Doorstop Transcript - AMA President, Dr Bill Glasson, AMA 2004 Election Report Card

                            And I'd like to thank both Mark Latham and the Labor Party and John Howard and the Coalition for really the commitment they have made to health through the likes of Tony Abbott and Julia Gillard.  I've had a very good working relationship with them both.  I think that both of them have played a very, very fair campaign and it's really all been about patients, about getting more money into the system, getting more access to the system.  So across the board I commend them.

                            We have the Report Card here this morning, which really goes through a range of issues that we attest across health, that the parties have committed to.  Really they'Re equivalent amounts of money, with different emphasis I suppose in different areas. 

                            And can I just say that just on a couple of them, probably on the point of view of Medicare we feel the Coalition gets a tick there in the sense of the, not in the amount of money that's been contributed but the reduced emphasis on bulk billing.  Not that we don't believe in bulk billing but essentially we can't judge the health system by bulk billing alone. 

                            The safety net we believe in, we believe that's a very important plan for the new strengthening Medicare and we certainly would like to see that stay in, because I think it's, as I said, it supports the system across the board and it is part of Medicare.

                            Through to the issues around workforce, I think both parties are committed tremendously.  Labor has got some specific strategies on Overseas Trained Doctors which we think are good.

                            Aged care, the Coalition's picked up on dementia as a national health priority, we commend them on that.

                            On mental health, the Labor Party we feel are stronger.  They've obviously got that as a national health priority and Mark Latham's going to form a special committee, Prime Minister's Committee around mental health.  Not enough money in the system across the board but at least Labor is committing significantly to that area.

                            Public health, particularly child and youth health, vaccination schedules, Labor has made a full commitment and we commend them on that.  Coalition is dragging their heels a bit on the polio and varicella vaccinations which, hopefully the ATAGI group could recommend and if they are re-elected they must fund it full stop.

                            And I think the Labor Party's public youth health strategy particularly it's much more broader, much more comprehensive and I think they'd certainly get a tick in that area.

                            So that's just some of the I suppose, issues we've addressed in this document, but as I said I commend both parties and really would like to say to you that no matter who wins tomorrow I believe the patients of Australia are the big winners.

JOURNALIST:   Is it possible to say which party they would be the biggest winner under?

GLASSON:        No I mean it depends on the area you're looking at.  I mean if it's mental health, I think it's probably going to be Labor Party; if it's dementia it'll be the Coalition.

                            But if it's Medicare as I said we have a strong belief in the safety net, we have a strong belief in obviously putting more money into Medicare and not actually linking it to bulk billing.  So we just say if you put enough money in the system the doctors will bulk bill anyway, and I suppose that's the philosophy we're going with.  So yeah, so that's...

JOURNALIST:   You sound like you're leaning towards the Coalition.

GLASSON:        I mean no, I mean it depends on what you're talking about.  At the end of the day we have a strength, I think the Coalition have strength in Medicare, Coalition has strength in that safety net and to some extent has strength round the veterans, they've made a large commitment to veterans.

                            Labor's got a stronger commitment I suppose round public health, mental health.  So across the board you know I think depends on what area you're looking at.  There are strengths on both sides and that needs to be sort of recognised as such.

JOURNALIST:   Doctors are the biggest winners from this election campaign aren't they?  A GP stands to get at least $50,000 extra a year no matter who's elected.

GLASSON:        Look, patients are the big winners, patients are big winners.  Patients will be paying less gaps, patients hope to have better access, better affordability and hopefully maintain their choice and also maintain the quality of medicine that we're used to in this country. 

                            So it's all about patients, it's all about making sure the patients have got a doctor to see tomorrow and making sure that that service is affordable.

JOURNALIST:   Do you think a $50,000 pay rise for a doctor's reasonable?

GLASSON:        Well I think, what I'd suggest to you is that that $50,000 pay rise you talk about in fact represents gaps that currently the patients are paying.  Patients pay about $2 billion worth of gaps per year.  What this money has done is in fact underpin a lot of those gaps, so you the patient out there will be paying less in the way of gaps to see your doctor, whether that be a GP or a specialist.  And I think we need to commend the Government for the money that has allowed patients to I suppose cover those gaps.

JOURNALIST:   The latest figures on the government's Medicare safety net show it's blown out to $1.3 billion.  It's two and a half times more expensive than it estimated and a large reason for that is doctors are charging higher out of pocket expenses.  With a pay rise like $50,000 isn't it time to ease off on that?

GLASSON:        I would question that.  I would question the fact there's been any actual rise in doctors fees.  In fact the information I've been given in fact doctors fees haven't gone up at all. 

                            What's happening is the safety net is picking up on this two billion dollars worth of gaps that you, the patient, have been paying out there.  And so we commend the commitment to obviously cover those gaps.  So this is all about patients.  This is about making services more affordable to patients.

                            And I think that the Coalition's package, particularly around that safety net, aims to address that and hopefully make those services more affordable and also make the patient more secure in the sense that if some major, catastrophic event in their life medically, that there is a system that will come along and pick them up.

                            And so I think that that's the clear message.  This is good for patients.  It's good for affordability from the patients' point of view and it hopefully will preserve access.  And access is a key issue.

JOURNALIST:   So what kind of commitment can we get from the doctors to not moderate their fees in the wake of these pay rises?  What are you going to do to make sure it doesn't blow up further?

GLASSON:        Well look, if we see a major sort of movement in fees, then obviously the system will not be sustainable.  That has not been demonstrated to me as yet.  I have been led to believe that, in fact, the doctors' fees hardly shifted at all.  All that shifted in fact is that the gap the patients have been paying to see their doctor in fact have been reduced.  And so this is all about making sure that actually patients have an affordable service and an available service in a timely manner.

                            The other point I should make and this is about Medicare Gold, and just to say that this was a bold initiative and I commend the Labor Party for actually thinking outside the square.  But in reality when we look at it, we don't think it's actually sustainable, for two reasons.  One is from the workforce side.  We don't have the resources either in doctors or nurses and I don't believe necessarily we've got the resources in the sense of hospital infrastructure to deliver.  And there're questions about the financial viability of this in the long term.

                            And so what I'd say to both parties is no matter who gets elected, they're going to have to look at this interface between community care, primary care, and I think that's what we have not been focussing on.  Money has to go into primary care.  The solution to these problems is not actually to get people in hospitals but it actually to keep them out of hospital.

                            And both parties really haven't targeted on that interface of enhancing primary care.  That's around your general practitioner, enhancing aged care and medicalising that, up into what we call a sub-acute facility.  So patients actually don't need to go into hospital.  Keep them in the home.  You may bring them out of the home briefly for a rehabilitation service and then get them back to their home.  But the last place you want them is either in a hospital bed or in an aged care bed.

                            But having said that, we do need to have sufficient hospital beds and aged care beds to meet the needs of an ageing population.

JOURNALIST:   Bill, you've given the Coalition a tick for Medicare rebate increases that aren't linked to bulk billing.  Now given that there's - if the Government wins, there'll be $8 billion going into the system.  Shouldn't doctors have to give a commitment to meet the government half way on that?  Shouldn't bulk billing go up?

GLASSON:        I think it will go up.  Absolutely, David, I think what will happen: I keep saying, if you put enough money in the system, bulk billing or rebating and I prefer to use that word - we accept the full amount from the government as the insurer - will increase.  There's no two ways about it.

                            And I think that that's why I'm saying to both sides, if you put enough money in the system, doctors will automatically accept the rebate amount, a bulk billing amount as the full amount, as full payment.  So I think this is - that's the message we're trying to give too.  I don't believe you get to 80% bulk billing by somehow making some rule that you have to bulk bill because it does not reflect the fact that you've got such a shortage of doctors out there.

                            And this is what patients are telling me is that I can't find a doctor.  If I do find one, I can't get in before two to three weeks.  And so there are huge access issues.  Obviously affordability is a factor.  There's no two ways about it, particularly those who are struggling on lower incomes.  And so we have to make sure we have a system so that we, as doctors, can say you're struggling; I'll accept what you get back.

                            Look when I go west, when I go bush, I rebate 80 per cent of my patients because they've got the backside out of their pants.  And I will continue with that, and I'll always do that.  Okay?  That's my - that's why I did medicine.  I'm not there, you know, to sort of try and rip people's pants off.  The whole idea is to get out there and make this service available and make it affordable.

                            The other issue I haven't made by the way, which I should have made, is that what happened to indigenous health?  What happened to the most important group in this society?  The most vulnerable group?  What happened?  What happened to John Howard and Mark Latham?  They had buckets of money two or three weeks ago to give away and they have left indigenous health standing with nothing.

                            These are the people basically who sit out in these communities - Sue will tell you - which I'm going to in about three weeks time, out at the back of Bedourie and Birdsville and those places, who really are struggling because they do not have the basic necessities of life.  That's housing, water, sanitation, proper food, clean vegetables you and I take for granted.  They have none of these basic commodities in life.

                            And I am disgusted with both parties for not having made a commitment to indigenous health.  It is really unforgivable, given the amount of money that's gone into the system across the board.  And so whoever's elected next Saturday, tomorrow, I promise you I'll be on your heels.  And I'll be on your heels until you deliver, okay?  I'll be on your heels until you deliver because I'll not stand around and let this country have the most atrocious indigenous record of anywhere in the world and with all this advanced, first world medicine, advanced first world education and we treat our indigenous people as some third class citizens.  It's not acceptable and I say to both parties, you've failed miserably.

                            And so when the people go to their ballot box, if they're concerned about indigenous health, then I'd put that very clearly on the square.  So that's one issue that I want to make very clear, that both parties have failed.  And as I said, it's a damned disgrace to put it politely.

JOURNALIST:   Is that because there's no votes in it, Bill?  And what does that say about the Australian population generally.

GLASSON:        Absolutely right, there're no votes in it.  God help us.  Doesn't anybody have a soul?  Doesn't anybody have a hand on their hearts?  And that's the reality.  There're no votes in it.  God help us.  Let's take a walk with me next week when we go to western Queensland and those areas, see those people struggling out there, and you'll see what we talk about votes.  And I think the people in Australia should, before they think tomorrow by the way, about these two major parties that they have been let down on this.  And if you can somehow send a signal to them at the ballot box, well please do so because I just think it's unforgivable.

JOURNALIST:   All those people, should they vote Green?

GLASSON:        Yes.  Well maybe - maybe they could write a little note on their ballot pad how disgusted they are.  What I meant - having said that, when the minor parties control the Senate, we will be going to the minor parties and talking to the minor parties and saying, listen guys, we need a lever to make these big fellows actually take heed and take stock.

                            So that's not beyond the par, pale when they do get elected, whoever's elected next week.  I will be going to the minor parties and saying, listen guys, let's see if we can lever these big fellows to actually make the right decision so that we as Australians can be proud of what we deliver to our indigenous counterparts.

                            So as I say, it's a disgrace and unforgivable.

JOURNALIST:   So vote Green in the Senate?

GLASSON:        No,.  No I think, think carefully when you vote in the Senate definitely.  So as I said, just in summary, I thank both sides.  I thank Julia Gillard and Tony Abbott for a very fair campaign and I thank them both for a great working relationship.  I think the reality is, unfortunately, whoever gets elected, both - either of those are going to lose their portfolios.  I think they'll move to something else.  I think that would be a loss for health.  They know those portfolios very well, but I suppose that's politics.  And as I said, it doesn't matter really who wins.  I think Australians health-wise will be the winners in the long term.

JOURNALIST:   Why you say that, Bill, that they're both going to leave their portfolios?

GLASSON:        Well I just think that Julia Gillard's obviously very senior.  I think she will sort of - they'll put her in a more senior post again.  And Tony Abbott, I think again he's very ambitious and no doubt will continue to climb the ladder.

                            So I think both of them have got huge potentials to lead their parties in the long term.  And I think that's where they're both heading.

                            Okay guys, thanks very much indeed.

Ends