Mark Butler
Hindmarsh · Australian Labor Party · Australia
“But earlier today we were all in here voting on the latest instalment in the member for Lindsay's ongoing but thus far unsuccessful campaign to rebrand the Liberal Party.”
“I thank the member for Werriwa for her contribution and for her really strong support for everything we're doing to make Medicare stronger and make medicines cheaper. I thank all members for their contributions to the debate on this bill. As the member for Werriwa said, Medicare is the very best of Australia.”
“I thank the member for his question, which is a question I've answered before in this place since the budget. As I've said on a number of occasions publicly and in this chamber, the additional support that over-65s have received since about 2004 for their private health insurance premium is something we did revisit given the significant p…”
“But, under ours, they'll receive an increase of more than 20 per cent, or an additional $160 million in this year alone, which means more doctors, more nurses and better care in Tasmania.”
“Importantly, this bill provides stability so patients can continue to benefit from the outcomes of these programs and strengthened access to primary care.”
“That approach gives providers and the government greater certainty while preserving the flexibility needed to keep program settings up to date as health system needs evolve. Importantly, the bill does not change the underlying policy settings of existing programs.”
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“Famously, John Howard called bulk-billing 'an absolute rort' and, of course, the Leader of the Opposition tried to abolish it altogether. Today, the latest data says that around four in five visits to the GP are bulk-billed. For me, that is too low. For Labor, that is too low. We would like to see it higher. But it must be said not everyone in this chamber shares that view. Back when he was the health minister, the Leader of the Opposition did a radio interview on Radio National in August 2014—”
“I thank the member for Lyons not only for his question but also for his friendship over nine years. He's been a terrific representative of his electorate and a terrific advocate for a stronger Medicare in Tasmania, in particular. He was also a fierce advocate for a Medicare urgent care clinic in Bridgewater, north of Hobart, and I was delighted to visit it after it opened very late last year. It's already seen more than 1,200 patients in only several weeks, and every single one of them has been fully bulk-billed. That is so important for Labor, because for Labor, bulk-billing has always been the beating heart of Medicare. It was from its very first day. But it has also always been very hard-fought. It was opposed by the AMA. Bulk-billing was opposed by the Liberal Party.”
“This was surprising, because there was not a single endometriosis medicine, not a single oral contraceptive pill, and not a single menopause hormonal treatment added to the PBS in their nine years. Of course, it was only nine years. What on earth can you do in a time that short?”
“Treatments like Estrogel Pro, which costs about $670 a year, is truly life-changing, as Allie Pepper, Australia's most accomplished female mountaineer told us on Sunday when we were launching the policy. Women will save up to $580 a year after these listings take effect in a short while. This package reverses decades of neglect and inaction, and finally delivers Australia's women more choice, better care and lower costs in these areas. It builds on all of our other cheaper medicines measures that have already saved Australians $1.2 billion at the pharmacy counter—important cost-of-living relief which was opposed by the Leader of the Opposition. So I was intrigued to read that Senator Cash had said on Sunday that they support our package, because apparently it builds on what they had done in government.”
“There has been no new oral contraceptive pill list for more than 30 years, and no new menopausal hormone treatment for more than 20 years. That is why I wrote to the Pharmaceutical Benefits Advisory Committee urging them to work with industry to rectify that. I'm so delighted to say that all that changes in a couple of weeks' time on 1 March. Two new oral contraceptive pills—Yaz and Yasmin—that are used by tens of thousands of Australian women will finally go onto the PBS, saving those women between $200 and $350 a year. On the same day, three new menopausal hormone treatments, used by 150,000 women every year, will go onto the PBS as well.”
“I appreciate the interjections by the member for New England on women's health. I particularly appreciate the question from the member. She is such a strong advocate for health care here and in the Hunter. She tells me, like so many members of our caucus do, that women, right across the course of their lives, face significant medical and medicine costs not because they are sick but because they are women—particularly around contraception and during menopause and perimenopause. The PBS is a great system, but it has to be kept up to date if it is to serve the interests of Australians. I'm proud we have made almost 300 new and expanded listings for the PBS, including the first listing of a new endometriosis drug in more than 30 years, Visanne, but it has to be said that too often the PBS has not been meeting the needs of Australia's women.”
“If the member for Sturt had any interest in South Australia, he'd know that the second-biggest increase in bulk-billing since we tripled the bulk-billing incentive has been in his state of South Australia. So I say this: we're not going to take lectures on bulk-billing from a party that has spent 41 years trying to dismantle the universal health mission of Medicare, a system that we created, that we delivered, that we have fought hard every one of those 41 years to defend and—now that we've inherited the mess that the Leader of the Opposition created—that we're fighting hard to strengthen now.”
“When they finally had to raise the white flag on the total abolition of Medicare, John Howard got his protege the Leader of the Opposition to try instead to kill it with a death of a thousand cuts by making sure that every single patient in Australia would have to pay a fee every time they went to the doctor. When we blocked him doing that, he did second best instead. He imposed a freeze on Medicare rebates, which unsurprisingly caused bulk-billing to start to slide. We're trying to turn that around. We tripled the bulk-billing incentive, which is exactly what the College of General Practitioners asked us to do. And, when we did it, when the Treasurer did it in the 2023 budget, the college said that would be a game changer, and it has stopped the slide in every single state and territory.”
“I thank the member for his question. I have very much enjoyed visiting his electorate more frequently in recent times with the terrific Labor candidate there, Claire Clutterham, who, I can tell you, gets health. She gets health. I'm not sure from that question that the current member for the eastern suburbs in Adelaide understands health. But I'm very pleased to get another opportunity to explain to those opposite why we have seen a slide in bulk-billing. I say again: perhaps after question time, go and have a talk to your leader about what happened to Medicare over the last 10 to 15 years. The truth is that those opposite have never supported bulk-billing. The father of the modern Liberal Party, John Howard, called bulk-billing an absolute rort. He fought it tooth and nail, election after election.”
“Why is there a bulk-billing crisis in Australia? Hmm! Who said, 'There are too many free Medicare services in this country'? Who tried to abolish bulk-billing altogether? And who, when he couldn't get that GP tax through, froze the Medicare rebate for six long years?”
“Of the three increases, we've delivered the biggest, the second biggest and the third biggest increases in the Medicare rebate in more than 30 years, since Paul Keating was the Prime Minister.”
“I'll take that question on notice and see if I can get an answer to the member in precise detail, but I will say that I've said since before the last election and since that the state of general practice when we came to government was its most parlous in 41 years. Bulk-billing was in freefall, and, as I've said once or twice at this dispatch box before, they were suffering through the impact of a six-year freeze on the Medicare rebate. Those opposite, particularly the Leader of the Opposition, when he was health minister, decided to freeze the income of general practices, while their costs continued to rise. Unsurprisingly, they come under very real pressure. Over the last 24 hours, I've signed off on the third increase in the Medicare rebate since we came to government.”
“The actual story of bulk-billing in the last decade is a story first penned by the Leader of the Opposition when he was the health minister, when he said that there were too many free Medicare services, echoing the view of his mentor, John Howard, who said that bulk-billing was 'an absolute rort'. He tried to abolish bulk-billing altogether and introduce a tax for every single Australian patient to pay every time they visited their GP.”
“I thank the member for Longman for that question indeed. The 88 per cent figure the member for Longman very unwisely took from his tactics committee was described by the College of GPs as a 'misleading and highly skewed' figure. I understand why the Leader of the Opposition would use it, but why would the member for Longman take a sucker punch like that? I thought the member for Longman was smarter than that. The reason why the College of GPs said this was 'misleading and highly skewed' is that it took into account all of those COVID vaccination and other services that were required to be bulk-billed to be delivered.”
“Unsurprisingly, this package has been broadly welcomed by doctor groups, nursing groups, pharmacy groups and, most importantly, women's organisations themselves. We're so grateful for that support and so grateful for the input that they are having. This will truly deliver women more choice, lower costs and better services in the future.”
“We have the some of the lowest rates of access to IUDs and implants in the developed world. The reasons for that are pretty clear. They are very hard to access and too often they are far too expensive. This package changes that. There's more training for GPs on insertions and removals, higher fees for doctors providing those services and, as the Minister representing the Minister for Women said, the first new listings on the PBS for oral contraceptives in more than three decades. The menopause inquiry also showed decades of poor literacy in our healthcare system and poor service for women going through perimenopause and menopause. Doctors are provided only one hour of training on menopause across their entire six-year degree. Again, we will provide better training, better clinical guidelines and better funded Medicare services.”
“Two really important Senate inquiries over the course of this term of parliament have shone a spotlight on the decades of neglect, inaction and poor service that women have received in these two areas. The assistant minister worked so hard with her advisory council to workshop solutions to this. Yesterday was a great day for women's health in this country. Finally, we reversed decades of that neglect and inaction and have delivered women more choice, better affordability, lower costs and better access to high-quality services. We are delivering more choice and lower cost in the important area of contraception. We have some of the highest rates of unplanned pregnancies and terminations in the developed world. We have declining rates of prescription of oral contraceptives.”
“I wish standing orders allowed the Assistant Minister for Health and Aged Care to take this question. She worked so hard on this package. But I am delighted to take the question in her stead from the member for Boothby, who is such a terrific advocate for good health policy in her community in Adelaide and in this chamber. This government has no higher priority than strengthening Medicare, and you simply can't be serious about strengthening Medicare without being serious about women's health. Women consume about 60 per cent of all health services in this country and they face significant costs, as every woman in this chamber and at home knows, simply because they are women, particularly costs around contraception and reproductive health and costs during the period of perimenopause and menopause later in life.”
“I'm sure the Leader of the Opposition can explain what all of this means to Australia's parents and Australia's school leavers. But I tell you this: in the meantime we'll be fighting big tobacco, not inviting them to dinner.”
“Last week, a large yearly survey found that the number of young people in Australia vaping dropped by 30 per cent over the last 12 months. The number of people over 30 years old vaping has dropped by 50 per cent, and, amazingly, the number of kids suspended from school for vaping has plummeted by half. It begs the question: why is the coalition so determined to roll back our laws and bring back the vapes? Well, at the same time we announced our determination to crack down on vaping, you wouldn't guess who emerged from the shadows and fired up their donations to the coalition again: British American Tobacco. Deirdre Chambers, what a coincidence! They have donated $360,000 over the last two years to the coalition, more than they donated in the past 18 years combined.”
“While the former government sat on their hands while this exploded around them, we were determined to act. Since then, we have seized millions of disposable vapes at the border, taking them out of the hands of young Australians. Vape stores have closed around the country, and we've conducted hundreds of joint operations with state governments to target those retailers who are still determined to breach the law. But I know people are asking: what does this mean for vaping rates? As our kids return to school, I'm pleased to report to Australia's parents, if not to this member, that we've turned the corner on vaping in this country. Last month, Sydney university reported the highest number of high-school students who have never vaped and never smoked that they'd ever seen in all of their research.”
“Thanks to my friend the member for Lalor for that question. She remembers that vaping was presented to our community and others around the world as a therapeutic device that would help hardened smokers kick the habit, but, years on, we now know that was all a lie. What big tobacco really wanted was to recruit a new generation to nicotine addiction and then to cigarettes, and the tragedy is that it has been working. Over recent years the number of teenagers and young people in Australia vaping has absolutely exploded. They are ingesting hundreds of dangerous chemicals into their young lungs. We now know that a high school student who vapes is five times as likely to take up cigarettes. A 12-year-old who vapes, and there are a number of them, is 29 times as likely to take up cigarettes.”
“The Northern Territory's funding from the Commonwealth will increase next year by 30 per cent, and the member for Solomon and the member for Lingiari have been arguing strongly for that for some considerable time. I'm asked if there are any approaches that would leave Australians worse off. Well, perhaps the approach of the Leader of the Opposition when he was health minister might be instructive. Although he promised there would be no cuts to health in 2013, in 2014 he tried to rip $50 billion out of our public hospital system. His approach this year is a little different: he admits there will be cuts; he just won't tell people what they will be. We know what they will be, because this man favours long lunches over public hospitals and he needs to find $600 billion for nuclear power stations.”
“But, in terms of public hospital funding, wage and activity pressure for hospitals means that right now the Commonwealth share of the hospital budget is declining. It's going to fall well below 40 per cent if we don't do something. Well, we are determined to be a reliable partner, and that's why the Prime Minister today announced a $1.7 billion additional funding commitment by this government for the next financial year for every state and territory and that we would keep negotiating a longer-term five-year funding agreement with them. This will be especially good for the NT because, for over a decade, the NT has been chronically underfunded by the Commonwealth. This government will be the first government determined to fix that.”
“We have a terrific public hospital system in Australia, staffed by probably the best-trained health workforce on the planet, but the truth is it's a system under very serious pressure. We're getting older as a population. We have more complex chronic disease. We have a serious legacy from the COVID pandemic and, frankly, more broadly in the healthcare system we are dealing with a decade of cuts from those opposite when they were in government. The existing public hospital funding arrangements simply are not fit for purpose. That's why we've been investing in urgent care clinics. That's why we've invested in state government initiatives to move longer-stay older patients out of the hospital system.”
“I thank the member for Lingiari not just for her question but for organising our visit to the Alice Springs Hospital in December, where I had the pleasure of meeting the extraordinary team that works in the emergency department there—one of the outstanding EDs that I have visited in my time. The Alice's is one of 700 public hospitals in Australia. They employ about half a million hardworking doctors, nurses, health professionals and support staff. For 41 years—because Saturday was the 41st birthday of Medicare—a core Medicare principle has been the assurance that every Australian can access high-quality care in a public hospital completely free of charge. You simply can't have a strong Medicare without strong public hospitals.”
“This man has to find $600 billion for his nuclear power stations, instead of investing in health. That is why Australians are never going to trust this man with Medicare.”
“On Sunday, he quite openly said that, if elected as Prime Minister, he would go about cutting services. He just would not fess up about which ones. We know that he'll go after Medicare, because that's exactly what he did when he last had the chance, as health minister, when he famously said that there were, in his opinion, 'too many free Medicare services'. That must be why they describe free urgent care clinics as wasteful spending. We can have no doubt: under a Dutton-led government, the urgent care clinics will close and hundreds of thousands of Australians, like Hayley, her son and others, will be forced back into waiting hours upon hours in crowded emergency departments. And for what? It's not just because they've never really supported Medicare but because this man favours long lunches on the taxpayer dime over free urgent care.”
“Already, it is making a real difference to that community. One member of that community, Hayley, said online: Took my son here for an injury in December. He was seen by the nurse, and treated by the Dr within an hour of arriving. Certainly better than waiting in the Royal— Hobart— for 8 hours!! That's the point: not just delivering high-quality urgent care in the community but also relieving pressure off local emergency departments. While this is making a real difference, the Prime Minister and I both said that we do need to do more to keep strengthening Medicare, after a decade of cuts and neglect. We also know that all of this progress, like urgent care clinics, is under threat from the Leader of the Opposition, who has opposed all of our investments in Medicare.”
“I thank the member for Lyons not just for his question but for terrific service over the last nine years in this place. He remembers that, at the last election, we promised 50 urgent care clinics across Australia, and we've delivered 87 of them. They're open seven days a week, with extended hours for walk-in patients. Already, they've seen more than 1.1 million patients—one in three of them kids under 15, one in three of them seen over the weekend, but every single one of them fully bulk billed. The member for Lyons and the Tasmanian government, it must be said, argued strongly for a clinic to be opened in Bridgewater, north of Hobart. I was delighted to visit that clinic with the Minister for Agriculture, Fisheries and Forestry and the terrific Rebecca White in early December, in its first couple of weeks of operation.”