CATHERINE KING MP
SHADOW MINISTER FOR HEALTH AND MEDICARE
MEMBER FOR BALLARAT
ADDRESS TO THE AUSTRALIAN INSTITUTE OF POLICY & SCIENCE
FRIDAY, 5 APRIL 2019
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In the long tradition of AIPS post-budget health briefings I am very happy, as Shadow Minister for Health, to be invited back a second time.
If you invite me back a third time I am hoping it will be in a slightly different capacity.
We are of course only weeks away from the federal election – if it’s not called today it will be called within days.
Whenever the election is called, Labor will be competitive but we are by no means complacent.
We’re not over-confident, and we certainly don’t underestimate the challenge ahead. Winning from Opposition is never easy.
But we are competitive largely because the hard work of our economic team and the terrific policy work we have been able to do, much of it with the help of people in this room.
Health will once again feature heavily in the election campaign – we will make sure it does.
And it will very much be a contest of ideas when it comes to health.
Who truly believes in the power of our universal health insurance scheme to transform lives and tackle health inequality?
Who cares deeply about the health of every Australian not just the few who can afford to pay more to get better care?
As you will have seen from Bill’s Budget-in-Reply Speech last night – we are making substantial investments in Medicare, particularly for cancer patients. It comes on top of our investments in public hospital care and our plans to improve the value and affordability of private health insurance.
We will have more to say about these, primary care and prevention over the coming weeks.
But I’ll begin with some reflections on the Budget.
I’ve said before that oppositions should work with governments where they can.
And from the measures included in the budget there are many that we welcome – indeed some of them are things that Labor had already announced such as MRI rebates for breast cancer, juvenile diabetes research funding, and funding for the Red Cross Milk bank.
We welcome as always the routine listing of medicines including for Life Saving Drugs and we support measures to reduce the prevalence of STIs, increase the number of breast cancer and prostate cancer nurses and to expand Continuous Glucose Monitoring.
We support the government continuing access for public dental clinics to the CDBS – we were frankly, given their massive cuts to public dental, very worried they would not.
The measures for primary care are worthwhile – while details about the big ticket item of $448 million over three years are still emerging – the focus on chronic disease is welcome.
Further disbursements from the MRFF are also welcome.
Many in this room have heard my concerns about MRFF governance and funding before.
But our commitment to the MRFF is rock solid – and of course we welcome disbursements from it in each budget update.
Now, The true implications of Budgets are really only understood over weeks and months, not hours and days.
We do have a day of Health Estimates today – our last opportunity for the Parliament to put the Government’s measures under some scrutiny.
We’ll be asking some questions about the Government’s changes to special pricing arrangements – which I know are of concern to many in this room.
But I do want to make two broad reflections about the Budget.
The first is that I think Australians will judge the Government on its record over the last six years – not a Budget in its last six weeks.
The Government hopes that all will be forgiven.
I am not sure this Budget was the vehicle for that – it is too little too late.
My second broad reflection on the Budget is that it’s short of vision.
I think Australians want a vision for reducing health inequality. A vision for keeping people well, not just treating illness. A vision for improving access and quality, and for patient-centred care.
I’d put it to you that we didn’t see that vision in this Budget, or any previous Budget under this Government.
And I’d put it to you that Labor has such a vision, some elements of which we have already announced.
Last night, Bill Shorten announced what I believe to be a visionary new policy.
Our $2.3 billion Medicare Cancer Plan is the most important investment in Medicare since it was first created by Bob Hawke’s Labor 35 years ago.
This is a plan that will deliver better and more affordable cancer care to hundreds of thousands of Australians.
It will mean millions of free scans, millions of free consultations and a guarantee of cheaper medicines for cancer patients.
We’ve been working on this package for a long time.
Labor has undertaken a series of Parliamentary Budget Office costings for amended MBS items for diagnostic imaging, including MRI deregulation. Those costings, as well as close consultation with the sector, have informed the $600m diagnostic imaging element Labor has announced.
The PBO also costed our $433 million investment in 3 million free specialist consults.
Today, we have announced a further $300 million will go towards funding capital projects to upgrade cancer care, including $60m for 13 regional radiation therapy centres.
This number is based on our consultations with state governments and cancer groups about the best capital investments we can make.
That means Labor has announced how $1.3 billion of the overall $2.3 billion Medicare Cancer Plan will be spent.
We have much more to announce and this is all new spending – contrary to the desperate claims of the Morrison Government.
PBS drug listings will be funded in the normal way. No money from our $2.3 billion package will go towards drug listings.
Details of how the remaining $1 billion will be allocated will be announced in the coming weeks.
Now, I’d wager that everyone in this room has been touched by cancer.
Some of you may have already been through your own cancer fights.
Any one of us could find ourselves in a cancer fight tomorrow, or next month or next year. One in two Australians who live to age of 85 will get some form of this terrible disease.
For those of us lucky enough to avoid getting cancer ourselves – we’re all still touched by this disease.
Almost all of us would have a loved one or a friend or a colleague who has been through a cancer fight.
Many of us have lost loved ones, friends or colleagues to the disease. I know I have.
Cancer is the greatest disease burden in Australia – and it also carries the greatest out-of-pocket costs in our healthcare system.
Nearly half of Australian cancer patients pay more than $5,000 in out-of-pocket costs over the course of their diagnosis and treatment. More than a quarter of cancer patients pay more than $10,000 out of their own pocket.
Some people can afford this.
But for many Australians, this is a massive financial burden.
For low-income earners. For single parents, or pensioners. For people in insecure work who may lose their income because they need time off to fight the disease.
Even for middle-income families who are already stretched with the rising cost of living and stagnant wages. Many need to make significant sacrifices in other areas to afford treatment – which can of course take years.
These people need our help. They need a Medicare that works for them. They are entitled to that.
So what are we actually going to do?
First, we will invest $600 million to make diagnostic imaging more affordable.
Many cancer patients need regular scans throughout their cancer journey.
But the average out-of-pocket cost for a scan right now is $100 – and we all know it can be much more expensive than that.
Our investment will do two things.
First, it will relax the rules around MRI machines so that any machine that meets minimum safety and quality standards can bill Medicare for cancer scans.
Second, we will work with an expert taskforce to look at the other cancer scan rebates for other modalities – X-rays, ultrasounds, CT scans and so on – and we will reform those Medicare items to close those out-of-pocket gaps.
Critically, on both of these – providers will only be able to charge Medicare if they bulk bill.
Meaning no out-of-pocket costs for patients.
This will deliver up to 6 million free scans.
Similarly, we’re going to invest $433 million into a new Medicare item to fund 3 million bulk-billed consultations with oncologists and surgeons. That’s 2000 appointments a day.
These visits would otherwise attract high out-of-pocket costs, which for specialist visits have gone up 40 per cent since 2013.
And finally, we have offered an Affordable Medicine Guarantee – a formal commitment that we will list every recommended drug on the PBS.
Today’s announcements are just the beginning. Labor will have more to say about how our Medicare Cancer Plan will improve the care of Australians battling cancer and cut their out-of-pocket costs.
Our Medicare Cancer Plan comes on top of our $2.8 billion Better Hospitals Fund, which Bill announced in his Budget Reply speech last year.
Everyone in this room knows the recent history of Commonwealth hospitals policy – from the historic National Health Reform Agreement with the states and territories in 2011, to the cuts of the 2014 Budget, to the Government’s partial backdown since.
And every Australian understands the impact those “hospital wars” have had on public hospitals.
With growing presentations and acuity on one hand and Commonwealth cuts on the other, hospitals are simply not keeping up with demand.
There were 7.8 million emergency department presentations in 2016-17 – one million more than five years ago (a 16 per cent increase).
More than one in four emergency department patients are not seen within the clinically recommended times.
In elective surgery, it’s a similar tale.
Almost 870,000 Australians needed elective surgery in 2016-17.
But one in 10 Australians is forced to wait an average 258 days.
The Australian Medical Association says the current funding formula will “doom our public hospitals to fail and patients will suffer as a result”.
That’s why Labor will fully reverse the Government’s cut by investing an extra $2.8 billion from 2019 to 2025 – from straight after the next election to the end of the Government’s proposed agreement.
Labor will establish the Better Hospitals Fund to allocate the funding.
We will announce more details in the months ahead.
The Better Hospitals Fund will pay for more activity – more emergency department presentations, more elective surgery. It will also pay for more resources – more beds; more doctors, nurses and hospital staff.
But we also want the Fund to drive innovation in our hospitals.
Activity-based funding has made our public hospitals more efficient. That’s a good thing, because it allows more services to be provided within the same budgets.
But now we need to work with the states and territories to make our hospitals more effective.
PRIVATE HEALTH INSURANCE
We have also announced a substantial reform agenda in private health insurance.
Labor has already announced our policy to task the Productivity Commission with an inquiry into the private health system, and to cap premium increases at two per cent for two years.
This policy was driven by two messages that we heard over and over in recent years.
The first was from consumers, who told us that private health insurance premiums have become unaffordable.
And they’re right – premiums have increased by 30 per cent since 2014 – costing families an average $1,100 more. Health insurance is now the leading cost-of-living concern – above energy bills.
But private health insurance is still a product that Australians want – and rightly so.
So Labor is intervening on their behalf, to make private health insurance more affordable.
The second message we heard loud and clear was from the private health insurance industry itself. It told us that governments and regulators needed to step in urgently to turn the tide.
And so while Labor’s policy prescription is different than the insurers’, we have the same aim: to maintain private health insurance coverage and the unique balance between our public and private systems.
We think that the two year cap will be an important circuit-breaker in the private health insurance affordability crisis.
But we accept it is only a short-term measure.
We know that our private health system also needs long-term reforms to improve affordability and value for consumers.
That’s why Labor will task the Productivity Commission with the most significant review of the private health system in 20 years – since the then-Industry Commission’s last review.
The reality is that recent reviews and reforms – including by the Government – have barely scratched the surface of the complex private health system.
In contrast, the last Productivity Commission review led to the modern private health insurance system. Within a few short years of that review, we saw the introduction of important measures like the Private Health Insurance Rebate and the Lifetime Health Cover loading.
We should be no less ambitious for this review.
HEALTH REFORM COMMISSION
Finally I want to turn to what I think is one of our most important commitments in health.
It won’t win us any votes.
But I think establishing a permanent Australian Health Reform Commission could be the game-changer that our system needs.
We’ve seen a boom and bust cycle in health reform, where good reforms are undone by subsequent governments, or undermined by jurisdictional divides.
That’s why Labor wants to embed reform into our health system by establishing the Commission.
It’ll be a COAG body, breaking down the usual Commonwealth-state divide.
And it’ll have independent commissioners appointed for five years, putting the Commission beyond the short-termism that sometimes characterises our politics.
I’ve identified two early priorities – primary care and public hospital outpatients.
So Labor has an ambitious agenda around Medicare, hospitals and private health insurance.
We are yet to announce policies in other important areas, like prevention, primary care and Indigenous health. I am very grateful for the work that many of you are doing with us on those.
Throughout the election campaign, I think it will become even clearer that we have fundamental differences with the Government on health policy.
Labor is the party of Medicare; the party that truly believes in universal health care; the party that believes a civilised society – and a Federal Government – must make the health and wellbeing of its citizens a top priority.
Thank you and I look forward to your questions.