Andrew Leigh

4 June 2014

The Tax and Superannuation Laws Amendment (2014 Measures No. 2) Bill 2014 has three parts. It increases the Medicare levy low-income threshold, the point at which the levy starts to be paid, for families and their dependent children or students, in line with movements in the CPI, commencing in 2013-14. It contains amendments to protect against situations where taxpayers have anticipated the impact of announcements made by the previous government in regard to tax law which have been overturned by the current government and as a result have been left worse off—this is taxpayers who have filed tax returns; lest any listeners think this might have broader applicability. Thirdly it is to introduce an integrity rule to limit the ability of taxpayers to avoid paying tax by dividend-washing, which is a taxation loophole created by the tax treatment of franking credits.

The opposition welcomes the government's decision to increase the Medicare levy low-income threshold but we will not resile from our condemnation of the government's attacks on the universality of health care in the country or its very clear broken promises.

From 1969 to 1993 elections were fought in this country over Medicare. This side of the House defended it; that side of the House, the conservatives, worked to bring it down. That period, nearly a generation, was a time in which the coalition attacked Medicare. Now they have a chance to rip into health care again.

It is not just Labor members who are saying that; it is Liberal state premiers, health ministers and treasurers. NSW Premier Mike Baird, when asked about the federal health cuts, said:

The impact starts on the 1st of July. The equivalent here in New South Wales is over 300 hospital beds in funding disappears.

He also said:

The cuts have an immediate impact, and we’ve seen that in health, in terms of the funding in health, what we are seeing in the next 12 months is hundreds and hundreds of hospital beds … impacted. This cannot proceed.

Liberal health minister in New South Wales, Jillian Skinner, said:

There is no doubt there have been significant cuts to the funding of state hospitals in the federal government’s budget, …

It is cost-shifting and NSW will have to accommodate a loss of more than $1 billion over the forward estimates for hospital services.

Andrew Constance, Liberal Treasurer in New South Wales said:

We are deeply concerned about what this budget means for health and education services.

Campbell Newman, the LNP Premier of Queensland, said 'a big red cross is cutting health and education spending. It's not acceptable.' He also said:

Essentially, the Prime Minister and the Treasurer are saying 'well, you guys have to but deal with health and education, but we're going to take away the money for you to achieve the things that need to be achieved.' We're also concerned about the co-payment. And I know that Premier Napthine particularly agrees with me that this could see people using ambulances more frequently and also turning up at our emergency departments rather than put their hand in their pocket to go and see a GP. It is again of great concern that this has been done with in a way without sitting down with the states and territories to properly plan it.

Tim Nicholls, Liberal Treasurer Queensland:

Well, the potential impacts for it could be, for example, you'd have to wait longer to get treatment at a hospital, because we wouldn't be able to have as many doctors or nurses on hand to be able to treat people.

An editorial in the Medical Journal of Australia this week starkly outlined the view that health professionals have taken about this government's approach to health care. Written by Andrew Wilson, the Director of the Menzies Centre for Health Policy it says:

Chronic disease is a common cause of shortened working life, even when it doesn't kill.

The direct effects of the proposed federal Budget on prevention include cuts to funding for the National Partnership Agreement on Preventive health, loss of much of the money previously administered through the now defunct Australian National Preventive Health Agency, and reductions in social media campaigns, for example, on smoking cessation.

The cuts to preventive health are particularly short-sighted. When bringing down the budget, the Treasurer spoke about the importance of long-term thinking. Yet nothing better epitomises short-termism than cuts to preventive health.

It was my pleasure last year on behalf of the Minister for Health to launch the first report of the Australian National Preventive Health Agency. It was a very thoughtful report that looked carefully through the costs and benefits of preventive health treatments, and focused on issues ranging from obesity to road safety, from smoking through to exercise. Yet that agency is being slashed.

The editorial the Medical Journal of Australia by Andrew Wilson is also concerned about the government's proposed $7 co-payment for GP visits:

Other studies confirm that health care visits for preventive activities are the ones most reduced by financial hardship or disincentives.

The editorial goes on to concerns about hospitals:

The Australian Government's commitment to index its contribution to public hospital costs to population growth and the consumer price index will be insufficient to meet the predicted increase in demand for health care.

Blind Freddy knows that health costs have been running faster than inflation for decades, and so these changes in indexation are going to hit the ability of Australia's healthcare professionals to tackle some of the big healthcare challenges.

It is a pleasure to have the member for Blair here in the chamber with me. I know he has been a tireless advocate of closing the gap on Indigenous health. Yet, as he has so articulately pointed out, the cuts to health in this budget are going to make it harder to meet the Indigenous targets, to close the gaps in healthcare outcomes. Indeed, these outcomes, as he has pointed out, could be widened. The gap between Indigenous and non-Indigenous Australians could be widened by the decisions that are made in this budget.

These decisions are not simply wrong; they are a breach of promise. There is a reason that the Prime Minister and the Minister for Health are so keen on trotting out things that I wrote over a decade ago when I was in university, and that is because they do not want to talk about what they said when they were campaigning to be the government of Australia. They were very clear that there would be no cuts to health and education; yet we are seeing more than $80 billion of cuts to health and education as a result of the budget.

In addition to not honouring the National Health Reform Agreement, the Abbott government has cut $368 million out of health by abandoning the National Partnership on Preventive Health and another $201 million by breaking their promise and not honouring the National Partnership Agreement on Improving Public Hospital Services. These cuts are going to lead to the sacking of nurses and doctors, the closure of hospital beds, putting off infrastructure upgrades and sacking frontline healthcare workers like psychiatric nurses and psychologists.

Labor is fighting these changes, as are health experts across the country. The Australian Medical Association's national conference has called for an overhaul of the model proposed by the government because of its potential effects on the most vulnerable patients in the community. Steve Hambleton, the outgoing AMA President, said:

Overseas evidence shows that better health outcomes are delivered when barriers to primary care are low.

Front line primary care services are very efficient and are a low cost part of the Australian health system.

Encouraging patients to access this part of the health system reduces pressure on the hospital sector and can avoid the need for more expensive medical interventions.

Co-payments can hit vulnerable groups hard.

It is particularly striking that both the Prime Minister and I have shifted our view on co-payments since the early 2000s. In 2002 the Prime Minister said that co-payments were 'madcap'. He has since shifted from that view to now be at odds with health experts in Australia. I have shifted my view too, and I am proud to say that I now stand with Australian health experts and organisations like the Australian Medical Association and the Medical Journal of Australia—deeply concerned by the impact that this government's healthcare policies will have on the most vulnerable.

Brian Owler, the Sydney neurosurgeon widely known as the face of the 'Don't Rush' road safety campaign has said:

If a large proportion of their patients can't afford to pay the co-payment, then those practices might still be bulk-billing, but it will be the GP that bears the cost, and who will be financially worse off … the only way they could do it would be to see more patients. Instead of doing 6-minute medicine, they'll go to 4-minute medicine. That's not something that we want to see happening.

The government have claimed that they are going to set up a medical research fund but, in fact, as has been pointed out this really is like something out of The Hollowmen—a fund which is currently funded only by ripping out money from existing funds. Really, it is the trick pulled by Peter Costello with the Future Fund. It is not a serious investment in medical research for the future. This government's healthcare policies will leave Australians sicker and show a lack of concern for the most vulnerable.