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Richard Di Natale on GP and PBS co-payments

Speeches in Parliament
Richard Di Natale 4 Sep 2014

Richard rose to speak in the senate during an urgency debate about the Abbott Government's proposed GP and PBS co-payments.

Senator DI NATALE (Victoria) (16:21): Before I go to the details of the issue of the GP co-payment, I want to refer to the matter of public importance, which is:
The impact of the Abbott Government's GP tax and medicine price hike on pensioners, the poor and the chronically ill.
I want to say something about that. The members of the coalition would be surprised to hear that I do not think this is a GP tax. I do not think it has any of the hallmarks of a tax. I think it is quite clearly a co-payment. It takes us closer to a user-pays system. In fact, I have deliberately avoided using the word 'tax'—and let me tell you why.
When this issue first came up, we considered calling this a GP tax and I resisted it. I resisted it because, every time we run around in this place and use the word 'tax' in this sort of context, we undermine those effective, fair and efficient taxes that allow us to fund universal health care, insurance, income support, education and so on.
Taxation is the price you pay for a civilised society. I am, for one, someone who supports progressive taxation and who supports a taxation on resource consumption. I think taxes can be a good thing if collected wisely and spent wisely. That is why I think it is a mistake to refer to this as a GP tax. This is a co-payment that works in precisely the opposite way in which a fair health system should work.
A fair health system should be based on the principle of fair taxation—the more you earn, the more you pay—and, at the point of delivery, the point of access of the service, everybody should get access to that service. That is the way taxes should work. Senator Seselja is right: health care is not free. It is not free under the current system. If you are a high income earner, you pay more into the system. You pay more into our health care system, and you should be entitled to access it. So this is not a tax; this takes us away from that important principle and moves us closer to a user-pays system in health care, which is both expensive and unfair. You only need to look at the US to see that in action.
What underpins this co-payment is the notion that our health care system is unsustainable. It is simply not borne out by the evidence. We have had inquiries into out-of-pocket health care costs. We have had inquiries into the PBS co-payment. We have had inquiries into the move from private health insurers into the health space in primary care. We have heard the same story over and over again: we have a good health system, it is sustainable, and by world standards people get access to one of the best health care systems in the world.
Let us look at some of those facts. We spend about nine per cent of our GDP on health care. By OECD standards, that is below the average. It is below the OECD average. Health care spending at a Commonwealth level has been stable for more than a decade. I say that again: health care spending by the Commonwealth has been stable as a proportion of GDP for more than a decade. We are on track to have a very small increase in our health care spend over the next 10 years.
The government would have you believe that that is due to health care costs spiralling out of control. Not at all. The small increase—maybe a half to another per cent of GDP on health care over the next decade, taking us to the OECD average—is because people are getting access to new, life-saving treatment. Health care technologies continue to develop all the time and we are in the enviable situation where we are providing people with the means to live longer, healthier and more productive lives. That is not a crisis. That is something to celebrate. If the whole proposition we all believe in, which is that we should strive for economic growth and development, is not going to provide the dividend of better health care, then what the hell are we doing in its place?
When you ask people time and time and time again what they want their governments to be spending money on—
Senator Bilyk: Health and education.
Senator DI NATALE: It is health and education. Thank you, Senator Bilyk. People say it time and time again. The whole point of economic progress is to be able to provide people with the means to spend money on the things they value, and that is health and education.
There is a notion that people visit the GP too frequently. Again, this is not borne out by any evidence. It is true that some people visit the doctor unnecessarily—that is, that if they do not visit a doctor their symptoms would resolve and they would not be any worse off because of it. But the whole point of having a trained health workforce is so that people who do not have the means to be able to distinguish between what is a serious symptom and one that is benign can get that advice and reassurance from a trained health professional.
As a former GP, I can tell you that a lot of what we did involved assessing and diagnosing, and providing people with reassurance. That is what the job involves. That is not a wasted visit. That is actually quite important, because the person sitting at home with a pain in their chest and who does not know if it is indigestion or the early signs of a heart attack, needs to have a professional assessment of those symptoms. That is what visiting a GP does. If you put a price barrier in front of a patient, you can be absolutely guaranteed that we will deter some of those necessary visits. The person sitting at home with chest pain and who is worrying, 'Could this be heart attack? No, it is probably indigestion', will be influenced by the fact that they will have to face a charge to see the GP potentially to have a blood test or an X-ray and have their script filled by a doctor—all of which will absolutely deter some of those necessary visits. As a consequence, it will cost our health system more. People will end up in emergency departments and in intensive-care units, because simple, treatable and preventable problems were missed in the first instance. That is why this is such a short-sighted policy.
There are so many things that we can do to improve the efficiency of our health system. We can invest much more in health promotion and illness prevention. We should be doing that. For example, we know from a study by Deakin and Queensland universities that the 20 best prevention strategies, based on good evidence, would cost us about $4 billion and return $11 billion in savings. We know that. Yet, at the same time that we introduce this co-payment, we are dismantling the Preventative Health Agency. It is short-sighted not just in terms of the impact it has on the lives of ordinary people, but because it will cost us money. Also, in medicine we do too many things that are not based on good evidence. We should be funding what works. A lot of what we do adds very little value. There is a big opportunity to start looking at the current Medicare list and reviewing how we fund a number of procedures that add very little value—the number of arthroscopies we do in this country, for example, many of which are unnecessary.
We should also look at Vitamin D testing, and the new and complex forms of prostatic surgery. They add very little value but a lot of cost. Of course, this would mean taking on some big interests, but we need to do that if we are going to make our already effective and efficient system more efficient.
We need to make sure that we resist the temptation—the great folly—of assuming that moving towards a user-pays system, introducing a price signal, is going to make the system any more efficient. It will not. You only need to look at the international evidence—to look at those countries that base their health system on fair taxation and universal access versus those that adopt the notion of user-pays in health—to be able to see a recipe not just for a less fair system, which is obviously something I am concerned about, but also a much more expensive system. That is why the US spends double what we do on health care and gets much worse health care as a result.
This is bad policy. It is unfair, inefficient and it must be stopped.

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