PRIME MINISTER:
Well, good morning ladies and gentlemen. Senator Patterson and I are with you on this beautiful Canberra morning to announce a series of measures which we believe very strongly will produce a fairer Medicare. These measures will make Medicare both more accessible and also more affordable.
The Government remains strongly committed to the principles of Medicare. We also remain strongly committed to the private health structures of this country and we believe that together they give this country the best health system in the world. That's not to say that it's without flaws and it can't be improved and today's package is in fact about further improving what we believe is the best health system in the world. Last week we announced a 17 per cent real funding boost to public hospitals and what that was designed to do was to reinforce one of the pillars of Medicare and that is the guarantee of free treatment in a public hospital ward. Today a series of measures to make Medicare fairer.
Firstly, through incentives to doctors to strengthen the availability of bulk-billing, especially in rural and outer metropolitan areas.
Secondly, to increase the supply of general practitioners and practice nurses in areas of greater need.
Thirdly, to dramatically simplify the claiming procedures and reduce the up-front cost of those Australians who are not bulk-billed.
And fourthly, and very importantly, to provide two additional safety nets for Australians who experience above-average medical costs.
And separately, we're announcing a new proposal in relation to the continued treatment by local medical officers as they are styled, doctors, GP's, of veterans holding Gold and White Cards. Although, the discussion regarding this has been part of the general discussion with medical organisations concerning the other measures, the agreement between the doctors and the Department of Veterans' Affairs will be a separate stand-alone arrangement from the measures we're announcing today.
I want to emphasise two things that aren't being introduced. We're not introducing a means test and we're not introducing a co-payment. The other point I'd like to emphasise is that on the latest figures available, since this Government came to office in 1996, the Commonwealth share of total health expenditure has risen from 43.8 per cent to 47.5 per cent, whereas the state and local shares have remained static. This overall is a package that will make Medicare fairer. It reinforces, it buttresses the fundamental principles of Medicare, it does not in anyway taint the universality of those things that have always been seen as central to Medicare since its inception in 1983, but it does add a number of additional measures that will improve the accessibility and the affordability and I'd like Senator Patterson to say one or two things about the detail of those measures.
SENATOR PATTERSON:
Well thank you, Prime Minister.
This is an integrated package and the Prime Minister has emphasised that it's designed to particularly strengthen availability of bulk-billing to people in outer metropolitan areas and in rural areas. And in developing the package we've been listening to the community and to General Practitioners. It's a $917 million package that will complement our package of $562 million which is already in play with 14 programmes to get doctors into rural areas and we're beginning to see that take significant effect. And also complement our $80 million programme to get doctors into outer metropolitan areas and we're going to accelerate that program. So the whole package is about access and about affordability and those two are inextricably linked. With regard to accelerating the $80 million programme for outer metropolitan areas, for example, we've announced new incentives of $30,000 for doctors to set up a new practice in an area of need, in an outer metropolitan area, or $20,000 to move an existing practice.
I want to put paid to the comments that have been made in the press to date that this package limits bulk-billing to healthcare card holders - that is not true, that is not the case, there's nothing in the package that should cause doctors to increase their fees. As is the case now, some doctors bulk-bill all their patients and some doctors choose to charge some a gap.
This package will not limit bulk-billing to healthcare card holders, it will strengthen the accessibility of bulk-billing to healthcare card holders, as I said, particularly in rural areas and outer metropolitan areas.
The universality of Medicare will be maintained.
All Australians will have access to the rebate.
As is the case now, and I emphasise, doctors will be free to choose to bulk-bill all their patients.
There'll be no copayment, as the Prime Minister said and there'll be no means test.
There'll be incentives for doctors to bulk-bill their healthcare card holders and it works out at about $3500 for a doctor in a metropolitan area, if they have a high number of healthcare card holders that figure could double. In non-metropolitan cities, the incentive will amount to about $10,250. In rural centres, around $18 500 and in outer rural and remote areas around $22,000.
But doctors will not only benefit from the incentives, they'll have reduced paperwork because they'll have access to HIC online. The payment lag will reduce from eight days to two days which will assist them with their cash flow and there'll be a payment for doctors in metropolitan areas of $750 and in rural areas of $1 000 to actually assist them with their start-up costs for health insurance commission online.
We're going to fund more nurses, particularly in outer metropolitan areas and in rural areas of workforce shortage. There'll be 457 new full-time estimated nurses which amounts to about 800 practices which will benefit. It's been estimated that a nurse takes up about half time load of a doctor and reduces pressure on doctors, they can do things like go out and do a wound management, look after a patient that has an ulcer on their leg, for example, while the doctor's continuing to do their GP work in their practice. So, it does relieve them enormously and in fact, the President of the Divisions of General Practice only last week wrote an article about the benefits of practice nurses in one of the doctor magazines. That will take our funding for practice nurses since 2001/2002 to $168 million.
We've had very different bulk-billing rates across the country and as I said, this is aimed to actually make it fairer particularly for people on healthcare cards. The people who go to a doctor who doesn't choose to bulk-bill non-concession card holders who signs up will find benefits as well because instead of having to pay full up-front fees - that is the rebate plus the doctors gap - and then go to the Medicare office often with sick children, often in their lunch hour when they're trying to stand in the queue and instead of getting their lunch in a Medicare office, they will be able to sign over the rebate to their General Practitioner, pay the gap and go out with no more to do and no more to pay. So, it's a win-win situation - that is if the doctor chooses to charge a gap.
There'll be new safety nets, as the Prime Minister has indicated, particularly for healthcare card holders once they reach $500 of out-of-pocket expenses for not only just the gap between the scheduled fee and the 85 per cent, but any gap above that the Commonwealth will pay 80 cents in the dollar and assisting them to meet those differences - that is a new gap, it's protection for people who have catastrophic events or a large billing in any one year. For those people not on a healthcare card, they will in fact be able to ensure irrespective of whether they have private health insurance or not, be able to insure for a thousand $1 000 gap for all medical procedures.
Again, there's been some misrepresentation in the press that you have to go to the doctor eighty times - that's not true. It will cover pathology, radiotherapy, general practice. So for people who - and most of us are concerned - that if we have a terrible year when everything goes wrong in terms of our health, how will we manage? For, preliminary estimations say that it will cost about $1 a week per year, per family, they'll be able to protect themselves against costs above $1000. And I believe that's something the Australian people will really find very attractive to actually guard against that rainy day.
We'll have more doctors in training - 234 new medical school places and in addition to that, 150 new general practice specialist trainees on the ground in 2004.
This is an integrated package, it's to improve access and affordability to healthcare for all Australians irrespective of where they live.
PRIME MINISTER:
Well ladies and gentlemen, just one thing - we'll be making available a full press kit immediately after the news conference has finished. And could I just emphasise one aspect of the new private health insurance product - it is a stand-alone product, it's not only available as an add on to an existing private health insurance policy. So in other words, if a person now doesn't have private health insurance for the full bid, that person will be able to take out this new product alone - and it'll be about $1 a week - to provide the cover to which Senator Patterson has referred.
JOURNALIST:
[inaudible]
PRIME MINISTER:
I don't believe this package will fail. I believe this package will succeed because it addresses areas of need and concern. If you look at the bulk-billing rates, they are largely, but not totally, a function of the availability of doctors. They don't follow any particular pattern of socioeconomic need. You can find some areas of the major cities that are regarded as very wealthy, or comfortable, where the bulk billing rates are high, you can find some of the other areas that are not regarded as as well off where the bulk billing rates are also very high but you can go to many of the rural areas, you take the parts of Victoria around Horsham in the Murray electorate, the bulk billing rates are quite low, the bulk billing rates are quite low in the electorate of Flinders, the outer periphery of Melbourne. So it's very much a function, not totally, but very much a function of the supply and demand of doctors. That's why there is such a very heavy emphasis on the workforce issues in this package and they are, the work that Senator Patterson has put into building the concept of practice nurses and increasing the availability of those, for example, as well as the extra medical places will make a huge difference.
JOURNALIST:
Will that be the test of the success of this package if it stops the decline...
PRIME MINISTER:
I have no doubt that whatever tests I set for the success of the package they won't be universally accepted. Others will make their judgement. In my mind, well I'll tell you what's in my mind: my starting point is that we have fundamentally an excellent health system in this country. Look it's not perfect but it's a lot better than the health system of the United States, the United Kingdom, of any continental country and certainly any nation in our region. So that the opening thing is, and the strength of our system is built upon the universality of Medicare and the private health insurance structures. The private structures have taken a load off the public hospitals and we have a good mix and once again this is an area where Australia mixes public and private in the provision of human services more successfully than many other nations. I believe that it will increase the supply of doctors, plus the other measures that Senator Patterson talked about, where we're going to accelerate as the package will, the media kit will show, the implementation of the $80 million package for outer-metropolitan doctors and we hope that that will produce more doctors in the period between now and the coming into force of these new measures.
JOURNALIST:
...shouldn't you be able to say that it will stop the fall in bulk billing?
PRIME MINISTER:
I believe that this will provide a fairer system, the impact of it will be to I believe to be very beneficial on bulk billing rates, I'm not going to commit myself to a particular rate. Nobody has ever done that and I might remind you that when Medicare was introduced 100 per cent bulk billing was never guaranteed, it was never part of the original Medicare, in fact if you have a look at Dr Blewett's address, his famous address, well I choose to call it famous because it was a real benchmark address on this issue to the Doctors' Reform Society, he said "on February the 1st next year all Australians residents will be guaranteed automatic entitlement under a single public fund to a medical and optimerical benefit of 85 per cent of a scheduled fee." In other words that was the principle and bulk billing started off as a low rate, it's grown, it reached 80 per cent, it has declined in the last few years and that decline has been very much a function of the shortage of doctors in certain areas. Now this is overwhelmingly designed to address that, and I believe it will and I believe it will highly successful.
JOURNALIST:
Prime Minister, wouldn't it have been fairer and simpler to raise the Medicare levy and the rebate that you're offering doctors?
PRIME MINISTER:
No, it wouldn't have been. It wouldn't have been as targeted and it would have ended up being a lot more expensive because I think it costs about $100 million a year to lift the Medicare rebate by an additional dollar. We have indexed the Medicare rebate, and Senator Patterson will correct me, but I think we have in fact over the last few years increased the Medicare rebate at at least if not at a faster rate than what it was under the last few years of the former government. So if the former government presents itself as a born again believer in lifting the Medicare rebate then they didn't demonstrate during their last few years in government.
JOURNALIST:
In effect aren't you asking Australians to double insure to go to the doctor now?
PRIME MINISTER:
Now we're not asking them to double insure.
JOURNALIST:
You're paying the income tax levy and then you've got to pay...
PRIME MINISTER:
The Medicare levy contributes about 16 per cent of the total cost of the Commonwealth provision for health services, now we have to keep that perspective in mind and of course that is a levy imposed on your income tax and therefore it is in that sense progressive. I don't think the answer to this is to increase taxation, I mean Labor's answer is presumably, and I mean it's up to them to announce a policy, but I would predict that their policy will be a mix of abolishing or hacking away at the private health insurance rebate and increasing tax. I don't think that's good health policy. I don't think it's good health policy to lift tax, which appears to be, on the available evidence and I want to be charitable because I don't really know what their policy is, they don't have one, but I can predict, I'm entitled to make a few predictions, I predict that if they have a policy which is different it will be based upon a combination of cutting the private health insurance rebate or getting rid of it all together, or severely means testing it, and or increasing taxation.
JOURNALIST:
Prime Minister can you guarantee that everyone who currently has access to a bulk billing GP will continue to have access under this package?
PRIME MINISTER:
Look, as Dr Blewett said, whether you're bulk billed or not is a choice left to the doctors. It's always been a choice and it's always been a matter between the doctor and the patient, it's always been like that. And nothing that we have introduced today will make that any different. Certainly the measures that we have introduced today will strengthen the availability of bulk billing. But given that the question of whether somebody bulk bills or not is a matter between the doctor and the patient and it was at the beginning and then it continues to be the case now.
SENATOR PATTERSON:
The vast majority of doctors, on our calculations, will be better off if they sign up to the package given the ones who don't bulk bill their healthcare card holders now. So the vast majority of doctors will be better off if they sign up to the package and the vast majority of patients I can tell you will be much better off.
JOURNALIST:
... patients on low incomes be more likely to face an increased fee if they're not on a pension?
PRIME MINISTER:
No, I don't accept that.
JOURNALIST:
Can you guarantee that?
PRIME MINISTER:
Well, look when you are dealing with millions of individual relationships between doctors and patients around the country I simply repeat what Dr Blewett said, it's a matter between the patient and the doctor, and I rest on that. What Senator Patterson says is right, if you take an average doctor who has bulk billed a large number of his or her patients including but not only pensioners and card holders, that doctor does very well out of this package if he or she signs up and on that reading there's a greater incentive to maintain the existing balance of those who are bulk billed and those who are not than to alter it.
JOURNALIST:
One of the fundamental principles of Medicare was that everybody got the same 85 per cent rebate, under your changes you'll get a higher rebate now if you're a pensioner or a card holder because the government will pay doctors between $1 and $5.30 extra to bulk bill those people. How does that not destroy the fundamental principles of Medicare?
PRIME MINISTER:
Well I find it a strange notion of destroying a universal health system where you provide additional incentives to look after the more needy in the community. I mean that is not my idea of social justice, my idea of social justice is that you have a basic entitlement and then you make sure that you have in place things that help the more needy in the community. That's my idea of social justice and I think it is the idea of social justice of most Australians. The universality of Medicare was the availability to everybody, as Dr Blewett said, I mean he was the Minister, he said 85 per cent, in this now very famous speech, 85 per cent of the scheduled fee. And that is not, I mean try as people may, now or over the weeks ahead, to argue that in some way this or the hospital package has undermined those two great pillars of the universality of Medicare, they can't do so.
SENATOR PATTERSON:
Can I just say something, that if you're talking about social justice then is it just that somebody on a healthcare card in a rural area has never had any incentive, or the doctor's never had any incentive to bulk bill them, two people on the same income, depending on where they live, are treated differently. This will strengthen the likelihood that doctors will bulk bill those people in those areas. We can't guarantee it because we can't dictate to doctors. But it will strengthen, I believe, that increases the social justice of the package, the Medicare package, particularly for general practice.
JOURNALIST:
Does it increase the chances of an average family who aren't on a concession card receiving access to bulk billing?
SENATOR PATTERSON:
The issue is that doctors can still choose, as the Prime Minister has said, to bulk bill whomever they please and it is that relationship between the doctor and the patient, as it is now, there are some people in that situation who are bulk billed and some who are not. This increases the likelihood of people in healthcare cards the vast majority of doctors will be better off and therefore should encourage them to work towards ensuring that those people are bulk billed too. Some doctors, and I had one in my office the other day, who bulk billed everyone, says this is tremendous, she'll continue to bulk bill people and she will benefit from it and be able to offer other services to her patients.
JOURNALIST:
... those on average incomes without healthcare cards won't get an increased access to bulk billing.
SENATOR PATTERSON:
But what will also happen, it's never happened before is, that they'll be able to ensure against having a gap of $1,000 of out of pocket expenses for medical services that are paid for under Medicare, whether it be GPs, specialists, pathology, radiology, they'll be protected in a way they've never had or been able to be protected before. And that's the thing I think that concerns most Australians, that concern that in a very bad year you'll have expenses you won't be able to meet, you'll know that for a very small sum you'll be able to insure, irrespective of whether you have private health insurance or not against that rainy day. And that's the thing I think that people are most concerned about.
JOURNALIST:
Minister this won't do anything for families who don't earn a lot of money, you might call them the working poor, you might call them the Howard battlers, who aren't getting increased bulk billing, may not be looking at a $1,000 worth of expenses a year but might be looking at increased doctors charges because the doctors' organisations have already told us that that's what this will lead to.
SENATOR PATTERSON:
Well that's what some doctors organisations have said and I believe that it will increase bulk billing for people on health care cards and as I said it protects those people who've never had protection before against extra or catastrophic health costs in a particular year.
PRIME MINISTER:
... the question of bulk billing generally and doctors fees generally, ultimately, as in all of these things, it isn't influenced by the availability and supply of doctors and the distortions that have emerged, particularly in the incidents of bulk billing, and the point that the Minister makes is very valid, you can have, you don't have any equity at the moment when somebody on the same income in a remote part of Australia has no hope of getting bulk billing, whether they're on a card or not, but people living in the inner suburbs in Sydney, in very comfortable areas, do. That is very much a product of the availability of doctors and where certainly the measures in this package will increase the supply of doctors and in the end that has a greater impact on cost factors than a lot of other measures that can be introduced. Can I just make the point about the family that Dennis alluded to, one of the great advantages out of this is that that family may at the present time not have any private health insurance and for $50 a year it can take out a private health insurance policy to cover a whole layer of medical expenses as a result of some unanticipated illness and I think that is a very important benefit that that family has at the present time. And just for the record can we remind ourselves that the health card is available to a two child family with an income of $32,300 or less and for families that are over that, and of course obviously there are a very large number and there certainly I wouldn't suggest for a moment other than families that are, that have very little money and certainly families that should be an area of concern, those families, if they are not now entitled to bulk billing one of the benefits that they will get out of this package is to be able to take out that additional private health insurance cover.
JOURNALIST:
... the doctors are pushing up fees generally as a result of this package, or after this package, will you undertake to have another look at things?
PRIME MINISTER:
Well Michelle I don't expect that will happen.
JOURNALIST:
Mr Howard what is in the package to discourage doctors from inflating their fees, because presumably if doctors fees rise, then the gap insurance will not stay at the price that you suggest. It will rise too.
PRIME MINISTER:
Perhaps I could turn it on its head. I don't think there is anything in this package to encourage doctors to inflate their fees.
JOURNALIST:
You said that. But what is there to discourage them?
PRIME MINISTER:
Well I mean, I might say to you what has there been over the last 19 years? I mean, that's sort of a... you can always say that you know things should have been different. But I mean what this does in the... I mean the more typical practice in an average area, particularly in the cities of Australia, is one where there is a mixture of bulk billing. I mean the sort of person that Kay spoke of - the doctor who says well look, I bulk bill a lot of people and I'll keep bulk billing them; or others they'll bulk bill some and they won't bulk bill others. The great advantage of this package is that there is an incentive. I mean if you're a doctor who bulk bills a lot of concessionals now, this is a great package. You sign up to it... you've actually got the incentive to maintain or even improve the generosity of your treatment of the rest of your patients.
JOURNALIST:
How will you keep the cost of gap insurance down though?
PRIME MINISTER:
Well the best way of keeping costs down, like all other situations, is to make sure that you have an adequate supply of doctors. And the reality is that a few years ago, there was a universal view, a near universal view, in the profession that there were too many doctors, particularly in the metropolitan areas of Australia. And the problem now is the lack of availability, the non availability and the shortage of doctors in particular areas, and you have got to improve that, and I believe that that more than anything else will act as a constraint.
JOURNALIST:
[inaudible] claiming of the rebate make it... facilitate doctors charging a bit more because people aren't having to...
PRIME MINISTER:
I mean I think the easy... can I say the great advantage for the easy claim of the rebate is that you know, we're going to get rid of all those Medicare queues. I mean, can I... just focus for a moment on the consumer. I mean, the average consumer now who isn't bulk billed, hands over what $40? I think the average gap is $12.43. So you might hand over $15. You pay an extra $15, so you've got to pay $40, and then you've got to go back, you've got to fill out the form, send it in, go to the Medicare office and so forth. Under this arrangement, you'll have your card swiped, you'll pay the $15, and you're off.
JOURNALIST:
[inaudible] attempted to charge $17.
PRIME MINISTER:
I mean Michelle, doctors... as Dr Blewett said have always been free to choose whether they direct bill or whether they bulk bill. I don't believe, particularly with the public focus that is going to be on this, and the increased supply of doctors, that that is going to happen because one of the complaints that the medical profession has brought to me over the years is they said because of the oversupply of doctors in certain areas, that they have been forced to do... their practices had become less profitable and so forth. And what this is going to do is to address many of those problems.
JOURNALIST:
So you accept there is nothing in this package to...
PRIME MINISTER:
Can we just try Steve?
JOURNALIST:
I was going to ask - doesn't it make sense then for you to bring somebody like the ACCC in to report back on this? Why don't you ask them to investigate whether doctors are going to...
PRIME MINISTER:
We're not going to have an ad hoc addition of the ACCC along the way. I mean look, this is a package which we think has enormous benefits for the public and it's going to strengthen elements of Medicare, strengthen them a great deal, and I haven't heard anything today that suggests that on the basis of what is in this package, we ought to bringing the ACCC in. I mean, you know, one thing at a time.
JOURNALIST:
[inaudible] insurance be subsidised by the 30% rebate?
PRIME MINISTER:
Oh yes. Yes. And can I emphasise it's a stand-alone policy.
JOURNALIST:
So the dollar a week is after the 30% rebate, or before the...
PRIME MINISTER:
No, well the dollar is a week is the premium, so you get the 30%, so it's a bit less. I mean look, when you're dealing with such a low amount, I've got to be careful. I don't want to get hung for a couple of cents. But our advice is that the premium will be about $50 a year. Now, that will attract the private health insurance rebate and it is a stand-alone policy. You don't have to have other private health insurance. You could decide, well I'll just take that out and nothing else.
JOURNALIST:
[inaudible]
PRIME MINISTER:
Yes there is. There is $1,000 threshold, yes. And there is a $500 one on the concessional cardholders. But bear in mind that both of them cover out of hospital specialist treatment as well. I mean this is a very important extension of the cover provided by private health insurance rebates.
JOURNALIST:
[inaudible] big public education campaign coming up?
PRIME MINISTER:
Matt, we will, as is appropriate with important announcements that affect the people, we will at the appropriate time be making certain that people are fully aware of the benefits to them and the benefits to the system of these important changes.
JOURNALIST:
[inaudible] a number on that yet?
PRIME MINISTER:
No, no.
JOURNALIST:
The starting time on these changes?
PRIME MINISTER:
Well that will all be set out. They vary a bit. I mean there are three items of legislation needed. You need to legislate in relation to the private health insurance rebate. You need to legislate in relation to the swiping of the card and the abolition of Medicare office queues. And you also need to legislate in relation to the 80 per cent, because there is an existing Medicare safety net which defines that concept a little differently.
SENATOR PATTERSON:
But we'll start working on the workforce issue for trainee doctors and medical school places immediately, discussing with the medical schools and discussing with the training organisation for general practice, how they will be distributed and how they will be... so they will be on the ground beginning of next year - 2004.
JOURNALIST:
Has there been any progress on the Commonwealth-State health package negotiations so far?
PRIME MINISTER:
Well I wrote to the Premiers and I haven't heard anything of a formal or coherent nature in return. And I understand that Kay has convened a meeting of the Health Ministers.
SENATOR PATTERSON:
In this not very busy week, I'm convening a meeting with the Health Ministers on Friday here in Canberra.
JOURNALIST:
The Senate is expected to turn down these moves. Where do you go from there?
PRIME MINISTER:
Well look, let's deal with the Senate when we know exactly what it's doing.
JOURNALIST:
Is the dollar amount of the incentives - will that be in the legislation...
PRIME MINISTER:
I beg your pardon?
JOURNALIST:
The dollar amount of the incentives. Will that be written into the legislation, or will that be a...
PRIME MINISTER:
Not normally.
JOURNALIST:
Okay.
PRIME MINISTER:
Well they're probably done by... I mean, I'd have to get advice. Perhaps it would be something that is just set administratively.
JOURNALIST:
Will you be able to cut down the number of Medicare offices?
PRIME MINISTER:
Well let's just wait, once again, for the forces of supply and demand to operate. I mean, it depends. I mean some people may still choose to queue up in their lunchhour to get their refund. Some people may choose. I suspect middle Australia will see this as a terrific reform. I think middle Australia will see this as getting, in a technological age where so much is online, you know you stop and think about it - the complications involved in filling out and getting back your Medicare rebate are significant, and I think a lot of people will think this is a great reform.
JOURNALIST:
Senator Patterson, just on the Health Care Agreement, can you confirm that the money that has been offered to the States is actually less than what is in the forward estimates?
SENATOR PATTERSON:
I can confirm that it's a significant increase, a 17% increase in real terms on what we've been paying over the last agreement. I can confirm that it's a $10 billion addition to the package that the States get.
JOURNALIST:
In terms of the forward estimates, there is an argument by some that it's less than what is in the forward estimates.
SENATOR PATTERSON:
Well the Prime Minister wrote to the Premiers and indicated that the issue, that the forward estimates were indicative, and now it's coming off a different base.
PRIME MINISTER:
In the letter I wrote to the Premiers, I pointed out that the figure in the forward estimates was based upon different utilisation rates, and the figure that we have offered is based upon the utilisation rates that have been revealed through the significant increase in private health insurance, the load that that has taken off public hospitals. I mean if you have in a four year period, you have an 82% of all the increases in the hospital admissions, 82% of them are private, you have a 12% increase in private hospital admissions and for the first time in the history of Medicare a fall in public hospital admissions, that has got to have some effect on the utilisation rates.
JOURNALIST:
Is there a danger of people jumping off private insurance and just grabbing the one dollar deal?
PRIME MINISTER:
I don't think that will happen. Some may choose to do that.
JOURNALIST:
[inaudible] at face value, it seems pretty... I'm thinking about it already.
PRIME MINISTER:
There are some other... You're thinking about it. Yes but see, I think it depends what your income is, then you've got to watch that high income penalty Matt. No? You're paid less than...
JOURNALIST:
[inaudible]
PRIME MINISTER:
He does it for love of it, does he?
JOURNALIST:
One dollar deal.
PRIME MINISTER:
Well it's a very good deal. It's a fantastic...
SENATOR PATTERSON:
But you may still want to keep your private health insurance to cover hospital admissions into a private hospital.
PRIME MINISTER:
It's the hospital thing that will encourage... I think you will have... I think what will happen is that, and this is just a personal prediction, it's not scientific, it's just a gut feel - I think a lot of people who are on modest incomes who calculate at the moment they can't afford private health insurance, they will take this. They will say gee, it's only a dollar a week and this will give me peace of mind if my kids really have a big illness. I think that's where it will be very, very valuable and I think is a major... and we've always had a problem in this area because of this hang-up about any kind of private insurance against the gap, I think this, and particularly having the threshold. You see the threshold provides I think a balance and means that it's not going to have an adverse effect on medical costs.
JOURNALIST:
If you don't expect doctors fees to go up, why the need to insure against it? Doesn't one thing follow from the other?
PRIME MINISTER:
Well hang on, no. With great respect, there has been a gap ever since Medicare existed. I mean, see this is what people who criticise this overlook. They are suggesting that for the first time we're introducing the right of doctors to do other than bulk bill. Doctors, since Medicare was introduced, have been electing whether to bulk bill or not, and those that don't bulk bill have been charging their patients x dollars, and then the difference between the rebate and that has been on average now is about $12. Well those $12 add up and then on top of that... not only do they add up, but can I just emphasise again that this is also in relation to all out of hospital expenses, all out of hospital, out of pocket expenses. It's not just to cover the gap for all the others. And those things haven't been... you haven't been able to cover against them in the past. And they exist now. I mean, you must know that from your own experience. And I guess just about everybody here would know that from their own experience. One more question, and then we'd better go.
JOURNALIST:
Why did you decide to stop private health cover only at the gap? Why can't you insure for the full cost of a GP's visit with private health insurance?
PRIME MINISTER:
Sorry. I don't understand that.
JOURNALIST:
Why can you only insure for the gap?
PRIME MINISTER:
I use the gap in the sense of the... well the difference between the Medicare rebate and...
JOURNALIST:
Can you see at some stage in the future where Australians might be able to insure fully for a GP's visit with private...
PRIME MINISTER:
But that would undermine the universal principles of Medicare and we're not going to do that. I mean, if I understand your question correctly, you mean insure against the 85%? But that would undermine Medicare. That would be against what we have said. I mean, Medicare is 85% scheduled fee, free treatment in a public hospital, PBS. They're the three universal principles of Medicare. I don't see that happening. No, I don't. Definitely not.
JOURNALIST:
Do you have a response to these revelations that you are talking to other Governments...
SENATOR PATTERSON:
I don't understand the question either, but the Prime Minister is absolutely right. No is the answer.
JOURNALIST:
Prime Minister, do you have a response to these revelations that your Government was talking to other Governments about John Herron's appointment as an Ambassador as early as February 01?
PRIME MINISTER:
Well I don't see them as revelations. And there is nothing that I have said or done in relation to that matter that represents any attempt by me to deliberately mislead the public.
JOURNALIST:
Is Mr Costello right when he says he expects that you will make an announcement on your intentions before your next birthday?
PRIME MINISTER:
Look, I don't have anything to add to what I've previously said on that subject. Thank you very much. Bye bye.
[ends]