Mr BUTLER (Hindmarsh—Deputy Manager of Opposition Business) (15:33): The most reliable truism of modern Australian politics over the last 50 years is this: the Liberal Party have never supported Medicare. They have never supported the concept of comprehensive, universal health insurance. They were at least very clear about that for decades, because, for decades, they tried to kill it. The godfather of the modern Liberal Party, John Howard, the former Prime Minister, was especially clear about this. He used phrase after phrase to reinforce the depth of his opposition not just to Medibank, and then to Medicare, but to the concept of universal health insurance in its broader sense. He described the Hawke government's achievement of introducing Medicare as a 'total disaster'. He said it was a 'nightmare'. He said Medicare was 'one of the great failures of the Hawke government'. Back in 1987, as the Leader of the Opposition, John Howard vowed that he would never stab Medicare in the back; he said he would 'stab it in the stomach'. After the 1993 election, when the Liberal Party lost another election on the platform of abolishing Medicare, they finally hoisted the white flag against the total abolition of Medicare. But let's be clear: they have never embraced the idea of comprehensive universal health insurance. Instead, what they've done for the last 25 years is what John Howard promised never to do. They've spent 25 years stabbing Medicare in the back because they've not been able to abolish it. In their hearts and actions, their only concession to Medicare is as a safety net, not a system of comprehensive universal health insurance. Yet again, they're playing from the playbook of the Republican Party in the US, reluctantly agreeing to a safety net of government funded insurance for low-income households and pensioners but insisting that the middle class pay their own way. Under the rubric of freedom, they're insisting that the middle class pay not only the Medicare levy and their private health insurance but also, increasingly, gap fees. This government has spent eight long years hacking away at the system of universal comprehensive health insurance, which is one of the shining jewels of Australian politics from the last five decades and one of the proudest legacies of the Labor Party. Memorably, their first attempt to hack away at it was the GP tax in the 2014 budget. They couldn't pass that, so instead they took it out on the doctors, who were, along with the Labor Party, one of the many groups that opposed the GP tax. They punished them directly, and indirectly punished patients, by freezing MBS rebates for years and years. Their budget papers made no secret of the fact that the four-year freeze on MBS rebates, which was introduced in 2014-15, was a direct result of their inability to pass a GP co-payment through the parliament. Four years later, after four years of freezing the indexation of MBS, the Treasurer, now the Prime Minister, added another two years to freeze the MBS rebates. A government member interjecting— Mr BUTLER: I hear the interjection from across the table. A government member interjecting— Mr BUTLER: You whispered it! It was another play from the Republican playbook. Like they do with so many things—the treatment of women, universal health insurance—they pulled out the equivalence chapter. They said the Labor Party started it. One of the great falsehoods of the last decade is that the Labor Party froze the indexation of the MBS system in the way that those opposite have done. It is quite clear that the realignment of MBS indexation in 2013 to the beginning of the financial year, which is when every other health program is indexed, was not a freezing. It is quite clear from the budget papers in 2013—page 177—that, under a Labor government, the next indexation of the MBS system was to be 1 July 2014. Unfortunately, we didn't bank on those opposite getting hold of the Treasury bench and freezing those indexations for year upon year. Those years of real cuts to Medicare funding have seen gap fees skyrocket. In question time, the minister said—quite falsely, I think—that 86 per cent of patients are getting bulk-billed. He said there had been a six per cent increase in patients, when he knows that the 86 per cent for bulk-billing is about consults. It's not about patients, and it reflects the fact that older Australians go to the GP far more often. The government doesn't release the number of patients who get bulk-billed against the number of patients who actually pay gap fees, but the Australian Institute of Health and Welfare estimates that one in three patients who go to a GP has to pay a co-payment. Those are working families. That is the middle class of Australia. Those Australians have seen their gap fees, in the face of indexation being frozen by this government, skyrocket. They've skyrocketed by one-third for visits to GPs and by fully one-half for visits to specialists. On average, one in three patients is paying $10 more for every GP visit than they were paying when this government came to power and $30 more for a visit to a specialist. On average, if you are seeing a GP seven times a year—as most patients do—and a specialist once a year, this government has lumped a $100 Medicare tax on you over the last eight years. It's all a product of the Medicare cut through the freeze on indexation for year upon year. Remarkably, under this minister the average gap to see a GP now, for the standard level-B consult, is actually more than the Medicare rebate. The gap was supposed to be a small contribution by the patient. But, under this government and under this minister, the average gap now is actually more than the government contributes to the cost of going to a GP. You pay your Medicare levy. You pay your private health insurance. And now, under this government, middle-class Australia—working families—are funding the majority of a standard level-B consult. That's the contribution to primary care and Medicare under this government. The concern we have about the latest MBS changes is that they continue this pattern of behaviour that will increase patient costs. They add surgery to GP consults and specialist consults that have seen gap fees and copayments go up. Now, we're not opposed to a review of the MBS to ensure that items in the MBS reflect contemporary practice. It's a sound idea. But, like so much about this government, it's been utterly bungled in its implementation, just like the 2018 changes to spinal surgery that were an earlier tranche of the MBS review. It was sound in approach, properly updating the MBS items associated with spinal surgery to reflect contemporary surgical practice. But, according to the AMA: Patients were left out of pocket, spinal surgeries were delayed, and doctors couldn't provide patients with informed financial consent about potential gap fees. And with the latest tranche—more complex, more broad—we are seeing history repeating. The minister tried to say there shouldn't be any increase in gap fees as a result of these 900 changes, but the Grattan Institute has said: This will almost inevitably mean that patients will face increased out-of-pocket costs. Mr Hunt interjecting— Mr BUTLER: I hear the minister scoffing at the Grattan Institute's analysis, but the AMA also said that that's guaranteed, that patients will see increased costs. As I said, a review of the MBS is a sound idea. But increased gap fees as a result of these changes that the AMA says are guaranteed are no accident. Just like low wages, they are a deliberate policy feature of this government. They are a deliberate design feature of their approach to public health care, because they have never, ever accepted the concept of comprehensive and universal health insurance. The minister says, 'Trust us.' The minister says, 'There's no reason that patient costs should rise.' But that has been the story of this government for eight years: patients having to put their hand in their pocket to go to the GP, patients having to put their hand in their pocket to go to a specialist and now patients having to put their hand in their pocket to have life-changing surgery. Well, when the minister says, 'Trust us,' I say to Australians: you should never trust the Liberal Party on Medicare.