Radio interview with Minister Butler and Rafael Epstein, ABC Melbourne Mornings – 4 September 2024

RAFAEL EPSTEIN, HOST: We're joined by Mark Butler. He is the federal Minister for Health and Aged Care.
 
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Good morning Raf.
 
EPSTEIN: I do want to get into the detail of what your Government is doing. But when you hear that story from our ambos here in Victoria, what goes through your mind?
 
BUTLER: It just reminds me how strained our hospital system is across Australia. The hospital emergency department really is the lightning rod for every failing, every gap in our health and aged care system around the country. If people can't get properly cared for in an aged care facility because the staffing levels aren't right, too often they're sent to a hospital emergency department. And if people can't get care in the community when their kid falls off a skateboard and busts their arm, then again, they end up in the ED. So the EDs are really built for once in a lifetime emergencies that really do need a fully equipped hospital. Our challenge is to try and take some of that pressure off the hospital emergency department so that they can deal with these sorts of cases that they were built for, which are the cardiac arrests, the very serious car accidents, the strokes and so on and so forth. And that's really the job of work that we have right now.
 
EPSTEIN: So I think it's like a probably a ten minute drive away right now, but it's a five minute drive away at other times from the Maroondah Hospital emergency department to the Government funded GP clinic, it's an Urgent Care Clinic. Um, there are 30, close to 30 of them in Victoria. You are taking over the funding of more and more of them. Um, will it make a big difference, you guys funding this clinic? Is it going to make a difference to the Maroondah Emergency Department?
 
BUTLER: I think it will. This is a relatively new model for Australia. I announced at the last election campaign. And then after we announced that commitment, Premier Andrews here in Victoria and Perrottet up in New South Wales, decided to open some in the interim so that we could then get ours up and running as a new Government. It's quite a common model in other countries. New Zealand, for example, has a very developed model of Urgent Care Clinics that sits somewhere between what your listeners would understand as a standard general practice on the one hand, and a fully equipped hospital on the other. And they're really set up, as their name suggests, to provide urgent care for people who need to be seen immediately or very, very quickly, but don't need to go to a fully equipped hospital. And that is why they are open seven days a week and they are open extended hours. They're staffed by really terrific doctors and nurses, many of whom have experience in emergency medicine. And already in a very short period of time, 700,000 patients have gone through these clinics. About 1 in 3 of them are kids under the age of 15. They're very busy on Saturday and Sunday afternoons after sport. And the bulk of the people who go through these clinics, fully bulk billed clinics say that if the clinic was not available, they would go to the local hospital. They are taking some pressure off the hospital ED.
 
EPSTEIN: Are they going to take off enough pressure? I guess would be my question, because the one that you are taking over the funding of in Maroondah, that's already open. I looked online this morning. It's sort of open till 10 pm. I don't know how many doctors are on sort of, you know, after 5 or 6 pm, but the point is it's already been open, so it's already taken the pressure off. So you guys taking over the funding of it, that's not going to solve our problems at Maroondah Hospital is it?
 
BUTLER: We're opening new clinics in parts of the country and in Victoria and New South Wales. We're taking over some clinics as well. The clinics at Maroondah at Glen Waverley, a number of others that we're announcing today, we're announcing seven, they don't have funding beyond June next year from the Victorian Government. As I said, I think Premier Andrews intended that as an interim solution while we got our network up and running. Taking them over gives it long term certainty. It also is a slightly different model. The Medicare Urgent Care Clinics that we operate from the Commonwealth are available for walk in patients, people can just come in they don't need to make an appointment. And as I said, I heard a couple of your listeners feedback before. Overwhelmingly the response from patients has been really, positive. They're getting quick care, they're getting high quality care. And as I said, overwhelmingly, they're taking pressure off our hospital EDs.
 
EPSTEIN: Mark Butler is who you're listening to. He's the federal Health Minister. On 774, I will get to your calls in a moment. I can see a whole lot of people on my screen have been to these different clinics, some successfully, some not.
 
Minister, just while I have you just a few other issues, um, some in your own Government, some Labor backbenchers are now pushing you to give Medicare coverage, uh, for dental work for adults. We've already got basic dental care for kids covered by Medicare, not for adults. Is your Government going to move fast on including dental in Medicare?
 
BUTLER: I'm focused right now on strengthening the fundamentals of Medicare, which are really under real strain after a decade of cuts and neglect, particularly the freezing of the Medicare rebate. I've said very clearly and unapologetically to the medical community and to Australians that my focus is on general practice. I mean, if we don't turn the condition of general practice around our health system is going to be under very, very serious strain. That is my focus -
 
EPSTEIN: Dental is fundamental as well, isn't it?
 
BUTLER: Oral care is very fundamental. But like it has not been a feature of either Medibank under Whitlam or Medicare under Hawke, and for the 40 years since. That has been a bugbear of many people who would like to see oral health covered by Medicare as well. But that's not something we're going to be able to do in the near term -  
 
EPSTEIN: Are your backbenchers feeling the pressure from the Greens?
 
BUTLER: I think our backbenchers are reflecting the sort of pride and ambition that they have around Medicare. Labor is very proud of the work that we did in creating and defending and ultimately strengthening Medicare. A lot of people have an ambition to see it broadened. But my focus right now is strengthening the fundamentals and in particular, strengthening general practice.
 
EPSTEIN: Just on illegal cigarettes and legal cigarettes, the amount of money, you've been very strong pushing for the banning of vapes. The tobacco tax goes up automatically, but you're not getting nearly as much of the tobacco tax as you expected. I think in the last Budget, the revenue the federal government received is down about 20 per cent. Clearly, it's about illegal cigarettes. I was actually in Sydney on the weekend I went into two convenience stores that both had illegal cigarettes just on the counter. You don't need to ask for them, like there's illegal cigarettes, big brand cigarettes with no warning labels on them just sitting there on the counter with a $20 label on them. Do you need to lower the tax on them so that you don't help to create an illegal market?
 
BUTLER: No, we're not going to lower the tax on them because every authority here in Australia and around the world says that price signals for cigarettes are really important way to drive down smoking rates. Part of the reason why tobacco excise revenue is going down is because smoking rates are going down -
 
EPSTEIN: That's only part of the reason.
 
BUTLER: But you're right, illicit tobacco is a serious challenge in our country along with vapes. I mean, this is a market that's being driven significantly by organised crime. That is not just leading to a public health problem, but is also gaining revenue for organised criminal gangs to fund their other criminal activities like drug trafficking, sex trafficking and the like. It's a problem the government takes very seriously. The tax office, which has responsibility for illicit tobacco, we have responsibility in health for vaping, is working with the Border Force really to go into source countries and try and cut off the supply of illicit tobacco from those source countries. I must say, I think we're having greater success with vapes, which are easier to detect at the border because of the metal content that they have. But look, illicit tobacco is a very serious challenge that we can continue to work on at a federal level.
 
EPSTEIN: I don't want to sound like a broken record on tobacco excise, because I know I've asked you about this before, but haven't you helped to create the black market? I appreciate, and I agree with what you're saying about people aren't smoking as much. Not as many people are smoking as much. But surely successive governments raising the tax on cigarettes, hasn't that helped to create the black market? Haven't you created a new problem?
 
BUTLER: It's going to be a factor. But we take advice from tax experts, from the World Bank, from the IMF and the World Health Organization who look at this stuff not just in Australia, but around the world. And all of their advice is to continue the price signals going up, in spite of the fact that there is an illicit tobacco market that operates globally. I mean, when we came to Government, one of the challenges we faced was that tobacco excise had been climbing under the previous Government, it went up by more than 100 per cent. But because those excise increases had tapered off, cigarettes were actually in real terms - so after inflation - becoming cheaper. And the very clear advice to us was that was not an acceptable public health position.
 
EPSTEIN: I appreciate your time this morning.
 
BUTLER: Thank you. Raf.
 
EPSTEIN: Mark Butler is the federal Health Minister.