GRAEME GOODINGS, HOST: Health Minister Mark Butler. Minister, good morning.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Good morning. Graham.
GOODINGS: There must be an election in the wind?
BUTLER: Well, there will be one soon. Quite when, I'm not sure. Only the Prime Minister knows, it will be in the next several weeks or couple of months, I would have thought. It's coming.
GOODINGS: At any election, health is always high on the agenda. The stakes are particularly high this time. Labor came up with its $8.5 billion pledge with bulk billing and the like. Then the Coalition came out and upped that $8.5 billion plus $500 million for mental health. Where do you see that? Is this just a bidding war?
BUTLER: The package that we announced on Sunday, the Prime Minister and I, is focused on really turning around bulk billing rates. It's the latest in a series of very big investments we've made in Medicare, which was under real pressure when we came to government. I mean, it had really been choked financially over the last decade, particularly when Medicare funding was frozen by Peter Dutton when he was Health Minister a decade ago. Then on top of that you get the fact we're getting older as a population, we're a little sicker. And then COVID on top of the healthcare system meant that general practice in particular was in a really parlous state when we came to government. So, a couple of years ago we tripled the bulk billing incentive that is paid to GPs if they bulk bill pensioners, concession card holders and kids under the age of 16, because we were told and we found that bulk billing was in “free fall” when we came to government. That was the language of the College of GPs. That investment worked exactly how we wanted it to. Bulk billing started turning around again for that cohort, that group of Australians: kids, pensioners and concession card holders, and bulk billing for them is now comfortably above 90 per cent. So more than nine out of ten visits to the GP for those Australians are bulk billed. The problem though, is for people without a concession card. Their bulk billing rates continue to slide. That's what Sunday's announcement was about. Extending, for the first time, bulk billing support to all Australians. Doctors will get a very, very big increase in their income if they bulk bill people who don't have a concession card. We're confident that will deliver about 18 million additional free visits to the GP every year, including about 1.5 million here in South Australia.
GOODINGS: We have Health Minister Mark Butler in the studio. If you have a question of the Minister, give us a call now 8223 0000. It's all well and good putting the money in for bulk billing, but there's no obligation for doctors to take it up, is there?
BUTLER: Well, there's none, and we don't have a system like Britain does where the government employs every doctor. We've got more of a private system. So, I can't force them to, but what we've modelled and it shows very clearly is that the majority of general practices would be substantially better off if they bulk billed all of their patients and took the additional income from the Medicare system that is on offer. On the other hand, Graham, some doctors have been arguing to just increase the Medicare rebate and just give us the income with no strings attached and, you know, we undertake to try to bulk bill as much as I can. I considered that and I just didn't think that was the right thing to do for taxpayers.
We, unapologetically as a Labor Party, from the time we introduced Medicare 41 years ago under Bob Hawke, have always had bulk billing as the beating heart of Medicare. Now it was hard fought. The AMA, the Australian Medical Association, back 40 years ago, instructed their members not to bulk bill threatened for doctors to go on strike, took out full page ads in the newspaper against bulk billing. But we've kept up the fight to maintain bulk billing. Free visits to the GP. They're good for peoples hip pocket, obviously, but we're finding more and more Australians are not going to the doctor because they can't afford it. And what that means is you just get sicker, and you end up having to be cared for somewhere else in the health care system, which is probably even more expensive, like a public hospital. This is one of those policies that is good for hip pockets, and that's important particularly now given cost of living is a real pressure, but it's also good for peoples health
GOODINGS: If your bulk billing expansion is so important, why are you waiting to November? Why couldn't you introduce it right now?
BUTLER: Medicare changes always take effect on the 1st of November when we update the Medicare schedule, and you need to give general practices some time to take advantage of the record investment we announced on Sunday. They'll have to update their software, they'll have to change their billing practices. In addition to paying the big bulk billing incentive for all Australians for the first time, I'm also adding a new payment to general practice so there's an additional loading of 12.5 per cent on top of their income they'll get if they bulk bill all of their patients. We'll have to update software, they'll have to change their billing systems. But we're not phasing it in. All of this new funding comes in on the 1st of November. That sounds a way away, but you know Graeme these systems don't work overnight. It will take some months to work into the system. In the meantime, I'm really pleased of the bulk billing investments we’ve made. At the end of 2023, bulk billing has seen a turnaround in every state and territory. Bulk billing is now up 4 per cent here in South Australia. Last year we delivered an additional half a million free visits to the GP in SA. So, what we've done has made a meaningful difference. But I know we have to do more and that's what Sunday's announcement was about.
GOODINGS: $8.5 billion, it's a huge commitment. Where does the money come from?
BUTLER: Essentially what it is, according to the Australian Medical Association, the AMA, it puts in what Peter Dutton pulled out when he froze the funding ten years ago. Doctors incomes were frozen for six long years while their costs were continuing to rise. You don't have to be a Nobel laureate economist to work out that at some point there comes a real pressure on doctors to move away from bulk billing. So, what we've done is essentially put the money back in or promise to put the money back in, that was taken out over the past ten years.
GOODINGS: Jenny from Hallett Cove has a question for the Minister. Jenny, go ahead.
CALLER: Oh, hello Mark. Thanks for taking my call. And hello, Graeme. I just wanted to know, I've heard recently that one of our doctor surgeries down Hallett Cove way is actually closing due to lack of doctors. I'm just wondering what we're doing in regard to that?
BUTLER: Thanks, Jenny. We've got a challenge right across the health system getting enough doctors and nurses and other health professionals. But we've got a real challenge for GPs. Thirty years ago, about half of all the young people coming out of medical school chose to become GPs, and the other half decided to become surgeons and anaesthetists and the rest. Now that's down from 1 in 2 to about 1 in 6. And we need more.
On Sunday, we also, in addition to the big bulk billing investment, announced a very big investment in new doctors. So, we're expanding medical school places, we're expanding the GP training scheme. We'll be training many, more young Australians to become GPs. Also, some additional nurse scholarships as well. And in the meantime, what we're doing for country areas, who have always relied on overseas trained doctors, we're bringing in doctors from systems we trust and know very well, like the UK, Ireland, New Zealand. We're bringing them in much, quicker. We're cutting red tape. Over the past couple of years we've added about 17,000 doctors to our system, which is more than we've added for a very long time indeed. But I get that it's still hard to find a doctor. We've got to do a lot more, which is what Sunday's announcements were all about. Training more of our own young Australians, particularly to become GPs and advanced nurses, while also recognising there are some parts of the country where we need doctors from overseas.
GOODINGS: Thanks for your call Jenny. Minister, can you stick around for a little bit longer? We've got more calls. We'll just take a break back shortly.
GOODINGS: I have the Health Minister Mark Butler in the studio. Minister, let's take some more calls. Geraldine, good morning.
CALLER: Hi. Mark Butler. Your portfolio is My Aged Care, isn't it?
BUTLER: Yes it is.
CALLER: Yeah, I'm with My Aged Care and my provider, what they do is they take a percentage of what you get every month, and that's the running cost. But what they're doing is for the cleaner and the gardener and so on, what they're doing is they're doubling those amounts and they're keeping that money for themselves. And I don't think that should be allowed. What's your opinion?
BUTLER: Well, Geraldine when we came to government there was lots of unrest about the amount that the home care providers were taking - I'm doing air quotes here in Graeme’s studio – of administration funding. And we've put in place controls on that. Of course, they've got to have some of the money to run their operations, but frankly they were taking too much in my view. There are strict rules around that. I don't obviously have your material in front of me, Geraldine, but you should ring my office if you want us to follow that up. You'll find my office details in plenty of places, and we can follow that up for you. Because I've always been determined to make sure that as much of the dollars that taxpayers invest in supporting older Australians at home actually goes to care, it doesn't get sort of taken off into administration and other things like that. I'm determined to make sure that taxpayers’ dollars are going to care. If you ring my office, we'll follow that up for you Geraldine.
CALLER: Can I ask you something else?
BUTLER: That's up to Graeme. It's his party.
GOODINGS: If you're quick, Geraldine, we've got other calls. Go ahead.
CALLER: Sorry. Um. I've forgotten what it was now. Sorry.
GOODINGS: Good on you, Geraldine. Maybe next time we'll get the Minister on. From the text line, addressed to the Minister. You have been in government three years, why all the announcements now Mr Butler?
BUTLER: We've been really busy strengthening Medicare. As I said, in 2023, we delivered the biggest investment in bulk billing. That's delivered more than half a million additional free visits to the doctor in South Australia, more than 6 million across the country. As I said to you earlier Graeme, that was really focused on pensioners, concession card holders and kids. We've rolled out 87 Medicare Urgent Care Clinics that have seen 1.2 million people, every single one bulk billed, taking pressure off hospitals. Really the announcement on Sunday was the latest chapter in a series of very big investments we've made to strengthen Medicare. We've been working from day one of our election to turn Medicare around after a decade of cuts and neglect. But I was very honest with people, I hope at the time to say, we're going to fix it in three years. This is a big system with a lot of pressure on it. We were determined to keep working chapter by chapter in making sure we delivered what Bob Hawke and Neal Blewett promised 41 years ago - universal healthcare for everyone; the best possible healthcare on the planet, no matter what your income.
GOODINGS: You can understand people being a little cynical because it always just ahead of an election, there are a lot of announcements made.
BUTLER: Sure, of course there are, because that's when people focus their attention. You know, most of the time people don't want to listen to me and other politicians. They're busy getting on with their lives. But the great democratic thing is that every three years in this country the people get to choose who's going to govern the show. I know that every election health, as you said in your intro Graeme, health is really important. Medicare is important because it touches everyone. Everyone touches the health care system at some point in a given year and they know that health care is under pressure after those things that I talked about. So, yes, we will roll ideas out. It doesn't mean we've been sitting on our hands for the last three years. We've been very busy on Medicare, on aged care that we talked about, and a range of other things in my portfolio as well.
GOODINGS: 8223 0000 the number to ring if you'd like to ask a question of federal Health Minister Mark Butler. Fay, good morning.
CALLER: Yes, good morning boys. The question I've got is with bulk billing. There’s a section of bulk billing that's been frozen since 1999. My questions are one, why is it that it hasn't been unfrozen? Two, who keeps freezing it? And three, why is it that you cannot introduce some compulsory legislation which says doctors must bulk bill, because you said you can't make them do it and I guess there's truth in that to a point, but there should be some legislation of some sort enshrined into law. Because if we're trying to get more people to go to the doctor, we all know the cost of living and if we're trying to get people to go to the doctors, why isn't this legislation compulsorily introduced?
BUTLER: It's a really interesting point you raise Fay. Way back in the 1940s when the British Labour government was introducing the National Health Service, the Labor government here under Ben Chifley wanted to do the same. But there ended up being a referendum that changed the constitution, that prohibited the Commonwealth government from engaging in what the Constitution calls “conscription of doctors.” It was a wording that Bob Menzies came up with. It meant that the Commonwealth was able to do health policy and aged care and things like that, and do pensions, but there's a constitutional prohibition on the Commonwealth conscripting doctors to do things like bulk billing. So that's just how the system works and that's why we have to put in place incentives. In terms of your earlier question about the freezing of bulk billing or rebates for some parts of the healthcare system, there have been some parts, I'm not sure what part you're talking about, but for example pathology income was frozen for 25 years. I lifted that freeze in last year's budget. So, pathology rebates will be indexed or increased every year for the first time in 25 years, except where I think pathology companies are getting the benefit of technological change that improves their bottom line rather than patient outcomes. We look at this carefully. You know, when you look at mobile phones and computers, there's a whole lot of efficiencies that businesses are getting. If pathology businesses or other businesses in the health care system are getting big efficiencies through technological change, I don't want to see those efficiencies simply improve their bottom line, I want to see it improve the healthcare system and patient outcomes. And that can be sometimes why we take different approaches to those parts of the healthcare system that very much rely on technology rather than face to face consults.
GOODINGS: We have calls flooding in. Let's see if we can get through a few of them. Linda, go ahead.
CALLER: Hi, I'd like to know why men with, my husband has stage four prostate cancer, and to tell where his cancer is at nuclear medicine scans are the only thing that will tell us. I'd like to know why men with stage four prostate cancer are limited to two of these scans in their lifetime, whereas a woman with breast cancer can have as many as they like?
BUTLER: So, Linda I have to say I don't know the answer to that off the top of my head. I'd be happy for you to contact my office and we can follow that up in specific detail. But broadly can I say there's about 5,800 items on the Medicare schedule including things like the scans you talked about. And the way they operate is not determined by me or other politicians, it is determined by experts, clinicians coming together and providing the government with advice about the best way, for example, nuclear medicine scans to operate. So, what are the costs, what are the benefits and things like that. Where there is an argument at the edge, usually we allow additional scans where the doctor provides advice about that. That's the general approach we take. All of those restrictions reflect the best possible expert clinical advice, and we’ll make sure that advice is from doctors who work in that particular area. But if you want some more specific advice about that Linda, I'm sorry I can't give it to you off the top of my head but you can contact my office and I will follow that up for you at a time where I know you're desperately concerned about making sure your husband gets the best possible care.
GOODINGS: Thanks for your call, Linda. Time to squeeze in. Just one final call. Steve, go ahead.
CALLER: Hello Minister. Basic dentistry, not cosmetic, have you ever thought about putting that on Medicare for like tooth pain and you know, plaque can get into your system. I know the Greens are all for it, but have you ever thought of doing it?
BUTLER: Steve, this is raised with me a lot. It's a quirk of history that the mouth is the one part of the body not covered by Medicare. Gough Whitlam, when he was introducing Medibank, and then Bob Hawke with Medicare in the early 1980s, took frankly, the view that they could only fight on so many fronts. Doctors were fighting them about Medicare, the Liberal Party wasn't supporting it, and dentists at the time opposed dental going into Medicare as well. So, it's a bit of a historical quirk. Our party, the Labor Party, has a commitment in the platform over time to change that. But I've tried to be honest with people that I wouldn't expect that to happen anytime really soon. As I said we're putting very substantial investments into trying to strengthen Medicare as we currently understand it. We do have some schemes. We have Medicare entitlements for kids from lower income households. We introduce that when we were last in government. That's made a huge difference to the oral health of children and teenagers in Australia right now. I'd love to do more in that area, but I can't promise you it's going to be very soon.
GOODINGS: Thanks for your call, Steve. We're out of time. One final question. When are we going to the polls?
BUTLER: I can't tell you that, Graeme.
GOODINGS: Do you know?
BUTLER: No, I don't, the Prime Minister will make that decision pretty soon. It will be in the next several weeks or few months in that it's got to be by May. And it will be at some time over the next few months.
GOODINGS: Thanks for dropping by.
BUTLER: Thanks very much.