MEDICARE CO-PAYMENT

Written on the 6 August 2014

Ms PULFORD (Western Victoria) -- I move:    That this house notes --

(1) the comments made by the Minister for Health in question time on 27 May 2014; and

(2) the Victorian government's opposition to the Medicare co-payment proposed by the federal government;

    and calls on Liberal and National Party senators for Victoria to oppose the Medicare co-payment.

 

As a member of Parliament, my work takes me far and wide. As it does all of us, it puts me into conversations with people across the community on all manner of things. There is a common theme. Time and again Australians and Victorians advocate for the same core principle -- that is, fairness. It is a tenet of our society that causes volunteers to be active in their communities. It is a belief in fairness that has led us to be a nation where citizens will donate their time and money to charities and non-government organisations. It is a desire for fairness that sends people in their hundreds into the streets and indeed into the bush when we are faced with a natural disaster. It is fairness that underpins the best policy that comes from this place -- the Victorian Parliament -- and indeed from the commonwealth Parliament.

When introducing the federal Health Legislation Amendment Bill 1983 -- the bill that sought to re-establish former Prime Minister Gough Whitlam's universal healthcare scheme and create what is now known as Medicare -- Hawke government health minister Dr Neal Blewett stated that the bill embodied not only a major social reform but a health insurance system that is simple, fair and affordable.

For the past 30 years we have all had the benefit of living in a country with a universal healthcare system that is simple, fair and affordable. Everyone in this state knows the comfort that universal health care brings.

For any of us, when a child falls off a bike and breaks an arm, when there is a call from school saying someone has been injured, when we deal with ageing parents, in-laws or neighbours, when our siblings have babies and we become aunts and uncles -- for all the reasons we encounter the health system as members of families and as members of communities -- we know that we have a world-class healthcare system because we know that in Australia leaving the sick and needy to ail without treatment is not fair and is not good enough.

The Medicare co-payment proposed by the federal coalition government seeks to destroy universal health care in Australia. It seeks to make Medicare complicated, unaffordable and unfair. Dr Liz Marles, president of the Royal Australian College of General Practitioners, has stated that the poorer and sicker members of our community will be disproportionately affected by the co-payment, creating a two-tiered healthcare system like the one in the United States.

The college has said that access to health care will decrease because of this new tax.

The Abbott government proclaims that a $7 contribution is a minor imposition, but people from both sides of this house know this is not the case. According to research conducted by the University of Sydney, a family with two children under the age of 16 will pay approximately $184 more per year on average to access basic medical care, a self-funded retiree couple will be impacted to the tune of an extra $244 per year and a pensioner couple with concession cards will pay an extra $199 per year. People who need to access out-of-hospital pathology will be charged twice -- $7 to see the doctor for the referral and $7 to go back for the test results. For people struggling to make ends meet, $14 to get necessary medical treatment is a significant sum of money. Further to this, and more importantly, it is likely to become a deterrent to seeking medical treatment in the first place.

Dr Liz Marles said:

    I have no doubt this will result in vulnerable patients choosing to delay or avoid general practice visits because they cannot afford the out-of-pocket costs. Health care is not discretionary spending.

By making GP visits and associated tests and treatments more expensive, patients will be forced into emergency rooms rather than going to their local doctor. Beyond its inherent unfairness, this is bad policy. The drive to emergency departments for basic primary health care will place additional strain on our already stretched public hospitals and emergency waiting rooms. The doctors and nurses in our emergency departments already have plenty to do and in many instances are stretched to breaking point already.

Thankfully the Victorian government has recognised the importance of preserving universal health care. In Victoria this crosses the political divide. I welcome the comments of our Victorian Minister for Health, David Davis, who on 27 May said:

   - In terms of the co-payment, we have been quite clear that we do not support the co-payment ...

Mr Davis continued:

   -  We do not believe the $7 proposed co-payment for GP services will assist our health system in Victoria. We do not believe it will make primary care stronger.

    - We do not believe it will assist patients, and we do not believe it will assist our health services.

Mr Davis went on to say he did not believe the co-payment would pass the Senate in the federal Parliament. Mr Davis is to be commended on his public opposition to the co-payment. This motion asks all government members to join with their leader in this house and the health minister in their government and take up the fight with us to save Medicare in the name of that basic Australian principle of fairness. I call on the minister and all members of the government to express this objection to their federal coalition colleagues in the Senate.

Students of politics will know -- and we may have some students of politics in the gallery who will know this -- the Senate is the states' house, and with both sides of the Victorian Parliament vociferously opposed to the Medicare co-payment it is the responsibility of federal coalition senators from Victoria to note the view of the Victorian government and the Victorian opposition in this regard. With the motion before the house today it is my fervent hope that federal coalition senators from Victoria will note the view of the upper house of the Victorian Parliament and vote in accordance with what is in the best interests of Victoria rather than toe the party line -- a position that has been determined by Tony Abbott, Joe Hockey and a bunch of other people who are not from Victoria. It is the obligation of Victorian federal senators to protect the best interests of Victorians needing to access health care and the best interests of the state and not to blindly and ideologically dismantle universal health care and destroy the wonderful and unique Australian institution that is Medicare.

Mr Ramsay -- Why were you so happy to have a carbon tax on hospitals then?

Ms PULFORD -- I hope Mr Ramsay's interjection is not a precursor to a case being put to oppose the motion by government members in this place. This is simply a question of the appropriateness for Victorian patients seeking to access health care of a co-payment introduced by the federal government. Members will be aware that Mr Ramsay, a number of other members in this place and I, as members of the Economy and Infrastructure References Committee, undertook an inquiry into the effect of the carbon tax on hospitals.

Mr Ramsay interjected.

Ms PULFORD -- I would discourage Mr Ramsay from re-prosecuting that case in this debate.

Mr Ramsay knows that decisions of his own government in relation to energy conservation in hospitals and other government buildings have a profoundly greater impact. I would be frightfully disheartened if Mr Ramsay chose to side in this debate with Liberal members of the federal Parliament rather than with his own health minister, who has made his personal views clear. I assume the views of the Victorian government are clear on this matter -- Mr Davis was not in any way equivocal.

Medicare has been with Victorians and with Australians in their moments of greatest delight and greatest despair -- the entry into a family of a new child and the loss of a loved one. It has been, and I certainly hope it will continue to be, a source of great comfort to Australians who know they can access health care when they need it, not if they can afford it.

Across the state we have seen people mobilising in their thousands to express their opposition to this new tax, this proposed destruction of universal health care. There are tens of thousands of people in federal electorates expressing to their federal member of Parliament their opposition to this charge. I can only imagine that those in the Senate who represent vastly larger constituencies are being bombarded with people's views on this. It is the responsibility of Victorian federal coalition senators to uphold the wishes of the people of Victoria in the Senate and oppose the co-payment. It is important for those senators to note that the Victorian government and the Victorian health minister have indicated that the $7 co-payment will be of no assistance to the Victorian health system, health services and patients.

To this day Medicare remains one of the proudest achievements of the Australian Labor Party. We in the ALP have brought it back from the brink of destruction in the past -- and if we have to, we will do it again.

But on this occasion we are turning to the Victorian government in the spirit of bipartisanship. We want the Victorian government to stand with its health minister and with us to express to Victorian federal senators the view of the Victorian Parliament that the Medicare co-payment is no good for Victoria, no good for Victorian patients and no good for our health system. I implore members opposite to help us send this message very clearly to the federal Parliament and the federal coalition senators and to help us ensure that health care remains simple, fair and affordable.We in the Labor Party will fight for Medicare to make sure all Australians are able to access world-class health care irrespective of their financial situation. We will fight for Medicare because we do not want to see a two-tiered American-style health system. We will fight for Medicare because it is fair. We very much hope that the Victorian government will join with us in this fight and support the motion.

 

Ms CROZIER (Southern Metropolitan) -- I am pleased to be able to rise to speak on Ms Pulford's motion this morning.

I reiterate for the chamber and for Ms Pulford what has been said by the Minister for Health on many occasions: the Victorian government does not support introducing the proposed co-payment. In addition the Victorian government has said it does not support introducing a co-payment in our Victorian emergency departments. The Minister for Health has said that on a number of occasions.

As we are having this debate today, we have discussions going on at a federal level. The Minister for Health is speaking with his counterpart, the federal Minister for Health, Mr Dutton, on a range of issues, and of course he continues to have discussions around the changes the commonwealth is seeking to introduce. Because the Senate is yet to decide on this matter, the debate we are having this morning is hypothetical.

I do not know what it is that those opposite do not understand about the very fervent points the Minister for Health has made about not supporting a co-payment, but I will say it again: the minister has said on numerous occasions that the Victorian government will not be supporting it.

The co-payment is not a new proposal. As a reminder, I note it was put to the Australian community in recent times. Back in 1991, when the federal budget was under significant strain, the then Prime Minister, Mr Hawke, and his government announced a co-payment of $3.50, which was later reduced to $2.50, and which was abandoned within months by the subsequent Prime Minister, Mr Keating. Therefore this is something that has been put up by those on the opposite side in the past; members of the opposition understand that health is a very expensive area of government.

Health is an area of great importance for our country and our state.

As someone who worked in the public health sector and the health industry for 16 years, I know very well how significant health is. Certainly in Victoria's public health system, where I have worked, the clinicians -- the doctors -- the nurses, the allied health professionals, the support staff and everybody else involved in running our public health services and public hospitals do a tremendous job. Again I place on the record my support for their ongoing efforts in providing what I think is one of the world's leading health services -- if not the world's leading health service. We should be very proud of their provision of that service, but again that goes to the heart of the question -- the point that health is really expensive. Health is a very expensive exercise, so it is necessary to have this discussion, if you like, and the federal government is certainly having this discussion. Our Minister for Health, however, has made it very plain that he will not be supporting the proposed co-payment.

I am also pleased to say that Victoria's health services are in a very healthy state. Since being elected to government we have grown the health budget by 32.2 per cent. That is a significant increase in health services and for the health budget, providing for the necessary requirements to cater for a growing and ageing population. This was something the former government neglected to do. In its 11 years of administration Labor failed to provide for a growing and ageing population -- that is, it failed to provide health services adequate for that population. We have invested significant funds in health to get to a point where our services are in a very good state.

Of course there are always challenges, and there always will be -- as I said, health is a complex and expensive business -- but relative to the other jurisdictions around the country, Victoria's health services are in extremely good shape, aided by the increase the coalition has provided to Victoria's health budget.

This is something that needs to be highlighted, and we have highlighted it in the chamber previously. Those increases in health spending are in stark contrast to what the former Labor government did at the federal level in putting hospitals and health services under significant pressure when it ripped $107 million out of their budgets halfway through a financial year. This was an extraordinary decision made by the then Minister for Health, Tanya Plibersek, under Prime Minister Julia Gillard. It was extraordinary for that government to put those financial pressures onto health services when it had already outlaid its budget. That just goes to the heart of the lack of understanding we see from those opposite about how our health services operate. They claim to know how they operate, but to rip out $107 million halfway through a financial year was quite an extraordinary undertaking. I remind the chamber it was our Minister for Health who took the lead in arguing for that $107 million to be reinstated for Victoria.

Subsequently the federal government saw sense and reinstated that money for Victoria and money for other jurisdictions as well. It was quite alarming, however, that the members of that Labor government and the Greens, who were on side with Labor at the time, voted in favour of those cuts to our health services. This was very much about them trying to save face in light of a failing budget. We know that the federal government is under extreme pressure given its fiscal situation. I am pleased to say that here in Victoria, under the stewardship and leadership of Treasurer Michael O'Brien and Premier Napthine, we are in a very good position; we are quite the envy of other jurisdictions around the country.

There has been a significant health infrastructure spend in my electorate. Only a few weeks ago I was with the Minister for Health, the Premier and members of the Monash Children's hospital board and the Monash Health board at Clayton, where construction has begun on that very important children's hospital facility. It is a $250 million infrastructure spend on a hospital that is greatly needed for south-eastern Melbourne and the eastern areas of our state.

Of course we have the Royal Children's Hospital, and I acknowledge and put on the record the Labor government's work in making that an absolutely extraordinary facility for Victoria's children, but it is not big enough. It is not catering for our growing population in the south-eastern suburbs and for families and children who have to cross large parts of the city or indeed the state to get to that facility.

The Monash Children's will meet a significant need in that part of the state.

Additionally and importantly the project is providing more than 700 construction-related jobs and it will deliver world-leading paediatric care. As I said, it will be a leader, as are a number of other health institutions around the state, and that is something that all of us in this chamber are proud of. The new hospital will provide leading paediatric care in a number of areas to young Victorians. This is all part of the Napthine government's plan to provide a healthier Victoria and to provide not only the required infrastructure to cater for the growing population but also the very important construction jobs which will deliver economic benefits right across the state.

It is not news to members when I say that we have an expanding, growing population and an ageing population. The Labor government looked at a proposal in this regard in 2002 but did absolutely nothing about it. It neglected those areas. It neglected to cater for the population expansion and did nothing about it for eight years, from 2002 to 2010.

It is the coalition government that has put this project in place and enabled it to occur.

As I said, it will be a significant medical centre that will cater for the population in the south-eastern parts of Melbourne and Victoria. There is no doubt that that will result in healthier outcomes for children, but it will also assist many families, both in Southern Metropolitan Region, which I represent, and in the south-eastern areas of Melbourne, as I have already stated. There will be 230 beds in that hospital, and that will provide great relief to other surrounding hospitals and indeed the Royal Children's Hospital. It will have 27 consulting rooms, and it is expected to deliver around 60 000 outpatient treatments for children each year. Importantly, I note also that it will provide the very necessary foetal surgery and treatment of cardiac rhythm disturbances and it will be the only hospital to conduct that complex work on paediatric patients.

Other areas of infrastructure funding have been undertaken since the coalition came to government. I am sure other members will talk about the work occurring in their own electorates, because it has not been only within metropolitan Melbourne that capital has been expended on improved health service infrastructure. It has also occurred in other areas of the state, such as Geelong, the Latrobe Valley and of course at the Bendigo Hospital. A total of $630 million has been spent on that facility in the northern region of Victoria, which will provide significant services to people in northern parts of the state and take significant loads off our larger metropolitan hospitals. I am sure Mrs Millar would agree that that will be of enormous benefit to the Bendigo community and surrounding areas.

The government has undertaken many improvements in the area of health. I know other members will also speak about these things when addressing the motion before the house today.

The Minister for Health has been very much focused on supporting our health services right across the state. The government has delivered record health funding since coming to office. Around $15 billion has been put into health in the 2014-15 budget, and concurrent with that around $4.5 billion of health infrastructure projects, some of which I have outlined this morning, have been funded.

As I said, the minister has been arguing strongly in the interests of Victorian patients and indeed in the interests of Victorian healthcare professionals, because they too get affected when significant cuts are made -- like the one I mentioned previously, when the former federal Labor Minister for Health, Tanya Plibersek, took $700 million out of the very necessary health budget. Some of those cuts were really significant. There is debate around waiting lists and various other elements. Of course there has to be a catch-up because the health services suffered such significant cuts in their budgets that they had to reassign or reprioritise what they were going to do as the money was no longer there. The cuts involved a significant amount of money.

In my electorate of Southern Metropolitan Region, the Alfred hospital had $26 million taken out of its budget. The impact in Northern Victoria Region was also substantial. In Bendigo the cuts amounted to $9 million; in Mildura, $3 million; in Ballarat, $9 million; and in South West Healthcare, $4 million.

These are just some examples of the very large amount of money that was taken out of health service budgets and the enormous impact on the way those services have conducted their operations in elective surgery, the running of their outpatient services and the like.

The managers of those health services need to look at what must be undertaken to ensure that their communities have the services they need, and they are doing that. The management and staff of the health services should be congratulated on the enormous amount of hard work they have done to enable their hospitals and health services to function in the way they have since that decision was made. As I said, it takes some time to realign when what was previously there has been taken out.

The motion before the house calls on Liberal and Nationals senators for Victoria to oppose a Medicare co-payment.

As I said, that is a hypothetical at this stage because the co-payment is not before the Senate. However, the Minister for Health, Mr Davis, has been very forthright. He has spoken widely on this issue and his views are well known. The federal Minister for Health, Mr Dutton, is well aware of Victoria's position on this. It is plain that this motion is about just looking at the issue from the opposition's point of view and about supporting the Medicare system.

As Australians we are very fortunate to have the health system we have, and in certain circumstances we need to take responsibility for ourselves and be aware that the health services experience is challenging at times. Much can be done by the individual to assist our health services in addressing many of those challenges. I am of course talking about health and wellbeing and various other things. Our health services should support all of us when required, but as a community we need to be looking at how we can support our health services and health workers.

We need to look at this issue, because there is increasing demand on our health services. As I have said, we have an ageing population with more complex health needs, requiring a greater length of stay at certain times and the delivery of more intensive care. Those issues need to be looked at as we progress.

Our health services do a tremendous job of providing significant health care, but we need to take charge of things like our health and wellbeing. We need to look at the rate of diseases like diabetes. I note that representatives of Diabetes Australia are coming to Parliament House tomorrow to allow members to be tested. Co-convenors Mrs Millar and Ms Garrett, the member for Brunswick in the other house, are undertaking that important process. As somebody who has worked in the area of diabetes, I commend them on that initiative. That is one area of complex chronic disease where the community can and should be doing more.

In this regard I particularly acknowledge the minister for his support of Healthy Together Victoria, a program involving communities across Victoria. I have had some input into this program in my role as Parliamentary Secretary for Health. Twelve local government areas are undertaking some terrific initiatives and looking at their own local communities to help prevent chronic disease. They have done a significant job in a number of areas, and it is making a real impact. With more than 500 000 Victorians engaged in that program, it is a very practical health initiative that is having real effects. I congratulate all the people involved, particularly those within the Department of Health who are running and coordinating that program. Importantly, I also commend the local mayors and others on their leadership. They have embraced the program and are doing an excellent job of speaking to people in their communities.

That is the responsibility that I am talking about -- the responsibility of communities for their own health and wellbeing.

If we attend to this, we will see a reduction in demand for our health services. We need to start at a very early age. A lot of the Healthy Together community work is being undertaken in our kindergartens and preschools. That is a significant step forward. We need to capture these children at an early age if we are going to see a generational change. I urge all involved to continue their great work and keep promoting healthy lifestyles to try to reverse the trend of the significant burden of diseases such as type 2 diabetes. If we can do that, as I said, we will take the strain off a lot of our health services.Again I have strayed a little from the motion, but this is very much related to how we support our health services and how we can provide for those who are most vulnerable and most in need of access to our public health services.

There is no question that those who are most vulnerable and most in need of the services that our larger health services provide should be able to access those. I again commend the significant health workforce we have in Victoria on the excellent care it provides to the Victorian community and extends to other communities, such as those in Tasmania and the southern parts of New South Wales, in many instances. I support the work they do.

In conclusion, the government will not oppose Ms Pulford's motion. As I said, the Minister for Health, Mr Davis, has been very forthright in his response to the Medicare co-payment. On a number of occasions, both within and outside the house, he has made clear the Victorian government's position on a Medicare co-payment.

 

Ms HARTLAND (Western Metropolitan) -- This is a very straightforward motion. While I accept that Ms Crozier would want to delve into a whole range of areas, the motion just says:

(2) the Victorian government's opposition to the Medicare co-payment proposed by the federal government;

    and calls on Liberal and National Party senators for Victoria to oppose the Medicare co-payment.

It is a very simple motion. I can say that Adam Bandt, the member for Melbourne in the House of Representatives, and our Greens senators will be opposing the co-payment. One of the problems with the federal government's budget is that it clearly shows its contempt and disregard for ordinary Australians. The co-payments in particular are harsh. If you are an older person, if you are a family with a number of children or if you are a family with a disabled child who has to go repeatedly to the doctor, these co-payments will be incredibly detrimental to your budget. It is quite clear that the federal government clearly does not care about people and that is why it has attempted to inflict these co-payments -- --

Mr Ramsay interjected.

Ms HARTLAND -- Mr Ramsay says by interjection that it is rubbish to say that the federal government does not care about ordinary people, yet its members are bringing in this co-payment. They are the ones who are going to inflict a co-payment on pensioners, on people with large families and on people who have children with disabilities. I do not see someone else inflicting the co-payment on people.

It will be interesting to listen to Mr Ramsay's contribution because it would seem that he supports the co-payments. I am not quite sure what his interjections are about. In my mind it is quite clear that the federal government dislikes ordinary people and that is why it has sought to inflict this co-payment on us. The Greens in the federal Parliament will fight against the co-payments in the Senate. We will campaign against them. That will be led by our health spokesman, Senator Richard Di Natale. I absolutely support the motion brought on by Ms Pulford today.

 

Mr ONDARCHIE (Northern Metropolitan) -- I rise today to speak to notice of motion 771 relating to co-payments and indicate, as have my colleagues, that the Victorian government will not oppose the motion because it does not support the introduction of the proposed co-payment. Further, we have also said that we do not support the introduction of an emergency department co-payment.

The Victorian coalition government will continue to talk to the government in Canberra about these proposed changes within the commonwealth and work through their impacts on the Victorian health system. I note that the Senate is yet to make a decision on this matter so in a sense it is a little hypothetical at this point in time. I remind members that in 1991 the then Hawke Labor government announced a co-payment of $3.50. That was eased down to $2.50 before it was due to begin and was abandoned within months by the new Prime Minister, Paul Keating.

I have to say Victorian health services are in a reasonably healthy state. The Victorian coalition government has continued to grow its health services budget and since being elected this government has grown the health budget by over 32 per cent. There has been a 5 per cent growth in the Victorian health services budgets from 2013-14 to 2014-15. This is in stark contrast to the funding cuts applied by the Labor government. I remind members, despite the denials from those on the other side of the chamber, that in 2012, $107 million was cut from our hospital system by the then federal Minister for Health, Tanya Plibersek, and the then Prime Minister, Julia Gillard. The Labor Party and the Greens voted in favour of those cuts. It was a case of Labor first and Victoria second.

The state government has always advocated strongly on behalf of Victorian patients in hospitals, unlike the Labor Party and the Greens. When Tanya Plibersek and Julia Gillard cut funding to our hospitals, Labor members simply rolled over and agreed with their colleagues in Canberra. We call upon members of the Labor Party in this state to stand up for Victorians ahead of their political mates. We call upon them to stand up for Victorians, but they refuse to do it.

Mr Melhem interjected.

Mr ONDARCHIE -- Mr Melhem, in a scene from Antony and Cleopatra, is in denial at the moment.

Honourable members interjecting.

The ACTING PRESIDENT (Mr D. R. J. O'Brien) -- Order! Mr Ondarchie to continue.

Mr ONDARCHIE -- I quite enjoyed the interjections.

The ACTING PRESIDENT (Mr D. R. J. O'Brien) -- Order! They do break up the speech, but they are disorderly.

Mr ONDARCHIE -- The 2014-2015 Victorian coalition state health budget delivered record health funding of $15 billion. Alongside this there is over $4.5 billion -- --

Mr Melhem -- On a point of order, Acting President, I could not hear what Mr Ramsay was saying earlier by interjection, but I have just been informed of his words. I ask that Mr Ramsay withdraw his comment about living off your members credit card. Is that correct, Mr Ramsay? Is that what you said?

Mr ONDARCHIE -- On the point of order, Acting President, since when can you ask a question of another member during the debate?

The ACTING PRESIDENT (Mr D. R. J. O'Brien) -- Order! I accept that last point of order. Mr Melhem should not use points of order to interrogate another member. I will allow him to complete his point of order.

Mr Melhem -- If that is what Mr Ramsay said, I simply ask him to withdraw.

The ACTING PRESIDENT (Mr D. R. J. O'Brien) -- Order! I am in some difficulty because, if I am right, the comment was heard by Ms Hartland more than others, and she has passed her comments on to Mr Melhem. If a statement was made, there is a need for clarity.

If Mr Ramsay made a statement implying that a member of Parliament was living off a credit card, that may be said to be unparliamentary and I would ask Mr Ramsay to withdraw, but I am not sure if that is what Mr Ramsay said. If that is what he said, I call on him to withdraw his comments. Otherwise, I ask Mr Ondarchie to resume.

Mr Ramsay -- I am happy to withdraw a comment if a second party has relayed to Mr Melhem that my comments reflected on him. However, I clearly remember that I did not reflect on Mr Melhem.

The ACTING PRESIDENT (Mr D. R. J. O'Brien) -- Order! If that is the case, withdraw.

Mr Ramsay -- I am not clear on what I am withdrawing.

The ACTING PRESIDENT (Mr D. R. J. O'Brien) -- Order! You are withdrawing any aspersions you may have cast on the member. Just say, 'I withdraw that', if that is what you said.

Mr Ramsay -- I withdraw the comments.

Mr ONDARCHIE -- It is interesting that members across the chamber tend to stymie debate when they do not like hearing the truth. Perhaps they can buy a recording device and tape the debate to make sure they know exactly what was said in the chamber. This is consistent with comments made by opposition members during the last few weeks -- they want to destroy what is before the people of Victoria.

The 2014-15 state budget delivered record health funding of $15 billion.

Alongside that, there are over $4.5 billion worth of health infrastructure projects underway in Victoria. The rural capital support fund was a Victorian government pre-election commitment to invest $56 million over four years for smaller capital projects at rural and regional healthcare facilities. A good example of that across the state of Victoria is the $5 million provided under the 2011-12 state budget to increase emergency maternity service capacity in community health departments at Mildura Base Hospital.

There is the new, game-changing $630 million that is being spent on Bendigo Hospital. This is the biggest regional hospital to be built in this state, and it is being done under a Napthine coalition government. Ballarat Health Services is receiving $46.3 million. There is also $250 million for Monash Children's hospital. The Frankston Hospital is receiving a $81 million redevelopment. Capital works costing $120 million are underway at Geelong Hospital and the development of Barwon Health North. The West Gippsland Hospital at Warragul is receiving an upgrade to its emergency department, costing $4.42 million. I know Mr Danny O'Brien was a strong advocate for this development long before he joined this place, and he continues to be.

Mr D. D. O'Brien interjected.

Mr ONDARCHIE -- I pick up Mr Danny O'Brien's interjection. I was just going to talk about the expansion and enhancement of Latrobe Regional Hospital. This government has committed $73 million to support the people of the Latrobe Valley and Gippsland. The Victorian Comprehensive Cancer Centre, located at the top of Elizabeth Street, is a world-class project that is well underway. The Royal Victorian Eye and Ear Hospital is also getting a redevelopment thanks to this government. There is $15 million to expand the intensive care maternity services at Sunshine Hospital, which I know Mr Finn and Mr Elsbury have been strong advocates for.

The capital funding we have provided for the expansion and redevelopment of hospitals and healthcare facilities is designed to cater for the Victorian community over the long term. In particular I think about one of my favourite hospitals in this state, the Northern Hospital. I had another chance to spend some time there on 9 July. I looked through the new acute inpatient tower block, a site that has been developed under this government, and the new expanded emergency department this government has funded. I also saw the maternity area, a special care nursery where tiny babies are being well cared for by the wonderful staff there. There is also the newly completed Northern Centre for Health Education and Research, which is on Cooper Street.

At this point I have to commend the great work being done by Marilyn Beaumont and the Northern Hospital's board and executive team. The executive team is running that hospital on a day-to-day basis, but it is also doing some wonderful things in developing its strategic outlook.

In particular I note the work of the hospital's CEO, Janet Compton; the executive director of research, Professor Peter Brooks; the executive director of corporate and commercial services, Robert Burnham; the man who manages the money on behalf of the hospital executive, the director of finances and data management, Sam Costanzo; the clinical service director, medical and continuing care and chief medical officer, Associate Professor Kwang Lim; the executive director of continuing care and ambulatory services and chief allied health officer, Ms Jenni Smith; the executive director of performance improvement, Michelle McDade; the executive director of people and culture, Zemeel Saba; and the executive director, acute health, and chief nursing officer, Clare McGinness.

These people and their teams are moving remarkable reforms through the Northern Hospital.

The northern suburbs of Melbourne are experiencing phenomenal growth, so much so that it is estimated that by 2026 the population catchment served by the Northern Hospital and its allied health services will grow by 64 per cent.

Mrs Amanda Millar and I have had several conversations about the population growth throughout Wallan. She actively represents the people of Wallan, Kilmore and beyond, many of whom make use of the services of the Northern Hospital. Mrs Millar has also been very vocal in her support for the great work being done at the Northern Hospital. The patient cohort there comes from 130 different countries and speaks 100 different languages. In an average week at the Northern Hospital there are 1300 emergency department presentations, including 230 paediatric presentations; 350 ambulance arrivals; 250 elective procedures; 111 emergency operations; and 58 births -- and that is just in one week! To give you an example, in the 2012-13 financial year 3031 babies were born at the Northern Hospital.

One can speculate what people in the north are doing with their time, but I have to say that this is a great example of a great hospital at work.

The Victorian government has also invested in the safety, health and wellbeing of our health workforce. The Napthine coalition government has committed over $40 million to improving the safety and security in our hospitals, from upgrading security systems to enhancing the management of clinical aggression. This government introduced the Sentencing Amendment (Emergency Workers) Bill 2014 into Parliament, which will provide a statutory minimum sentence of six months imprisonment for assault of emergency workers and other health professionals. When it goes to the topic of the day, we do not oppose Ms Pulford's motion.

 

Mr MELHEM (Western Metropolitan) -- I rise to support the motion moved by Ms Pulford.

I am pleased that coalition members are supportive of that motion; the only thing missing in their contributions is what real work they are going to do to convince their counterparts in Canberra to withdraw the proposed Medicare co-payment. It is fine to go and oppose something through a press release or in an interview on radio -- that is one thing -- but if you are really opposing something, you have to do some real, hard work. Coalition members have to put more pressure on their colleagues in Canberra. I do not see them jumping up and down to try to get their colleagues in Canberra to abolish or withdraw the co-payment.

Let me talk about the impact the $7 co-payment will have on people in this state. The people most affected by this co-payment will be poor people, working people on low incomes, people on unemployment benefits, pensioners and homeless people. We are talking about people for whom $7 could buy three loaves of bread. In some cases it could probably only buy them two; it depends where you buy it from. There is a report that has just been released by Medicare Local for the northern and western regions of Melbourne which quotes that 15 per cent of people who were surveyed would put off a visit to the doctor because they could not afford to go to the doctor or buy medicine. That is with no co-payment. Adding the co-payment is obviously going to add to the problem.

Mr Ramsay -- So you're happy to charge them $550 in electricity and heating? That's the carbon tax.

Mr MELHEM -- Hang on, I thought the coalition in Victoria was supporting the resolution. I have not criticised. Let us talk about the facts here. I will come back to that.

I am quoting people in the industry talking about what impact this is going to have on people. The federal government has said, 'We're not going to put the money back into health. We're going to create a fund, and the interest generated from that fund will be used for medical research'. That is great; it is about time we put more money into medical research. The idea itself is a good idea, but do we really have to slug patients who cannot afford it? Medical treatment in this country is not free; we actually pay for it. There is something called the Medicare levy, which most working people pay. Fifty per cent of Australians can afford to purchase private health insurance as well. We need to encourage that. I get that, but this idea of a co-payment is about saying to people, 'You are visiting the doctor too many times. You don't need to visit.

Therefore we want to put a $7 co-payment on it to discourage you from going to the doctor'. That is one of the arguments the federal Treasurer and some other people from the coalition in Canberra are using to try to put some logic behind why the $7 co-payment needs to be put in place -- to discourage people from getting service from their doctors.

Look at what doctors -- the Australian Medical Association and the Royal Australian College of General Practitioners -- have all said. Dr Jones, who is vice-president of the college, said that in his 30 years he has not seen any evidence of people going to the doctor because they feel like they want to go to the doctor. They go to the doctor because they have a problem. They go to the doctor because they need to. They go to get a consultation and make themselves better, not because they think, 'I want to have a chat to someone today, so what I'll do is pick up the phone and go to see the doctor and have a chat to the doctor for 5 minutes and socialise'. Let me tell you: people do not do that.

Imposing the $7 co-payment as a deterrent to stop people going to the doctor is going to put more pressure on our hospital system and put more pressure on people who cannot afford to go to the doctor, preventing them from putting in place preventive measures to make sure that if they have a small ailment, it does not become a big problem as they go on in life and then end up costing taxpayers even more money. If people are going to the doctor to get advice about their general wellbeing and get treatment straightaway, that could prevent us paying more in medical costs down the track.

Mr Ondarchie interjected.

Mr MELHEM -- If you are supporting this, then you should not be arguing with what I am saying. This will be a disincentive for doctors who currently bulk-bill. A recent article in the Guardian warns that every time a doctor bulk-bills it will cost them $11. It goes on to state:

- Doctors will be financially penalised $11 for bulk-billing concession card holders and children under the government's proposed changes to Medicare. 

- The Australian Medical Association says small medical practices could lose up to 25 per cent of their income if they continue to bulk-bill.

-  Currently doctors receive a $36.60 rebate from the government for each patient they see, which will be reduced to $31.60 under the new system. In metropolitan areas doctors receive a $6 low-gap incentive payment when they bulk-bill concession card holders and children under 16.

- Under the new system doctors will only receive the low-gap incentive if they charge the co-payment.

- So instead of receiving the $42.60 they currently get for bulk-billing a disadvantaged patient, they will receive $31.60. If they charge the co-payment, they will get $44.60 for treating a disadvantaged patient.

Small clinics will have to accept a 25 per cent reduction in revenue. That is what is going to happen to these doctors. According to the Australian Medical Association, we will probably drive some of these small clinics and doctors out of business. That is the problem.

The government has not given much consideration to the impact this is going to have on disadvantaged people, including pensioners, people in residential care, people on social security benefits, the homeless and low-income earners. The only consideration it has given is that after 10 visits, you do not have to pay. I think that is absolutely wrong. We should not force these people to pay anything. They should be bulk-billed. The whole thing should just be abolished.

The article goes on to quote a doctor as saying:

    You'll be saying to a patient for example, I think you have an ear infection, go and get a sample, and they'll be saying, 'I'm not getting the test'. It'll be $7 for the doctor, $7 for the pathologist and another $7 if they need an X-ray, and the patient says they're not getting it.

We are not talking about people like you and I. You can afford it. I can afford it. I have private health insurance; I do not know what you have. But we are not talking about ourselves here, and that is the problem.

That is the problem with Joe Hockey, the federal Treasurer, and some of the people in Canberra. They think people in our society are as well off as they are. Let me give them some news: they are not.

Therefore if the government is fair dinkum about supporting this resolution, if it is fair dinkum about opposing the co-payment, then it needs to make a bit more noise and make sure its colleagues in Canberra, its Liberal and Nationals senators . . .

Honourable members interjecting.

Mr MELHEM -- We are doing it; we are going to oppose it. The Victorian Labor senators will vote against the co-payment. The challenge for government members is to get their federal Liberal and Nationals senators from Victoria -- who do not take any notice of them, I might add -- to vote against the co-payment.

I doubt very much that those opposite are even going to pick up the phone and talk to them. Those opposite are only making a token objection. They have put out a press release saying they are going to oppose the co-payment, but what they are really saying is, 'Joe, no, we're not. It's okay; go ahead. We need to appease the people of Victoria. We have an election coming up. We are going to say we're against it, but really it's okay'. If you are fair dinkum, either put up or shut up. Be fair dinkum about it.

 

Mr RAMSAY (Western Victoria) -- I am pleased to rise to contribute to debate on Ms Pulford's motion. Mr Melhem seems to be a sensitive flower this morning, so I will not respond to some of his rhetoric. I will get down to the real issues.

I note the minister has made it quite clear that the government does not support the introduction of an emergency department co-payment.

I also note that we are not opposing Ms Pulford's motion. That is for the record in case Ms Hartland wants to misconstrue anything I say from here on in with respect to my taking a position one way or another in relation to this motion. I also wish to note, however, that Ms Pulford's motion is a cheap political trick to try to make us support a motion that opposes a federal coalition government policy.

However, Mr Melhem is right. This issue is having an impact and is raising concerns among the Victorian community. The Victorian coalition government has quite rightly made it clear that it does not support the co-payment in its current form. In fact it is seeking to consult with the federal government to look at other ways in which Medicare can be made more sustainable in the long term. That is the crux of the matter. In the contributions from the other side, no-one has actually talked about the philosophy of providing one of the best healthcare services in the world.

Anyone who has travelled the world will appreciate and acknowledge that in Australia we have one of the world's best healthcare systems. We want to continue to provide that service to our nation on a long-term, sustainable footing.

I acknowledge that modern health funding should ensure that people have universal protection against the potential large financial risk that is posed by sudden illness and that people who are poor or sick are not excluded from the beneficial health care that is presently being provided. I too have some reservations about the federal government's proposal on the co-payment, which is supposed to be a price signal to try to reduce some of the trivial visits to GPs. Despite Mr Melhem's protestations, the fact is that many people wait a considerable time before they can access a GP because demand has increased substantially over the years, particularly as Australia faces an ageing population.

I draw members' attention to some statistics which the current federal government was left with as a legacy from Labor. When it came to office the federal government had a $350 billion net debt to contend with, so a lot of the services and programs that are traditionally provided by the federal government have come under scrutiny. Health has not been excluded from that. Ten years ago the Australian government was spending $8 billion on Medicare. Today it is spending $19 billion. That is more than a 164 per cent increase. Over the next 10 years the spend is projected to be more than $34 billion.

The taxpayer currently funds 263 million services a year that are free to patients under Medicare. I think all sides would agree that this is unsustainable. There is growing pressure on the health system from the ageing population. There is an increasing incidence of chronic disease, and there are increases in costs generated by new technologies. Ms Crozier is doing work in relation to preventive medicine. Of particular concern to me is the rising incidence of diabetes and obesity in rural communities. It is great to see there are a number of good preventive programs now being provided to regional healthcare services to try to encourage people to take responsibility for themselves in relation to their health, fitness and diet, all of which accompany good preventive medicine. It is important that we are proactive in that space to make sure that we can reduce the cost of health services to this nation.

I draw the attention of the house to a couple of other facts. Ms Pulford, Ms Hartland and Mr Melhem take a fairly populist view of the cost of health care and the imposition of a new charge. The charge consists of $2 which goes to a GP and $5 which goes to long-term science research. I think that is important.

As a rural ambassador for the Prostate Cancer Foundation of Australia I know that we need more work and more money to be invested in researching a cure for prostate cancer. There is almost a 3 to 1 ratio of money going into breast cancer research compared to prostate cancer research. There is certainly a need for ongoing research and funding to look into cancers that are prolific and affecting this nation increasingly.

The federal government's investment in Medicare will continue to increase. In 2014-15 the government will invest $20.3 billion in Medicare, and by 2017-18 that investment will grow to $22.6 billion. In response to Ms Hartland -- who stood up, as the Greens always do, puffed out her chest and provided the do-gooder populist view of the world -- the assertion that the federal government does not care is absolute nonsense. That is the point I made. It is a pity Ms Hartland is not in the chamber now.

The government is spending over $22.6 billion in additional payments to fund the Medicare system -- the healthcare system -- as we know it today. In fact the government funds about $30 of the cost of a visit to a GP over and above the Medicare levy at the moment. Ms Hartland's rhetoric in relation to the federal government not caring to provide a superior healthcare system for Australia is absolute nonsense.

It is interesting to note that again Mr Melhem stood there and pontificated about the impost of the co-payment, yet in his time as a member of Parliament he has been happy, in an embracing and in a conciliatory manner, to support the carbon tax. If Mr Melhem would like to take stock and review the impact of the carbon tax on health services and on those who live in Victoria generally, he would find that the cost of the carbon tax to every Victorian household was about $550.

Mr Melhem is jumping up and down and crying foul in relation to a proposed co-payment of $2 for members of the Victorian community to have a GP consultation, yet he is more than happy to embrace a levy on every Victorian household of $550 in the name of a carbon tax.

I question Labor's philosophy and ideology in relation to taxes, particularly in relation to one of the most corruptive and expensive taxes that would cause considerable harm to communities nationally. This tax would create more challenges for communities than a $2 impost on a GP consultation. I remind Mr Melhem that for those who would be financially challenged in relation to providing a co-payment, whether it is $2 or whatever, after 10 visits there would be concessions and other things, and the free service would continue to apply.

I am not here to argue the case for the federal government in relation to the co-payment. The Victorian government's position is clear. The Senate is yet to have the discussion, so what the outcome might be is hypothetical at the moment. Despite the changes that Labor federally enforced during its term of government, it passed on a debt of $350 billion to the federal coalition government, and obviously the federal government faces some challenges with its budget.

The Victorian government is increasing its investment in health services despite the fact that federal Labor did its very best to continue to withdraw funding through the national health agreement and other agreements for health care in Victoria. The minister has indicated that the state will continue its discussions with the commonwealth, and this is important in relation to the proposed changes. He will make the federal coalition government aware of the potential impacts on the Victorian health system if the co-payment as proposed passes through the Senate and becomes legislation.

As I said, it is hypothetical at this time because the Senate is yet to make a decision on the matter.

It was ironic to see Mr Melhem standing before us in this chamber bemoaning the co-payment proposal when the supposedly most successful Labor Prime Minister in history, Bob Hawke, proposed a co-payment of $3.50, which is in fact $1.50 more than the current proposal. He was aided and abetted by the supposedly most successful Labor Treasurer in history, Paul Keating, who was his support act. If anyone in this place has a bit of spare time, they should look at the federal shadow frontbench during question time. They will see three or four shadow ministers who were all supporters of the co-payment proposal back in the luxury times of the Hawke and Keating governments.Despite the fact that the then federal Minister for Health, Tanya Plibersek, tried her very best to rip as much funding as she could -- $107 million -- out of the Victorian healthcare system, through prudent fiscal management the Victorian government has managed to increase funding to health care across Victoria.

Mr Leane interjected.

Mr RAMSAY -- There is no better example than Ballarat, Mr Leane, where a number of election commitments are rising from the ground. We have a new car park at the Ballarat Base Hospital and we have a helipad.

We will not have a red helicopter flying around the skies with people looking at water reservoirs and at how best to take water from the north of the state and put at risk all the northern food bowl areas along the Goulburn River. We would not have had a desalination plant. I am glad to see Mr Lenders has come into the chamber, because this is his baby. The beautiful, big white elephant sitting at Wonthaggi -- --

Mr Scheffer interjected.

Mr RAMSAY -- I know you live down there too, Mr Scheffer, and I am sure you had your hand up saying, 'Yes please'. He wanted a $1 billion desalination plant built in the swamps of Wonthaggi. In order to provide water to Melbourne he wanted to create more environmental hazards by taking salt out of salt water and dumping it on the marshlands of Wonthaggi and around the communities he is supposed to represent.

That is not to mention the friction losses of transferring water up to Melbourne and throwing it into the Sugarloaf Reservoir. I am sure the Victorian community is very happy to pay $1 million a day for the white elephant that had no business plan and no fiscal parameters. As we stand here today, the cost to the Victorian taxpayer of the desalination plant is now over $1 billion and not one drop of water has been transferred from Wonthaggi.

But I digress from Ms Pulford's motion, and I am sure she will be disappointed if I do not mention some of the other good things that are happening in health care around Western Victoria Region, and that is what this motion should be about. It is about the Victorian government investing in health care in Victoria.

As I said, we have 68 new beds at the Ballarat Base Hospital, an ambulatory care centre, a cancer care clinic, a new helipad and new car parks.

In Beaufort we have a new ambulance station and wonderful new environmental innovations. We have boilers using woodchips that are providing hot-water services into the hospital. In Creswick there is a new ambulance station. We have biowaste in the Ballarat employment zone now becoming a reality with the green collection bins that will turn waste into energy.

I want to note a couple of other figures. In the 2014-15 budget the government delivered record health funding of $15 billion, and with that more than $4.5 billion worth of health infrastructure projects are underway. I refer to the wonderful new, innovative $630 million hospital in Bendigo, which has the latest technology. It is a prime example of a good community project with the Victorian government, local government and community coming together to build what will be one of the best state-of-the-art, most technically equipped hospitals in regional Victoria. Following the floods in Charlton a new hospital has risen out of the waters.

When Mr O'Brien and I became new members for Western Victoria Region one of our first duties was to support communities across the region that had been savaged by the floods.

Ms Tierney interjected.

Mr RAMSAY -- I am sorry; I did not see you around, Ms Tierney. As a pre-election commitment we said we would invest $56 million over four years for smaller capital projects in rural and regional healthcare facilities, and we are now seeing them being delivered. At the Mildura hospital $5 million was provided in the 2011-12 budget to increase service capacity, $630 million to the Bendigo Hospital, $250 million to the Monash Children's hospital and $81 million to the Melton and Frankston hospitals.

Business interrupted pursuant to standing orders.

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