November 05, 2021


LEON COMPTON, HOST: Mark Butler is Labor’s Shadow Health and Ageing spokesperson and he's in Bernie this morning. Mark Butler, good morning to you.


COMPTON: Mark Butler, we heard in news that Premiers have written to the Prime Minister heading to National Cabinet today and asking for Federal support for health systems coping with COVID. I'm imagining you support that. What sort of supports should the Federal Government offer the Premiers?

BUTLER: You’re right, you don't have to be Rhodes Scholar to work out that business-as-usual on hospitals is not going to cut it in a once-in-a-century pandemic. We know the pressure that our hospital systems were under even before the pandemic, we see it in jurisdictions like Tasmania but also my state of South Australia that have been relatively COVID-free for months and months now. They've had no flu season, but hospitals are still dealing with record levels of ramping with code yellows, with real pressure on the system without COVID. So, that's why I think Liberal Premiers, Labor Premiers from across the country have now, yet again, written to the Prime Minister. They've written a number of letters over recent months, asking for the Federal Government to sit down, maturely and constructively work with them on a plan to deal with the next phase of the pandemic.

COMPTON: Okay, to the specifics Mark Butler, what should the Federal Government be doing? What nature should that support take?

BUTLER: The first thing we've said, and the AMA has said yet again this morning, is that the Prime Minister needs to release the modelling that was done back in September to show what was going to come down the path, what the pressure was going to be on the hospital system. Only when you've got that modelling in front of you, can you then sit down and maturely have a discussion about a plan to deal with it. That's what the AMA has again said this morning as they've released their hospitals report. Again, I call on the Prime Minister today to release the modelling that he's had in his hands for weeks and weeks now. My state of South Australia is opening its borders in two and a half weeks. Here in Tasmania, it's probably five or so weeks away and still we don't know what's coming down the path. You have to have that information as a precondition to establishing a plan to deal with it.

And it can't just be the states’ responsibility, too often through this pandemic, the Prime Minister has said, this is all someone else's responsibility. Well, the Commonwealth does have shared responsibility for making sure our hospital systems remain safe and strong over the course of this next phase.

COMPTON: Okay, but to the specifics. What should the Prime Minister do then or what role is there for the Federal Government to support state-funded health infrastructure like hospitals, as we prepare to reopen borders?

BUTLER: We know activity is going to be higher. Activity is already very significant in our hospital system. We know that pressure on our hospital system is going to be more than a usual year. Again, as I said, you don't have to be a Rhodes Scholar to work that out. So, what is the Commonwealth going to do to support the states in dealing with that additional pressure, that activity coming through emergency departments. We've seen –

COMPTON: So, what can they do? I'm asking you for the answers, you're the Shadow Health Minister, you're in the North West, you've near the North West Regional Hospital talking with us this morning. What is the answer for that? What is the best form of Federal support at what is expected to be a time of increased demand given that we're already battling with ramping and we're already battling with difficulty conducting appropriate levels of elective surgery?

BUTLER: I'm not going to second guess what the agreement should look like that the Commonwealth and the states come up with. All I'm saying is that the Prime Minister from the start of this process, from when the states first wrote to him, I think probably now two months ago, and said we need you to sit down with us. Instead he picked a political fight with the Queensland Premier, who was only one of eight premiers and chief ministers making this call, instead of sitting down maturely with them.

COMPTON: Mark Butler, I'm asking you, one day you might be Health Minister, what sort of support would be valuable for people listening to us in the North West of Tasmania, or the North, where you're heading later today?

BUTLER: Look, the Premieres have put a series of claims in their letter. Things like the sort of growth funding arrangements, a range of other things. I'm not going to second guess what the outcome of that negotiation should be. I tell you, if I were the Health Minister and Anthony Albanese was the Prime Minister, my advice from the get-go, two months ago, would have been release the modelling, sit down with the states and have a constructive, mature discussion about how we're going to keep our hospitals safe and strong. I don't have access to the information that Scott Morrison and Greg Hunt have. 

What I do say though is they should have been open and they should have been constructive from the beginning of that claim from the states. Instead, we're six, eight weeks on. We're only a few weeks away from the COVID-free jurisdictions starting to relax their borders and still we don't have a plan.

COMPTON: How would you solve the over-reliance on locums in the health system in North Western Tasmania if you were Minister for Health?

BUTLER: As I've been Shadow Health Minister over the course of this year, the deepest impression I've got about the state of our health system is the parlous state of General Practice and this has been rundown over really eight long years of very big cuts to our Medicare system and so there does need to be a very deep look at the state of General Practice, particularly in the outer suburbs of our major cities and even more so in regional communities. 

We've got a Senate Enquiry now that's looking at that, it was taking evidence yesterday from particularly regional communities about the hollowing out of General Practice. What I'm hearing, and I heard this morning at a breakfast with GPs in Ulverston is it is harder and harder to get in to see a GP than it's ever been, and if you do get in to see a GP you're more and more likely to be paying big gap fees. 

COMPTON: That's the problem and we hear all the time that people with immediate health concerns are being told it will be three weeks to get into a GP in regional Tas if you can get on their books at all. So, what is the answer to that?

BUTLER: I've heard I've heard more than three weeks, but it's clearly a very long time. We need more GPs coming into the system. Probably the scariest statistic I've got, and it was repeated to me again at breakfast this morning by some GPs, is right now only 15 per cent of our young medical graduates are choosing to go into General Practice. That figure not too long ago was 50 or even 60 per cent. We have a supply crisis coming into our system and as some of the existing GPs who are reaching retirement age leave the system, you know, they're the sorts of family doctors who typically work 70-80 hours a week, have a portfolio of aged care facilities that they visit on the way home.

Some of the GPs coming into the system, you know, have a different idea of their work-life balance and they're not working on the same full-time basis. So even at 15 per cent, we're not getting a one-for-one replacement. This situation that is already parlous for Regional Tasmania, for example, the difficulty getting into a GP, the fees you have to pay once you get in, is going to become profoundly worse if we don't focus on that workforce supply, and that would be a major priority of an Albanese Labor Government.

COMPTON: If you're running into a Federal election, will you be proposing as policy a significant increase in the gap fee that GPs get paid for each consultation as a way of encouraging more people to look at General Practice and think that it might compare, you know, in terms of money remuneration compared with other specialisation.

BUTLER: The gap fee that people are having to pay out of their own pocket has climbed by 50-60 per cent over the course of this term of Government, over the course of this Liberal Government, because they froze the amount that Medicare pays to doctors - 

COMPTON: Labor did that, and you'll say, that was only for twelve months - 

BUTLER: No, it wasn't even for twelve months, it was for seven months to realign the Medicare rebate changes with the financial year, and if you look at the Budget Papers of 2013, it made it very clear that the change was only from November to the following July, and in the following July, the indexation would resume.

It was very clear in the 2013 Budget Papers, but then the Government because it couldn't get their GP tax through the Senate because we stopped it, instead put the rebate freeze in place for six long years cutting, already it’s baked into the system still, 500 million dollars out of the Medicare system every single year, and so unsurprisingly doctors who had to keep up with the rising costs of running their practice had to lift the gap fee.

So the gap fee for a standard consult now, for the first time in the history of Medicare, you're paying more out of your own pocket than Medicare contributes to the cost of your GP consultation. So we're not going to be increasing the gap fee. That's the worst thing that we could do given what's happened under this Government.

COMPTON: Is it fair to say about that you can't win government if you don't pick up seats in Tasmania in the upcoming Federal election? Just in a word, is that a fair comment?

BUTLER: I think that's fair. Yes. I mean, it would be a remarkable result to win government and not to pick up some seats in Tasmania. Doesn't mean it can't happen, but very extraordinary.

COMPTON: How is it being in Tasmania, where by any sort of empirical measure the State Labor Party is a complete rabble?

BUTLER: Certainly across the country we want to see all of our branches, including the branch here in Tasmania, focus on the state interest and the national interest and not focus on themselves.

You know, it is important that every member, every supporter of the Labor Party, focus on the main game here which is winning the next election. It is overwhelmingly in the interest of Tasmania to have a change of government here. Health policy for example is as important to Tasmania as to any other part of the country, like my state of South Australia it's a little bit older than the national average, it has more health demand than the national average.

It needs a change of government to deal with some of the pressing health challenges that are raised with me every time I come here. I’ve been to Tasmania three times this year, the same issues keep getting raised and I'd like the Labor Party here to focus on the election.

COMPTON: It's the difficulty of presenting yourself as a credible option. I mean, the list of dysfunction in the State Labor Party at the moment, we could go on for the rest of the interview, but let's pick your former President suing the Leader currently, I believe that is still a live issue. You've got unions disaffiliating. You've got factional tensions that run deep as a starting point. So, I mean, what sort of a foundation is that to try and pitch for people's votes?

BUTLER: It’s incredibly frustrating for people who want to see a change in Government in Canberra and know what that could do for the people of Tasmania to see this sort of in-fighting, people focused on themselves rather than on the national interest, on the importance of winning the next election. So, all I can say, without sort of being across all of the details of all of the different things that we know are happening in the Branch here is I just encourage people to focus on the main game and the main game is delivering a change of government for the benefit of the people of Tasmania.

COMPTON: Mark Butler is our guest this morning, Shadow Federal Health Minister in the North West of the state and then heading across East, over to Launceston as the day rolls on. Just a question about your local part of part of the country, let's focus on the submarine deal that's been such an international attention source, the France-Australia tension. Part of the issue with that submarine deal was that it was designed so that there'd be local content generated in marginal seats in South Australia. I mean, that was a big part of the choices that were made in the initial deal with France. Mark Butler, should we accept that Australia should just get decent subs that work even if little of them are built in this country

BUTLER: Let me be upfront, Leon, the submarines since the 1980s have been built in my electorate in Port Adelaide and the reason that that decision was taken by the Hawke Government then, with the strong urging of people like Mick Young, but the support of the Defence people was, if you are going to spend as much money as you have to spend to acquire a submarine capability, you should also get some industrial benefit from it.

The capability that comes from having a submarine project, not just in South Australia, but there are other parts of the country that fed into that in terms of skills and economic activity was enormous. I mean, the loss of the automotive industry which hit South Australia, my state, very hard, just again meant that our country dropped further down the table of complex economies. In terms of the complexity of our manufacturing industry and the broader economic benefit that comes from that, the skills that young people are able to acquire and work through their lives acquitting. Think about the alternative, what Tony Abbott wanted to do was essentially to spend many, many billions of dollars in acquiring submarines and every one of those dollars would have been spent in Japan, with jobs there, the infrastructure there, the skills acquisition there. I make no apologies for the argument that if you are going to spend as much money as we have to spend to have that important national security capability that you get a jobs benefit from it.

COMPTON: I hear what you're saying, but we've got a situation where those subs could have been pretty close to rolling off the production line if we had chosen a proven technology from Japan right now, what we have instead is an enormous capability gap that might run out a decade and a half or more, and billions of dollars in excess expenditure, and no subs.

BUTLER: I think you can make a very legitimate criticism of the Government for really now having their third plan for the replacement of the Collins-class submarines, we've effectively lost eight years with three different plans. Now, when we were briefed I wasn't part of this group, but when the Labor Opposition was briefed from Defence officials and other experts on the AUKUS deal, the deal with the US and the UK, we accepted the case as being quite compelling that now was the time to make the shift to a technology of nuclear propulsion. So we accept that that is the best option for our national security, but we still do think, this is not just my argument as a South Australian, but across the country we still do think the Government needs to show what that will mean for jobs and industrial capability here.

COMPTON: On Mornings around Tasmania, Mark Butler. Appreciate you talking with us this morning.

BUTLER: Thanks, Leon.