Transcript: AM Agenda, Sky News interview with Kieran Gilbert

31 March 2016

The Hon Alan Tudge MP

Minister for Human Services
Healthier Medicare package, State taxation


Today we're anticipating a major announcement from the Prime Minister on a number of fronts.  We've got some detail already on one of them.

This relates to the Government's response to the chronic health problems around the nation and it's a major overhaul of the way Medicare is used.  Basically they would be Medicare 'homes' for those with chronic diseases, one GP that would have the treatment for their entire medical issues.  Now this is a major overhaul, a big shift.  It's going to cost quite a bit of money.

I've received this morning a copy of the draft Heads of Agreement of the COAG talks.  Obviously this comes ahead of tonight's gathering at The Lodge, the Prime Minister hosting the State Premiers tomorrow for the COAG meeting.

Point 18 of this draft Heads of Agreement explains how the Government's going to fund this response to chronic health issues.  Now it says the Commonwealth will retain $70 million in each year from 2017-18 to 2019-20 from the amount provided for public hospital services as the Commonwealth's contribution to supporting the chronic health response.

Now with me this morning to discuss this and other elements of this communique and other issues of the day I've got the Human Services Minister Alan Tudge and also Labor frontbencher Nick Champion.

Before I get to the Minister let's get Nick Champion's thoughts on this, the fact that the money for that chronic health response will actually come from public hospitals, Nick Champion, your reaction to that.


Well it's typical of what this Government's doing, a pea and thimble trick on every occasion with health.  They've cut $2 billion out of primary care, $2 billion out of GPs.

They've tried to load them up first with a co-payment, that was a complete abject failure. They then cut doctors' rebates, and now they're trying to address chronic illness, which is a laudable thing, but they're doing it in the context of having done those cuts and already hacked into general practitioners' business models and all the rest of it.

I can't go around my electorate without talking to a GP who's aggrieved at the way this Government's treated them, both in terms of the rebate, but also the way in which they've been dealt with and devalued in the general community.

So this plan I don't think will be received with open arms by doctors because it's done in this context overall of a pea and thimble trick – cuts on one hand to doctors' rebates, to public health, and on the other they seem to be giving on the chronic illness issue.


I'll get back to you on that because actually it has been overwhelmingly welcomed by the College of GPs, they've been effusive in the praise of this policy.  But you can come back to that in a moment.

Alan Tudge, your thoughts on what Nick Champion said and also the explanation as to why, if you're going to focus on this issue of chronic health and preventative health, that we're seeing tens of millions of dollars cut at the same time from hospitals to pay for it.


Well overall we hope this will lead to fewer hospital admissions, and so therefore there'll be a saving there.

Now some experts say that if you better co-ordinate chronic disease management you can avoid as much as 400,000 hospital admissions per annum.

This is a very important plan which the Health Minister is announcing today, to provide better care for those with chronic diseases such as heart conditions, or diabetes or mental health problems.

The co-ordination of chronic diseases has been an issue on the agenda for some time, it's a well-recognised problem in our health system and we are addressing it today with this plan.

And we hope that it does lead to a more efficient system with fewer people having to go to hospitals, but more importantly it leads to better care for the individual patient because they will get a dedicated package for them, tailored for their needs and it will be managed by their GP.

So the GP can have the oversight of their chronic disease as they need to go into hospital, if they do, as they need to go to some of the allied health care professionals, and as they need to go to the GP.

This is a very, very important initiative and it has been welcomed by the health professionals generally.


Yeah, well as I said, the College of General Practitioners overwhelming in their support of this, and this is something that they've been calling for for a long time, basically a centre, one central GP, a medical professional that can help people with a chronic disease.


That's right.


Sometimes, Nick Champion, one/two chronic diseases at the same time, this is one in five Australians that we're talking about.

If you do have that better treatment at the GP primary care level it's inevitable is it not, as the Minister points out there, that you will have less people fronting the hospitals, therefore this reduction in funding that we're seeing in this Heads of Agreement is appropriate.


Oh well exactly, of course chronic disease is better dealt with by GPs, by allied health professionals, and prevention is always better than cure, and you see that in diabetes.

If a diabetic sees a podiatrist just once a year, their chance of getting an amputation reduces dramatically, and amputations cost $50,000 a pop, and obviously a very serious operation.

So there are plenty of examples of where primary care does save money in the acute hospital sector.

But this is all being done in the context of having doctors, local doctors having their rebates cut.

And of course while the AMA and the Royal College will welcome today's package, the average GP I can tell you, out in the suburbs, feels pretty neglected and pretty diminished by this Government.  And I've met with many of them who are providing tremendous care in the community, but don't feel that they're getting backed up by this Government.


I think to the contrary actually.


Ok, let's get Alan Tudge's response.


I think to the contrary Nick, that this actually empowers the GP to properly manage the care of the individual.

Now our health care system is world class in dealing with individual procedures and individual surgery – a broken arm for example.  But it hasn't been set up to date for dealing with those complex chronic diseases where you might be in and out of hospital, you might need to see an allied health professional, you might be in and out of the GP's clinic.

What this does is it enables the GP to co-ordinate for the first time all of that care.  Now that will lead to better outcomes for the patient and it will lead to fewer hospital admissions, which ultimately means a more efficient system at the same time.

This occurs elsewhere in the world, we're modelling it off that and I think it is a very important initiative which the Health Minister is leading here.


And I've got to say it seems quite odd, Nick Champion, it makes so much sense, that Governments haven't done this before.

You might quibble about where the money is coming from but surely underpinning this there is a lot of logic to it isn't there, before we move on to some other discussion about tax, Nick Champion.


Well what you'll find is GPs already have had care plans.  The problem has been people have moved around from GP to GP, and sometimes their regular GP hasn't been the one who has had access to the care plan and those Medicare provider numbers. So there have been some issues with the administration of care plans.

It's not quite true to say that people with chronic illness at the moment receive no attention – they do.  It's just the management of that attention hasn't been all that it could be.

Of course everybody welcomes a renewed focus on chronic disease, but we've been talking about this now for two years and anybody who looks at our public health system knows that prevention is better than cure, that you're better dealing with people with complex chronic conditions, and there'll be increasing numbers of them as people live longer, everybody knows this and everybody's been talking about it.

The Government rocks up, you know, five minutes to midnight and expects to have golfers' claps.  Well they'll get a golfers' clap, but you know, it's done in the context of cuts.


Let's move on to this tax debate now.  The Prime Minister, he went a bit further yesterday than I think was intended it seems, making this detail out there at Panthers'.  It seems to me that he got a bit ahead of himself in terms of the detail that he went into out at Penrith yesterday, Alan Tudge.

Correct me if I'm wrong, but it's not normally the location you'd make such a major proposal to change the Federation.  Nothing against the Panthers, they're a great rugby league team, but to do that on the oval out there, it just seemed like it was all a bit ad hoc.

And if you look again at this draft Heads of Agreement, point 19 under tax reform, there's one line in brackets that says 'language to be circulated separately'.

So clearly very much a work in progress, a lot of work for him to not just convince voters but the Premiers, if this deal is going to be worth anything.


This plan has been under consideration for some time.  You might recall that it was initially outlined in the National Commission of Audit report.  It was then put up as an option in the Federation White Paper Discussion Paper which was launched well over a year ago.  It's been discussed in Cabinet most recently, and then the Prime Minister outlined some of the details yesterday.

The overall problem which it's trying to address is the fact that the states are so reliant upon the Commonwealth for revenue. Now that leads to two problems.

Firstly, it leads to a lack of clarity in relation to who is responsible for what, and therefore you get the blame game, which the public hates.

But secondly, you get less efficient service delivery when a level of Government doesn't have to raise the revenue to pay for that service delivery.

At the moment, it's the easiest thing in the world for a State Premier to raise expectations of higher quality services and then to go to the Commonwealth and ask for that to be paid for.

Whereas if that State Premier has to go to the Australian public, to the people, then the people rightly ask is that service necessary, is it being done in the most efficient manner? Is there an implementation plan to ensure that the results will be delivered?  And that's what this discussion is about – ensuring that there's accountability at the state level, ensuring that the states have true sovereignty over what they do, because they're raising the revenue and expending the revenue and are accountable back to the people.


And Nick Champion the point, first of all it seems a bit odd Jay Weatherill proposes the idea then is negative about it when there's a change in the approach to it.  But he said, Weatherill, your state's Premier that there should be a section of income tax, although he wanted it a set level for all the states, surely he'd be more open to this than the initial criticism?

The key point to what Alan Tudge and the Prime Minister are arguing, and that is if you're accountable for the revenue coming in, you'll be more accountable for the spending going out. It makes sense.


Well Kieran the problem here is the cure is worse than the disease.  And what's happening, what the Liberal Party are proposing is to do is to send the national economy and our taxation system back to the pre-war days, which is completely barking mad in a modern economy.

And just think about it, let's say we've got a soldier in my electorate who's based at Edinburgh.  They get reposted in a single year up to Townsville.  They may face a different income tax rate in a single year, just moving postings.

Let's say a FIFO worker who lives in Tasmania but who works out on Barrow Island – which income tax rate do they pay?

And what we'll have is people entering into convoluted residency arrangements where they live nominally in one state and pay tax in another, or work in another.  It is a crazy, crackpot idea, and I can't even believe that it's being proposed to be honest.  It's that mad.  It's that mad.


Well it was proposed once by Bob Hawke, but anyway we're out of time.

Nick Champion, Alan Tudge – thank you both.