June 10, 2021


HAMISH MACDONALD, HOST: Labor is vowing to fight a proposed overhaul of health rebates, accusing the Coalition Government of making sneaky cuts while no one is looking. The changes to over 900 items on the Medicare Benefits Schedule are due to kick in next month with rebates updated to reflect the latest medical advice and technological advances. The Australian Medical Association has raised some concerns, it says it is now working with the Government to implement the refresh.

OMARK KHORSHID, AMA (RECORDING): I certainly hope we're not going to see a “Mediscare” campaign. Now this review that the AMA has supported was designed at modernising the MBS and it has taken five years to do. We have a few quibbles and issues with how it was done. But at the end of the day, the AMA is supportive of the review process and of most of the outcomes.

MACDONALD: That's the AMA President Dr Omar Khorshid speaking at the Press Club yesterday. Mark Butler is Labor's Shadow Minister for Health and Ageing. Welcome back to Breakfast. 


MACDONALD: The AMA says it doesn't want another “Mediscare” campaign. Why is Labor more concerned than the health bodies?

BUTLER: The AMA also said over the weekend that patient costs will rise. To use Omar Khorshid’s words over the over the weekend, he said “that's guaranteed.” The Grattan Institute in looking at these changes said it's almost inevitable that patient costs or the gap fees that patients pay in addition to the Medicare rebate, and the private health insurance contribution, will rise as well. Now, no one can explain how this enormous change in Medicare Benefits Schedule, 900 out of 5700 items being changed, how it will actually work on the ground. The only thing that is clear is that patient costs will rise here. It’s our job as the Opposition, it’s been the Labor Party's job for 50 years, to call out the Liberal Party on changes that reduce access to patient services and increase their costs. That's what we're doing right now.

MACDONALD: Is anyone saying that they're going to rise across the board are we talking about in those specific instances where the MBS is being altered?

BUTLER: It's about these particular changes. But this is the biggest change to the Medicare Benefits Schedule in its history. One in six items are being changed. A huge number of orthopaedic surgery items, a huge number of cardiac surgery items, and other general surgery items as well. This just repeats a pattern with this Government that has seen out of pocket costs, or the gap fees that patients pay, increase by about $10 per GP visit, and a whopping $30 for visits to specialists. So in addition to the average $90 that Australians are paying every year in gap fees, they're now going to be slugged an additional patient bill or gap fee for surgery items as well. It's just not acceptable.

MACDONALD: Greg Hunt though, the Health Minister says any savings from these changes are going to be reinvested back into the MBS. Does that necessarily make it a cut? Could we see actually some benefit to us as consumers in other parts of the system?
BUTLER: No one can explain what that is. All that we know is the patient costs are going up. No one can explain how this is actually going to operate on the ground. Greg Hunt might make these vague assurances that there'll be a reinvestment but I think Australians know enough about this Government, that if these changes were good for patients, there would be a big press conference with PowerPoint slides and a range of other materials to demonstrate that. Instead, we've got a Government that has gone to ground and incapable or refusing to give a guarantee to patients, that their costs, their gap fees will not rise as a result of these changes.
MACDONALD: The changes affect things like orthopaedic surgeries, heart procedures, all of which were recommended and drafted by health experts through the review process. There are over 900 changes planned are there any specific changes that you object to?

BUTLER: We know very little about how those will operate in practice. That's not just me, people working in the system don't really understand how these are going to operate in practice. They're taking effect in three weeks’ time. So surgeries that are already locked in. We know some things for example, the Orthopaedic Association is concerned about the fact that some hip arthroscopies will be removed from the schedule altogether, which will be a huge hit to patients who get life changing surgery in that area. But look, if there are changes to the schedule that would better reflect contemporary surgical practice that's all well and good. But the Government's got an obligation to bring them forward clearly with an explanation about what they will mean for patients both in their access to services, but particularly their costs and the Government's not being able to do that

MACDONALD: To that point, though, the review taskforce was supposed to make the health system more efficient and reflect changes in technology that lower the cost of procedures. From what you're saying it sounds like you believe that there's nothing wrong with cutting rebates for procedures that don't have the health value they once did?

BUTLER: There is an argument, for example, that a whole range of procedures that used to be done by open surgery as opposed to keyhole surgery could be adjusted. That's all well and good. I don't think anyone would argue with those sorts of changes to reflect contemporary surgical practice. But we've got to be clear about what the impact on patients is going to be. We've got 900 items dropped on us three weeks before they take effect, potentially impacting hundreds and hundreds of surgeries that are already planned, and no one can explain what it means for patients except as I said, the AMA says it's guaranteed the patient costs will rise. The Grattan Institute has said it's almost inevitable that patient costs will rise. We've got a Government that's gone to ground and won't give a guarantee that that's not the case.

MACDONALD: The peak body, the Consumers Health Forum wants the Government to consider a short pause so that these changes can be better explained, would that be sufficient for you? Or do you think they should be scrapped entirely?
BUTLER: They’ve got to shelf the changes that are supposed to take effect on the first of July in three weeks’ time immediately. They've got to give patients confidence that they will be able to access their life changing surgeries in a way in which they've been discussing with their surgeons and with their doctors. Now, if they want to bring forward changes that reflect that long review, and as I said, reflect contemporary surgical practice, that's all well and good. I think everyone would agree that is a good thing but that's not what they're doing. They're lumping changes on us with no explanation as to how they would work, except everyone agreeing that they will result in increased patient costs.
MACDONALD: Mark Butler on the vaccine rollout, AMA President Omar Khorshid was raising concern at the Press Club yesterday about the way in which states and territories are doing different things as far as different age categories and are concerned that it would be best to get the most vulnerable and the most exposed, vaccinated first and then move on to other age groups. Does Labor have a view on this?

BUTLER: I've said pretty much exactly that over the last several weeks. The priority that we agreed back in January as a nation was to vaccinate the most vulnerable Australians, that is older Australians and particularly those living in residential aged care and residential disability care, as well as the hundreds of thousands of people who care for them every day aged care staff and disability staff. They were all supposed to be vaccinated by Easter so that we were confident that by the time winter came when respiratory illness is much more dangerous, those vulnerable Australians will be protected and we heard particularly over the last fortnight in Canberra, just how woefully underprepared we are there. How woefully underperformed that job is by Scott Morrison. That's got to be the priority. All of the Commonwealth Government's effort should be going into fixing the mess they’ve made or that promise they made back in January.
MACDONALD: But do you have a problem with an individual state or territory moving into other age categories if they feel they’ve got the supply and the mechanisms to get it out there?

BUTLER: That's the point I've made. If a state government takes the view they’ve got enough supply additional to what the Commonwealth needs to do its job, which is in those other areas I’ve talked about, that's all well and good. But the nation, led by the Commonwealth Government, must keep in mind that the priority must be to vaccinate those vulnerable Australians and we are woefully behind on that task.
MACDONALD: The Pharmacy Guild is making a push to see more pharmacies included in the rollout particularly in regional and rural Australia. Do you see any reason as to why states and territories haven't taken up the offer made by pharmacies other than the small number of them in regional Queensland?
I’d like to see pharmacies brought into the fold as soon as is practicable. They were supposed to be in the fold, as Scott Morrison said in May. Greg Hunt told the pharmacy conference that it would be well into the second half of the year before their services are utilised. They're a very important part of the flu vaccination program. I think your listeners would know and they’ve got a great connection to community. So my view is we need all hands on deck. We still only have about two and a half per cent of the population fully vaccinated. We are way behind schedule. And why we would not be utilising the skills and the community connection of these highly skilled health professionals, the community pharmacy sector, is beyond me.
If I can ask you about the Biloela family there's growing speculation the Government may soon announce a decision on the fate of this Tamil family. They've been on Christmas Island for years now. The three year old daughter is being treated in a Perth hospital for suspected blood infection and pneumonia. Do you have a view as to whether an overseas resettlement option is appropriate?
BUTLER: My instinct is that's a cop out. I think if ever there were a case for ministerial discretion, which has been a long standing provision in the legislation, this is it. Instead, we've had a young family with two incredibly young children locked up by themselves on Christmas Island with taxpayers shelling out $7 million, essentially, to bankroll Scott Morrison’s stubbornness and at an even greater cost to this young family and these children. Enough is enough, there is a ministerial discretion there, whether it's Alex Hawke, or Karen Andrews, or the Prime Minister himself, just act, just exercise this discretion and let this family get back to the community that desperately wants them back.

MACDONALD: Why would New Zealand or the United States be a cop out what's wrong with those options?
BUTLER: There is a community, Biloela, who has consistently said for years now that they want their friends, their neighbours back. They were a cherished part of their community. I don't see the reason for essentially negotiating something with a third country instead of just exercising ministerial discretion and a case that I think is more meritorious for that exercise than any that we've seen for some time.
MACDONALD: Mark Butler, thank you very much for your time this morning. 
BUTLER: Thanks Hamish.