Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Link to this | Hansard source

I rise today to speak on the National Health Amendment (Supporting Patient Access to Cheaper Medicines and Other Measures) Bill 2024. This is the enabling legislation to put in place certain healthcare measures that were contained in the 2024-25 budget. Most particularly it includes the $3 billion of new measures as they relate to the Eighth Community Pharmacy Agreement.

We saw for the first time earlier this month the Eighth Community Pharmacy Agreement, which was finally agreed between the Minister for Health and Aged Care and the Pharmacy Guild of Australia. It followed intense pressure on the government, including by the coalition over the last year, because we are the party that supports community pharmacists, and we believed that the community pharmacists had been done wrong by this government over actions last year in relation to 60-day dispensing. Last year the government—as is true to form for this government—shoved through a measure in relation to double dispensing without any consultation whatsoever with the sector that was going to be most impacted by it. This lack of consultation and the rushed policy that was put forward as a result of that was placing Australians' health care at risk.

Many community pharmacies are small businesses. In fact, just about all community pharmacies are small businesses. What this government was expecting was that around 6,000 small businesses around the country were going to shoulder the costs of the government's policy alone, and we believe that was completely unreasonable. At a time when primary care is in crisis, this government thought it was a good idea to put it at further risk, particularly our frontline primary care: the community pharmacy sector. No-one disputes the benefits of cheaper and easier access to medicine, and the coalition absolutely supports Australians getting access to cheaper medicines, especially while they're enduring this prolonged cost-of-living crisis that has been brought on by the economic mismanagement of this government.

Not only did the government fail to consult with pharmacies before implementing their policy but also they have been running around claiming credit for this policy and the cost-of-living savings that Australians were going to benefit from, when it was being entirely funded by the 6,000 small community pharmacists. So, we called on the government to get back to the table with the community pharmacy sector and negotiate a new Community Pharmacy Agreement to resolve the legitimate concerns that were raised at the time about the mucked-up and botched implementation of 60-day dispensing—because cheaper medicines are no use to any community if their pharmacy closes down.

The new agreement is clear proof that the government has been forced to admit that their initial implementation to 60-day dispensing could and would have seriously impacted Australians who rely on their community pharmacy. The eighth Community Pharmacy Agreement, the 8CPA, will commence on 1 July 2024, in just a few days time, and will provide increased support to pharmacies, with a funding boost of $3 billion for additional measures and a total of $26.5 billion over the five years of the agreement. In the 2024-25 budget the government provided further details around these measures that were agreed to as part of this agreement. They include a new payment to pharmacies to handle and dispense all medicines, worth over $2 billion, which recognises the cost impacts on pharmacies of the botched introduction of the double-dispensing measure in last year's budget. The measures also include a one-year freeze on the PBS for general co-payment and a five-year freeze on indexation of the PBS concessional co-payment. This will result, basically, in the phasing out of the dollar discount that currently can be offered to patients in certain circumstances.

The agreement also acknowledges the coalition's longstanding concerns about access by rural, regional and remote communities to primary care by providing additional funding to the Regional Pharmacy Maintenance Allowance. This additional support hopefully will mitigate our concerns about the viability of community pharmacy, particularly for those in more-remote communities in the bush. The Albanese government's initial plans would have devastated regional communities. As those of us who come from regional Australia know only too well, often the community pharmacist is the only health professional in town, and the loss of a pharmacy in these situations is absolutely catastrophic for that community.

But this bill need never have been drafted; this bill never have needed to be in this place. The distress and uncertainty created by the government's incompetence on this issue need never have happened. The government could have simply spoken to community pharmacists and worked through their legitimate concerns. Instead, they just announced and defended. And in the recent round of Senate estimates we learnt that this double-dispensing policy that the government has heralded as delivering cheaper medicines to Australians has in fact delivered very little financial relief. Also, the department was unable to explain how removing the dollar discount, along with freezing the current price of medicines, will make medicines cheaper, despite the claim that the government is running around making. This government needs to tell Australians the truth: how much have Australians actually saved through the measures that are being put forward by the government compared with how much taxpayers have had to fork out to fix the government's mistakes?

However, the coalition will support this bill, because we support the community pharmacy sector, because the community pharmacy sector provides critical primary care to Australians at the coalface. But we put on the record that these measures came about only because the government has botched its policy implementation and put Australians' primary care and their health care at risk. That's why I'll be moving a second reading amendment to note that this bill is a direct result of the sustained advocacy of community pharmacy, community and of course the support of the coalition. The bill represents the government's recognition that its initial approach to 60-day dispensing would have caused damage to all Australians who rely on their community pharmacy.

It's also important to note that the ink is not even dry on this new Community Pharmacy Agreement but the government is once again undermining our critical community pharmacy sector. They've done so by forcing on community pharmacies another rushed and ill-conceived policy without consultation or support—this time in the implementation of their chaotic vaping policy model, designed through a dirty deal with the Greens. We know community pharmacists do not want to be vape dispensers or disposers or, in the words of the Pharmacy Guild themselves, 'tobacconists and garbologists'.

The contempt of this government for stakeholders seems to know no bounds. The first the pharmacists knew that the government planned for them to be the dumping ground for used vapes was when they heard it in the media. The coalition will always stand up for community pharmacists because we stand up for Australians who rely on the primary care that community pharmacists provide. As the Albanese government continues to undermine the important role of pharmacists in our community, community pharmacists in Australia can be absolutely assured the coalition will not undermine your access to something that is so important. On that point I move:

At the end of the motion, add ", but the Senate notes that:

(a) the measures contained in this bill are only a result of sustained advocacy from the Pharmacy Guild of Australia and other groups with the support of the coalition;

(b) the bill is recognition by the government that its initial approach to 60-day dispensing would have caused damage to all Australians who rely on their local community pharmacist; and

(c) the ink is not even dry on the Eighth Community Pharmacy Agreement and the government is already undermining community pharmacies by foisting a rushed and ill-conceived vaping model on community pharmacies without their consultation or support".

Jordon Steele-John (WA, Australian Greens) Share this | Link to 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.

Dorinda Cox (WA, Australian Greens) Share this | Link to this | Hansard source

I also rise to speak on the National Health Amendment (Supporting Patient Access to Cheaper Medicines and Other Measures) Bill 2024. I note, on behalf of the Australian Greens, the amazing work that my colleague from Western Australia, Senator Steele-John, has done as our health portfolio spokesperson, and I echo his sentiments, particularly on the significant health gaps that I see existing as the First Nations spokesperson for the Greens. I reiterate also that we will be supporting this bill today. Anything that keeps the price of medicines under control is a really important part of the tenor of our community. It is an important time, in a cost-of-living crisis, for us to have cheaper medicines. As Senator Steele-John already outlined, we can and should be more ambitious in relation to what we do through the PBS and what we can do to make sure that people are not left in pain and people have access to the medicines that they require in their time of need.

Importantly, as Senator Steele-John already said, this bill does not actually reduce the price of medicines; it just stops it from being subject to inflation. What it does is just to keep the price from rising, just for a short time—five years, I think it was—and then it continues to rise. For most people who don't have a low-income health card—and there are many of those in First Nations communities—the five-year freeze for healthcare cardholders is welcomed, but at the end of the day there is that big-picture view, and Senator Steele-John, in his statement to the chamber today, articulated that so well. Dental care should be put into Medicare. It should be free for everybody.

For First Nations people—who have such a large body of research that talks about the links between lack of good oral health care or dental care, particularly in early childhood, and our chronic diseases and, as Senator Steele-John already said, our mental health—this is critical. In places like the Northern Territory, we are seeing children going into emergency departments to have their teeth removed. Their teeth are rotting inside their jaws and can't be removed by dentists, and they're going into emergency departments. Having cheaper medicines isn't going to make that better. Having early access to free dental is what is going to make a difference.

For many people who live in rural and remote communities—and people who might not necessarily be on a low income but are caring for large families—the cost of medicines can be absolutely crippling, as Senator Steele-John articulated very well. In this country, it is the choice between putting food on the table, having to pay your rent, putting fuel in your car to get your kids to school and having to pay the cost of medicines.

I echo the comments that Senator Steele-John made that the average cost of $41 to see a GP in Western Australia is absolutely unacceptable. There's been a 17 per cent drop in bulk-billing, just in one year in Western Australia. We're often called the 'grateful state' because of the mining boom we have in Western Australia—and I know people like Senator O'Sullivan would agree that we are very fortunate—but it seems different when you're looking down the barrel of having to fork out to get access to a GP. Never mind the money that it costs you, it's also about finding one that's open or that isn't just open nine to five. It's about finding one that has an appointment available so that you are not left in pain. As the mother of two children, I can tell you that nursing my child on my lap while she is in pain is one of the most difficult things to do.

Access to cheaper medicines is just one part of this frame. We can and should do better. I am imploring this government to do that, to be ambitious and to do the things that are required after a decade of sitting here and listening to the lack of focus on our healthcare system. It is the responsibility of all of us here in this chamber, the lawmakers of the nation, to think about what it is that we do have in common—that is, health care. I know several senators in this place needed dental care during our break last year, as did I. We had to access medicines because we were in pain. I spent four hours in the dental chair, and it cost me a lot of money. It was only after I came to the Senate that I was able to afford to do that. I speak to Australians who are in pain because they have an abscess or because they've lost a tooth. They may have to get a temporary plate made that they then have to wear for the next five years and that causes all sorts of other problems, not to mention the intrinsic link to mental health.

This is a serious problem we could solve in this place. We have the power in this place to close those gaps in health care for our Australian constituents. This is what we should be doing: we should be putting dental and mental health into Medicare, into our Australian system that is about free health care for our nation, because at the heart of that is how we see wellness for our community.

When we evaluate the Closing the Gap targets for our nation and our people, in the wellbeing research and evaluation that we do, we should be thinking not just about cheaper medicines, but also about all of the other significant health gaps. I have had wonderful conversations with Senator McCarthy—she is here today—in relation to that, and I acknowledge her work in this area. It is important that we work together across the aisle to ensure that we can close those gaps, as we should. Getting dental and mental health into Medicare should be our priority, and I implore senators to think about, as their legacy in this place, supporting this Greens policy, led by my wonderful Western Australian colleague, Senator Steele-John, and others here on the crossbench. Think about its importance for yourself, for your family, for your children and for future generations of Australians.

Nick McKim (Tasmania, Australian Greens) Share this | Link to this | Hansard source

From a political party that quite rightly celebrates the creation of Medicare as one of its most consequential actions in government for many decades, this bill and other reforms in the health sector are something that Australians would be well entitled to view as fiddling at the margins. If we really wanted to value Medicare in this country, we would be ensuring that visits to the dentist were covered by Medicare. If we really wanted to value Medicare in this country, we would be ensuring that mental health supports were covered by Medicare. The last time I looked, our brains, our nervous systems, our teeth and the inside of our mouths were actually part of our bodies. It's ridiculous that an allegedly universal healthcare system like Medicare, which is quite rightly seen as a significant achievement by Labor and well worth celebrating, doesn't cover dental and mental health.

The other great challenge facing Australians today is visits to GPs. We have a GP workforce crisis. I know in my home state of Tasmania there are some incredibly worrying projections about the number of GPs that we will have in Tasmania in the not-too-distant future, with a significant decline. There are regional communities in Tasmania now that are losing their only GP. That means that local health services are in decline, meaning people have to drive further, and where there is urgency in a situation it takes them longer to get to a GP. Often, when you want to make a booking with your GP, you're faced with a significant delay—many days or, in some cases, many weeks—because the demand for GPs is so high. There are simply not enough GPs to meet that demand and enable people to see a doctor that is close to them within a reasonable timeframe.

Then, when you get to see a GP, there's the gap payment. Some GPs bulk-bill at high rates; others bulk-bill at low rates or don't bulk-bill at all, and GPs have different ways of making the decision on whether or not to bulk-bill. I do acknowledge that GPs are part of a business. They have to either run their own business or be part of a business that someone else is running, and there are commercial imperatives there. I'm not blaming GPs for this, but what the Greens do say—and this is just a simple statement of fact—is that the average gap payment has continued to grow over the years because the Medicare rebate is not keeping pace with the cost of doing business.

Again, for a party that prides itself on Medicare, which at its heart was designed to enable free medical support for all Australians as a universal system, as it should be, what we are finding now is that, because the GP rebate and the government rebate for a range of GP services is nowhere near keeping pace with health inflation and the increased cost pressures that's placing on GPs, the gap continues to grow. That is actually pricing people out of being able to visit a GP. For millions of Australians, wherever they look right now, they are getting smashed by what a lot of people describe as a cost-of-living crisis but is actually becoming a cost-of-existence crisis. Whether it's the supermarket checkout, rent payments, mortgage payments, energy bills, transport costs or healthcare costs like going to a GP, people just can't make ends meet. Wages have been flatlining for many, many years in this country. Real wages have been going backwards for many, many years in this country. They are just starting to fall into the same ballpark as inflation. Whether that continues with the rise in inflation revealed in the CPI figures released yesterday remains to be seen. But people are getting smashed in a cost-of-existing crisis.

Health costs are a significant part of that. A significant part of health costs is people going to a GP. They are the first port of call. If you develop a health issue, the first thing you do is pick up the phone or log onto a website and book yourself a visit at your local GP. Far too many people now are being priced out of that opportunity. For far too many people now, their local GP has closed or reduced their opening hours and they have to travel further and pay more just for a simple GP visit which is the first port of call for millions of Australians when they want to take initial health advice about a health condition that they have.

We have a government that trumpeted, quite rightly, a recent anniversary for Medicare. I've got no problem with the Labor Party celebrating Medicare; it's worth celebrating, fantastic health system that it is. But, over time, it has become less than it was designed to be and less than it was created to be. Over time, we are seeing more and more Australians priced out of accessing essential health services. GP visits are essential health services. We've got to do something about this slow erosion of the principles of Medicare and universal free health care. We have to do something about the fact that more and more Australians who are getting smashed with costs right across the spectrum—rents, interest rates impacting on their mortgages, transport costs, power bills, bank charges, price gouging by the big supermarket corporations and now an ever steady increase in the gap payments for visiting GPs.

So I say to the government: while the Greens are supporting this legislation, this should be seen as a very preliminary step in what needs to be done to make the provision of essential health care more available and more affordable for millions of Australians—in fact, for all Australians. Medicare needs surgery. Medicare itself needs care. Medicare needs expanding and extending to make sure that dental and mental health supports are included within it, because our teeth, the inside of our mouths, our brains and our nervous systems are all interconnected inside our body with everything else that is inside our body. A true universal provision of free health care would include dental and mental health, and it would include a framework whereby GP visits were genuinely free and everyone in this country had a universal right to a free GP visit. End the gap payments. This is doable. This is affordable. These things are political choices.

When you're spending tens of billions of dollars in every budget subsidising the burning of fossil fuels in the middle of a climate crisis, and when you are spending tens of billions of dollars in every budget subsidising property speculators and investors, many of whom own five, 10, 20, 50 or in some cases many hundreds of investment properties—when you've decided you can spend tens of billions of dollars every year looking after the big fossil fuel companies, bolstering the super profits they are making, and in subsidising property speculators and investors—you can actually afford to end gap payments and make GP visits genuinely free. That can be done, and it's a choice that the Labor Party is making not to do that. They would prefer to subsidise the big fossil fuel corporations, cooking the planet at the same time. They would prefer to offer taxpayer subsidies, worth tens of billions of dollars a year in negative gearing and capital gains tax concessions, to property speculators who own multiple investment properties. They would prefer to do those things than to act to bring dental and mental health into Medicare and make GP visits genuinely free.

That's where we find ourselves, colleagues. We find ourselves, as we so often do in this chamber, debating political choices. We should be debating political choices in this place—of course we should—but I know in my home state of Tasmania that we are seeing fewer and fewer GPs, and the projections are frightening. We are seeing regional town after regional town lose GPs and, in some cases, lose their only GP. We need radical surgery on Medicare. We need to put dental and mental health into Medicare. We need radical supports so that Australians can actually access their GP for free, as was the principle behind Medicare in the first place. The way we do that is by ending the gap payments and making sure, therefore, that people can have a free visit to the GP. If we could just do those simple things—put dental and mental health into Medicare and make GP visits free—it would provide massive relief to people who are being absolutely smashed by rents that are going through the roof, by soaring interest rates with the prospect of more yet to come, by rising energy bills, by rising transport costs and by being price gouged by supermarket corporations and banking corporations.

We could provide genuine relief to people in the health sector. And that wouldn't only be a lightening of a massive financial burden on many Australians; it would be a massive lightening of a psychological burden on people. People would love to know that, if they got sick, they could get in to see a GP at a place close to them, it wouldn't cost them anything to do it and that they could see that GP within a reasonable timeframe. Those are the things that we should be aspiring to as a country, and doing those things would be a massive step forward for people who are getting smashed by a cost-of-existence crisis.

Sarah Hanson-Young (SA, Australian Greens) Share this | Link to this | Hansard source

I rise to contribute to this debate today. It is a really important issue. People are struggling with the cost of living, they are struggling with everything in their household budgets going up, and sadly we have even heard over the last 48 hours that it is more than likely that many people are going to cop another rate rise on their mortgages, at a time when people are already out their wits end.

A cost-of-living crisis is putting a wrecking ball through family budgets. It costs more to go to the supermarket each week. It costs more to make sure the lunchboxes are full. It costs more to make sure the kids have school uniforms and new jumpers for winter. It costs more to pay for the home insurance. It costs more to pay for private health insurance. It costs more to go to the doctor and it is costing a whole lot more if you need to get dental or mental healthcare.

So, while this bill does help some in the community with the freezing of the indexation of costs, when it comes to medicines, it is already pretty bloody expensive to even get the prescription in the first place. We have got this proud history and a narrative we tell ourselves in Australia about universal health care: 'We are not like America.' But, when you look at each of the financial barriers and the practical barriers to getting good-quality, affordable healthcare in this country, there is another story for many people. If you can even get an appointment with your local GP on the day that you are sick, it is going to cost you anywhere from $40 to $100. That is with Medicare. Fewer and fewer doctors' practices around the country bulk-bill. It is very, very hard to get a bulk-billed spot these days. So, if you don't have the cash flow to pay that upfront fee, the $60, $80, $100—sometimes even more—just to get in to see the doctor, you are not going. So you can't even get in to the doctor to get the prescription and then wonder how you're going to afford the prescription.

You walk into the supermarket these days and you see ads for Afterpay on the supermarket shelves—packet of pasta here, fresh vegetables there—'Put it on Afterpay'. The reason Afterpay is advertising in our supermarkets and on supermarket shelves is because people don't have cash in their bank accounts. They don't have enough money to pay for the essentials, so they're having to make decisions day in, day out about what they pay for. Do they do the full supermarket shop this week, make sure the school lunches are all sorted and make sure everybody's got good tucker for when they come home from school and work? Or do they think that that sniffle that little Freddie has is about to turn into the flu and they actually might need to go to the doctor, so perhaps they won't do the full supermarket shop this week? Perhaps they'll wait and see whether that sniffle runs through the whole family and everyone has to go and get a prescription for antibiotics or other medicine. These are the real-life choices that families are having to make every day and every week. People are struggling. As we know, it is always those who are already on the margins and already struggling, the lowest-paid workers in this country, who every single day are forced to make these decisions.

What happens if you get sick anyway and you work a casual job? You don't get paid for your days off. You don't get paid sick leave. Your income is going to go down anyway, so how on earth are you going to pay for the doctor and that prescription when you are going to have to take time off work either to go the doctor or because you are so sick? So, then, people are making choices about whether they are even going to go to work. It's crazy to me that in 2024 we don't have universal sick leave for every worker in this country.

In my home state of South Australia in the last month we have had code yellows on and off in our public hospital system. Do you know what that means? It means that elective surgery gets pushed back because the hospitals are struggling with the number of emergency patients. The reason there are so many emergency patients is that everybody is sick with the flu and COVID. During the pandemic, during the COVID period, health officials advised governments that one of the best things we could do to stop the spread of COVID was encourage people to stay at home and, in order to encourage people to stay at home, they could access sick pay, pandemic pay. They didn't lose out financially because they had to stay at home to stop the spread of disease. Fast forward a couple of years and we are now in a situation where the lowest paid workers in this country are still having to go to work sick because there is no paid sick leave. So if you took the day off work, or the morning or the afternoon, to go to the doctor, you'll fork out your $80, you'll get your prescription and it'll cost you another $20. You'll maybe get some more Panadol or Nurofen. If the doctor has said to you, 'You're really sick and should not go back to work; I'll give you a sick certificate,' good luck with that if you are casual. This is what is wrong with the system. We pretend that everybody has access to good-quality health care in this country, but they don't. The barriers are too high. The costs are too high. The supports for people to be able to take care of their health and be preventive are simply not there.

We know that preventive health isn't taken seriously in this country because, if it were, you'd be able to pay for your dental health on your Medicare card. One of the single easiest, simplest ways of helping people stay healthy and not fall into chronic disease is ensuring that people's mouths are kept healthy and that their teeth are able to be cared for. It costs an average of $215 to go to the dentist and get a check-up, and none of that can be put on Medicare. Some dentists charge more just for a clean, a check-up and a scale. If we are serious about ensuring Australians are kept healthy and can be encouraged to keep themselves healthy to reduce the burden on the health budget of chronic illness, this government has got to get serious about funding dental care for everyone and allow people to go to the dentist, put it on their Medicare card and ensure they can keep their mouths healthy.

It is ridiculous that, in a wealthy country like Australia, if you break your elbow, you can go to the emergency department and get your elbow looked at, put in plaster and x-rayed, but if you break your tooth, it will cost you hundreds, if not thousands, of dollars. If we're serious about looking after the health of Australians, we have to get serious about making doctors accessible, making prescriptions affordable, and ensuring that mental health or dental care can be paid for by the healthcare system or Medicare as well.

We know that the cost of health care is rising. Two-thirds of Australians—67 per cent—avoid going to the dentist because it's too expensive. Everyone in this place might think: 'Why don't people just pay private health insurance and get extras cover? You can get to the dentist, have a clean and look after your teeth.' But, of course, you have to have the money to pay for the huge hikes in private health insurance to do that, and people just don't have that kind of cash in a cost-of-living crisis, particularly our lowest income families and lowest paid workers.

Only last year, in 2023, the Australian Bureau of Statistics found that 19.3 per cent of patients could not afford to see a healthcare professional for their mental health. That's up 16 per cent from the year before. Not only are we not helping people care for their teeth to keep the rest of their bodies healthy; we're forcing people to neglect their mental health. We know that the flow-on effects of that on the broader health system are catastrophic. The number of patients in our public hospitals is crippling our emergency departments because mental health has hit a crisis point. It's crippling the bed numbers in our hospitals.

You're a Labor government. You care about health care. It's in your blood. You have to start funding it properly. You have to start funding it so that people can prevent serious illness. We need to find preventive health so the community can be kept healthy and reduce the burden on the rest of the health budget. You shouldn't have to go to the emergency department at the hospital just to get a prescription because you couldn't get in to see a doctor. You shouldn't have to take your kids to the emergency room just because they have a cold and you're worried about it spreading or because you need a doctor's certificate to prove to your boss that you're sick. And when are we going to start supporting parents in this country to take time off work because their kids are sick, without losing hours? If you want to stop the spread of COVID, the flu and other diseases, people have to be able to afford to stay at home. It worked during the pandemic—we know it did—why on earth haven't we been able to see that follow through to 2024? (Time Expired)