Radio interview with Minister Butler, ABC Adelaide Breakfast – 24 February 2025

SONYA FELDHOFF, CO-HOST: Yesterday, big announcement from the Federal government that it was going to invest $8.5 billion over four years into a Medicare package. Yeah, it feels like an election is coming on, doesn't it?
 
JULES SCHILLER, CO-HOST: It does. I mean, reading about this, the number of people in their 20s not going to the doctor has tripled because of the cost over the last three years. I mean, this is when you really see, you know, how cost of living is affecting people's ability to go to GPs and of course, which then puts pressure on hospitals.
 
FELDHOFF: And I guess what we say from that is, are people actually going to the GP when they need to if they can't afford to? Probably not. Mark Butler is the Australian Minister for Health and Aged Care and joins us now. Minister, do you think this investment will see more people going to the doctor when they have to?
 
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: The short answer is yes, Sonya and that intro was spot on. What we're seeing is bulk billing slides and out-of-pocket costs that are going up, particularly for people who don't have a concession card. More and more Australians are saying they're not going to the doctor when they need to because of cost. We saw that with medicines before we made some very big cuts to the price of medicines. People were saying they weren't getting scripts filled because of cost. That's really why we invested such a big amount. I mean, it's a big amount of money, but I can't think of anything more important for a government to do than ensure that people are able to access the health care they need when they need it, without worrying about their credit card limit. That's what yesterday's announcement was about. It was good for people's hip pocket, that's important, but as the Health Minister, the really important thing, is it's good for their health. Because if you're not getting to your GP in time, the chances are you're going to get sicker and end up in somewhere some other part of the health care system that's probably more expensive, like a hospital.
 
SCHILLER: Minister, let's get to some of the details. So you're boosting Medicare rebates, and you're also going to give a practice a boost of 12.5 per cent if they switch to bulk billing only. So is that right? And how much are the rebates being increased by?
 
BUTLER: For many years now doctors have got an additional payment if they bulk bill pensioners, people with a concession card, so people on very low incomes, and children under 16. We tripled that incentive the year before last because we were concerned that bulk billing rates for that cohort in the community were starting to slide as well. What that tripling of the incentive did was stop that slide and turn it around. That group; pensioners, concession card holders, their bulk billing rate is now comfortably over 90 per cent. But if you don't have a concession card then bulk billing rates are starting to slide - they have been for years quite considerably. What we've done for the first time is make that bulk billing payment available to all Australians, not just Australians with a concession card. On top of that, for the first time, we're going to provide practices who bulk bill all of their patients with an additional 12.5 per cent loading. It's a huge investment to turn that slide that we're seeing right now in bulk billing, to turn that around and lift it back up to 90 per cent.
 
FELDHOFF: So only GPs who agree to bulk bill all of their patients will get this incentive?
 
BUTLER: No you'll get the incentive, the per patient incentive, if you bulk bill that patient. But on top of that, if you bulk bill all of your patients, you'll get an additional payment as well. That's an entirely new payment that's never existed before.
 
FELDHOFF: And is that increase to the level that doctors say is required to make it viable for them to keep their businesses going?
 
BUTLER: We have really good info on what doctors bill Medicare and then what they bill their patients with gap fees. We've got a very good line of sight about what's happening in general practice Our modelling shows very clearly that the announcement yesterday means that almost 5,000 general practices around the country would be better off under our funding arrangements if they bulk bill all of their patients, if they become fully bulk billing practices. That's about triple the number of bulk billing practices that we have right now in Australia.
 
SCHILLER: We're getting texts from GPs Mark Butler saying that this won't change the fees charged where I work and it actually amounts to a significant pay cut. Now, I'm not sure how this GPs practice operates, but we've heard this a few times. So will it amount to a pay cut for some models of practices?
 
BUTLER: There will be some practices who want to continue what they call “mixed billing.” They might bulk bill pensioners and kids but still charge a gap fee to some people. Our modelling sees bulk billing get up back up to 90 per cent. At the moment it's dropping to about 60 per cent for people who don't have a concession card. It's a very big increase. We think about an additional almost 20 million free visits to the doctor every year because of the investment yesterday. But that doesn't mean every doctor's going to do it for every single patient. We've been very clear about that. But as I said, if you look at the numbers, crunch the numbers as a general practice, a very significant percentage of them will be better off under the arrangements we announced yesterday. Just to give you a sense, if you're in Adelaide, a standard consult  for a doctor bulk billed after yesterday's announcement increases by more than 60 per cent and if you're in a small rural town, it's basically doubled the amount of income that a GP will get from the Medicare system. It's a huge increase.
 
FELDHOFF: Minister, one of the other aspects of this, aside from the bulk billing is the numbers of doctors. And we know now, under this plan, you say we will be able to have more people being bulk billed. That's if they can get in to see a doctor. And that is a real struggle at the moment. When are we going to see the first of these 2,000 extra doctors per year that you're promising under this plan?
 
BUTLER: This year already, we're we've got more junior doctors in general practice training than at any time in our history. For the last couple of years, that number of medical graduates who are choosing to become GPs, rather than, for example, a surgeon or anaesthetist, that's been climbing quite sharply, which is really reassuring. They're just green shoots of recovery. We need more junior doctors choosing general practice So next year we'll add another 200 to the training scheme, and the year after that, another 200 as well. It's an upward rise that's already over the last couple of years.
 
SCHILLER: Sorry to interrupt, does this mean you're having more medical school places. Or does this mean that you're just increasing the traineeships?
 
BUTLER: We're doing both. In addition to that, we're increasing the number of university medical school places as well. More medical graduates and hopefully more of them choosing general practice as well. We're going to start to deal with some of the frankly, financial disincentives there are for a young doctor to choose general practice If you're a GP in training, you're probably going to earn a fair bit less than a junior doctor training in the hospital system. We're going to give them an additional $30,000 incentive every year to close that financial gap. We're going to give them access to parental leave because if you train in a hospital for five years, you'll end up having access to a parental leave entitlement that you won't necessarily get if you're a GP and training. We're going to close that gap as well.
 
FELDHOFF: Mark Butler If this is such a good plan, why not do it right now? That's what people are asking. Why can't we get this in right now?
 
BUTLER: We're going to do it this year. It takes a while to change the big Medicare schedule system. We've made the announcement now,  it'll go through the budget process when that happens. In the first half of this year, it's currently scheduled for March 25th. And it would then take effect in the annual change to the Medicare system on the 1st of November. General practices have to update their software. They’ll have to make a range of changes to their businesses. This is about as quick as a change as you get in a very big healthcare system.
 
SCHILLER: Why not six months ago then?
 
BUTLER: Last year we were focused on the tripling of the bulk billing incentive that we did for pensioners and concession card holders, what the College of GPs at the time called a “game changer.” In South Australia that led to a 4 per cent increase in bulk billing, an additional half a million free visits to the doctor just in South Australia last year. We've been very busy rolling out Urgent Care Clinics, big cheaper medicines policies and this is the latest in our commitment to strengthen Medicare.
 
SCHILLER: How are you going to fund this? Because Mark on the text line is asking are the any new taxes that are going to fund this? Is this being just funded through bracket creep and the increase in commodity prices?
 
BUTLER: Most of this was provisioned in the Mid-Year Budget update that we released in December. The rest of it will  be very clear at the next budget on March 25th or the next budget update if there's an election called before then. People will be very clear on what our numbers are. But I will remind your listeners, we've delivered two budget surpluses back to back. The first time that's happened in 15 years. We're taking a very responsible approach to the management of the budget. There won't be new taxes to answer that question to pay for this.  
 
SCHILLER: So it’s bracket creep?
 
BUTLER: We'll manage it in the usual way. Frankly, I can't think of a more important thing for a federal government to do than to arrest this slide in bulk billing and deal with the fact that people aren't going to the doctor when they need it.
 
FELDHOFF: You'd be happy, then, that the federal Opposition has agreed to support it as well and do it themselves and in fact increase it?
 
BUTLER: A little bit more sceptical than happy, because I was around when they promised that last time in 2013 and said there'd be no cuts to health. And then Peter Dutton tried to abolish bulk billing altogether and cut $50 billion from hospitals. We've seen this film before. And even if you ignore the film, you don't want to watch it. Why would you trust the bloke who created this mess to fix it?
 
SCHILLER: But they've increased it by $500 million, they're saying, which I believe they've already announced. Will you increase yours by $500 million?
 
BUTLER: We'll have more to say about Medicare between now and the election. There's no more important policy area for Labor than Medicare. We created it. We've defended it time and time again against attacks and cuts by the Liberal Party particularly Peter Dutton, when he was Health Minister. We'll have more to say but what we've done over the last three years has turned the ship around. More free GP visits, more Urgent Care Clinics, more doctors. After the decade that Peter Dutton delivered when he was Health Minister.
 
SCHILLER: Well, the Coalition have pointed to data and say when Peter Dutton was health minister, there was an 84 per cent bulk billing rate and compared to a 77.7 per cent rate in December 2024? So they're saying that the bulk billing rate was better under Peter Dutton in 2014?
 
BUTLER: Yeah, he inherited a bulk billing rate from a Labor government that's why, then in his first budget, he tried to abolish bulk billing. People will remember he tried to make everyone pay a GP tax every time they visited the doctor and when he couldn't get that through the Senate, instead, he froze Medicare funding for six years. That is what has created. No one contests the fact that the bulk billing slide we have now and have had for some years a “freefall” the College of GPs called it. And it all traces back to the decision by Peter Dutton, when he was Health Minister, to freeze Medicare funding to GPs.
 
FELDHOFF: Minister, if we're aiming for a 90 per cent bulk billing target by 2030, does that mean that everyone gets that or is it means tested? I mean, some of our texters say high income earners don't need the bulk billing avenue?
 
BUTLER: If you're on a high income, your doctor may well continue to charge you a gap fee. The challenge I've identified is that the concession card that currently gives you access to bulk billing support cuts out I think at about $40,000 a year for a single and $70,000 for a couple. There are a lot of people who don't qualify for a concession card, who are under real cost of living pressure, and who are making these choices about whether they go to the doctor or fill a script or pay their energy bill. Extending that bulk billing support to all Australians doesn't mean that people on the highest income like Gina Rinehart's are going to get bulk billed, but it is going to mean that a whole swathe of the Australian population who are doing it tough right now will know that they can go to the doctor.
 
SCHILLER: We'll just take a couple of quick calls while we've got you. Andrew from Blackwood has called. Andrew, what was your comment or question?
 
ANDREW, CALLER: Well morning, everyone. Good morning Minister. I'm just wondering, I'm glad to hear you're increasing university places that is long overdue. I'm wondering if that's a net increase or that's just going to be completely absorbed with the record immigration numbers we've got coming into Australia at the moment?
 
SCHILLER: Andrew, look, it's a good point. Federal Health Minister, we haven’t an increased medical school places for quite a while yet. We're increasing our population. Are these new places going to keep pace with the new population with people coming to this country?
 
BUTLER: You're right. It's the first increase in medical school places in our big cities for a decade. We have had increases in rural areas. And in terms of people coming into the country, there are more doctors and more nurses coming into our country than there have been for a very long time. What I'm doing is fast tracking GPs and nurses, particularly from jurisdictions that we have confidence in, like the UK, New Zealand. Training systems that are essentially the same as ours to fill some of the really significant gaps we have in the medical workforce in rural communities.
 
SCHILLER: Any new places in Adelaide?
 
BUTLER: That'll be a competitive process universities will bid for that. I know there's interest in Adelaide for additional medical school places there is in the other cities as well. But there'll be a process, a proper arm's length competitive process that medical schools can apply to for that.
 
FELDHOFF: Hello, Dan you’ve got a question?
 
DAN, CALLER: This increase in bulk billing, for item numbers, is this going to apply to all services specialists as well as GPs?
 
BUTLER: No, this is focused on GPs. I know there's a concern about out-of-pocket costs for non GPs specialists that people go to. Our focus is unapologetically, I have to say, been on general practice over the past couple of years. Of all of the pressures in the health care system I encountered when we came to government general practice was the thing I was most worried about. These are bulk billing incentives for general practice visits. Frankly, there is an issue that we have to address about the rising out-of-pocket costs for non-GP specialists. But the announcement yesterday was particularly about visiting your GP.
 
SCHILLER: Marg from Modbury. Marg what's your comment or question?
 
MARG, CALLER: Hi guys. Hello Minister, I just can't believe this is an extraordinary amount of money to be invested and someone has to pay for this. They say it's in the budget, but it still has to come from somewhere. And I don't believe it's going to help country people. I have family in the Yorke Peninsula. They just can't even get an appointment, let alone get bulk billed. It's just it's all for the city people. If it does come about, I don't believe them because we still haven't got our $275 off our power bill, have we?
 
SCHILLER: Well, Marg, thank you for your comment, Minister?
 
BUTLER: As I said earlier, we're working really hard to increase the number of doctors in rural communities. We've had more doctors added over the last couple of years than any time in the past decade. But I know it's still tough. In terms of the cost, the incentive that GPs receive in places like I think Marg talked about, the Yorke Peninsula are actually a lot higher than the incentives that doctors in Adelaide are going to receive. For a doctor in towns on the Yorke Peninsula, they're going to get pretty much double what they get today to bulk bill a standard consult.
 
FELDHOFF: So you're hoping we'll see more doctors encouraged to go into those rural areas as a result of this?
 
BUTLER: We've been doing a lot to try and encourage young Australian trained doctors into rural areas where there's student debt relief. We passed legislation to provide them with student debt relief, essentially wiping their university debt if they go and practice in rural communities and a range of other things as well.
 
FELDHOFF: Mark Butler, thank you for your time.