Mr STEPHEN JONES (Throsby) (16:45): If Medicare was a Facebook page it would have around 23 million 'likes'. It is every Australian's favourite brand. Peter Dutton and the coalition claim that they are Medicare's best friends. They are waiting until after the Western Australian election before they hit the 'unfriend' button. Peter Dutton says he wants to start a national conversation about the future of Medicare, but it is not a real conversation because if you are going to have a real conversation you listen to what the other side is saying. He has already concluded what he wants to dohe is just not letting on. A national conversation would be welcome, but that is not what the government plans.

The Minister for Health has refused to release the Commission of Audit recommendations on health spending, but he revealed last week that he knows what the cuts are that are in the Commission of Audit report, he knows what the recommendations are, he is just not going to let on. He has got it sitting on his desk, and the only thing that is sitting on top of it on his desk is the polling on the Western Australian election. As soon as that is out of the way we will see the commission of horrors and what it means for the health system and the future of Medicare. The coalition are clearly considering means testing Medicare. The minister is flying a new kite every week on this one. He wants to create a multitiered system by restricting the amount the Commonwealth pays GPs for seeing certain groups in the community. He will not tell us what he has decided but he will tell us what he thinks, and what he clearly thinks is that some people should pay more when they go and see their doctor.

We on this side of the House say that it is not up to the minister to decide who is and is not capable of affording to go to see their doctor when they are sick. This is, and should remain, the privilege of the GP. Each and every GP who knows their patients and knows their own community is going to be in a better position than the minister sitting here in Canberra to determine what is in the best interests of those patients. The coalition's plan would clearly remove the discretion that currently lives with the community GP. Make no mistake about it, what is being planned here is a radical downgrade of what we know and love: Medicare Australia. Introducing a tiered systemand that is what is seriously being proposedmeans that the GP's Medicare rebate would be the highest for those people on concession cards and their children. They will get the highest level of Medicare rebate and everyone else will get different treatment. The Medicare rebate for family tax benefit A patients would be less again, and for everyone else it would be lower still. Bulk-billing would be for concession card holders and their kids onlynobody else. Obviously, this style of health system is going to put pressure to open up private health insurance to GP services as well.

We have said in the past that this is going to hit people who are poor, but that is only half the picture. Make no mistake about it, this is an attack on the middle class. The AMA's recommended GP consultation cost is currently around $72. Just because you do not qualify for a concession card does not mean you are a high-income earner; it does not mean that you can afford to pay out-of-pocket fees every time you need to see your GP. That is very short-sighted. About 12.8 million Australiansalmost 55 per cent of Australianshave private health insurance, so the majority of middle-income earners already pay out-of-pocket expenses each month for their health care. Private health insurance costs are going up and up and up. Recently the coalition approved the largest ever increase in over a decade for private health insurance premiums: around 6.2 per cent or $21 a month. They go on and on about the impact of carbon pricing, but you will not hear them say a word about their own decisions and the impact that they are having on private health insurance rebates, because this is their plan for the future of health care in this country.

Direct impacts will hit the hip pockets of millions of working Australians. Millions of working Australians have their own stories to tell, like Kim Parker, a casual casino worker in Tasmania. Kim's daughter contracted gastroenteritis when she was nine months old. It was in the middle of the night. Kim took her daughter to the emergency room at a local hospital for treatment. It took over three hours and she still never received that treatment. Kim signed up for private health insurance after that experience. It costs her $140 a fortnight. That is a huge chunk of her take-home pay, but she pays that money to make sure her family is healthy. People like Kim exist all over Australia. The cost of health cover is going up and up and up, and make no mistake: for middle-income earners and for people like Kim, under the coalition's plan these costs are going to skyrocket. Many simply will not be able to afford it.

Introducing a fee does not fix the problem; it just creates another one. Dr Hambleton of the AMA says that the federally funded costs associated with GP visits have actually flatlined relative to the cost of hospitals and state government budgets, so this manufactured crisis that they are trying to fix does not exist. The average cost of somebody going to a GP for a Medicare visit is now $36. The average cost of going to an emergency ward in a public hospital could easily be 10 times more than that.

The big drivers of healthcare costs are not spending in general practice. They are public health challenges that the current assistant health minister could not be less interested inthings like tobacco, alcohol and obesity from the sorts of foods that we are eating and encouraging our kids to eat. These are chronic lifestyle diseases that can only be prevented by better health care, better health planning and more affordable access to GPs.

In my electorate, Throsby in the Illawarra in New South Wales, we have a higher-than-national-average incidence of a lot of chronic diseases, and diabetes is one of these diseases. The incidence of diabetes is about 5.6 per cent of the population nationally. In my electorate it is over six per centcloser to 6.5 per cent, almost one percentage point above the national average. The people who have this disease need more intensive healthcare management. There is a reason for that: if you are able to provide greater care, it means that they are less likely to be hospitalised and less likely to suffer the worst results of having those chronic diseases. This is why bulk-billing rates in the Illawarra are also at historically high levels. They have increased over the last five years, to 91.7 per cent. GPs understand that patients in my electorate require bulk-billing in order to have access to basic primary health care. They need to make sure that patients continue to get access to GPs so we can do health promotion and preventive care and keep people out of the expensive part of the healthcare system, the public hospital system.

So there are three things that we can be absolutely certain will happen if Prime Minister Abbott's plan succeeds. The first is that patients will shift from GPs to the emergency waiting rooms in public hospitals. The second thing is that there is going to be a shift of the cost onto individuals, many of whom are already paying increased costs for private health insurance, particularly middle-income earners. The third will be the unavoidable cost pressure on private health insurance premiums. They will go up and up and up as well.

We only need to look at the US to see what this looks like. We can see that there are spiralling costs in health care. We can see they are paying a greater percentage of GDP than we pay here in Australia for their health services and getting a worse health outcome. The USA today spends the equivalent of 17 per cent of GDP on health care. The total Commonwealth expenditure on health care is about nine per cent of GDP in Australia, less than the OECD average of 9.3 per cent. So we have the American path or we have the Australian path. We know what is going to work.

A division having been called in the House of Representatives

Sitting suspended from 16:54 to 17:09

Mr STEPHEN JONES: As I was saying before the division, if Medicare were a Facebook page we would have 23 million likes, and that is because it is a great system. Australia spends less on health care than any other country in the world for better outcomes.

Australians have an opportunity in the Western Australian Senate election to send a real message to Tony Abbott and the coalition: 'We do not want your plan for health care'. He says that they are the best friends that Medicare has ever had; well, real friends do not do this.