Minister for Health and Aged Care – transcript – ABC Brisbane Mornings – 3 May 2023

Read the transcript of Minister Butler's interview with Rebecca Levingston on Medicare, the health system and healthy living.

The Hon Mark Butler MP
Minister for Health and Aged Care

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REBECCA LEVINGSTON, HOST: The Federal Health Minister is Mark Butler. Minister, good morning.

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Good morning. I'm so glad you kept that song going to the end.

LEVINGSTON: I know, isn't it funny how it's sort of, it's nostalgia, and I bet there'll be a lot of people who go: that worked, that was great. Do we need another campaign like that today, Minister?

BUTLER: Well, it's reminded me, I'm going to go and dig into the history of it and really try to understand better what drove the campaign and what the government was trying to achieve by funding it. But these campaigns are very effective, we know that across a range of different health areas. I've been talking over the last 24 hours mainly about smoking and vaping, we know the importance of good information campaigns there – but that question of physical activity, and of diet is probably the biggest health challenge we are facing today, and certainly will be facing over the coming 10 to 20 years, I think.

LEVINGSTON: You do sound a bit croakey, Minister, you haven't been vaping, have you?

BUTLER: I sound worse than I feel, but I apologise, it’s an occupational hazard.
LEVINGSTON: Yes, all the talking.

BUTLER: Speaking too much.

LEVINGSTON: All right. I thought you might have been testing out bubble gum vapes or something but clearly not. On vaping, there’s lots of detail yesterday on the vaping crackdown, why not just phase out smoking altogether like New Zealand? They've introduced that steadily rising smoking age to stop kids under the age of 14 from ever legally being able to buy cigarettes. That was world first legislation. Why doesn't Australia follow?
BUTLER: It hasn't been recommended to me. We're watching over the ditch very carefully and closely to see the impact of that decision by the New Zealand Government, but we've got a range of other measures that we think will continue to drive down the rates of tobacco use – of smoking cigarettes. It was only a few decades when the Norm ad was on, for example, 30 or 40% of adults smoked cigarettes regularly. It's now down to 10%. Now we have to get that down further, but we have made really significant strides with the efforts that we made. Some of them world leading like plain packaging, for example.

LEVINGSTON: Yeah, I reckon Norm probably smoked...

BUTLER: Looked like it to me...

LEVINGSTON: I mean if you went back and watched it, there was a whole series of ads, but some of them in 2023 probably aren't appropriate to run for various reasons. The other thing that's part of the campaign is, you know, a doctor can tell you how your heart is going, or if you're too heavy. For a lot of Australians today, Minister, getting into the doctor is a challenge, and I know you're looking closely at bulk billing. What is the ideal mix of bulk-billing doctors versus private doctors in Australia? What are you shooting for?
BUTLER: I think the first thing to say is it's a very varied picture across the country. So, the highest point is in Western Sydney, where over 90% of patients are fully bulk-billed. In Brisbane, north of the river it's about 55%, south of the river it's about 67% so quite a difference across your city.

BUTLER: It really is not clear to me why you have such a variety across the country. In Western Sydney it's very expensive to run a business, so it's not clear to me why it would be over 90% in Western Sydney, but under 50% in Tasmania, for example. There's obviously a lot of work for us to do to put a floor under bulk-billing rates. They're falling very quickly at the moment and the most significant worry I have is that increasingly pensioners, concession cardholders, children are also being charged a gap fee to go to the doctor, and that's a particular worry because that's never been the case through the history of Medicare.

LEVINGSTON: Is your goal then that all Australian pensioners and all Australian children would have access to a bulk-billing doctor?
BUTLER: I'd like to see bulk billing as high as it possibly can be. But you're right, my particular focus is on pensioners, concession cardholders – those on the lowest incomes and also children.

LEVINGSTON: Can we expect funding to that extent in next week’s Budget?
BUTLER: I can't reveal what's in next week's Budget. But we've been working very closely with doctors' groups who are obviously also deeply concerned about the financial pressure they've been under, because the Medicare rebate was frozen for 6 long years under the last government and that's really imposed a big cost on doctors and their ability to just run their businesses, which has become particularly acute as we've seen inflation rise over the last 12 or 18 months across the world.
LEVINGSTON: Minister we also need more doctors, where are they going to come from?

BUTLER: Medical schools obviously, but...

LEVINGSTON: But in Australia or internationally? Are you anticipating that there will be – or do you need – a big influx of international doctors?
BUTLER: We've always relied on international doctors to supplement the workforce, particularly in rural communities, but my major focus is that fewer and fewer medical graduates from Australian universities are choosing general practice. It used to be about half of young doctors chose a career in general practice. Now that's down to only 14% lower than it’s ever, ever been. We've got to turn that around. That is simply an unsustainable level. We've got a send them a message that we value general practice, we value it financially, but also we value it as the backbone of Australia's healthcare system which generally is what it is. And if we continue to see this crisis in general practice, which is what I think it is right now, we’re going to see more and more pressure built on our hospital system and our community become sicker and sicker.

LEVINGSTON: You're listening to the Federal Health Minister, Mark Butler, who has been talking a lot about vaping over the last couple of days, or 24 hours or so, which is why his voice is pretty croaky. But this morning, giving the nation a bit of a health check. Just on budgets, and I know you're saying next Tuesday night a lot will be revealed, health is top of mind for a lot of Aussies and a lot of my listeners to you this morning, Minister. Budgets are tight, whether it's your family or the government. In simple terms, can you explain how the health funding is split between the Commonwealth Government and the Queensland Government? Because, to put that into context, we're asking lots of questions all the time from the Palaszczuk Government on, you know, where are we at with hospitals? Where are we at with ambulances ramping, is that a state responsibility? But we know that there is a huge funding responsibility from the government, so can you explain that funding split in simple terms?

BUTLER: Nothing in Australia is simple given we've got so many different levels of government, but broadly the Commonwealth funds Medicare entirely, the Commonwealth entirely funds our medical system, so the Pharmaceutical Benefits Scheme, and essentially, we split hospital funding something close to 50/50, it’s actually about 55% the states, and 45% the Commonwealth. But broadly it sort of half-half, something close to half-half. So that's about as simple as I can make it, Rebecca.

LEVINGSTON: That’s super helpful. Ok, Commonwealth responsible for Medicare and for medicines – the PBS, that hospital split, 55% for Queensland 45% for the Commonwealth. The Australian Medical Association would say it needs to be bumped up to be a 50/50 split without taking any money away. Do you see that split changing any time soon?

BUTLER: Not any time soon. We're partway through a 5-year funding agreement with the states that I didn't sign, it was signed by the Queensland Government, other state governments, along with the former government. We've agreed as health ministers, including your terrific Health Minister Yvette D'Ath there, to conduct a mid-term review of that agreement, which we've got a couple of experts including Former Director-General of Queensland Health conducting right now. That will report by the end of the year and then at some point over the course of next year, I think we'll start negotiations for another agreement but really, I think states agree that the best thing the Commonwealth can do right now is focus on strengthening Medicare because they understand that the crisis in general practice, essentially is showing up at their emergency departments placing real pressure on the hospital system, which is why National Cabinet has been talking so deeply about Medicare over the last couple of months.

LEVINGSTON: Yeah, it's interesting, Minister, that you described Queensland's Health Minister as terrific that's the word you used for Yvette D’Ath. I don't want to make this personal, it's an incredibly challenging task no doubt to be a Health Minister at a state or federal level, but for my listeners they are hearing stories of ambulance ramping delays, overcrowded emergency departments, that's before we get to the kind of the mental health challenges of someone turning up at an episode in ED when that's not where they should be. We touched on already the challenges in getting in to see your doctor and let alone getting in to see a bulk billing doctor. Why do you describe Queensland's Health Minister as terrific?

BUTLER: Yvette has been the Chair of the Health Ministers across the country through a really difficult period over the course of the pandemic. She's shown really strong national leadership, and it won't be a particular comfort to your listeners, but can I say, those points you raise around ramping, around the pressure hospital systems are under, are being seen right across the country, and actually right across the world. Hospital systems, health systems generally are under enormous pressure, after 3 years of COVID the health workforce is exhausted. Patients are much sicker than they otherwise would be, because so many that weren't able to get in to see a doctor when they should have, because of lockdowns, because of pressure on the health system driven by the pandemic. So, we are going to see essentially a hangover from COVID in health systems across the world - not just in Queensland - for some time to come, it's going to take really determined effort by governments, by doctor, by nurses and health professionals to bring the system back to a level of equilibrium, if you like after 3 years of such enormous stress.

LEVINGSTON: Australia has got a hangover. Norm, I'll put this back to him, before you go, Minister Mark Butler, as the Federal Health Minister in Australia, what do you do to keep healthy?
BUTLER: I try to exercise every day. It's not always easy. I try to take my old, tired body to the gym. If I'm staying somewhere near water I try to walk along the water, I find that not only good physical exercise, but mentally, spiritually, really calming as well. So, at my age, I am in my 50s, it's really important to try to exercise every day, if possible, get the blood moving, particularly do some resistance training to keep the joints, to keep the muscles alive, as well. But it is hard – I understand it's hard for everyone – we all live busy lives right now and they just keep getting busier it seems. Finding time for exercise is hard but it's just so important.
LEVINGSTON: Well, here’s your soundtrack when you go out on your walk tomorrow, Minister, appreciate your time. Mark Butler, thank you so much. We’ll stay in touch.

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