Fairer Australia Campaign Public Meeting

Dr Peter Sainsbury

National President, Public Health Association

Introduction

Peter Sainsbury has been Director of the Division of Population Health in Central Sydney Area Health Service for 10 years. He is also an Associate Professor in the School of Public Health at Sydney University, President of the Public Health Association of Australia, and a member of the NH&MRC.

Peter's qualifications and experience cover medicine, health planning, sociology, health services management and public health. His professional interests include inequalities in health, social relationships and health, the experience of illness, health needs assessment, the history of public health, mental health promotion and social policy.

Tonight, he is speaking with his Public Health Association hat on.

Sainsbury

Thank you very much in deed, good evening ladies and gentlemen.
Haven't you folk got anything better to do on a Tuesday evening? Coming here, listening to us? Couldn't you watch telly?

Of course you haven't got anything better to do, this is very important. It's common these days to resent politics and voting, education, health, and the environment as tedious issues, but they're not. They're essential to what we value as a society. It's crucial that we ask ourselves at all times, what sort of society do we want to live in? It's by being active, by turning up on a Tuesday night at the end of August, by hearing what we have to say, by saying what you've got to say, that we participate in the democratic process which is so important to what we have in Australia these days. So I congratulate you on coming here this evening. It's a tremendous effort. It's people like you who keep democracy alive in Australia.

Now I'm here this evening wearing my Public Health Association hat, a national organisation with about 2000 members, who promote good health, illness prevention, health promotion and good healthcare services throughout Australia.

We're in a funny situation as far as health is concerned in Australia. We're one of the healthiest nations in the world, we've got very low mortality rates, very low death rates, we're generally pretty healthy, although there's obviously lots of chronic illness as people get older. We have very, very low death rates in infancy and by most measures we enjoy good health. On top of which we also enjoy a very, very good health service. Most of us, most of the time, get really good access to really good health care when we're sick and we live in a society that to a large extent promotes our health, through screening and things like that to detect illness early and treat it early. So, why is health the big issue?

Well it's a big issue for individuals, and it's a big issue politically, because although we enjoy such good health and although we've got such good health services, for two reasons.

Firstly not everyone is sharing in that bonanza. There are many people in Australia, unemployed people, poor people, homeless people, people in rural areas, people in the outskirts of cities, people in towns in rural Australia, Aboriginal Australians, who aren't sharing that good health and that good access to health care.

And secondly we're missing many opportunities to prevent illness, prevent death and provide better care when people are sick. We have been becoming increasingly aware of that in recent years, there's no doubt about it.

We haven't got much time so I can't go into a lot of detail. What we had with Medicare was a universal health care system. A system that was available to everyone, anyone in Australia could use this healthcare system, and it was free when you needed it. You entered your public hospital as a public patient it was free, and it still is. If you went to a GP you were bulk billed and it was free, you went to many specialists you could get bulk billed and it was also free. The other remarkable thing about it was that it was the same everywhere, it was remarkably simple to understand. There are many other features of the Medicare system which are commendable, I haven't got time to go into all of them, but I'll just highlight one and that is that it's funded fairly, its funded by taxation. There's a Medicare levy, which pays for a little bit of the total cost of the health care system. Most of it comes out of our general taxation, where just like with income tax, wealthier people pay more, and that's right and proper that wealthier people contribute more to the Medicare system, to the health care system in Australia. And private health care is there as something that is available for people if they want it. It's an add-on extra if they're prepared to pay for it.

Now that's the way it used to be, and what we've seen in recent years, is that the system has been downgraded in various ways. It's been undermined, sometimes quite blatantly and sometimes quite subtly. For many years we saw support for bulk billing fall and fall so that bulk billing rates fell to around 60% overall, but much lower in some areas. In fact I think that in this constituency there are some areas where bulk billing rates have fallen lower than that. We've also seen it get more and more complicated with different payments to GPs depending on which state you lived in, or whether you lived in a poor area or a country town, or one thing and another. The whole simplicity of it, the whole universal aspect of it has been undermined.

Then one of the worst policies of all time was implemented about 5 years ago and that was the private health insurance rebate (PHIR). People taking out private health insurance get 30% of the cost back from the government. This was bad health policy and it was bad economic policy. About 45% of people have private health insurance, and what it means is that the other 55% are actually paying a third of the private health insurance of the other 45% who actually have it. Now it's more wealthy people who have private health insurance so poor people are actually subsidising wealthy peoples private health insurance. It's absolutely ludicrous. It hasn't taken the pressure of the public health system as most people claimed it would either, although in actual fact, it never stood a chance of doing that. The PHIR has achieved nothing, its just transferring money from poorer people to rich people and its undermining the health care system.

Now, what I wanted to say to you this evening, is to say as voters in any constituency in Australia I think we need to be asking ourselves, what sort of society to we want to live in? What are the values that should be underpinning that society? With particular reference to health, which is what I'm here talking about tonight, what sort of system do we want for our health care system?

Do we want a system that actually puts quite a bit of money into promoting health and protecting you against disease? I do. Do we want a health care system that's predominantly funded from taxation fairly, so that people pay in proportion to their income and wealth? I do. Do people want a simple health care system that's easy to understand and easy to access? I do. Do people want access to drugs, from just about the best pharmaceutical benefits system in the world where the drugs are available, we pay for them at prices we can afford as individuals and nationally we pay for them as cheaply as any country in the world, and the drug companies still make a decent profit? Then yes, I want that as well.

I don't want a system, a public system, a Medicare system, a PBS system that's turned into a second rate welfare system for poor people and everyone else gets a better system because either they want private health, or they're forced, cajoled and bullied into it. These are the sorts of things I want from a health care system. I want decent care for older people.

So, in closing, I'm going to say, vote for a fairer Australia according to the values that you want to see in a health care system.

Thank-you.