MATTERS OF PUBLIC IMPORTANCE;Budget – 02 Sep 2014

I am really pleased that the Senate has decided today to discuss this issue as a matter of public importance, because this issue is one of utmost public importance.

While the Liberal government is pre-occupied with creating knights and dames, and looking to protect hate speech, it is the government’s unfair $7 GP tax and their hike in the price of PBS medication that Australians are really concerned about. It is what the people of Australia are talking about with their friends and their families. It is one of the most loathed facets of a budget that is still being talked about four months after it was handed down in May. This government is utterly out of touch with the Australian community. They are utterly out-of-touch with Australian values.

If the Liberal government had campaigned on a platform of introducing a $7 GP tax, protecting hate speech and reinstating knights and dames, the Australian people would not have let the Liberal and National parties anywhere near the government benches. Even if Mr Abbott and his Sydney, North Shore Treasurer Joe Hockey do not understand the devastating impact this will have on the health of those with chronic disease, the mentally ill, the unemployed, seniors and pensioners, the people of Australia do. And the Australian people are very concerned that this government wants to turn Australia into a place where you do not help out a sick mate, and where we turn our back on a fundamental egalitarian belief that quality health care should be available for all, based on need, not income or postcode. Australians do not want an Australia like this.

Recently the Senate Community Affairs References Committee tabled a report into out-of-pocket costs in Australian healthcare. I was pleased to participate in this inquiry and to have the opportunity to speak in this place last week on its report. Senate inquiries are an important part of the process of government, because they are a mechanism to allow expert advice to inform debate on proposed measures.

It was important to hear this expert advice to the Senate Community Affairs Committee, because Mr Abbott did not bother to consult the experts when drafting this ill-informed policy disaster. And the expert advice on the government’s $7 GP tax and their $5 hike to pharmaceutical benefit scheme medications was absolutely damning. The inquiry showed that the $7 GP tax is a disastrous thought bubble, which will have a severe impact on the health of pensioners, the poor and the chronically ill.

Submitters and witnesses to this inquiry expressed concern that an increase in out-of pocket costs in the form of a co-payment for GP services would result in people delaying seeking medical treatment. In its review of health care in Australia, the COAG Reform Council found that nationally, in 2012-13, 5.8 per cent of people delayed or did not see a GP for financial reasons. That is 5.8 per cent of people—mainly pensioners, the poor and the chronically ill—who have had to choose between eating and having their health looked after. Adding an additional co-payment will only make this situation worse. It will impact disproportionately on individuals with the greatest healthcare needs, including Aboriginal and Torres Strait Islanders, elderly people, women, people on low or fixed incomes, and people with chronic illnesses. It will exacerbate their conditions and increase their suffering. Mr Abbott and the Liberal-Nationals government may not care about the health of people in these groups, or their suffering, but we on this side—the Labor Party—certainly do.

The government says that the $7 tax is to prevent unnecessary visits to the doctor. However, the Royal Australian College of General Practitioners provided the following evidence as to why the policy would not be effective in reducing healthcare costs:

… international studies demonstrate that, with the exception of the most vulnerable patients, there is limited evidence that co-payments actually reduce health service use. The economic rationale for implementing co-payments is further confounded by evidence suggesting that healthcare costs increase due to preventable conditions not being treated and poorer control of chronic disease and greater hospitalisations

Primary health care is the most efficient part of the health system. It allows for the early diagnosis, management and prevention of disease. Early diagnosis and effective management is extremely economical compared to emergency treatment or continual, ongoing treatment because an illness was not caught early.

The inquiry heard that countries with strong primary healthcare systems report the best health outcomes at the most efficient cost. The AMA told the committee:

Now is not the time to strip money out of primary health care. It is the time to invest in primary care to ensure sustainability of the healthcare system. People need access to general practitioners to know what their healthcare needs are. General practitioners need access to pathology and imaging services in order to diagnose conditions early and put treatment plans in place.

The Royal Australian College of General Practitioners also observed that there is no economic benefit in dissuading patients from seeing their GP. They said:

In fact there is good evidence to suggest that there is a negative economic impact with patients using more expensive health care through the hospital system that could be delivered by general practice at a fraction of the cost. General practice has been, and remains, the most efficient component of the healthcare system, with general practice costs per patient remaining steady over the past 20 years, while hospital costs have continued to rise.

Submitters and witnesses argued in general that co-payments may affect other parts of the health system in a number of ways—for example: by placing increased stress on the public health system, particularly emergency departments, as patients seek hospital treatment to avoid paying a GP co-payment; by shifting responsibility for primary care to community pharmacies; and by reducing the number of patients undertaking all required pathology and diagnostic testing.

This policy is a short-term approach to fix a budget emergency that does not exist. It will lead to more suffering by patients, worse management of disease and more severe and expensive treatment. It is as if this policy were designed to artificially spiral health costs out of control to destroy the viability of our healthcare system. And we all know it is the first step in the Abbott government’s quest to destroy Medicare. The Liberals have abolished Medicare before, so they should not be trusted to protect it into the future.

Submitters to the inquiry also overwhelmingly rejected an increase in the PBS co-payment. An increase in the co-payment for medicines will again lead to worse health outcomes for Australians. The Consumers Health Forum of Australia provided evidence about the impact of the 2005 increase on individuals, saying:

Studies have shown that, following the January 2005 increase in PBS copayments, there was a significant decrease in dispensing volumes observed across 12 of the 17 medicine categories, including anti-epileptic medication, anti-Parkinson’s treatments, combination asthma medicines, insulin and osteoporosis treatments. Importantly, we also know that the copayment increase had a particular impact at that time on medicine utilisation by concessional patients.

By increasing the co-payment on medicines again, we will see a decrease in the number of people who are able to afford their medication to treat their chronic illnesses. I shudder to think what would happen to a young person under 30 who has no income because they are unemployed who might need medication. I do not think the other side has thought about the areas this will impact on at all. This will lead to suffering, poorer health outcomes and further increases in emergency treatment for manageable diseases.

As a member of the Senate Community Affairs References Committee, I was also particularly concerned about the evidence given that the $7 GP tax and other proposed government measures would have on my home state of Tasmania. The President of the AMA, Associate Professor Owler, has said:

Tasmania has a higher burden of chronic disease and higher smoking rates, and we need to do more to encourage preventive health care and chronic disease management. That is why I think the co-payment is probably going to affect Tasmanians more than it affects people in other jurisdictions.

I do not see those Liberal senators opposite from Tasmania standing up and saying why they support a policy which will lead to worse health outcomes and suffering for Tasmanians. I would like to see those Tasmanian Liberal senators stand up and say why they support a policy which will lead to longer delays at the Royal Hobart and Launceston General emergency departments. And I would like to see the Liberal senators from Tasmania stand up and say why they support a policy which will lead to the state of Tasmania paying more for its health system while at the same time delivering worse health outcomes.

This government need to start listening to what the Australian people want, not just what their friends in the IPA tell them. We are a generous, caring country. We care about those in our society who need a little bit of extra help. This Abbott government are out of touch and utterly indifferent to the disastrous impacts their GP tax and medicine price hikes will have on pensioners, the poor and the chronically ill.