Television interview with Minister Butler and Tom Connell, Sky News - 29 April 2024

Read the transcript of Minister Butler's interview with Tom Connell on bulk billing; domestic violence; vaping.

The Hon Mark Butler MP
Minister for Health and Aged Care

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TOM CONNELL, HOST: Incentives to boost bulk billing rates appear to be working, data from the first five months since the changes were enacted indicate a national rise of 2.1% in the number of bulk billed sessions. The increase is as high as 5% in Tasmania, previously, it had recorded some of the lowest bulk billing rates in the country. Joining me now, the Health Minister, Mark Butler, thanks for your time. So, it’s an increase, doctors groups are saying, look, this is basically a stabilisation if you factor in previous years. So, are you happy with this level or are you looking to fund this further to increase it more?
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Look, I'm happy with the early results as I think is implicit in the doctors feedback. Really what we needed to do was stop the slide. When we came to government, bulk billing, frankly, was in free fall. Australians were telling us that it had never been harder to see a doctor, and it would never been more expensive. The objective, number one, in our record investment in the Budget last year to triple the bulk billing incentive was to stop that slide and that appears to have happened in early results at least, but we've also seen a rebound. In just the first five months there have been 950,000, almost a million additional free visits to the doctor.  As you said, in some of the areas that I was most worried about, states like Tasmania, regional Australia, we've seen some of the biggest increases in bulk billing, which is really pleasing, but it's still early days, so we're going to watch it closely.
CONNELL: One of the cohorts really struggling are younger people. They might have a mortgage, they've just started, or they're renting, which is even worse and if they're not under 16, they’re not targeted by these incentives. Is it unapologetic that targeting? Because a lot of these people say 77% bulk billing, I haven't had bulk billing, no one I know has, it doesn't feel like their reality?
BUTLER: Those incentives have, for as long as they've been around, which is a couple of decades, they've always been targeted at pensioners, at health card holders and at children under the age of 16. What we think is that if you increase the income for general practices, and this is a very big increase in their income overall, that will relieve the pressure for charging big gap fees for those people who traditionally have not been covered by those incentives.
CONNELL: There’s still a gap fee, but you hope they don't grow by as much as well?
BUTLER: A 77% bulk billing rate indicates there are a lot of people not covered by the incentive who are still getting bulk billed. But there's a lot who are not, and we're very conscious of that. We've also been very careful to target our cheaper medicines policies to those people who are not traditionally supported by government. The non-concessional payments, as you say, young working age people who might be paying full costs for their medicines, we gave them the biggest cut to the price of their medicines in the history of the PBS last year.
CONNELL: The other thing is, when you talk about GPs overall going better and maybe helping out on gap payments, payroll tax, so states sort of looking to tuck into GP surgeries. I know you've urged states not to do that. Beyond that though, there's a health agreement coming up, are you going to try to codify this or force a result out of this? Because you can urge all you want, but it might fall on deaf ears?
BUTLER: As you know, payroll tax is a state issue in the same way income tax is a federal issue, not something that could be determined by state governments. I've been pretty clear, though, that I'm very concerned about the risk that our record investment in Medicare last year would eventually end up finding its way to state revenue offices instead of general practices. State premiers as much as anyone have been urging the Federal Government to strengthen Medicare because they know that the parlous state of general practice was starting to feed into their emergency departments. This is still something that's a work in progress at state level.
CONNELL: What does that mean? I understand it's not your responsibility, but can you make it part of overall negotiations? Because otherwise things will just happen without you.
BUTLER: We're negotiating a hospital funding agreement and that's a really important piece of work for all of us. We're going to focus on the health of our hospitals. But I have been clear that we would want state governments, Health Ministers and Treasurers to sit down with doctors groups and work our way forward. As the Queensland Government has, I think, work their way forward. That is, true to their tax laws, but also protects the integrity of general practice.
CONNELL: Domestic violence, so the role of mental health services, drug and alcohol addiction as well as up in the spotlight here, these services, every expert says they're too stretched, this is a big part of the problem. Are we able to afford more in a tough Budget environment? Is there more money coming in this area?
BUTLER: The Prime Minister has made it clear that he and the premiers and chief ministers are coming together this week and they recognise this is a crisis. He said yesterday that governments must do better as other elements of the community must do better, frankly –
CONNELL: Will there be funding?
BUTLER: If there is a direction for us in the health portfolio to do something different, I know that my Health Minister colleagues will be keen to do that. As I’ve said earlier today, last year we heard a very clear call from GPs who were often the first port of call for a woman and her children experiencing family violence. GPs were saying they needed a longer consult funded for them to be able to sit down over an extended period of time and work with a woman and her children who might be dealing with domestic violence issues. That had been a call from the domestic violence sector as well, and we were able to deliver that additional, longer consult funded through Medicare last year.
CONNELL: The longer consults for doctors’ sort of didn’t used to make economic sense, we’ll see what comes out of Wednesday. Just finally, vaping, are you concerned that the horse has bolted on this? Cause it’s so prevalent in schools and you’ve spoken about how prevalent it is. Kids like them, they’ve got cache and they’re already probably have an addiction many of them. Have we got a generation already on vapes, whether you like it or not?
BUTLER: I am worried that there is a generation on vapes, but what I'm not willing to do is raise the white flag and say, well, there's nothing we can do about it, we're just the government. I mean, what we're hearing from parents and school communities is an urgent need for action here. They are reporting this as the number one behavioural issue in our schools. This is a product so deliberately targeted at young people. It's no accident that nine out of ten vaping stores are located within walking distance of our schools, because something that was presented to us several years ago as a therapeutic good to help harden smokers kick the habit, we know now is a product designed to recruit a new generation to nicotine addiction.
CONNELL: If they're addicted, though, I mean, some of these a lot of these kids will be adults not too far away. They can get a prescription that's not really limited anyway. They can get a prescription and they can vape for the rest of their lives. Is that something you’re looking at as well?
BUTLER: They can get a prescription for vapes to be used as a smoking cessation tool. That's what it was presented as. We're going to regulate it as a therapeutic good.
CONNELL: All you need to say is I'm quitting smoking. Well, the reality is anyone can get access to it?
BUTLER: No, it's a little bit harder than that. Think of it as a regulated therapeutic product, like codeine or like pseudoephedrine. Some of my political opponents and people from the tobacco sector who want to sort of accept this as part of Australia's way of life, now are saying this is somehow prohibition. It's no more prohibition than the regulation of codeine or the regulation of pseudoephedrine if it is a genuine therapeutic good, which is what the industry presented it as several years ago, let's return it to that. Not a recreational product with cartoon characters and bubble gum flavours designed to recruit our kids.
CONNELL: Is it set and forget though? Do you ever imagine you would just ban the prescriptions all together? If its not truly the cessation that it’s meant to be in your view?
BUTLER: The evidence is still marginal in its impact that the doctors and the researchers tell me. But we are willing to have it in the toolbox to help hardened smokers, kick the habit. But what I’m determined to do, is stamp it out as a recreational product.
CONNELL: Minister, appreciate your time today, thank you.
BUTLER: Thanks Tom.


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