Minister for Health and Aged Care – Speech – National Press Club – 2 May 2023

Read the transcript for Minister Butler's speech at the National Press Club on 2 May 2023.

The Hon Mark Butler MP
Minister for Health and Aged Care

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I’d like to begin by acknowledging the traditional owners of the lands on which we stand, the Ngunnawal and Ngambri people.
I offer my respect to Elders past and present and extend that respect to any First Nations people joining us today.
As a nation we stand at a turning point in our relationship with First Nations peoples and if there is one area where hearing from First Nations voices directly would improve outcomes, it is in health.
The persistent gap in health outcomes between Indigenous and non-Indigenous people of Australia is proof that a Voice is needed – a Voice that can make representations to the Executive.
Now it might seem strange to start a speech on the future of Medicare by talking about the past.  
But to understand the future of Medicare, you have to go back to its beginning.
So cast your mind back – those of you old enough to remember - to 1984.
Bob Hawke is the Prime Minister and Medicare is in its first year.
The Ford Falcon is Australia's bestselling car.
 “Ghostbusters” is the pinnacle of movie special effects.
Fax machines are in every office.
And in the suburbs of Adelaide a teenager is praying that his mum will buy him a walkman for his 14th birthday.
Medicare was created to solve the health problems of 1984.
In those days … we were younger, on average, and tended not to live as long.
We smoked a lot: 40 per cent of men and 30 per cent of women were regular smokers.
Our health issues were more episodic and acute.
Back then, Medicare was a symbol of modernity.
But it didn’t have an easy birth.
Just like every other time a Labor Prime Minister had tried to introduce universal healthcare, we were opposed by an alliance between the Liberal Party and the doctors’ associations.
When Ben Chifley introduced the Pharmaceutical Benefits Scheme 75 years ago, he was opposed by the Liberal Party and the British Medical Association.
When Gough Whitlam created Medibank 50 years ago, the Coalition and the Australian Medical Association fought it, before the Liberals dismantled it altogether.
And it was the same when Bob Hawke introduced Medicare nearly 40 years ago.
At that time, the father of the modern Liberal Party John Howard described bulk billing as “an absolute rort” and threatened to “pull Medicare right apart”.
He didn’t get the chance.
Medicare succeeded, because it was the right reform for the health needs of the time.
A fee-for-service rebate schedule that reimbursed small local doctors and specialists for the procedures they did was just what the Australia of 1984 needed.
But Australia has changed, thanks, in some part, to the success of Medicare.
Universal healthcare, world leading tobacco control and a revolution in cardiac health, among other innovations, means we now live almost 9 years longer.
Our health problems are increasingly chronic and complex.
General practice is no longer just a small cottage industry.
And our health workforce is now among the best educated in the OECD.
But while Australia has changed a lot, Medicare hasn’t changed much at all.
That same fee-for-service model that provided rebates to local doctors in 1984 is still largely intact, some forty years later.
And as the years have passed, it’s started to show its age.
Let’s now fast forward thirty years … to May 2014.
Nine years ago, almost to the day.
The new Coalition Health Minister stands here and says he wants to strengthen Medicare. But the policies he puts forward are more likely to strangle, rather than strengthen it.
$50 billion ripped out of public hospitals.
A tax on every visit to the GP for every man, woman, pensioner and child.
And when Labor blocked that vandalism, he responded by freezing Medicare rebates for six long years, ripping billions out of general practice.
Those nine years of nasty cuts and calculated neglect have precipitated the crisis before us today.
Bulk billing has declined at alarming rates.
In some places, particularly rural and regional Australia, forget finding a bulk billing doctor, you struggle to find a doctor at all.
Practices are closing, forcing people to drive long distances because their corporately owned clinics are relocating and consolidating to achieve economies of scale.
And when you do manage to get in to see your GP, they are under pressure to move quickly onto the next patient, which isn’t good for you and isn’t what they trained for.
All this puts pressure on our hospitals, because too many conditions go untreated until they get serious.
The case for reform is now urgent. We can’t keep trying to treat 21st century Australia with 1980s Medicare.
In the first six months of the Albanese Government, I chaired the Strengthening Medicare Taskforce.
Around the table were representatives from the College of General Practitioners, the Australian Medical Association, the Australian Nursing and Midwifery Association, allied health and rural professionals, First Nations perspectives and – importantly – patient perspectives from the Consumers’ Health Forum, alongside a range of other experts.
I am a firm believer in the value of this kind of direct stakeholder engagement by Ministers.
Health is a sector full of very hardworking, and highly-skilled stakeholders. They have sharp elbows and loud voices and they don’t always agree.
But over the six months that I sat around that table, what I heard was a remarkable degree of goodwill and agreement on the direction that reform should take.
And at National Cabinet last Friday, the Prime Minister unveiled the important first measures of the Government’s response: $2.2 billion worth of critical reforms that will build a stronger Medicare.
The Treasurer will give a full accounting of the dollars and cents behind those investments in the Budget next week, as well as other initiatives still to be announced.
But today I’ll outline how the reforms knit together to build a stronger Medicare that’s fit for the 21st century, underpinned by three foundational changes.
First … digital systems that drive better care.
We simply cannot build a stronger Medicare without better realising the opportunities that digital health technologies open up for more efficient and collaborative healthcare.
The former government had so little commitment to digital health that it couldn't even be bothered to fund My Health Record beyond June 30 this year.
On July 1, My Health Record was due to be switched off. Unplugged. Gone.
Time for doctors everywhere to dust off that 1980s fax machine!
In contrast, the Budget will include over $950 million worth of investment in digital health, including funding to make the Australian Digital Health Agency an ongoing entity and upgrade My Health Record.
My Health Record is now old technology. It still uses the old PDF format that Labor installed when we were last in government.
It was cutting edge then, but it’s clunky now.
For starters, it needs to be more compatible with the information and billing systems that practitioners are already using.
It should provide better connections between different parts of our health system and make it easier for people to access and securely share their data.
Only 1 in 10 specialists use My Health Record.
Just 1 in 5 diagnostic reports in radiology are uploaded. The other 4 disappear into the digital ether.
Patients find this so frustrating, because every lost test result means another day off work, another waiting room, another procedure and yet another gap fee.
What a waste of time and money. For patients and for the health system.
If a patient gets a diagnostic scan or pathology test, then those results should be uploaded.
At the moment, this happens by exception. It is not the rule. I intend to make it the rule.
The second foundational change in a stronger Medicare is to enable a more multi-disciplinary and team-based approach to primary health care.
Chronic conditions are the leading cause of illness, disability and death in Australia.
Treating them effectively needs more than just the occasional, sporadic visit to the doctor.
Patients with chronic conditions need a coordinated team of health workers proactively working together with them for their long-term health. This includes GPs, allied health, nurses, specialists, and everything in between.
Which means primary care providers need support and investment to engage a broad range of health professionals to provide that more comprehensive care.
This Government is investing to deliver just that, by providing a big increase to the Workforce Incentive Payment that general practices use to hire different health professionals to join their team.
For smaller practices and in thin markets, Primary Health Networks will be funded to commission allied health professionals like social workers, physios, diabetes educators or mental health nurses.
But it’s become increasingly clear that a Medicare built solely on the old fee-for-service model of the 1980s doesn't address our needs or suit the times.
A Medicare Benefits Schedule that is nearly 6,000 items long is proof of that.
When it launched in 1984, there were barely more than 2,000 items on the Schedule.
Now, it is hugely complex. Some find it so complex that they underbill. Others incorrectly overbill, despite their best efforts.
The time has come to develop new funding models that supplement fee-for-service.
And it begins this year, with the launch of something called “MyMedicare”
General practices will be able to register with MyMedicare, so that patients can register with their preferred GP at that practice. Over time, MyMedicare will also be extended to nurse practitioners and other primary care providers.
Patients will gain a stronger relationship with their health care teams and will get access to more consistent care, including longer telehealth consultations under Medicare.
Providers will get access to new funding packages, and more information about their regular patients, so they can provide more tailored care.
MyMedicare will be open to everyone and entirely voluntary, and the benefits of this system-wide reform will grow over time, as more patients and providers join.
But the true power of MyMedicare is not what it is … but what it allows.
MyMedicare is the foundation upon which we can build a range of blended funding models to better serve the needs of patients that fall through the cracks of our 1980s Medicare.
There are more than 13 thousand patients that present to hospital 10 or more times each year. These are people with complex, chronic conditions that aren’t getting the comprehensive, team-based care that they need out in the community.
Through MyMedicare, these patients will be identified and the GP they register with will receive incentive payments to deliver the tailored care that they need to stay healthy and out of hospital.
It’s the kind of program that has been sorely lacking in Australia, and one that Medicare of the 1980s just couldn’t deliver.
It blends fee-for-service with patient-centred funding, so doctors can spend more time doing what they trained for, and health teams get support to provide long-term care, not just piecemeal funding for the procedures that they perform.
Because if COVID-19 taught us anything, it’s that our people are our health system’s greatest asset.
That’s why the third and most important foundational change is to grow, support and invest in the incredible health workforce that Australia already has.
Our highly-educated and trusted nurses and midwives, in particular, can play a much bigger role in primary care.
Next week’s Budget will include funding for up to 6,000 nursing students to do clinical placements in primary care services around the country, as well as funding to support 500 enrolled and registered nurses to return to the profession.
There are 450,000 registered nurses and midwives in Australia, and we want them to be at the forefront of reforms to primary care. 
But, at the moment, Medicare does not do enough to encourage or enable them – or many other health professionals – to provide care.
Even if they have the training and expertise to deliver the care that a patient needs, they may be held back by a complex maze of regulations and funding programs.
We need to ask the question: does that meet the needs of 21st century Australia?
The Government will commission a Review of Scope of Practice to ask – and answer – that question.
We cannot build a more collaborative primary care system, or support practitioners to work autonomously, unless we are prepared to get rid of the red tape and outdated silos that prevent team-based care.
That goes not just for nurses, midwives and allied health, but for pharmacists as well.
People tell me time and time again that over the course of this pandemic, there has been no more accessible health setting than their local pharmacy.
Pharmacists have already administered more than 10 million COVID-19 vaccinations. They administered 2 of every 5 vaccines last week.
From next year, Australians will be able to walk into community pharmacies and get safe and convenient access to vaccines on the National Immunisation Program, free of charge.
Australians battling through opioid dependency will soon get the affordable and subsidised treatment that they need at a community pharmacy.
Together, these two programs alone mean a nearly $500 million investment by the Albanese Government in community pharmacies over five years.
A stronger Medicare means growing the health workforce, while removing the red tape that prevents our highly skilled nurses, midwives, pharmacists and other health professionals from providing every ounce of care they can.
Because that will also free up our doctors to focus more on the complex conditions that only they can treat.
These three foundational reforms will make Medicare stronger.
But remaking Medicare for the 21st century will take persistent evolution, not overnight revolution.
It took nine years of nasty cuts and calculated neglect to bring Medicare to this weakened state. It will take time again to strengthen it.
But I make this promise to you today: with every gradual, foundational change that we make, we will put the needs of patients first.
As we take the hard choices, I fully expect that some will oppose them, just like the Liberal Party opposed Hawke’s Medicare in the 80s, Whitlam's Medibank in the 70s and Chifley’s PBS in the 40s.
Change is scary, because with change comes risk.
But the risk of not changing is far greater.
We can’t keep trying to treat 21st century Australia with 1980s Medicare.
So we will listen to all good arguments and evidence about the way forward, but our north star is – and will always be – what's good for Australians.
Because at the end of the day, Medicare is for people.
Today and tomorrow.
In 1984 and 2024.
And -- as long as Labor is around to strengthen it -- in 2064 as well.
I’d like to turn now to another area of urgent reform – vaping.
When Medicare was getting underway in the 1980s, the biggest public health challenge was tobacco: 40 per cent of men and 30 per cent of women were regular smokers.
We’ve done well on that count. Today, only around 10 per cent of Australians smoke.
The progress that we have made is thanks, in large part, to the efforts of successive Labor Health Ministers, especially Nicola Roxon who introduced our world-leading plain packaging reforms.
In November last year, on the ten-year anniversary of those laws, I announced our intention to build on that legacy and implement the next generation of tobacco control reforms.
But unfortunately, the gains we’ve made in tobacco could be undone by a new threat to public health.
Vaping was sold to governments and communities around the world as a therapeutic product to help long-term smokers quit.
It was not sold as a recreational product - especially not one for our kids. But that is what it has become: the biggest loophole in Australian history.
1 in 6 teenagers aged 14-17 has vaped.
1 in 4 people aged 18-24 has vaped.
By contrast, only 1 in 70 people my age has vaped.
And when more than a thousand teenagers aged 15 to 17 were asked where they could get vapes, 4 out of 5 of them said they found it easy or somewhat easy to buy them in retail stores.
In retail stores.
This is a product targeted at our kids, sold alongside lollies and chocolate bars.
Vaping has become the number one behavioural issue in high schools. And it’s becoming widespread in primary schools.
Over the past 12 months, Victoria’s poisons hotline has taken 50 calls about children under 4 becoming sick from ingesting or using a vape.
Under the age of 4!
Vapes contain more than 200 toxic chemicals that do not belong in the lungs, some of the same chemicals you’ll find in nail polish remover and weed killer.
Just like they did with smoking, Big Tobacco has taken another addictive product, wrapped it in shiny packaging and added sweet flavours to create a new generation of nicotine addicts.
Young vapers are three times as likely to take up smoking. So is it any wonder that under 25s are the only cohort in the community currently recording an increase in smoking rates.
This must end.
To his credit, the former Health Minister Greg Hunt tried to put border controls in place, but there was a revolt in his party room and that regulation was overturned within two weeks.
Instead, the former Government created the perfect conditions for an unregulated - essentially illegal - market to flourish right before our eyes; in convenience stores, tobacconists and vape shops
Sometimes deliberately set up down the road from their target markets - schools.
A so-called prescription model, with no prescribers.
A ban, with no enforcement.
An addictive product, with no support to quit.
Over Summer, the Therapeutic Goods Administration consulted health groups and the community about vaping and provided us with a clear roadmap.
The first thing to do is to stop the import of vapes that aren’t destined for pharmacy shelves - to be sold as a therapeutic product with the approval of a health professional.
To obtain an import permit, an importer will have to show the vapes comply with new standards and processes established by the Therapeutic Goods Administration.
They will have to be imported for sale in pharmacies only.
The import of vapes for sale in retail settings will end.
These are supposed to be pharmaceutical products, so they will have to present that way - no more bubblegum flavours or pink unicorn packaging.
Pharmaceutical-style packaging and devices, with plain flavours.
I also intend to accept the TGA’s advice and ban single-use, disposable vapes that clog landfill and are toxic to the environment.
Obviously, to make this work, we will need the assistance of State and Territory governments to close down the sale of vapes outside pharmacies - in convenience stores and the like.
But, I know my colleagues at State and Territory level are just as committed as I am to stamping out this public health menace with a strong national response.
We also all recognise, though, that there is still a therapeutic use for vapes in the right circumstances - to help long term smokers quit cigarettes, or perhaps now also to assist in nicotine addiction caused by vapes themselves.
But a prescription is hard to come by.
Only 1 in 20 doctors are authorised to prescribe vapes to those who need it. That has to change.
It will require removing the restrictions on doctors prescribing, so all doctors can write a script for those who really need it.
Governments will also consider whether other proper therapeutic pathways should be examined to allow patients to obtain vapes through a pharmacy where they need them.
Because a whole new generation of Australians will need support to quit their nicotine dependency.
And they won’t be alone in their quest to kick the habit!
Next week’s Budget will include $30 million for support programs to help Australians quit and $63 million for a national evidence-based information campaign, with a particular emphasis on young people.
And as we stamp out the growing black market in illegal vaping, we also need to prevent young people from trading their vapes for cigarettes.
Which is why this Budget will also include measures to bring smoking rates down, protect people from taking it up, and additional support for current and former smokers to look after their health.
Today I announce that tax on tobacco will be increased by 5% per year for 3 years starting September 1, because we know that a higher priced cigarette is a more unattractive cigarette.
We will also align the tax treatment of tobacco products, so that products like roll-your-own tobacco and manufactured sticks are taxed equally.
Together, these changes will raise an additional $3.3 billion over the coming 4 years, including $290 million of GST payments to the states and territories, helping to support our health system, and the health of current and former smokers and vapers.
More than $260m will be invested in a new national lung cancer screening program that will prevent more than 4,000 deaths from lung cancer.
At risk Australians will be able to get a lung scan every two years, as recommended by the independent Medical Services Advisory Committee.
Lung cancer is the leading cause of cancer death in Australia.
And we know that First Nations communities carry a much higher burden, when it comes to rates of both smoking and cancer, such that cancer is now the leading cause of disease-related death for First Nations people.
The Budget will include nearly $240m to address this inequity, with funding to ensure mainstream cancer services are culturally safe and accessible to First Nations people, as well as funding to build the capacity and capability of the Aboriginal Community Controlled Health Services sector to support cancer on the ground.
And the successful Tackling Indigenous Smoking (TIS) program will be extended and also widened to reduce vaping among First Nations people, as well as smoking.
Health Ministers are unanimous in their commitment to work together on vaping and tobacco control.
Yesterday, we all agreed to work urgently together to develop the comprehensive, coordinated suite of regulations to make this plan work.
We will not stand by and allow vaping to create another generation of nicotine addicts.
Thank you.

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