HANSARD EXTRACT
|
Health Insurance Amendment (Medicare Safety-Nets) Bill
2005: Second Reading |
| 5 September 2005 |
Mr HAYES
(Werriwa)
(6.51
p.m.)—The
chickens have certainly come home to roost on another occasion. It
seems that this sitting of parliament has been more about cleaning
up the government’s mess rather than tackling the problems that
Australia is facing on a daily basis. It should come as no surprise
that Labor is opposing the
Health Insurance Amendment (Medicare
Safety-nets) Bill 2005. It certainly opposed the safety
net approach to Medicare from day one and will continue to do so
while the government continues to make attempts to patch up Medicare
and fall back on bandaid solutions rather than addressing the real
issues at the core of Australia’s health system.
The Medicare safety net was a fundamentally flawed policy from day
one and things will certainly not change with the passage of the
bill. It will not change because the sole purpose of the bill is to
avoid the problem rather than to address it. The government’s
approach to fixing the problem—a problem which, I have to say, is of
their own making—is simply to raise the threshold so that fewer
people are eligible. Under the government’s proposals, some one
million claiming units will no longer be eligible for the safety net
because the threshold has been raised. The government might refer to
them as ‘claiming units’ but the rest of us know them as people.
This bill seeks to increase the safety net threshold from $300 to
$500 for low-income earners and concession card holders and to
increase the threshold from $700 to $1,000 for higher income
earners. In practice, what does this do? This means that, despite
all the promises made by the Minister for Health and Ageing and his
coalition candidates during the last election campaign, patients
will have to spend more money on health care before they are
eligible to claim their out-of-pocket expenses. Lower income earners
and concession card holders will now be forced to spend up to $500
before they are eligible and higher income earners will be required
to spend up to $1,000.
The most staggering thing about this is that the safety net was
designed to assist patients to meet their often significant
out-of-pocket expenses that they face when using medical services.
The bill flies in the face of this approach by making it even harder
to access the safety net. Why has this happened? Simply because the
rock solid, ironclad guarantee that the minister for health gave on
6 September last year was not worth a jot. When the minister gave
his commitment, he knew that the Medicare safety net was
unsustainable. He was not willing to come clean because he also knew
it was important to people. He knew that the voters would not see
his admission of policy failure in a positive light when they went
to cast their vote. I am quite sure that when the government came up
with this policy they knew it would not last the distance—quite
frankly, they should have known. The opposition certainly knew it
would not work. Health care representatives knew it would not work.
Consumer groups knew it would not work. So why is it only the
government which could not see that it would not work. I guess it is
because they did not want to admit it; they did not want to face the
voter backlash when they went to the last election with a backdown
on this policy. It would have also put a severe dint in the
government’s key election strategy.
This approach to dealing with the problems of our medical system was
never going to work because it was fundamentally flawed. As Tim
Woodruff from the Doctors Reform Society said when the safety net
was introduced, this policy is going do nothing more than provide ‘a
blank cheque to increase co-payments’. That is exactly what it did.
At its heart, this is the most fundamental of all flaws in the
policy. It provided a green light for medical practitioners to
increase their charges because it gave a guarantee that the
Commonwealth would pick up the tab. They knew the government would
pick up the tab because that is the way this policy is
structured—the safety net rebate is not tied to anything.
Unlike other programs, such as Medicare rebates or the costs of
medicines under the Pharmaceutical Benefits Scheme, which are tied
to price controls, the safety net was an open-ended promise for the
government to pay for out-of-pocket costs. At the time of its
introduction Labor pointed out the potential inflationary impact of
this policy and how that was bound to blow-out, but the government
failed to do anything about it, instead making the policy a central
plank of its election strategy and, in effect, ignoring its problems
until it was forced to come clean last April. Once again the
government said one thing before the election and something
radically different after it. In his second reading speech, the
minister referred to increasing the threshold as a ‘tough decision’.
The only reason it was a tough decision is that the minister knew
when he went to the last election and sold a plan for Medicare that
it had a limited life span. We can be quite sure that he knew about
the limited life span—
Mr Martin Ferguson—Six
weeks.
Mr HAYES—Yes—and
also the imminent cost blow-out at the time because he has been
unwilling to give a straight answer ever since. I find it staggering
that the minister continues to avoid answering simple questions on
what he knew about the blow-out and when he knew about it. Many of
my constituents can see through the tactic of avoiding the question.
They can see through the excuse that the changes before us today
simply seek to implement the thresholds that the government
originally intended to introduce back in 2003. They are sure that a
competent minister would have been closely monitoring the progress
of such a significant policy in the lead-up to the last election.
But most importantly, they now know not to believe any ironclad
commitments that this government might give in future because they
know that these commitments soon turn to rust. The minister may
claim that this was a tough decision but he knew the decision had to
be made, that it was unavoidable.
The one thing that really disappoints me about this bill is that the
government had the opportunity to fix the whole scheme but has
failed to take it. This plan is not about the future; this plan is
about a desperate attempt to try to make up for the ill-considered
decisions of the past. The changes we have before us today do
nothing to address the medium- to long-term sustainability of the
safety net because they fail to address the structural problems. The
changes seek to overcome the cost blow-out but do nothing to reduce
the inflationary effects of the policy nor to address the inherent
bias towards high-income earners.
As the Australian Medical Association said when the government
announced that the safety net thresholds would be increased, the
decision was ‘a great disappointment’. It went on to say:
... the young families out there that are struggling—struggling to
meet medical costs, and who are relying on that safety net, ... to
deliver security and affordability, now feel as though they’ve been
cheated.
Families feel cheated because they have been cheated, and not for
the first time over the life of this parliament. Recently they have
been cheated on child care, and now they are going to be cheated on
Medicare.
If we look at the data we can see that, in electorates like mine,
families are really missing out. In answers to questions in writing
to the Minister for Health and Ageing, I found that to the end of
July last year fewer than 600 families had reached the safety net
threshold in my electorate. The same number had reached the
threshold in the neighbouring electorate of Fowler, but as we cross
the river and look at the electorate of
Hughes, for instance, more than 1,600 families reached the
threshold. If we compare the average incomes of these three
electorates, it confirms that high-income bias is attached to this
safety net. The average income in Fowler is just over $700 a week
and in Werriwa it is a tad over $1,000 a week, but the average
income in the electorate of
Hughes
is nearly $1,400 a week. That is almost double the average in Fowler
and is 40 per cent higher than in Werriwa.
The minister’s own figures, released in September last year, show
that only $123,000 in safety net payments has been received by
residents of Werriwa. Quite frankly, these people deserve more. They
did not get tax cuts in the budget when they deserved them, they
will not be getting the support they need in child care through the
30 per cent offset, and the changes to the safety net threshold mean
that they will not get the support they need when it comes to
medical services.
A closer examination of the Medicare safety net data released by the
minister for health at the end of September last year adds further
weight to the argument that the safety net benefits higher income
earners. When electorates are ranked by the level of safety net
rebate paid, one sees that nine out of the top 10 electorates are
held by government members. Those same electorates are also among
those with the highest average incomes. This skewed approach has
been allowed to happen because those who can most afford to pay the
high costs associated with medical services are able to reach the
threshold more quickly than those who can least afford to pay.
The changes we have before us are a slap in the face for Australian
families. They were led to believe that they would be able to access
health care services and have a considerable proportion of their
out-of-pocket expenses refunded. Australian families believed the
minister was doing something to help them to meet their medical
costs. They believed they were going to get the break they deserved,
but they could not have been more wrong. They did not realise that
his policy would help high-income earners first in yet another
example of the government’s approach of shifting welfare away from
those who need it most to those who need it least.
I noted earlier that this bill does nothing to combat the
inflationary impact of the safety net policy. While the government
might like to ignore the inflationary impact of the policy, the
figures certainly speak for themselves. We have all heard reports of
how, after practitioners worked out that this was a blank cheque—a
government guarantee that they would be paid—fees were restructured.
What this bill actually achieves is a restructuring of our
in-hospital costs to out-of-hospital costs. As a consequence, we
have seen Medicare rebates for obstetrics, for example, increase by
151.8 per cent from March 2004 to March 2005.
Practitioners reacted to the environment in which they operate. The
government had agreed to pick up the tab for price increases through
their blank-cheque approach to this policy, and it should be of no
surprise to anyone that practitioners have filled it in to their
advantage. That is not being critical. I think any rational person
would have reacted in the same way to a government guarantee to
provide a blank cheque.
Health care costs continue to rise. The CPI figures released in July
show that health care costs rose by five per cent in the last year
and that hospital and medical services were up 4.2 per cent over the
last quarter. Granted, the Australian Bureau of Statistics notes
that the increase was partly due to increases in the cost of private
health insurance—another flawed policy of this government—but that
does not hide the fact that people are facing higher costs for
medical services.
In a decent society, one in which most Australians believe we live,
there is an expectation that health services will be reasonably
accessible and reasonably affordable. The Medicare safety net is bad
health policy—there is no other description for it. This government
knows it and the minister knows it. It is staggering that the
minister for health still clings to the hope that people fell for
his deceit about this policy before, during and immediately after
the last election. He hopes that all will be forgotten and that he
will be able to carry on avoiding the development of the serious
health policy that the Australian people want him to come up with.
Medicare has been critical to the provision of affordable access to
health care in this country for the last 20 years and should
continue to play that role. But this bill is a slap in the face for
most Australians, particularly those one million people who will now
miss out on receiving a refund of their out-of-pocket expenses
because the threshold has been raised. Raising the bar on this
policy will only get the minister so far. The policy needs a radical
overhaul, not a tinkering at the edges. It was never going to work;
Labor said at the start that this was the case and it has been
proved to be true.
Labor proposed a complete redirection of the funding at the last
election—a redirection of funding that would have introduced
incentives to increase bulk-billing to 80 per cent and provided
funding for specialist out-clinics in public hospitals, a
redistribution of funding that would have facilitated health
spending in areas where people need it. It would not be a system
under which funding is skewed in favour of high-income earners. The
blow-out in the safety net should have meant that it was blown up
rather than patched up, as this government is seeking to do with
this bill today. The actions of the government in introducing this
bill are certainly not the actions of the best friend that Medicare
has ever had. This bill is nothing more than the product of an
out-of-touch government trying to paper over the huge cracks that
have appeared in one of its key policies. This will not help
families in Werriwa, it will not help families in the south-west of
Sydney
and it will certainly not help low-income earners throughout
Australia access medical services in an acceptable way.
This approach will affect electorates in different ways. My
electorate in particular will suffer—I speak very much personally on
the position that we find in Werriwa. This is going to dramatically
affect the ability of my constituents to access the safety net. It
will put the safety net out of their reach, which will have a real
impact on families making decisions about accessing appropriate
medical care in various circumstances. This is clearly an issue
about moving the provision of government services to those who need
it least from those who deserve it most. This is not a balanced
approach. This clearly is an approach which works against
working-class families and those people who are struggling in the
current environment to take care of their families, and they deserve
all the support that this government can give them. The government
should not simply be moving their position on such a key policy as
this and making it more difficult for families to access the safety
net. This policy goes to the heart of bringing up families in a
community, and this bill is moving to rip that heart out.
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