Happy Birthday Medicare! Julia Gillard - Shadow Minister for Health, Deputy Manager of Opposition Business in the House of Representatives

Speech

Transcript - Newcastle - 1 October 2003

We're here to celebrate a birthday party. Twenty years ago today, on 1 October 1983, the first set of legislative amendments giving birth to Medicare were given Royal Assent by the Governor General of the day, the Rt Hon. Sir Ninian Stephen.

Medicare was a grand vision, a brave blow in the battle of values and ideals that had created Medibank under Whitlam, and seen it fatally undermined under the subsequent Liberal Government – the Government led by Malcolm Fraser and John Howard, in the days when they were still speaking.

Introducing the Medicare enabling legislation in 1983, Health Minister Neal Blewett stated:

"Medicare … will make health insurance fairer and affordable to every Australian because everyone will contribute towards the nation's health costs according to his or her ability to pay… We have sought in planning Medicare to produce a simple, fair, affordable insurance system that provides basic health cover to all Australians…"

And this was exactly the system that was created. A system based on equity, and not on the capacity to pay. A system based on fair contributions from everyone through the tax system, in return for reliable health care when it was needed. A system made by, and perfect for, the Australian values of equality and community that we all believe in.

Medicare provides universal health cover to every Australian, every family. Everyone is entitled to be bulk billed, to see a doctor for no charge.

If they are given a prescription, the Pharmaceutical Benefits Scheme puts a cap on how much they'll have to pay for their medicines.

In an emergency, or for more serious care, everyone is entitled to the same treatment, free of charge, in Australia's public hospital system.

Internationally, Medicare has given us one of the best value health systems in the world, keeping the cost down to around 9% of GDP, while delivering some of the highest quality health care in the world.

Medicare is a part of the Australian landscape, and more importantly, it's a part of the Australian ethos. Medicare is a uniquely Australia institution of which we should be proud. It's something we should rightly celebrate.

And yet this birthday party is a little like a birthday party in a hospital ward. No matter how much we try to celebrate, there's something not right. Medicare is not well. In fact, fear is crowding out our celebration as we all ask ourselves, will Medicare be here next year to turn 21?

Like a wicked witch in a fairy tale, casting curses over the cradle of a newborn infant, John Howard was there when Medicare was christened.

John Howard was Medicare's greatest enemy. Again and again he declared his opposition to Medicare. When he was Leader of the Opposition in the 1980s, he said that Medicare was a "miserable, cruel fraud", a "scandal", a "total and complete failure", a "quagmire", a "total disaster", an "unmitigated disaster", a "financial monster" and a "human nightmare". He also said that Medicare had "raped the poor in this country."

He threatened to "pull Medicare right apart" and to "get rid of the bulk billing system". And he said bulk billing was an "absolute rort".

John Howard's 1987 election commitment stated:

"Bulk billing will not be permitted for anyone except the pensioners and the disadvantaged. Doctors will be free to charge whatever fees they choose."

But John Howard could never win an election while threatening to dismantle Medicare and kill off bulk billing.

So something happened between 1987 and 1995. In 1995, John Howard told Australians:

"We absolutely guarantee the retention of Medicare. We guarantee the retention of bulk billing."

Australians believed him, trusted him, and elected him Prime Minister. Now it is only too clear what he has done with that trust. Any sense that this man could be trusted died on the day it was falsely claimed children were thrown overboard. Now John Howard stands revealed before the Australian public as a man who will do anything and say anything for electoral gain.

Prior to John Howard's election, bulk billing rates had climbed steadily, until 80% of all GP services were delivered free of charge. Following his election, they have steadily plunged – 68.5% is where they sat at the end of June 2003, following a decline of over 5% in just one financial year.

While fewer and fewer services are delivered free, the fee charged for the rest is climbing, reaching its highest ever charge in June of $13.24 for a single GP service, over and above the rebate.

These figures are not just about the fee structure of the health system. For ordinary working Australians, these numbers mean the difference between going to the doctor and not going to the doctor.

There are many examples of this difference, provided to me by worried Australians around the country.

The Batemans Bay Medical Centre on the South Coast of NSW does not bulk bill. The centre charges $48 for a normal consultation, $45 for a health care card-holder consultation and $37 for a pensioner consultation. In order to see a doctor, a patient must make an appointment one week in advance, then wait 90 minutes in the practice before being seen. A constituent informed my office that she was charged $144 on a weekday for her two young children to be seen.

In Alice Springs, the after hours GP service charges health care card-holders $50 for a standard consultation lasting 15 minutes, and general patients $70 for the same consultation.

On the NSW Central Coast, a woman sick with pneumonia was told by the Munmorah Medical Centre that a doctor would not come to treat her at night unless she had $58.80 up front.

In the San Remo area, more than 8000 people live with no GP. A single mother on a disability pension recently paid $110 before a doctor would come to her home to treat one of her children with chicken pox.

Another young woman had to travel from Maitland to Broadmeadow (a 40 minute car trip or more than an hour by train) with her three children to find a bulk billing doctor.

Kids don't wait till payday to get sick. These dollar figures mean real heartache for struggling Australian families. And they mean going without health care.

In the last financial year there were 3 million fewer visits to GPs than the year before. That's three million decisions about whether to pay the doctor's bill, or wait. Kids with asthma aren't having their medication checked. People with diabetes aren't getting the regular tests they need to stay healthy. Preventative health advice is not going out to the community.

In the last year, out-of-pocket costs for health care for individuals in Australia have risen by 7.7%. That means average out-of-pocket costs of $630 per year for every person in Australia. That's over $2,500 for a family of four.

Clearly Medicare is sick and the illness has been caused by the Howard Government's neglect. The Australian health system is under new pressures, our population has changed, our health has changed, and Medicare needs tender loving care to make sure it is fit and well and ready to meet the new challenges of the 21^st century.

But Medicare hasn't received tender loving care for its birthday. Instead, John Howard has given Medicare to his attack dog, Tony Abbott, to sink his teeth into.

Wherever Tony Abbott has been confrontation and division have followed.

And Tony Abbott's reputation for honesty rivals John Howard's. Tony Abbott is the only person in Australia who would fail to see the irony of creating an organisation called Australians for Honest Politics, and then lying about it.

There has been media speculation that Tony Abbott will seek to amend the Howard Government's unfair Medicare package, which is now before the Senate, that he wants to try and take the sting out of Patterson's curse.

But let's be clear. Senator Patterson might have been the mouthpiece for the Howard Government's unfair Medicare package, but the package is all John Howard's. The Prime Minister's fingerprints are all over it. The package was conceived in and driven by his office. The package is about implementing his 1987 election commitment to confine bulkbill to the poor and disadvantaged.

Tony Abbott can't walk away from one word of the package. It is John Howard's package and John Howard holds Abbott's leash.

And this package is about the destruction of Medicare.

Echoing Howard's miserly promise of 1987, the package gives incentives to doctors to bulk bill only concession-card holders. It gives doctors a green light to charge whatever they can get from the pockets of Australian families to make up the funding shortfall.

These are not simply assertions I'm making. The recently released report by the Australian Institute for Primary Care at La Trobe University provides a careful economic analysis of the likely outcomes of the Fairer Medicare package.

The report was commissioned by the Senate Select Committee on Medicare because the Government had prevented the Department of Health and Ageing from modelling these outcomes themselves. And now we know why.

The report found, unsurprisingly, that a package designed only to give doctors incentives to provide a safety net of care for concession card-holders, would trigger a decline in GP bulk billing to around 50% - a residual rate covering only concession card-holders.

The package then removes one of the only effective barriers that the Government has to keep doctors' costs low: the requirement to charge patients up front for the whole cost of a visit when not bulk billing. This requirement acted as a "hard threshold", a significant price barrier. The need to jump from no fee to a fee of over $25.00 for a standard consultation keeps many doctors bulk billing despite the sliding value of Medicare rebates and rising practice costs.

The Howard Government's unfair Medicare package removes this requirement and replaces it with a system under which doctors can charge the patient and direct-bill Medicare for the same service. Now only needing to make the jump from no charge to $5.00 or $10.00, doctors will abandon bulk billing.

Though many will do it reluctantly, the Howard Government's package gives them no reason to act otherwise, and indeed gives them no option but to recover their flagging relative incomes from the pockets of their patients. Bulk billing will plummet, and the price for the rest of us will rise by up to 56%.

If these incentives are introduced, we can say goodbye to a universal Medicare. We will end up with a two-tiered, Americanised system where those who can afford it get the highest quality care, and those reliant on the remnants of the public system get whatever is left over.

Already, in a number of cities around the country, there are GP waiting rooms where appointments aren't based on how sick you are, but how much you can pay.

The cost of a GP visit isn't the only thing on the rise. The Government remains committed to its nefarious plan to increase consumer co-payments for PBS medicines by up to 30%.

Government figures show that Australian pensioners, concession card-holders and families under financial pressure will go without almost five and a half million prescriptions for their essential medicines, because people will not be able to afford the proposed increase.

At the same time, the Government has spent $27 million on an advertising campaign designed to soften people up for the blow.

John Howard has proffered empty reassurances that he is committed to Medicare, but only last week, he said on national television:

"I thought that we had a very good system in the very early 1970s…"

He's referring to the system before Medicare, even before Whitlam's Medibank, when many Australian families faced a cruel choice between getting no treatment or paying to go to the doctor and even paying to get treated in a public hospital. It is an offense against Australian values that our Prime Minister would muse nostalgically about a system in which you had to pay to get treated in a public hospital as ‘a very good system'.

Such a system is a sick disgrace. That's not the kind of Australia I want to live in.

Like many Australians, I believe in Medicare. I'm proud of what Medicare has done for the health standards in Australia, and the protection it gives our older people, our families and our children.

John Howard's birthday present for Medicare may be a painful death, but Labor has other plans. Labor's birthday present to Medicare is our plan to save Medicare.

The same report, which revealed the consequences of the Howard Government's unfair Medicare package, also looked at the consequences of Labor's $1.9 billion package to save Medicare. It's no surprise that the results were quite different.

Rather than using Medicare as a last-ditch safety net for the poor and desperate, Labor's plan is designed to strengthen Medicare across the board. Our plan includes increases to GP rebates up to 95% and then 100% of the Schedule fee. This is a recognition of rising practice costs, including indemnity costs, that face all our doctors, and not just when they're treating concession-card holders.

Then, our package includes powerful financial incentives to increase bulk billing for all Australians. The report found that under Labor's plan bulk billing would turn around and increase to around 77% of GP consultations. At the same time, the average out-of-pocket cost would drop by around 25%.

This is a fundamental divide in the values of the Government and the Labor Party. They see Medicare as an enemy, to be fought and destroyed. We see Medicare as a mechanism through which we strengthen our community, and ensure that we all have access to the health care we need.

The Australian health system is at a turning point. The only answer from the Howard Government is to let the divisive Tony Abbott take a turn for the worse.

Labor built Medicare, believes in Medicare, has a plan to save Medicare and will strengthen Medicare so it can face the challenges of the 21^st century.

Medicare deserves a happy birthday. I know the Australian community stands with the Labor Party in our belief in the value of caring for each other. We all wish Medicare many happy returns.

Ends. Check Against Delivery