Radio interview with Minister Butler, ABC Radio Melbourne Mornings - 20 November 2025

RAFAEL EPSTEIN, HOST: It is one of the oldest free medical services in Melbourne. They have received a financial lifeline. That does mean it might not close. Cohealth is crucial for people in places like Fitzroy, Collingwood and Kensington. The Federal Health Minister, part of Anthony Albanese's government, is in Melbourne to give them an emergency $1.5 million. It will only keep them open until the middle of next year. Mark Butler is the Federal Health Minister, good morning.
 
MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Morning Raf.
 
EPSTEIN: Labor won the electorate of Melbourne from the Greens this year. Some cohealth services are in that seat. Is that why you did this?
 
BUTLER: No. Some are, some are outside it. Kensington's not in it, as far as I know. We did it because I've been to cohealth, I've been to the Collingwood Clinic. I know how important that service is for communities, not just in Fitzroy, but into Collingwood and into Kensington as well. And we've heard very clearly the voice of the community. I've been meeting very regularly with Sarah Witty, as you mentioned it, but also Jo Briskey out in Maribyrnong, who've attended community meetings, who've been talking to the staff at cohealth about how important this service is. So we think there is a future for this service. We want to get into the books really and have a look at their Medicare billing and their model of care to explore every opportunity for them to have a future well beyond 31 July. But they needed some bridging funding to do that. We've been working with them closely as well as with the Primary Health Network and the Victorian Government and the $1.5 million to get them through the middle of next year to the end of July next year will give us time to really review their service and chart a future for it.
 
EPSTEIN: So what does getting into the books mean and reviewing their service? Is that an audit? What does that mean?
 
BUTLER: We're going to do a review of their service to understand what their particular model of care they have is and how they bill Medicare and whether there are ways in which they can bill Medicare in a more advantageous way. We've already talked initially to them about this. This is not the sort of problem that's been faced in other community health centres. We have put record amounts of funding into Medicare, as you know Raf, particularly behind bulk billing vulnerable clients. So they will have received a very, very significant increase in their Medicare billing already. But as a couple of commentators, including Stephen Duckett, who's well known in Victoria, have said, there's something particular happening at cohealth that you're not seeing in the other Victorian community health centres. So we want to get to the bottom of that and see whether there is a way we can work together along with the Victorian government to ensure this has a strong future, because it is such an important part of health services in this part of Melbourne.
 
EPSTEIN: Yeah, just to repeat, this is bulk billing for some of the most disadvantaged and in a crucial and highly- big population. Mark Butler, the other issue is the buildings. The state government has been asked for money to fix those buildings up. It has not been forthcoming. Do you want the Victorian Government to do that?
 
BUTLER: The Victorian Government has said they want to participate in this review. For your listeners, Raf, it's important to recognise this is a pretty unique Victorian model. Gough Whitlam built community health centres back in the 1970s. They were then closed as a Commonwealth program by Malcolm Fraser and they largely disappeared in every other part of the country except here in Victoria. And government after government at a state level in this state has kept that model because it's a terrific model. So they have skin in the game in a way that you don't see in New South Wales or the other big states. And Mary-Anne Thomas has indicated to me she wants to be a part of this review. So the review will be co-commissioned by us as a Commonwealth and Victoria, and I'm sure that issue will be raised.
 
EPSTEIN: Does that mean you think money's coming for the buildings from the state government?
 
BUTLER: No, I don't know, frankly, Raf, we haven't made any commitments beyond 31 July. We want to get in there, have a good look at the review, but I know that question of the buildings has been raised not just by cohealth, but by some other community health centres in Victoria.
 
EPSTEIN: And infrastructure in Victoria.
 
BUTLER: That’s right.
 
EPSTEIN: Mark Butler is with you. He's the Federal Health Minister. It is 20 minutes to 9. We'll get on to underquoting and the publication of the reserve price in this half hour as well.
 
Mark Butler, to really broaden this out to the whole country, one of the issues cohealth faces is the funding, the Medicare rebates for people with complex conditions, the longer doctor's appointments. That's something cohealth has spoken about. That is an issue for people with complex conditions across the country. There needs to be more Medicare money, doesn't there, for those longer appointments?
 
BUTLER: We put in place a new longer consult a couple of years ago, and because that was a message we got from the College of GPs, a longer consult with an additional bulk billing incentive there. We've put in place other bespoke arrangements for particularly long consults where people have particular conditions. What cohealth is talking about is not unique to cohealth, obviously. As you say, this is something that general practices and community health centres across the country are facing and they're having to adapt their business models. They're not getting into the sort of difficulty that cohealth appears to have got itself into, which is why we want to have a look at their books in particular. But you're right to say that we do need to reshape Medicare around the needs of patients today. They have much more complex chronic conditions than when Bob Hawke and Neal Blewett were building Medicare back in the 1980s.
 
EPSTEIN: Have you got the funding for that? Can you fund that?
 
BUTLER: The first thing we had to do was to deal with the affordability crisis in Medicare in general practice. Bulk billing was in freefall, which is the description the College of GPs put to it. A couple of years ago, we tripled the bulk billing payment that GPs got for concession card holders. That's a big part of cohealth's clientele. But earlier this month, we also extended bulk billing support for the first time to all patients because we found that people who might not qualify for concession cards were declining to go to the doctor because of cost, because their bulk billing rates were in free fall as well. And already we've seen more than 300 clinics in Victoria just in the last two weeks move from charging gap fees last month, to this month, bulk billing every single patient that comes through their doors.
 
I wish I didn't have to spend as much time and money over the last two years on basic affordability, but I've had to do that because the Medicare rebate was frozen for so long and bulk billing was in freefall. But I've been very clear, we also have to reshape Medicare. And I've talked to the AMA about that. I've talked to patient groups about that. We've done some work on it already, as I say, with this longer consult and some other arrangements around particular conditions. But I do recognise cohealth is right, the AMA is right. We've got more work to do in that area.
 
EPSTEIN: Mark Butler, I am old enough to remember when Kevin Rudd, in his first iteration as Prime Minister, was going to fix the fight between state and federal governments over health funding, especially hospital funding. You are still fighting with the state governments over hospital funding. The Coalition was fighting with state governments over hospital funding. Why is the federal government still fighting with the states over funding something like hospitals?
 
BUTLER: I'm old enough to remember it too, Raf. I was a very junior assistant minister for health at the time and it was the Victorian government, as much as any, that pushed back away from the offer that Kevin Rudd made, which was to return to 50-50 Commonwealth state funding arrangements in hospitals in exchange for some reforms that some of the states, including here in Victoria, didn't like. Governance reforms, some reporting about performance in hospitals. And so we ended up with a very different arrangement because of that collapse in those negotiations. So we are where we are.
 
But we're conducting really constructive negotiations. On Friday, there was a full-day meeting again between officials. I think Victoria is represented by their head of treasury. All the states have either their head of premier's department or heads of treasury around the table, so represented at a very senior level. But it's no surprise that states want more money in hospitals. At the same time, we have the obligation to fund Medicare, to fund aged care, to fund the National Disability Insurance Scheme. Those are just the programs in my portfolio, let alone some of the other pressures beyond. So, look, hospitals are obviously a central part of the health and social care system, but states are also telling us at the same time, you've got to put more money into Medicare. We're doing that. You've got to put money into aged care. We're doing that as well. We've put a very generous offer of $20 billion more than they otherwise would have received under the old agreements. But there'll be negotiations over the course of the coming weeks, I'm sure.
 
EPSTEIN: I’m sure there will be. Thank you for your time.
 
BUTLER: Thanks Raf.
 
EPSTEIN: Mark Butler is the Federal Health Minister.