Transcript: AMA President Dr Steve Hambleton, Doorstop Parliament House, 6 November 2013
Subjects: Proposed $2000 cap on tax deductions for work-related self-education expenses, COAG Report and Medibank Private
STEVE HAMBLETON: Thank you very much everyone for coming here today, we'd really like to congratulate the Government for a victory for common sense.
The scrapping of the $2000 cap was something that we've asked for, that we've certainly said to the previous Government it was not appropriate policy. The AMA was probably the first group to come out to actually recognise the impact of this. It was going to have a huge impact on junior doctors, a huge impact on rural doctors, and a huge impact on the medical profession's ability to stay up to date. Of course, when we examined it further, we realised there was a whole lot of other professions that this would have impacted on, so we congratulate the Government for actually understanding, hearing the message, and delivering an outcome which is quite appropriate for the medical care of Australians.
This means Australian doctors will be able to stay up to date, they'll be able to maintain their position as first-world care in this country, maintain the self-education, look after the people of Australia.
QUESTION: Wasn't this cap introduced to stop lawyers and doctors taking very fancy junkets to Vienna, and Morocco; what's to stop abuse of the scheme now?
STEVE HAMBLETON: Well, this was rhetoric put out by the previous Treasurer and, of course, there are mechanisms currently to make sure that - first class airfares, five star hotels, simply don't happen. We're not defending that, we're actually defending the right of professions to properly self-educate, to stay up to date, and certainly we would suggest they turn to the mechanisms that already exist to make sure that if any of those things are not happening.
QUESTION: So, couldn't the Government have just lifted the cap rather than abolish it altogether?
STEVE HAMBLETON: Well, the problem is that young doctors are spending an enormous amount of money on self-education, in some cases up to $40,000. So, lifting the cap wasn't appropriate, removing the cap so that legitimate expenses, the ones that would be acceptable to the Australian people, to say this is legitimate education expense, it should be paid for. Our rural doctors, of course, who are particularly hit, as well as our junior doctors, just travelling to a capital city to actually attend a conference, often went over the cap, and this would have had a devastating effect on their ability to stay up to date.
QUESTION: [Indistinct] …unless there's any other aspects of the tax system that you think the Government should be tampering with whilst they're doing what they're doing at the moment?
STEVE HAMBLETON: Well, I guess, from our perspective it's the health care impacts in the health system that we're concerned about. The previous Government did put together a number of things that we were concerned about. The $2000 cap was one of them, obviously delaying the Medicare rebate rise has cost - will transfer about $600 million worth of costs onto patients. And as of 1 November, of course, normally that rebate rise would have occurred and it hasn't, so that shifts costs onto patients. The lifting of the safety net for higher income earners means that [indistinct] and it kicks in later and that tax deduction at the end of the year is also missing.
So, all of these things shift costs onto the individual, and we need to bear that in mind when we have people in a very finely balanced situation trying to look after their health. There's a fine balance between the private health system and the public health system, and anything that tips the balance between the two has potentially got a great impact on where people seek health care.
QUESTION: Dr Hambleton, what do you think the COAG Report shows in terms of how [indistinct]?
STEVE HAMBLETON: Look, the COAG Report certainly looks at a number of things, it's got long-term health goals that we need to look at. It's very good that our life expectancy is continuing to go up, it's also very good that our smoking rates are coming down. We are disturbed to see that obesity rates have gone up, that is a problem. It's also good, it shows that general practice, and that focus that this Government has said it will have on general practice, is working.
We're seeing that preventable hospitalisations are down, that's a good thing. We haven't seen, though, the decrease in the waiting times for elective surgery that we'd like to see come out from better cooperation from state and federal. So, there's more work to be done. It's good that we're measuring these things, and we've made some improvements. But there's still some areas that we can do better.
QUESTION: But how is that even possible given that the states are getting more money, and those outcomes, specifically waiting [indistinct]?
STEVE HAMBLETON: Well, it's very interesting. When you look at the two targets that we're measuring, the emergency access targets, in other words, getting into and out of emergency departments relies on hospital beds being available. Of course, those available hospital beds are also the limiting factor for elective surgery. So, those two targets work against each other.
We have got an ageing population, we've got increasing amounts of conditions that we can treat in our population, that's putting pressure on our hospitals, and we know the number of beds per patient really hasn't gone up, in fact it's falling. So, as well as doing better with what we've got, we actually still need that infrastructure, we still need those beds to treat our public and our population.
QUESTION: And what needs to be done to address obesity [indistinct]?
STEVE HAMBLETON: Well obesity has got to be something that should not just involve the health system. Obesity needs a multi-factorial approach. We've got to think about urban design so it makes it easier for us to walk to the shop and back, walk our kids to school and back. We've actually got to think about how - the front of packet labelling that's on our foodstuffs, so people can choose better things when they go to the supermarket. We've actually got to think about education of children in schools about what good nutrition's all about, how to prepare nutritious meals and avoid those fast food products.
We've got to make sure that we have a population that embraces exercise, and recognises that one hour of exercise every day is really important to maintain our health. The message is not getting through, so it's not just a health message, this is every portfolio needs to think about this so we can all work together to turn this around. Obesity rates are driving up rates of diabetes, they're driving up rates of heart disease. We're certainly seeing increased numbers of cancers because of obesity, it's something that we need to tackle as a nation.
QUESTION: And what [indistinct] reform do you think that - the new Government should rethink it, or do you support it in its current state, even if some of those outcomes [indistinct]?
STEVE HAMBLETON: Well, we've got a new Government so we've got a new approach. We've seen the Prime Minister say he's going to engage with the Premiers. We know the problems, we know that there's a blame game in our hospitals, that hasn't been solved. We know that there's different funding mechanisms for our hospitals now. So, look, we've got a new Government, I think a new focus, a new strengthening of that relationship between the states and Federal Government needs to happen to make sure we can deliver those common goals.
QUESTION: Dr Hambleton, does the AMA have any concerns about the Federal Government selling off Medibank Private?
STEVE HAMBLETON: Yes, we do have concerns and when we looked at this issue a number of years ago. Our main concern was that there may be potential for decreased competition in this industry. If that's the case, that will drive up premiums for everyone. So, as part of this scoping study that's being done to prepare for the decision about the sale, we would like to see that addressed. We want to understand about whether competition will be decreased, whether there is a risk of premiums, because that'll affect us all.
It's a very fine balance between the public and private sector in this country, and we know that you don't have the capacity in public hospitals if there's a major shift away from the private system.
QUESTION: Does the AMA have a view on how that competition issue can best be managed?
STEVE HAMBLETON: Well, I think we'd like to see the results of the scoping study and understand the issues. Certainly the two options that have been put out there are a trade sale, and if it's a trade sale to one of the other players then that decreases the number of players. Certainly, if there are international sales, I mean, that may bring in some further risk. So, we'd like to see the results of the scoping study.
QUESTION: Who actually owns Medibank Private? I mean, if it is sold, shouldn't the members be given the money, not the Government?
STEVE HAMBLETON: Well, currently the revenue that's retained by Medibank Private is from member subscription, so in reality it's all the members that own that business, and the people of Australia benefit from it because it's in public ownership.
QUESTION: So the members should get the money if it's sold then?
STEVE HAMBLETON: Well, I think we need to think about asking those questions in the scoping study. You know, what is the impact of the sale? What about the people that paid premiums, what happens to them in the long run?
6 November 2013
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