I PRIME MINISTER
SPEECH BY THE PRIME MINISTER, THE HON P J KEATING MP
HEALTH POLICY LAUNCH, MELBOURNE, 6 FEBRUARY 1996
At this election as in every election the Government seeks a new mandate
from the people of Australia. We seek to re-establish the trust of the people
of Australia to govern for another three year term.
We are very proud of what we have done in the past three years. It has been
a Government, I think, of great enterprise and purpose. And we have
delivered those things we said we would deliver.
But we know that, once again, we must convince the Australian people that
the policies we have implemented, and the policies we propose, are the best
policies for Australia. And that they will be delivered by the people who are
best able to deliver them.
A crucial element of the new mandate we seek is a mandate to maintain and
extend Australia's universal health care system a health care system for all
Australians. We ask Australians to invest their trust in us to protect and
extend Medicare.
And. as the pioneers of Medicare, we believe that Australians can extend
their trust to us with confidence. We will defend Medicare. We will extend
and improve it.
Between now and March 2 the Australian people must make a decision about
the kind of health system they want.
Because health care is fundamental to the well-being of every Australian and
every Australian family, because a fair and effective health care system is
fundamental to our aspirations as a civilised society it will be a momentous
decision.
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Health care is an immensely complex issue in modem society and
immensely expensive. In Australia it consumes more than 8 per cent of
Gross Domestic Product. But the system we have developed is efficient. In
the United States health care accounts for more than 14 per cent of GDP.
and yet it leaves millions of peoole with no health insurance, or inadequate
health insurance and. as a consequence, without decent health care.
The Australian system is a good one and Labor will protect it.
Countries have choices in health care. In Australia the choices have been
argued for the last 20 years.
The major political parties have come to the debate with two entirely different
perspectives. More than twenty years ago, a Labor government made its
andateposition clear when it introduced a system of universal health insurance
. ndate kno'., vn as Medibank. The Coalition. in turn. showed its preference for a
. eopleprivate system by ripping Meoibank down. When they left office in 1983,
more than two million Austraiians had no health insurance.
3s been The same divisions have characterised the debate ever since. Labor has
rebuilt a universal health care system. Medicare is not perfect no system
ever will be. But there are few better systems in the world. And we can make
3 thatours better.
-ie best The crucial thing is that all Australians are covered. That has been the
ici areessential choice should all Australians be covered in a universal system, or
should there be a two tiered system? A system with gilt edged services for
iin andthose who can afford it and much poorer and less reliable services for those
i no ad on lower incomes.
, id Until now the Coalition has never disguised its preference for the two tiered
system and its contempt for Medicare. At successive elections they have
and vowed to pull Medicare apart and no one more consistently or virulently
: tnd than John Howard.
In fact they were the very words Mr Howard used in 1987 " I will pull it right
) n about apart", he said. He would do things " that amount to its dle facto dismantling".
He made no attempt to hide the fact of his ambitions for it. 1I would love to go
back" to the pre-Medicare days, he said.
* mi s ian andThat mistawkea, s iht iiss haims baimtiobnit ioinn 1n9o8w7.. It was his ambition in 1993. And, make no
ientous This time he says he will keep Medicare. But we all know he won't. Jeff
Kennett \-. ill turn his casiio into an Anclican mission before John Howard
supports Medicare.
Over the last decade. Australians have said again and again that they want a
universal system. and not an American style system. They have said it at five
nationai elections. In the most recent Doils of cuolic ocinion over 85 oer cen:
of them say they want Meoicare retaineo.
And it is only for this reason that the Coalition are saying they will keep_
Medicare. There it was in the newspaper advertisement placed by the Liberal candidate
for Fremantle this week: Medicare is " a medical and moral scandal", he said.
Anid there it was in the Financial Review yesterday:
Coalition sources [ the report says] privately concede that Medicare is
financially unsustainable in the medium term and that it is being
embraced by the Coalition mainly because it is electorally popular.
Not because they believe in it. Not because they will keep it. But because
they think it will help them win the election if they pretend to support it.
That is why we say the decision Australians make about health in this
election will be a momentous one. This is the same fight to the death for
Medicare as it has been at every election since 1984.
Once again the election will decide the kind of health care system we will
have over the next generation, and in so doing it will decide in large part the
kind of society we leave our children. It will substantially determine the kind
of country Australia will be.
John Howard is saying that we are running a scare campaign on Medicare.
Apparently we should take him at his word when he says he won't harm it.
Well let me say even if we half believed him, or a quarter believed him we
would be issuing the most dire warnings. But in fact we don't believe him at
all. We pioneered Medicare. We nurtured and built it into one of the best health
systems in the world. It was our baby and now it is Australia's health system.
So no one should be surprised if we are passionate about defending it. N.
Erect the two-tiered system Mr Howard wants; put the weight of the well-off
into the pnivate health system, make the private system stronger than the * i
public, and the public health system will start to crumble.
Australia will then have an entirely different kind of health system a SNVV
flourishing first rate pnivate industry for those who can afford it, and a second
rate public system for those who ican't.
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Lose universality, and essentially we lose Medicare.
' hey want a
aid it at five Lose Medicare, and we lose one of the great building blocks of fairness and
per cent cohesion in Australian society.
And it will not be a temporary loss. It will not be a little experiment which we
keep can abandon if we don't like the way it's going. Pull away the universality of
our health care system and you pull Medicare down.
I candidate Fail to support it, say you support it while leaving the states to rip into the
ihe said. health system, and you pull Medicare down. And when it's down, we will
have lost one of our great social achievements and our children will inherit a
very different Australia.
edicare is It's a free choice. That's what an election is. But there must be no doubt
eing about what the choice is between. At this election the Coalition are not
opular. presenting policies, they are presenting tactics.
because Their environment proposal was not a policy it was a tactic. A tactic to sell
rt it. Telstra by bribing the environmental vote.
: his Their industrial relations proposal was not a policy, it was a tactic a tactic to
aath for drive wages and conditions down and undermine job security by embracing
enough of the Government policy to neutralise the debate.
we will Their health proposal is also a tactic a tactic to create the health system
le part the they want by pretending to keep the health system they hate.
e thekindBut even if we believed them, even if we believed that they had undergone a
change of heart and were not merely heeding the polls for the purpose of
/ ledicare. winning the election. even if we ignored the mountain of evidence from the
harm it. past, their health proposal still constitutes a critical attack on the foundations
of Medicare.
. v him at The fact is they neither understand it nor like it. Medicare is hostile to the
very basis of their thinking. And it is hostile to their friends in the private
health care system.
et heystm Mr Howard says he will leave Medicare alone. But leaving it alone is not
ilth sstem. supporting Medicare. Leaving it to Jeff Kennett is not supporting Medicare.
ng it. Nor is introducing tax rebates for private health insurance by itself supporting
a well-off Medicare. Their tax rebates are designed to encourage people out of the
ian the Medicare system. They are designed as much to be an industry policy as a
health policy a policy for a private health care industry.
. a Supporting Medicare demands that you believe in Medicare. Supporting
J a second IMedicare demahds that we see it as a rock on which our future will be built. 4,587
Ano supporting Medicare means building on that rock. Ohr
P-at is n doinc in naamt'c.' ' Ae are building on the rock, just ne
to c~ ai.
Meoicare gives all Australians access to free first rate treatment in a public visit to
hospital and affordable medical care from general practitioners. chiidre
But Medicare generally does not help with the costs of dental and orthodontic The La
treatment, or other services such as physiotherapy, speech therapy or public,
chiropractic treatment. These health services can be very expensive for familie,.
families, particularly the cost of dental care for children. But the only way Rebate
families can get help with these costs is to take out private health insurance. childre familie
Today I am announcing a new way for families to get assistance with these The Li
costs. ak
The new Family Health Rebate will be a cash payment from Medicare Offices Theirr
to help meet the costs of dental and orthodontic treatment. physiotherapy, aoi
speech therapy and other health services for children. mantor
Families who receive Family Payments will be eligible for the rebate that is for thei
about 80 per cent of all Australian families. Fra
The maximum rebate in a year will be $ 350 for a family with one child and would
$ 500 for a family with two or more children. hospitF
Families will be able to claim 50 per cent of the cost of dental and other The acheaith
services for children up to the maximum rebates. choice take u
The Medicare system is a balanced system providing for people who take outAsIz
private insurance. Because private heaith insurance is a major cost to As. I s
famrilies, a flat rebate of $ 350 will be available towards the cost of health i. Yi
insurance premiums. T his S350 will te countec towards a family's maximumUne
rebate. billion
An important element of the new rebate is that, if a family does not claim their hospit;
maximum rebate in one year. they will be able to carry over unused rebatesOvrt
for up to seven years. This will help families plan ahead and cope with large Ovce f
bills, for orthodontic treatment for example. flrm4
The strength of the Family Health Rebate is the choice it gives families in
meeting the health needs of their children. Howev
servic(
Many families around 40 per cent already take out health insurance and
these families will be able to claim $ 350 towards this cost. The pr
their e
Many other families would like to take out health insurance to better manage Comm
health costs, but--find the premiums too high. A rebate of $ 350 will be a past tt
substantial help.
88
Other families will be happy to remain in the public system. These families
just need help with the costs not covered by Medicare. They will now be able
to claim a rebate of 50 per cent of the cost of these services whether it is a
Ic visit to the dentist or a physiotherapist or other health services so that their
children can get the help they need when they need it.
) ntic The Labor approach to health care is built on Medicare. We start with the
public health system and ask how can we make it better. We start with
families' needs and ask how can we best meet them. The Family Health
Rebate extends public insurance to cover dental and health services for
ice. children not presently picked up by Medicare. but at the same time allows
families the choice to insure privately if they prefer.
ie The Liberal approach to health care starts with the private health system and
asks how they can give it more business, how they can boost its profits.
: ices Their policy of tax rebates for private health insurance does nothing for the
majority of families who do not have private health insurance and who do not
want to take it up. These families will get no help with the extra health costs
t is for their children.
For families who choose to have private health insurance, the Liberals' policy
would push up premiums by blowing out costs as specialists and private
hospitals simply increase their fees to take advantage of the rebates.
The advantage of Labor's Family Health Rebate is that, by giving families a
choice, if health insurance premiums go up, people will vote will their feet and
take up the alternative of the family health rebate.
9 out As I said. it is not enough to say you support Medicare. You need to defend
it. You need to extend it. And you need to protect it.
ium Under the Medicare agreements, the Commonwealth provides about
billion a year to the States and Territories for free patient care in public
their hospitals.
. re Over the past few years, under the agreements, the Commonwealth has
3rge increased its funding by 26 per cent, which has taken our share of funding
from 47 per cent to 55 per cent.
However, this has not resulted in the reduced waiting times and improved
services we intended and the Australian people have every right to expect.
rid The principal reason for this shortfall hos been t'-e Staes' 0 pe-: tcut in
their expenditure on public hospitals-l10 per cent in real terms. VVrnile the
age Commonwealth has put in an extra $ 800 million to public hospitals over the
past three years,-Ahe States have taken out $ 700 million from public health. I 0,1
The problem is that the Medicare agreements are basically " gentlemen's It is PC
agreements". by which I mean they are not tied to performance or achieving make
better results for their oatients. We neec a new caninershio cetweer. the With
States and the Commonwealt., on iinairg for puolic nospitals. We need zo
relate funding to performance, to better results in health care. We want to To str(
see what we are paying for. haer
The most important result we want to see is Australians having to wait no " L1awbaotcrhlonger
for surgery than their doctors recommend.
A Labor Government will offer the States and Territories an additional $ 150 TeA
million over the next two years to reduce substantially the number of patients ties. c
waiting longer than the time deemed clinically appropriate. trivati
But to be eligible for the new funding, the States will need to achieve a protec
reduction in the number of patients waiting too long for surgery. We will only I beg
pay on performance, on results. States will only qualify for their full share of tegait
the $ 150 million if they ensure patients are treated within times recommendedthvi
by doctors. Toa
This new approach to funding will form the basis of new Medicare the wa
Agreements to be negotiated with the States. The new Agreements will look Electic
at the overall performance of public hospitals, with performance on waiting
lists being one very important area. A h
But attacking waiting lists without looking more generally at performance abolitik
could be counter-productive. For example, hospitals could reduce waiting $ 1.3 b
lists quite easily by forcing patients out of hospitals too soon in order to save per ce
money. Just tv.
The new funding arrangements will include other targets for quality health
care, such as how long patients wait for emergency treatment: the number of
unplanned readmissions to hospital: and the links between hospital and other
services such as community care and general practitioners.
The new approach to funding will particularly benefit older people who are In othe
the main users of hospital services. were n
Understandably, many in the community are cynical about government And M,
promises to tackle waiting lists and to improve health services. Many are entecti
confused about the role of the Commonwealth and the States. has hai
But it is important to emphasise that we can make our public hospitals better. He ask
But this can only be achieved if the Federal Government plays its role and is yia
willing to fight to protect Medicare. The fa(
Medicz
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It is possible to reduce waiting lists. The number of patients on waiting lists
wing make up only about 3 per cent of the total load of the public hospital system.
3vingWith a new approach to paying on results. a target to ensure all patients are
to treated in the time recommended by doctors is achievable.
To strengthen confidence in the public hospitals. the community needs to
have reliable, independent information about public hospital performance.
Labor will establish an independent Hospital Services Authority to be a
" watchdog" of the public hospital system for the public interest.
150 The Authority will monitor hospitals' performance and, in particular, report on
150t the achievement of targets for better care, including the reduction in waiting
tentstimes. It will also report on the effect on patients of any proposed
privatisation of the public hospital services. The public interest must be
protected in any contracting out and privatisation.
only I began by saying that in this election we ask Australians to entrust us with
* e of
indled the vital task of protecting Medicare and our universal health care system.
Today we ask to be given the opportunity to extend it and make it stronger in
the ways I have outlined.
look Elections are about choices. On health the choice could not be clearer.
ng At the last election our opponents went to the people with a policy for the
abolition of bulk billing for more than 13 million Australians, a cut of at least
-lig $ 1.3 billion in Commonwealth funding for public hospitals and a more than
save per cent cut in the Medicare rebate.
Just two months ago Mr Howard said this:
, h I don't accept for a moment that we went to the last election as Paul
er of Keating alleges promising to abolish Medicare: that is wrong, we
other didn't. We promised to make changes but not to abolish it, he said.
re In other words, we were going to remove Medicare's heart and soul but we
were not going to abolish it. We did not intend to kill it only to make it dead.
And Mr Howard asks to be believed about Medicare. He asks Australians to
e entrust their health care system to him. He asks us to believe he will deal
effectively with State Governments. He asks us to believe that on health he
has had a change of heart and not just a change of tactic.
sitter. He asks us to believe that his proposal for the people's health is not simply a
d~ is cyr. tcal deceit.
The fact is they cannot with a skerrnck of credibility ask to be trusted with
I Medicare and the health of the Australian people. ' 1F 9) 1
9
With the release of this policy, Labor asks Australians to continue to put their
trust with the people and the party who dreamed of Medicare. who made it a
reaity, who are still expanding and imoroving it and who believe it is
funcam= ntal to our gooc society. Ne1
lMinister for
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The F
Minis, Coalit " Tod.
statin said. " In sh
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advoc. " Whilt
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MrBr the EI(
Gover " First
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