Minister for Health and Aged Care, doorstop interview – 13 January 2025

Read the transcript of Minister Butler's doorstop interview in Canberra about Medicare, bulk billing, vaping, public hospitals and NSW psychiatrists.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Yesterday, Peter Dutton gave a 38-minute speech that contained not a single policy or promise that would actually help Australian households with their cost of living or to access affordable healthcare. You can't pretend to govern a country as significant and terrific as Australia based on rhetoric and sledging alone. To pretend arrogantly that you can skate into government on that basis, I think that says everything about Peter Dutton.

Buried in that speech was an admission that he intends to conduct a review of Medicare and the PBS if he's elected over the next few months. For every doctor, nurse, and importantly, every patient who remembers Peter Dutton's time as Health Minister, that idea of a review will send a shiver down their spine. Because when Peter Dutton was Health Minister, in one short Budget, he tried to abolish bulk billing altogether and make every single Australian pay a fee every single time they visited the doctor. He did that because, in his words, he believed that there were “too many free Medicare services.” He tried to impose a fee every time an Australian went to the hospital emergency department. Instead, what we're doing is trying to take pressure off hospital emergency departments through our network of Urgent Care Clinics. He tried to cut $50 billion from our hardworking public hospitals, while we’ve put on the table $17.8 billion in additional funding to help states and territories and doctors, nurses and other health professionals do the important work of our public hospitals. And he tried to jack up the price of medicines by up to $5 a script, while already, we've saved Australians more than $1 billion in out-of-pocket costs through our cheaper medicines policies. When he was health minister, Peter Dutton tried to wreck Medicare, so why on earth should Australians now trust him to strengthen it? Happy to take questions.

JOURNALIST: Cleanbill has said that bulk billing services have dropped from 35 to 20 per cent. I know that the way they record their information differs to yours. Can you explain the difference?
 
BUTLER: The important thing is that a ring around of general practices by this private company is no substitute for core Medicare data. Medicare data shows that there aren't as many bulk billed visits as we would like. But importantly, what our record bulk billing investment the year before last has done is arrested the freefall in bulk billing that we inherited when we came to government. That was no accident. It reflected a decade of cuts and neglect by the former government, and in particular the freeze to the Medicare rebate, the 6-year freeze that was kicked off when Peter Dutton was the health minister. Now the word “freefall” is not mine. It's the description that was given to the state of bulk billing when we came to government by the College of General Practitioners. They said that general practice was at a tipping point and if there wasn't further investment to support bulk billing, it would continue to slide in this country. That's why we tripled the bulk billing incentive. It's exactly what the College of GPs had asked from the Australian Government, and we delivered it. When we delivered it, the College of GPs described it as a “game changer”, and very pleasingly, in the first 12 months of that record investment, what we saw was an arrest of the freefall. The freefall simply stopped. Really pleasingly, bulk billing rates for GP visits have started decline in every single state and territory in the Federation. Last year alone, an additional almost 6 million free visits to the doctor.
 
Now this morning, not on one occasion, but on 2 occasions, Peter Dutton has described that investment in bulk billing as “wrong.” He needs to come clean with the Australian people, what does he intend to do to drive bulk billing rates up further? What we've done has already made a meaningful difference. We know we need to do more, and I've said already that we're committed to doing more to strengthen Medicare.
 
JOURNALIST: Doctors have said that your investment in Medicare has arrested the freefall. It's stabilised now, but they're still at that tipping point, and they'd like to see those incentives extended beyond just concession card holders and kids. Are you going to do that?
 
BUTLER: I'm not in a position to announce further policy today. I have said, from the time I was first appointed health minister, that we're not going to be able to fix a decade of cuts and neglect in one term of parliament alone. In this term of parliament, we have delivered record investments in Medicare. In addition to tripling the bulk billing investment, we've delivered the two biggest overall increases to the Medicare rebate in 30 years. We've increased the Medicare rebate in 2 years by more than the former government did in nine long years. That is starting to improve the financial position of general practice. But I've been very clear we need to do more, and what we have done has made a meaningful difference, but it is still tough for general practices, and importantly, it's tough for patients to find affordable access to a GP when they need it. We do need to do more. Of course, a Labor Party will take a platform to a federal election to strengthen Medicare. Medicare is part of our DNA. We introduced it, we fought so hard for it, and for Labor, bulk billing is the beating heart of Medicare. We will have more to say about our plans to strengthen Medicare, but there could not be a clearer difference in this upcoming election campaign between our record over 40 years of backing in Medicare and our record over the last 2 to turn this situation around on the one hand, and Peter Dutton's record. It's no accident that he was voted by Australia's doctors as the worst health minister in the history of Medicare. His record reflects that.
 
JOURNALIST: Does it concern you that only 3 states have bulk billing rates above 10 per cent?
 
BUTLER: It depends on how you measure it. As I said, this ring around effectively asks general practices, whoever happens to pick up the phone, whether they have a policy of bulk billing every single person, every single time that person walks in the front door, whether it's an age pensioner or whether it's Gina Rinehart or James Packer. That is no substitute at the end of the day for the transparent reporting we now conduct about MBS data. On a regular basis, we now publish the percentage of GP visits that are bulk filled. What we know is that across the country, about 77 per cent of visits to the doctor are now bulk billed. As I said, that was starting to freefall when we came to government. It has stopped and it started to turn around. In Tasmania, for example, the bulk billing rate is up 5 per cent because of our record investments in bulk billing. We want to see it increase more. That's not the number we want to see. We want to see it go higher. Peter Dutton said there were “too many free Medicare services” when he was health minister. As today's Health Minister, I want to see more free Medicare services, which is why I have said, of course, there will be further announcements by our government about what we would do if we had the privilege of being re-elected to a second term.
 
JOURNALIST: Cleanbill also says that out-of-pocket costs have gone up by about $2 in a year. Is that right?   
 
BUTLER: That reflects about our assessment as well. As I said, the general increases to the Medicare rebate have started to take some of the financial pressure off GPs, not only allowing them to bulk bill, importantly, age pensioners, concession card holders and children under the age of 16, but also to take some of the pressure off out-of-pocket costs for other Australians. Obviously that group of other Australians are a big focus of ours. They were a big focus of our cheaper medicines policies, those Australians who don't qualify for concession cards. That was the biggest investment we made in our cheaper medicines policies, to help their hip pocket. Of course, we're interested to know what else we can do to improve their access to bulk billed GP visits as well.
 
JOURNALIST: It's been a few months since the latest tranche of vaping restrictions. Have you gotten any indication that or not this is improving?
 
BUTLER: It's still very early days, as you say, only a few months since the new laws took effect, particularly the access to vaping products in pharmacies without a GP script. We do know we're continuing to have great success in seizing vapes at the border. Millions and millions of vapes have been seized since 1st of January last year. We've been working very closely with state authorities, state policing authorities, but state health authorities as well to conduct joint operations in the retail space, to remind retailers of the new laws and the very serious penalties that they face for selling vapes and vaping products in their stores. There have been literally hundreds of operations conducted. I want to see a situation very soon where we start to move to prosecutions. There are very serious penalties in place for breaching these laws. I want to remind retailers we're deadly serious about enforcing those penalties.
 
JOURNALIST: Some health insurance insurers are calling for an end to government ban on insurers covering GP visits, and given what you see today, with rising costs and the slow death of bulk billing, will the government consider letting insurers cover GP visits?
 
BUTLER: We have no plans currently to do that. There's been a very long-standing position in Australia not to create the possibility of a two-tier system in basic general practice and access to basic primary care. I think that's been a very important part of the Medicare principles that have delivered such a high-quality healthcare system that's ranked among the best in the world. We have no current plans to do that. That would be a very, very significant change to the way in which Medicare operates. I also understand that some of our big private health insurers are doing some really innovative work to improve the access that their members have to, not just primary healthcare, but also prevention as well, and I encourage them to continue doing that.
 
JOURNALIST: Emergency department in South Australia are often at code while being subject to thousands of hours of ramping a month, can Medicare funding turn this around?
 
BUTLER: We now have 87 Medicare Urgent Care Clinics that are open across the country. At the last election, I promised we'd open 50. We've opened 87 of them. They've already seen a million patients over the last 18 months or so, every single one of whom has been bulk billed. The majority of patients who go through our Urgent Care Clinics tell us that if that clinic was not available, they'd be visiting their local emergency department. Not only are we delivering good quality urgent care to people, when and where they need it in their community, fully bulk billed. We are also starting to take pressure off the very busy emergency departments in the country's public hospitals.
 
In addition to that work, as I said in my introductory remarks, we're committed to making sure we deliver more support to our public hospital system through an additional $17.8 billion, which has been on the table now for some time to conclude a new hospital funding agreement. We know what an important part of our overall healthcare system our hard-working public hospitals are. We want to take as much pressure off them as we possibly can, on the one hand, but also make a fair contribution as a Commonwealth Government to the operating costs of the system.
 
JOURNALIST: Over the weekend, your New South Wales state counterpart, Ryan Park, made quite an impassioned plea to psychiatrists in the hospital systems not to quit as part of ongoing pay disputes. Do you have any more comment you'd like to make on the situation unfolding there?
 
BUTLER: The sort of mass resignation I've read about being contemplated in New South Wales would have devastating consequences for psychiatric patients and their families in New South Wales. I really do urge both parties, because I understand this is largely the product of a wage negotiation between the public psychiatrists on the one hand and the New South Wales Government on the other. I really urge them both to get back to the table and to resolve this in the interests of patients. I have the utmost respect for the work that our public psychiatrists do. It really is some of the hardest work in our mental health system that we have. They don't earn as much as they could be earning if they were fully working in the private system. We know that this is a sense of mission that drives so many public psychiatrists to do the important work that they do, and I know that they don't do it lightly, but it would be devastating to have the sort of mass resignation that is being contemplated or talked about in our biggest state. I urge both parties to do whatever they possibly can to resolve this negotiation. Thanks everyone.

 

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