LAWS:
Prime Minister, good morning.
PRIME MINISTER:
Good morning John.
LAWS:
Are you in Sydney?
PRIME MINISTER:
I am indeed.
LAWS:
Not a bad day to be in Sydney.
PRIME MINISTER:
No, it';s a great week to be in Sydney.
LAWS:
Yeah, it';s going to be an exciting weekend.
PRIME MINISTER:
Wonderful.
LAWS:
Yeah, should be terrific.
PRIME MINISTER:
A wonderful culmination. Let';s all hope we get the right result.
LAWS:
Okay. Let';s hope we get the right result with Medicare. Is it possible? A lot of people are confused.
PRIME MINISTER:
Well I always am respectful to the Australian public, but it really is a fairly simple change. There is a $5 additional rebate to the doctor if he or she bulk bills a concession cardholder or a child up to the age of 16. That';s very straight forward.
LAWS:
Yes, but is $5 enough for the doctors?
PRIME MINISTER:
Well it is a very significant additional amount. I was in a doctor';s surgery yesterday in Melbourne and he told me that he bulk billed about 85 to 90 per cent of his patients, of whom a very high proportion were pensioners, cardholders and children. And for him it';s a very significant immediate boost to his income. Because at the moment he doesn';t… he gets $5 less than that for all of those people, and they comprise, 62 per cent of all GP consultations are made up of concession cardholders and children. The main reason…
LAWS:
Could I just say this to you.
PRIME MINISTER:
Sorry.
LAWS:
That';s okay. Back to the $5.
PRIME MINISTER:
Sure.
LAWS:
It wasn';t all that long ago that Amanda Vanstone, whom both you and I respect, was saying that $5 wouldn';t even buy you a milkshake and a sandwich - $5 is not a significant amount of money.
PRIME MINISTER:
Well $5 will add $15,000 to $20,000 to the income of the average GP in one stroke.
LAWS:
In one year.
PRIME MINISTER:
Yes. I mean okay, you can say that';s not a lot, but it';s a lot more than the situation yesterday.
LAWS:
That';s true, that';s true.
PRIME MINISTER:
And it does… I mean you';re talking here about $5. I mean let';s compare like with like. You';re talking here about $5 for each normal consultation, and how many would a doctor have of those during the day? I mean he might have 20 or 30, I don';t know, depending on how ill the individual patients are. He might have even more. So we';re not talking peanuts. We are talking a significant incentive that…
LAWS:
Can I also say this to you. That means that a GP would be paid $27.90 for a patient consultation. Now why should he only get that, when a plumber is paid $50 just to turn up.
PRIME MINISTER:
From the Government he is paid, it will be $30, not $27.
LAWS:
Okay, well $30. But the plumber gets…
PRIME MINISTER:
Yes, but you';re not comparing once again, with respect, like with like. You';re talking here about the Government contribution. The governments don';t make any contribution to plumbers.
LAWS:
No.
PRIME MINISTER:
They don';t. I mean maybe plumbers think they should, the governments should, but you';re talking here about taxpayer contribution.
LAWS:
Okay, but you';re talking about that being $19,000 in one fell swoop.
PRIME MINISTER:
Well it depends. I mean it';s, I think I said 15 to 20. It will vary. I mean some of them… for some of them it will be, that now have very high levels of bulk billing, it will be even more. But for those that have lower levels of bulk billing, and it is in… can I just without wearying you with statistics, but it';s a statistical argument – one of the interesting figures is that I';ve been told that 81 per cent of pensioners and cardholders are either bulk billed or their treatment attracts a copayment of no more than $5. So in straight, rational financial terms, there would be an enormous incentive for those doctors who still bulk bill pensioners and cardholders to keep doing so, and some of those who charge them a very modest copayment – some of them only charge them 2, 3, 4, 5 dollars – to perhaps discontinue that because of the additional $5. So the impact on that category of patients of this new change should be not be underestimated. But can I just make a broader point about bulk billing John.
LAWS:
Would you abolish bulk billing totally if it was left entirely to you?
PRIME MINISTER:
No. No, I wouldn';t. Certainly not. Look it is true that years ago I was critical of Medicare. That';s on the record and I don';t and can';t run away from it, and won';t. But before I was elected Prime Minister way back in 1995, I made a commitment that we would keep Medicare and we have honoured that commitment.
LAWS:
Yes.
PRIME MINISTER:
And Medicare is something the Australian people want. And the thing that I get most complaints about is the lack of availability, the shortage of doctors in certain areas. And even the Labor dominated Senate inquiry acknowledged that the shortage of doctors was at least as big a driver of falling bulk billing rates as the level of the Medicare rebate. If you go around the country, you will find in an electorate like mine, which includes suburbs like Ryde and Eastwood and Epping, that bulk billing rates are quite high, they';re over 80 per cent. You will find in some of the outer suburbs of Sydney, which are Labor electorates, that the bulk billing rates are even higher. So it really doesn';t vary according, in a sense, to political allegiance. It varies according to the number of doctors, and the areas where bulk billing rates are very low now and are falling, are in the main – not totally, but in the main – outer metropolitan and country areas. The electorate of Murray, which is based on Shepparton and Horsham in central Victoria, the bulk billing rate is about 40 per cent or less. The electorate of Indi, which is based on Wangaratta and Benalla on the Murray River, has the lowest bulk billing rate in the nation and that is 30 per cent. And all of this – or not all of it, no that';s an exaggeration – most of it can be attributed to the shortage of doctors.
LAWS:
Well how is this going to create more doctors in rural areas?
PRIME MINISTER:
Well it';s the other elements of the package John – the bringing forward of the injection into the system of more overseas trained doctors, the rapid introduction of practice nurses that will take some of the routine workload off GPs such as immunisation and wound management, where we';re introducing a special Medicare fee. We are investing hundreds of millions of dollars extra in bringing forward more doctors – not only additional places, because they';ll take a while… in universities, that will take a while to come through the system – but bringing in overseas trained doctors, providing incentives for doctors who are now out of the workforce to come back into the workforce, providing encouragement for young interns who haven';t decided whether they';re going to go into general practice or take up a specialty to have three and six month stints working in a rural or outer metropolitan GP surgery. If you add all of those workforce measures together, and even the AMA will acknowledge that we have picked up virtually everything that they have put to us in relation to the workforce measures, over time getting more doctors and getting more health professionals generally, and particularly practice nurses, into the system, that will add to the supply. And we all know the old laws of supply and demand…
LAWS:
Yes, certainly.
PRIME MINISTER:
… have an effect. Where you have a good supply of doctors, bulk billing rates are high because competition is high, and where you have a low supply, a small supply of doctors, a shortage of supply, bulk billing rates have fallen because there is no economic pressure, there is no competition on the doctors to bulk bill. Now however you look at it, the relationship between the availability of doctors and the levels of bulk billing, that relationship is unmistakable. And you can go anywhere in Australia and you can see the very sharp correlation between the two, and as I say, even the Senate committee which was dominated by the Labor Party, acknowledged this fact and it also acknowledged its real reservations as to whether an increase in the rebate was going to have a dramatic effect on levels of bulk billing.
LAWS:
Okay. Well I understand all of that, but just back to… are you getting a cold?
PRIME MINISTER:
Oh no, I';m just recovering from a bit of a cough, that';s alright.
LAWS:
Okay. Just getting back to this substantial increase of $5, which I don';t see obviously as being substantial.
PRIME MINISTER:
Well I haven';t used that word. I think it';s significant. I mean I';m not overclaiming it. I haven';t done that. But you can';t sneeze at it.
LAWS:
Certainly not. But the amount, I don';t think is significant. I mean $15,000 to $20,000 in a year. You wouldn';t employ half a secretary for $15,000 to $20,000 a year these days. I don';t think that… I don';t think it';s enough.
PRIME MINISTER:
Yes, but the name of the game here is not just the level of remuneration of doctors. That is important and I respect the doctors a lot, but it';s not the only game in town. The interest of the patient is important and providing people with peace of mind if they get unexpectedly large medical bills, and bear in mind that this safety net is not just about picking up the additional cost of a lot of GP consultations – it will cover things like x-rays, it will cover tissue biopsies, it will cover pap smears, it will cover blood tests, it will cover all of the things that you might have to undertake if you have a potentially serious illness. It will cover any out of pockets associated with a specialist consultation. Now at various stages in your life, you break a bone – I heard a lady on one of the talkback sessions yesterday saying that the family had gone on a skiing trip and their daughter had broken her leg and she was regaling us, quite understandably, with all the out of pocket expenses. And she had very rapidly got past the $500, and it didn';t have much to do with GP consultations. It had to do with x-rays, it had to do with the plaster, it had to do with the orthopaedic and so forth. Now, it';s the worry that something like that will come along and knock you for six, that is on the minds of a lot of Australian families. And the great beauty of this new safety net, which will catch four out five families with children, they';ll get the benefit of the $500, which incidentally is going to be very easy to administer. I';ve heard some people, I think it may have even been someone on your programme, saying that oh this is going to be very complicated. It';s not.
LAWS:
It sounds complicated. Just turning to the…
PRIME MINISTER:
Well, it';s not. It really isn';t because all the information is there so…
LAWS:
Yeah, somebody else said that.
PRIME MINISTER:
And the only thing that you have to do is if you';ve got a family grouping you';ve got to tell the health insurance commission what that family grouping is so that you can aggregate the individual expenses so you get to the $500 quicker – that';s all you';ve got to do. So it';s not very… it';s administratively very straightforward because the health insurance commission automatically calculates and when you go over the grouping goes over the $500, the next time you get a rebate you get the 80 per cent reimbursement. Now the health insurance commission will do that and they';ll know whether you';re on Family Tax A because the Centrelink will tell them. So there';s nothing hard about this and people who are running around saying this is an administrative nightmare, and I know some of my political critics may be tempted to do that, are wrong.
LAWS:
But if all the doctors in a specific area agree to stop bulkbilling – and that';s happened, you know, they';ve done that before – how the hell is that going to help anybody? The rebate won';t make any difference.
PRIME MINISTER:
Well, John, what the whole package will do, because it';s targeted at those sorts of areas, will overtime it will increase the availability and the supply of doctors in some of those areas, new doctors will come in and those new doctors will offer to bulkbill and that will begin to build a competitive pressure on the others to do likewise – that';s what will happen.
LAWS:
So, what does this…?
PRIME MINISTER:
The laws of supply and demand can never be ignored and I just emphasise the point again that there are many parts of Australia where the bulkbilling rates are high, it is not directly related to the wealth or the otherwise of the district, it';s got to do with the supply of doctors.
LAWS:
Yeah, I okay.
PRIME MINISTER:
And where you';ve got a lot of doctors you have high levels of bulkbilling and these measures, the $5, will reinforce those doctors, I don';t want to posit my whole argument on the one bloke I spoke to yesterday, but he made the point – well look I';ve got a high level of bulkbilling, this is more generous than I expected it to be, this will make it more likely that I will maintain my high level of bulkbilling.
LAWS:
Okay, just turning quickly to those changes for the people who are eligible for the Family Tax Benefit, it will take at least something like 33 visits to the GP for somebody to be eligible, and many people say they wouldn';t reach that in a year…
PRIME MINISTER:
But John, it is not limited to GP visits…
LAWS:
Well it will…
PRIME MINISTER:
Well, if you have an accident and you break something, you';ve got to go and get an x-ray, it';ll pick up the out of pockets in relation to that, if you';ve got to have a blood test, if you';ve got to have any kind of scan. Now that happens to a lot of people and, of course, we have more modern equipment now it happens far more frequently. If you';ve got to consult a specialist, any out of hospital expense, any out of hospital expense which is the subject of a MBS item, any out of pocket you have in relation to that will be counted towards this figure, not just the excess visits, the large number of visits to the doctor. Now in an average family situation it is not the beginning and the end of the medical treatment is not GP visits increasingly it does involve, even in relatively benign health situations, it does involve going to get a test of some description, of getting a bloodtest, an x-ray, a specialist consultation. I mean, we all know that. It';s not just limited to visiting a GP and it';s… I find talking to people, it';s the fear of the unexpectedly large expense with a major health issue that people worry about. They can manage the GP side of it, but it';s the worry at the back of their mind if one of the kids has an accident or gets really ill they';ll be off to the specialist three or four times in a month, I have to go back to the doctor, I';ve got to get a whole amount of x-rays and it will all mount up…
LAWS:
And it does.
PRIME MINISTER:
And it does and you';ll get to that… in a situation like that you will get to that $500 just, you know, at the snap of the fingers almost. Now that';s the worry that people have and this safety net will give families all around Australia a great peace of mind that that, sort of, unexpectedly dramatic and very expensive health situation is protected. Now..
LAWS:
Can I just ask you this – when we talk of families spending $500 before being eligible for the new rebate, is that per person in the family…?
PRIME MINISTER:
No, it';s the aggregation – that';s the point.
LAWS:
So it';s for the whole family?
PRIME MINISTER:
For the whole family, yes.
LAWS:
Okay, so why is nothing for single people or couples without kids? What about them?
PRIME MINISTER:
Well, they';re on… well if they';re concession card holders they';re on the $500. If you';re a single person and you have a concession card you get the $500, you get the benefit of that. It';s just not limited to families. It';s just that if you are a family you can add mum and dad the kids together. Now mum and dad and the kids, you';re talking therefore about $500 if you';ve got a mother, a father and two children…
LAWS:
Yeah, but just back to the single person.
PRIME MINISTER:
Yeah.
LAWS:
What about a single person who hasn';t got a concession card?
PRIME MINISTER:
Well, a single person who hasn';t got a concession card is… will be like you and me on $1,000.
LAWS:
Well, he could be earning $40,000.
PRIME MINISTER:
Yeah, he could be earning $40,000. Well the view is taken that if you';re a bloke earning $40,000 and you don';t have any dependents your financial position is a lot better than a bloke earning $40,000 who has got dependents.
LAWS:
So in other words, he does suffer.
PRIME MINISTER:
Well, not it';s not that… hang on, suffer is a… I mean, right at the moment none of them have it.
LAWS:
No.
PRIME MINISTER:
So you';re….
LAWS:
Okay, but by comparison…
PRIME MINISTER:
I mean, he is… well many people would argue that if you';re on $40,00-$50,000 a year and you';ve only got yourself to support you';re better able to cope with things than if you';re on $40,000 or $50,000 a year and you have two or three dependents.
LAWS:
Okay, but you';ve got to remember…
PRIME MINISTER:
I think we all have to agree with that, John, don';t we?
LAWS:
No argument from me, Prime Minister.
PRIME MINISTER:
Well, I mean, I don';t think anybody would argue with that. And that is the simple logic of the system. Now obviously…
LAWS:
But something else that is simple and also logical is the fact that the single person without kids doesn';t get all the family tax benefits.
PRIME MINISTER:
Well, he doesn';t need them because he doesn';t have the expense of children.
LAWS:
Yeah, but he';s losing out there.
PRIME MINISTER:
Yeah, but he';s not losing out because he doesn';t have the cost of raising children.
LAWS:
That';s right. Nor does… consequently, he doesn';t have the tax deduction.
PRIME MINISTER:
But hang on, he doesn';t have the cost. I mean, John, come on, I mean you are very logical on these things. But the whole idea of a family tax system is to in part help people with the cost of raising children. We want people to have children and for heavens sake, we';ve got to have something in our tax system that says good on you, you';ve had some children and we';re now going to give you some kind of tax benefit.
LAWS:
Okay, Prime Minister, I';ve got to leave you. But I must say before I do leave you, it';s quite extraordinary when you have a Minister to do the job for you, the way you can get yourself over all these issues so totally, I think it';s quite amazing. I admire you…
PRIME MINISTER:
That';s very kind of you.
LAWS:
No, I mean, for you to understand every single little detail, it doesn';t matter what I ask you, you';ve got the answer to it and you could be shoving me off to the Minister but you';re not doing that.
PRIME MINISTER:
Well, I';m very interested in this issue and I think this new safety net when it';s understood will really touch a nerve in the community. It';s that peace of mind thing. A lot of people say to me, look I can cope with the bills if they';re normal but my great worry is one of my children will get a really major illness and I';ve got to take him off to a specialist and I';ve got to have x-rays and all this sort of thing and how can I handle that? And I think that safety net will really tackle it.
LAWS:
Okay. I appreciate your time very much, let';s hope we have a win at the weekend.
PRIME MINISTER:
I do indeed.
LAWS:
And I';ll talk to you again soon.
PRIME MINISTER:
Thanks, John.
[ends]