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Wed, Jun 1, 2005 |
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Shadow Health Minister Julia Gillard
23/11/2003 |
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Julia Gillard talks about Medicare Plus and where health rates in an election. |
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Health has long been the Howard Government's Achilles heel. Repeated Newpolls show it's the issue voters care about most, and the Government knows it.
Health Minister Tony Abbott is hoping "MedicarePlus" will take the health high-ground from Labor in an election. Program host Chris Bath and chief Political correspondent Glenn Milne interview Shadow Health Ministor Julia Gillard about it.
Chris Bath, Program Host: Ms Gillard joins us now from Brisbane. Good morning to you. Thanks for joining us. Are you worried that the Government's taken the wind out of Labor's sails on Medicare?
Julia Gillard, Shadow Health Minister: No, I'm not. In May this year the Government launched its so-called fairer Medicare package, initially that was pretty well received but we pointed out over time all of the flaws in it, we campaigned on it in the community, and people came to understand that it would in fact, despite its title, be the destruction of Medicare. I think we can do the same job this time because behind all of the spin and the slogans and the newspaper ads this is the same old bad package dressed up again.
Chris Bath: Surely it's going to be harder this time round. This time round you have the AMA President Bill Glasson supporting the changes, you've got the architect of Medicare John Deeble saying this is much better than the previous deal. They can't be wrong, can they, and they're fairly influential in the community. It's being to be an uphill battle.
Julia Gillard: Bill Glasson, when he initially looked at the package, didn't think it was going to be a sustainable change. I'm here in Brisbane meeting with doctors today. When they were asked to put their hand up the other day as to whether or not this would fix Medicare for the long-term only one lone hand went up and someone quipped that that was probably the person from the Health Department.
John Deeble, the father of Medicare, is very suspect about the safety nets. He believes that they will have very high transaction costs and also cause inflation in doctors' fees. There are many holes in this package.
Glenn Milne, Chief Political Correspondent: Ms Gillard, Professor Deeble did say the Medicare Plus package so-called was a move in the right direction - towards universality.
Julia Gillard: He has also said - and I saw this in the newspaper this week - that he believes the safety nets are a smoke and mirror trick and believes they will lead to an escalation in doctors' fees. John Deeble believes centrally in universality and his solution to the Medicare crisis is to invest in the core of it and that is to invest in the Medicare rebate for everyone.
So I can understand that he is saying if you compare a truly dreadful package to a very bad package you will say there's been a slight improvement, but this is still a very bad package and John Deeble's analysis supports that.
Glenn Milne: Let's address this question of universality because it's at the core of the debate. You say that Medicare ought to be universal but the co-architect of Medicare, Neal Blewett, former Labor minister, when he established Medicare said it was not meant to be universal. How do you respond to that? Julia Gillard: This is a bit of Tony Abbott's spin. He's got a 20-year-old quote from Neal Blewett that he trumpets out on all occasions. He should ask Neal Blewett for -
Glenn Milne: He did say it.
Julia Gillard: Well, he did say it and words quoted back over 20 years might sound different in a radically different context. If you ask Neal Blewett today - and I've certainly heard him speak at conferences, and if Tony Abbott wanted to find out what Neal Blewett thinks he can pick up the phone and ask him - Neal Blewett will say to you that Medicare, when introduced had two central promises for Australians.
One was reasonable access to bulk-billing and the other, of course - and we can't forget this - was free access to public hospitals, because before Medicare in every State in Australia except Queensland where I am now there was means tested fees at public hospitals.
That was what was meant by universality, reasonable access to bulk-billing and, of course, access to public hospitals without the need to pay.
Glenn Milne: Let's talk about bulk-billing. You're offering a five dollar incentive to GPs to bulk-bill, the Government's offering a five dollar incentive to GPs to bulk-bill.
You say you will increase bulk-billing, you say the Government will decrease bulk-billing. How does that work? You're both doing the same thing essentially, aren't you?
Julia Gillard: No. When they steal an idea they can't even steal it right, Glenn. Our idea, of course, is to give an increased Medicare rebate for every bulk-billed consultation for every Australian and also to give powerful incentives, targeted incentives of up to $22,500 per GP to get them bulk-billing again.
What the Government's done is stolen the five dollar idea but said, "Let's just apply it to consultations that are bulk-billed for concession card holders or for children under 16."
Now, in the face of that your rational doctor is going to say, "I'll take the five dollars and I will bulk-bill those people, but I'm not going to bulk-bill the next Australian who's not a concession card holder or a child under 16 for five dollars less.
I'm going to at least ask them for a co-payment of five dollars. That means that bulk-billing rates will dive to the rate required to cover only concession card holders and children under 16.
That's why it will drive bulk-billing down and the analysis, even the Government's own analysis, supports that. Their own web site says that will mean 60 per cent bulk-billing. I actually think it will mean less than that, we will see bulk-billing rate rates at about 50 per cent.
Chris Bath: The odds are that this particular package will probably get through the Senate before Christmas. Will Labor support it or oppose it?
Julia Gillard: Labor, of course, is opposed to this package as a bad deal for the Australian health system. It really is the end of universal Medicare as we know it, it is the creation of a two-tiered system - bulk-billing for some, not for all.
The safety net's properly analysed are a sham, so we are opposed to it. Unfortunately, the mechanics of this package are such that not every aspect of it will come before the Parliament.
We're still waiting for reasonable advice from Tony Abbott's office as to what will come before the Parliament and in what form.
Labor Caucus on Tuesday will make the final decision about every aspect of what comes before Parliament. I think you can tell that our intentions are clear - we believe this is a bad package for Medicare, a bad package for Australians. Chris Bath: So there are no measures that you're prepared to support?
Julia Gillard: Look, the five dollar rebate that was put in for children under 16 and for concession card holders obviously we support there being an extra rebate when those people are bulk-billed, we want it to be for everybody who's bulk-billed, that's the key difference between us and the Government.
I think that only needs to come before Parliament as a regulation change and we wouldn't stand in the way of that increase because it's part but not all of Labor's plan and when we got to government we'd put the rest of the plan in place.
We are waiting a briefing from Tony Abbott's office about what else will come before the Parliament and in what form and Labor Caucus on Tuesday will take the final decisions.
Obviously my colleagues want a say in this, but I think Labor's intention in relation to this package has been clear from day one when we said, "It's Medicare Minus, it's Medicare minus its heart and soul, which is bulk-billing.
Glenn Milne: Doctors consistently say that the central problem with the health system is that the scheduled fee set by the government is too low, in other words the system's under funded. Would Labor consider increasing the scheduled fee?
Julia Gillard: There was a great deal of work done on what should be the appropriate fee structures for doctors, the Relative Value Study, which after many years of work was basically abandoned by the Howard government. I think there is a need to look again at fee structures for doctors.
We've really moved now from a circumstance where the burden of disease in our society was infectious diseases to a time when the burden of disease is chronic disease, diabetes, heart disease, cancer and the like, and I think we do need to look again at how the Medicare schedule deals with patients who need to keep coming back for continuous care.
Glenn Milne: Does that mean more - Julia Gillard: So in government we've heralded -
Glenn Milne: Does that mean a higher fee, though?
Julia Gillard: In government we've heralded an intention to have a major reform process which would deal with that issue as well as deal with how do we work so that our primary care - our GPs, our nurses, our people out in the community - can be working better to keep people away from the hospital door.
One of the great distortions in the system now is because you can't find a bulk-billing GP - and in some parts of Australia you can't find a GP at all - people end up in the public hospital emergency department looking for GP-style care.
Glenn Milnep: The private health insurance rebate, we can't let you go without asking you about that. I think we've had you on three times and you always say it's under review.
You're going to have to make that decision by the ALP national conference in January, aren't you, or can you tell us now?
Julia Gillard: I can't tell you now, Glenn. We will be announcing that policy as I've reassured you time and time again and I'll reassure you once more, Glenn. I know you're anxious.
But you will know the full details of that policy well and truly before the time that you will be required to vote in the next federal election.
We will announce it so Australians can have a good look at it before they are required to vote, but we want to get it right and clearly we've had other health issues which we've needed to respond to in this time, not the least of which, of course, is Medicare Minus coming out this week. So the private health insurance policy will be out there for all to see by the next election but it won't be out there on today's show and it won't be out there by the end of this year.
Chris Bath: Just quickly, while we missed the scoop on that perhaps another scoop on policy direction - should future Labor governments spend surpluses on services or give them back to Australians as tax cuts?
Julia Gillard: I'm a shocking conservative when it comes to money. It might be because of the difficulties I've always had balancing my cheque account. I think the best thing that we should do is wait for the new set of figures.
We're waiting for the mid-year economic outlook figures to see what is still in the budget surplus. Then of course we will probably get the May budget before we have a federal election and when we know what the figures are we should then make costed announcements investing in Health, investing in education, and alleviating the tax burden where we can. So all of those policies need to be attended to but against a backdrop of knowing what there is to spend. I of course as Shadow Health Minister, as you would expect, will be advocating for additional expenditure in the Health area. I know from talking to my colleagues that everybody is prepared to invest and invest strongly in our health system.
Glenn Milne: Just quickly and finally, there are reports this morning that Simon Crean's support is eroding within the Labor Caucus. You're a Simon Crean supporter, how do you assess his level of support within the Caucus? Julia Gillard: I think the level of support within the Caucus remains strong.
People have been very engaged in this Parliamentary term in prosecuting our arguments about health and about education, and I'd have to say the one thing Medicare Minus proves this week is that those arguments have been working - working in the Parliament and working in the community.
And as we see Brendan Nelson desperate back-pedalling on his education package I think we can say our education arguments have been working too.
There's been a great deal of Caucus support for putting forward those policy positions and a great deal of support for Simon's leadership as we've done so. I haven't seen the press report you refer to, Glenn, but I don't think anything's changed.
I think Simon is enjoying good support from Caucus and will be leading us and leading us strongly into the next federal election.
Chris Bath: Julia Gillard, no doubt you're headed for a rather interesting Caucus meeting on Tuesday. Thank you very much for your time this morning. Julia Gillard: Thank you.
Chris Bath: And thank you, Glenn. We'll see you next week for the last show.
Glenn Milne: It'll be a date. |
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The Warren Files.
Watch Mark Warren's greatest hits online here.
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