SUBJECT/S: Private Health Insurance premiums, State hospital funding arrangements, ABCC legislation, HECS, Senate reform.

HOST:  Well let’s start off and talk about health insurance this afternoon here on ABC New South Wales,  we might first go to the Minister and say good afternoon.

SUSSAN LEY, MINISTER FOR HEALTH:  Good afternoon Fiona, lovely to be on the program.

HOST:  Thank you very much for joining us, we appreciate your time.  And the issue of health insurance of course, with many fees going up on the 1st, on Friday, and research saying that many are ditching – one Galaxy Poll says 530,000 Australians are planning to leave health cover, that is going to put a huge increase of pressure onto public hospitals isn’t it?

LEY:  I am dismayed by those figures Fiona, and that is why the action we have taken on premium increases is just part of an overall package of reforms.  So I know – I am getting the emails, particularly from older Australians, who have done their best to hold onto their private health insurance and just saying it is not delivering value, it is not affordable,  it is not transparent, we don’t know what we are getting, so we have got, as I said, a balanced package of reforms, and they include: transparency; winding back regulations; doing something about medical devices; and so on.  So next year when you get those premium rises, you probably want to reassure Australians that they will not be as steep as they were this year, if we get our reforms through. 

HOST:  If 530,000 people leave health insurance, and I guess some of those are families and not just individuals leaving, are you going to have to rethink rebates?

LEY:  We are going to have to make sure that private health insure is a strong product that delivers value, because if we don’t have strong private health insurance we don’t have strong public insurance as you have correctly pointed out, if people go onto the public system- I want to keep the public system for the vulnerable, for those who cannot afford private health insurance and we know that when individuals make a contribution of their own they support the overall Government tax contribution and the health system is better off.  But at the moment, as I said, you are right, people are leaving, people are downgrading, some of the policies people are taking out I have described as “junk” because when you turn up to hospitals – you find you are not even covered or your gap is so big that you wonder why you have been paying insurance all these years.  So to come back to the point Fiona, we are doing lots and lots to fix it because it is close to breaking.

HOST:  Marcella from Robinson says a little known website is which is government website that has no advertising, it lets you compare apples with apples – highly recommended.  That is the second message we have had on that today.  Alison from Batemans Bay puts up an interesting idea, why can’t you use your private health care insurance card at the chemist as you do at the dentist to save all the rigmarole of filling out paperwork to get $3 back?  

LEY:  Well, the PDS which supports access to medicines is a different system to the MBF which is Medicare, but what we do want to do over time is bring these payment ystems into the 21st Century and we do envisage that people will have a card that they would tap, that they would move between all of their services, all of their health providers, and even when they go into aged care that would help them get consumer directed care delivered to their own homes.  But we do have to modernise the system, the Prime Minister’s message of innovation is also about the consumer and putting the consumer at the centre of what they do because it is people that will drive this change and say “I need an app” – I need an ehealth record that works for me and delivers for me what I want.

HOST:  Let’s get a different perspective perhaps, or maybe agreement, from the Federal Opposition spokesperson for Agriculture and Rural Affairs, Joel Fitzgibbon, good afternoon.

HOST:   I will let you both on but please don’t argue too much…

FITZGIBBON:  Well you know Fiona I always try very hard to agree whenever I can…

HOST:  Well, what is the current ALP policy when it comes to private health insurance and rebates.

FITZGIBBON:  Well, those survey figures we saw today are a looming crisis, even if they are half right,  and what we will see of course is more and more strain put on a public system which is already under considerable pressure because  the Abbott/ Turnbull Government have substantially cut the funding to the public system.  So this is a very serious problem and Sussan gave three solutions there:  something about red tape, something about transparency and of course a bit about medical devices; but it is not the answer people are looking for.  When they were in Opposition, Sussan’s team, they screamed every time private health insurance rebates went up under a Labor Government…

HOST: Rebates went up or?

FITZGIBBON:  Premiums went up.  Yet they are going up at a considerably faster pace and in larger steps than they ever did under the former Labor Government.  We need more than platitudes about red tape and transparency – we need action.

HOST:  So you still have a policy of supporting tax rebates on private health insurance?

FITZGIBBON:  Oh absolutely.  There is a whole range of obviously other pressures on the system, for example, let’s talk about efficiencies.  I mean when Rudd delivered all that additional public health funding to the public system, he didn’t just hand more money out.  He pushed it onto a more efficient system, he required them to be paid on outcomes and not just on a flat rate as they had historically.  That is a good  example of how you milk efficiencies out of a system.  How is it that a knee replacement under the private health sector system can be 4 times more expensive in one metropolitan part of Australia when compared with another.

HOST:  Our listeners just want to know, you know, who charges what and what they are going to be out of pocket for, you know, it is the gap that is scaring people.

FITZGIBBON:  Well the survey debate today is all about premiums going up very rapidly, and then therefore people opting out of the system because they can’t afford it…

HOST:  I understand that.  I am just saying our listeners are saying why can’t they go somewhere and find out who’ll do it for – they are happy to pay private health insurance if they know that when they need something done, as we had a call from Hallidays Point, he can’t find out where he can get, you know, where he can find a surgeon that is good who will do it at the scheduled fee.

FITZGIBBON:  The anti-competitive nature of some of these processes is something the Minister, after three years in Government, could be addressing.

HOST:  Richard from Coffs Harbour just called in Minister, to say he is one of the people you are referring to, he is questioning whether to stay with private health insurance, he is paying $600 a month but is getting little back and he recently had surgery and that cost him $9,000.

LEY:  That Fiona demonstrates the transparency point that I think Joel has acknowledged, and I certainly have, we do need clinical transparency so you know what you are signing up for.  If you look at the fine print of some insurance policies, it flummoxes even people who look at a lot of fine print, like members of Parliament.  We need to standardise the product, so that you can be confident if you take out this particular product, branded this way across the whole industry, because there are thousands of different policies and many, many different private health insurers, you know exactly what you are getting and that is really, really important.  It is too obscure, it is too murky.  So again, we are working on the transparency.  One of the things I also want to see can I say, is single billing – so you go to your private hospital and you get a bill from the anaesthetist, you get a bill from the doctor, and you get a bill from the hospital.  It is almost archaic in the modern world.  Coming back, consumers are demanding better and I agree.  And so a lot of these things will help put down the pressure on prices and I just want to say – “hang on – work is underway” and the cost of devices, which was mentioned by Joel, and has certainly been mentioned by some of your correspondents, is really driving up the cost of your operations inside the private hospitals and is adding to the cost of your insurance and we are bringing those down too.

HOST:  We are talking to the Federal Health Minister and member for Farrer, Sussan Ley.  Money going back to the States, have you been involved in discussions on that ahead of the COAG Meeting?

LEY:  Yes I have and I am sitting down with my Health Minister colleagues on 8th April, I think, and we will be following on from what the Prime Minister and Premiers decide on hospital funding on Friday.  So it’s a terrific opportunity to do better, Joel mentioned the efficiencies that were started under the Rudd Government – I think there were some sizable inefficiencies -  but I also recognise, credit where credit’s due, that the National Efficient Price and Activity Based Funding which were actually started under the Kennett Victorian Government but they were made national under the previous government.  There are gaps in their operation and still areas of safety and quality that need addressing. And the number one downward pressure on hospital costs is actually to keep people out of hospital or stop them being readmitted and we are absolutely focussed on that as well.  It is better chronic care for people with complex conditions, also helps them and saves governments’ money.

HOST:  I would like to move topics from health to the ABCC legislation and I might start with you Joel Fitzgibbon.  What are you hearing from people about the construction industry and I am sure that you would know a few people involved in the unions in it.

FITZGIBBON:   Well I am not hearing anything on the streets Fiona, to be quite frank.  In my Electorate and wherever I travel throughout rural and regional Australia, no one raises it with me.  I don’t believe it is a big issue in the looming Federal Election, but of course Malcolm Turnbull wants to make it the issue and that’s what all these threats of a double dissolution are the recall of Parliament is all about.  The Labor Party is always willing to consider any strategies to reduce corruption in any industry.  Our concerns are that Malcolm Turnbull is misrepresenting what the ABCC does  and of course it singles out some people, some particular workers in some industries, or an industry, while not providing a wider net.  Why Attack..

HOST:  Do you think it varies from State to State? Do you think for some reason New South Wales is not as impacted by industrial action and pickets and so forth?

FITZGIBBON:  Well I travel the country, and I was in North Queensland last week and no one, many people raised many issues with me there,  jobs, NBN, health, education et cetera, cost of living, no one was running up to me asking about the ABCC.  Look, the Labor Party has zero tolerance for corruption and bullying in any industry, be that bullying or corruption be perpetrated by someone in a white collar or someone in a blue collar.  So if the Government wants to talk to us about efficient and reasonable proposals we are always open to that.  We all know what this is about, Fiona, it is about making one particular Union the election issue because Malcolm Turnbull thinks that is to his favour.

HOST:  Well, we have got the Health Minister here, I don’t know if you have been involved in the discussions around this particular piece of legislation, have you got a comment to make?

LEY:  In Dyson Hayden’s introduction to his Royal Commission report, he said in the world of our Trade Union officials there are louts, thugs, bullies, thieves, perjurers and those who threaten violence.  I don’t think the average Australian wants that sort of world on their constructions sites.  If we are going to have the drive for infrastructure, the building of the infrastructure for the next generation across this country that we have talked about, and were very committed to delivering. Even if you ignore that sort of behaviour, and what it must be like to work in that sort of world, surely you wouldn’t ignore the added cost to building the infrastructure of tomorrow.  This is just so overdue.  You know what really surprises me? I can’t get my head around why people think we shouldn’t pass legislation to restore the ABCC back in place.  This was a body that was there before, that kept this behaviour under wraps and was there as a place to go to make sure it didn’t happen, as a protection for everyone involved in that industry.  It is more than one Union, by the way.  So I think it has just got to happen, and I am always surprised when people suggest it doesn’t need to.

HOST:  Let’s talk about another suggestion that students who have a HECS debt should start paying it at a lower income.  Your thoughts on that Minister?

LEY:  Well there has been a Grattan Report today that talks about the student loans scheme and I know my colleague, Education Minister, has had a bit to say about the growing cost of tax payer funding for Commonwealth supported places.  What really matters to me Fiona, particularly in rural and regional Australia, where we have, as you know, high  youth unemployment is that the training they undertake whether it be in universities or in trades and training, enables them to get a job.  I have seen over the past ten years, a big push to university at the expense of the trades, at the expense of applied skills, and I don’t know if that has always been good for those who have undertaken it.  And of course if you don’t pay back your Higher Education Debt it means that you haven’t reached the level of income at which to pay that back.  So of course governments are observing that there are debts that are not paid, but the bigger issue for me is that there is an individual that doesn’t have a really good job following that education.  So I want to encourage as many young people to consider skills, I am not trying to suggest that they don’t go to University, but we have to get away from “if you haven’t been to university you haven’t made it” ethos as well.  And I know Joel would agree with me on that.

HOST:  Is that correct Joel Fitzgibbon?

FITZGIBBON:  If you don’t mind Fiona, I just want to go back to the ABCC.  It did exist before, but when it did exist, productivity was lower and industrial disputes were higher.  But I do agree with the sentiments to make sure that we do have skilled tradesmen and that we have people doing  VET course – absolutely.  But whether we are talking VET here or university loans, what the Government is now doing here is turning to the people who can least afford it, those who are most vulnerable, and at a time when we want to be the smartest country in the world, they are putting further barriers in the way of people going onto higher education.  That is not the place to go looking for savings.

HOST:  Let’s talk about Senate reform and the micro-parties and the Independents.  We might start with you Joel Fitzgibbon, and of course there was one member of your Party that thought it was a very good idea and stood down as Leader in the Upper House didn’t he?

FITZGIBBON:   Gary Gray is no longer the Special Minister for State, I think that is what you mean, Shadow Minister, Fiona.

HOST:  yes, Shadow Minister.  Why did you feel so, why did your Party feel so opposed to it?

FITZGIBBON:  You know, there is an old saying, Fiona, the punters usually get it right.  Malcolm Turnbull’s problem is he doesn’t like the Senate he currently has to deal with and he wants to change the rules, in a deal with the Greens, by the way, to give him a better outcome after the next election.  Well I remember the last time the liberal Party had absolute control of the Senate, that was under John Howard and that delivered the now infamous WorkChoices legislation.  So we all know what this is about, it is about political advantage and Malcolm Turnbull has decided to go to the extreme to get what he wants.

HOST:  There is a lot of people that just watch politics very closely who say the system is broken, it needs fixing, how can people be elected on such a tiny vote, you are not getting, people aren’t getting who they voted for.  Is that your thoughts on it Minister Ley?

LEY:  Yes it is.  I am sad that Gary Gray who was the Labor Party’s Special Minister of State, exit stage left, saying that 95% of what is being implemented is exactly what Labor agreed with during the Select Committee that investigated these matters.  It does seem entirely political that Labor has decided not to support them.   This is about political advantage, because no one knows where the votes are going to fall, particularly for the major parties in any election.  We just don’t know that.  But what we do know is that when we put a number in a box  we want to be reflecting what we want not a cascading series of preference deals  that has been done behind the scenes that we have no knowledge of, but somehow decides the outcome and that is all this reform is.  It is about people being able to have their say.  It really is about democracy. I have no idea, if we have a double dissolution election, what will happen as a result – no one does, because that is the power of democracy and it does need to reflect the will of the people.

HOST:  Now,  I think because we have so many text messages on health and because we do have the Health Minister with us, and Member for Farrer,  Sussan Ley, I will just share some of the comments that are coming through.  Richard in Shell Harbour says about not being able to find out about doctors’ fees, he says the AMA is the second most powerful union in the country and maintains strict control over the fees they charge and he believes the reason for this is that doctors do not want a competitive market.  And on private health insurance, David said thought about  giving up private health insurance in 1972, but didn’t, up until 2001 had no claims but since then has had 4 eye operations, at $400 each all fully paid by the health fund.  And his wife has now developed stomach cancer the first operation was $37,000, sully paid and he estimates the health fund has paid out about quarter of a million dollars.  They have been able to get into specialists of their choice within minutes, thinks that it is vital to stay with private health insurance when you are older.  Which Minister makes me wonder with an aging population, and many in health insurance for that long is it sustainable?

LEY:  Well not at the moment, unless we develop and implement the reforms we  have well underway. Because the numbers speak for themselves with over 500,000 people downgrading or dropping their insurance with the lack of transparency of products, with fact that insurers are often price-takers for very expensive devices that often cost less in the public system than the private system…

HOST:  Just on that, Ed says what are you referring to when you talk about devices in health delivery?

LEY:  A pace-maker is an example.  So in the private system a certain type of pace-maker costs $43,000 but the same device in the public system costs about $17,000.  So that is an extreme example, but if you look at joints, they typically vary hugely in price.  They are called as a group prosthesis and we have a list and we are acting to introduce better pricing in that list with the agreement of everyone sitting around the table.  This isn’t about taking a stick to any particular area of the private health system but it is about working together and it is about recognising where the costs are too high at the moment.

HOST:  While you are taking that stick, Joe says…

LEY:  No Fiona – I said there was no stick.

HOST: oh sorry.  Joe says please ask the Minister about private patients that fill public hospitals because some private hospitals refuse to accept patients that require a lot of expensive care even though they are fully insured.  I work in the public system and see it often some hospitals are cherry-picking services.

LEY:  That’s not good and it may well be something that we talk in detail to the States about.  But the opposite happens too, you can go into a public hospital and you can be treated, you can be a private patient in a public hospital which tends to advantage the public system against the private hospital down the road.  So those two effects probably offset each other. Most importantly we want the hospital system, whether public or private to deliver value for you as the patient and we don’t want cross shifting between levels of government so that is something I am talking to my State Health Ministers about.

HOST:  And we appreciate your time, I might ask when are we going to hear about health policies, we have heard a lot of policies from the Opposition Joel Fitzgibbon, are there some big announcements, will we hear about health soon?

FITZGIBBON:  Oh Fiona, you will hear a lot of announcements across a whole range of areas.  We have of course already announced a number of bold policies, pretty unusual for an Opposition at this point in the political cycle, and yes, there will be plenty more to come.

HOST:  Well when I am thinking about health the only thing is the smoking tax which I suppose will help save looking after people later, health care related to smoking diseases- is that the only one to do with health?

FITZGIBBON:  Well that is the only big announcement made at this point.  And it was a tough decision to take as obviously it has an impact on consumer prices but we believe it is the right thing to do.  We need budget revenue but at the same time we need to encourage people away from smoking but again there will be more policies to come of course.

HOST:  I appreciate both your time.  I know how busy you are.  Thank you very much for being part of the program.


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