we are seeing big corporate practices across the country. It is really important that we have legislation in place which is wide enough and has enough scope that we can make sure that, however our health system adapts in the future, we'll have a good model there when providers are not doing the right thing. It is absolutely critical, given that health is a significant part of our budget spend, to make sure that we are in a position to be able to recover moneys that are owed to the Commonwealth.

I think it's important, too, that the bill will introduce compulsory offsetting and garnishee provisions for providers who do not voluntarily agree to repayment plans in 90 days. It's very easy, I think, for people to avoid, to put off and to make promises that they'll get to repaying a debt in a certain time frame yet fail to do that, so the chasing of that debt continues. This move is to make sure that we have an enforceable repayment plan in 90 days. I hope we don't have to use that. I hope that most in the health sector in Australia will come to the table and pay the debts that may be owed, but, at the hopefully rare times that that doesn't occur, we've now got a real tool there to ensure that those moneys are recovered. That, too, is a good thing.

Again, the bill is looking at record-keeping requirements that are consistent, because it is very hard in a compliance regime to go after outstanding moneys if they're able to be hidden or highlighted in a particular way that doesn't quite make sense. Consistent record keeping will give a much sharper focus to that ability to quickly see what's going on and to get into a recovery payment plan with health professionals if it's needed. We're roping in additional allied health professionals, who will be required to keep referrals for two years.

Australia does have a universal health system, and whatever we can do to protect that universal health system is obviously going to be supported by Labor. We introduced Medicare, and despite the opposition of the Liberals particularly, who fought it off twice, it has survived. I'm not sure that the government really does believe that it should be a universal scheme, but for us, for Labor, it's an essential part of who we are to provide that universal health scheme.

It was Mr Fraser who messed around with Medicare. At the time that he did that, I was a much younger person and just starting out having a family. My first child, my daughter, was born outside of the Medicare system. We'd had it for a short time, and then it was cancelled. At the time I was not in paid employment. My partner at the time was a very low-income earner but just a few dollars above what would have given us access to a health card. So, when I had my daughter, all of the associated medical costs—like most young kids, she had all sorts of illnesses and conditions and so on, so we had to see a number of specialists—had to be paid for out of our own pockets. As I say, we were low-income earners—I think we were $2 or $3 above the cut-off for getting a concession card. Quite frankly, if it hadn't been for my grandmother and my mother-in-law, who from time to time gave us the cash to pay those bills, we would not have survived. I don't know what we would have done. Certainly, when my children were sick, the first place that I went to was the accident and emergency at the fabulous Armadale-Kelmscott Memorial Public Hospital, because, quite frankly, I couldn't afford other services. There weren't that many after-hours GPs available when my daughter was young, but I certainly couldn't afford the fees that they charged. So on weekends and late at night, when children tend to get sick, you would find me, more often than not, sitting in A&E waiting to get health care for my children, because that was the only option available to me. Now, I knew that I was churning up the valuable time of those in the accident and emergency department but, quite frankly, I didn't have any other options. I didn't have hundreds of dollars to pay out to GPs and specialists. My only option—and I'm sure the only option of many other people—was to sit in emergency.

A couple of years later my son was born. We had Medicare again. It was back, obviously because there was a Labor government in power. And what a difference it made to have that weight of bearing the health costs of my children lifted off my shoulders by Medicare. That was something I still remember, and my children are well and truly adults now. But I remember that burden—the difference between my daughter's birth and her early years and my son's birth and his early years. All of us in this place who are parents or grandparents know that when children are young they often get sick—they get viruses—and you're worried about their development, so there are lots of visits to health professionals. So my own personal experience has well and truly made me a passionate advocate of Medicare.

As I said, we can't trust Liberal governments with our health system. Certainly Mr Abbott and Mr Turnbull have demonstrated that by the actions they've taken in reducing funding to various parts of Medicare, the attack on women's health care in particular, and just their general view that it shouldn't be a universal healthcare system. I can't quite remember when it was, whether Mr Abbott or Mr Turnbull was the Prime Minister of the day, but do you remember that we had that very serious proposition whereby the government was looking at how we had a view—not a scientific view, but a view—that GPs were being overused, that we were just being pests and going off to GP clinics way too many times? They didn't have any real scientific evidence of that, and perhaps the rise in chronic disease in Australia is the reason people make more visits—if indeed they do—to GPs.

For quite some time there was serious contemplation of restricting GP visits. If you went over a certain number of GP visits, you'd be paying much more. What an outrageous position: for a government to stand in the middle of the relationship between a GP and a patient. But that's exactly what the government was seeking to do. It was saying, 'We're going to fund X number of GP visits for you each year, and if you exceed that limit we're going to charge you for it.' Now, obviously they met a lot of resistance. We were very strong on that and really fought against it. The AMA saw it as an attack on their professionalism. Eventually that proposition was dropped. Maybe privately it's still being entertained, but it's not something the government is publicly talking about any longer. But that proposition was floated not that long ago—that you would have a certain amount of GP visits and then your quota was up. Imagine having a quota system for visits to a doctor. Imagine that. Imagine if you were the young mother that I was, with two children getting sick, and you overtook your limit. Where would you go? You'd go back to A&E, because you wouldn't have had the money to pay for additional visits.

The other thing we've seen the Prime Minister do—and this is really very poor—is use Medicare as a bargaining chip. We saw recently, in relation to One Nation's support for the corporate tax cuts—and we don't really know where they are on that at the moment, because it's created a split in their party; they've gone from three senators to two, at today's count—that One Nation had managed to negotiate getting an MRI licence in Kalgoorlie. For those of you who are not Western Australians, Kalgoorlie is a regional town towards the east. Regional towns in Western Australia are not massive, but by Western Australian standards Kalgoorlie is a major regional town, and of course it has all the Centrecare and other sorts of offices that you would normally expect in a large regional town. It is 600 kilometres away from Perth CBD, yet it didn't have an MRI. So what do we see? We see Mr Turnbull willing to do a deal with One Nation to provide an MRI licence in Kalgoorlie if they signed on the bottom line for the corporate tax cuts. Isn't it a disgrace that we have a government that is willing to trade away the provision of a fundamental health service? Labor has made that commitment with no strings attached. We didn't do any dirty deals with any crossbenchers. We have said, as a party who's committed to Medicare, that we will make available that MRI licence.

We've seen during the life of the Turnbull government that only four MRI licences have been granted in the last five years. By contrast, under the Labor government, there were 238 licences granted, and they're an important tool in today's diagnosis. If you go to your GP with, say, a hip problem or something like that, you get referred to a specialist. Even today, specialists will insist upon an MRI scan, because it has become a tool. Of course, it gives the specialist a much clearer picture of what's actually going on. So they're not just the fancy, if you like, of surgeons who want all the bells and whistles; they've become a fundamental tool of good health practice. Yet we've seen the Turnbull government, in its negotiation with Pauline Hanson's One Nation party, well and truly ready to trade on that. What a disgrace!

These compliance measures are really important across the nation because we see, unfortunately, that in Australia there's an increase in chronic diseases, some of which are preventable if we were able to get to people when they're children or young adolescents to talk about good health, good eating, good exercise and so on. Some of these chronic diseases are absolutely preventable, so that's also where we should be focusing energy. With greater chronic diseases and an ageing population, it is more important than ever that we make sure that our health system is streamlined, that we are recovering debt and that we're making it easy for practitioners and providers to comply with regulation, because, at the end of the day, doctors are there to provide a health service and, if we can make the reporting procedures more streamlined, that in turn that will deliver better health.

I want to make sure that we get this bill done and that we can start, particularly, to recover the moneys that are there. But we'll watch it very closely because, as we say, we don't believe that the Turnbull government can be trusted with our health system. We don't believe that the Turnbull government really believes in a universal health system, which is part of Labor's DNA. It is absolutely a fundamental core value of ours. Senator O'Neill spoke about an American type of system. Certainly when I visited the US before I became a senator, I saw low-income earners having to fund their own breast cancer treatment or go on waiting lists for benevolent services that would accommodate them and look after them—shocking. I was truly shocked to see and talk to women who worked in jobs where there wasn't a healthcare system and had to fund breast cancer treatment. Believe me, there's no way that we would want that sort of system as any part of the Australian health system. Our universal health system's something we need to be proud of.

Debate interrupted.