Payroll tax - Parliament House doorstop transcript

David Crisafulli: Please, everyone, I just want to express the significance of what you are seeing here this morning. For representatives of well-respected bodies, as well as practice owners to stand up and call this out for what it is, shows how serious this is and why we have to work towards shining a light on what is a massive pressure that will be borne on Queenslanders. Make no mistake, the Palaszczuk government's patients tax will cost you more for your child to see your local doctor. It is that simple, and it is being felt in communities across the state. And on 26 occasions before the last election, the treasurer said there would be no new or increased taxes.

Well, nothing has changed from a single medical practitioner across the state. Their business model remains exactly as it was and yet in the shadows of Christmas, a new tax grab was implemented that will be passed on to patients. In the middle of a cost of living crisis, why would you charge people more to see their GP? In the middle of a health crisis, why would you funnel more people into an emergency department that is already bursting at the seams? It doesn't make sense. It is a broken promise, and today you will hear why it matters. Today you will hear why it is important that, as a community, it is called out for what it is, and we do everything we can, in an environment where people are looking at every single dollar, to show the government that this is a broken promise and it will cost Queenslanders in their pocket.

Bruce, I might actually ask you to start, and then you can hand over to Maria.

Dr Bruce Willett: Yeah, so thank you very much. This is a tax on the patients rebate. This is an increased tax that will come out of the pockets of patients directly from your Medicare levy, straight into the pockets of the State Government. It will cost patients more and that's a problem. It is a problem all around the country. I would like to thank the Queensland government for working with us to try and work through it for the no retrospectivity part of this, and the entering into a cooperative arrangement.

However, that's not enough. I would urge the Queensland government to continue to lead, and to actually stop this additional tax on patients that will drive up costs, will drive up out-of-pocket costs, and will drive down bulk billing. It is time for the Queensland government to step up and to lead the other states and to stop this really regressive tax on healthcare. Maria?

Dr Maria Boulton: Payroll tax is a tax on patients accessing their GPs. This is an immoral tax. This will affect our most vulnerable patients. When you think about patients who frequent their GPs, it's patients who have chronic disease, the elderly, young families, and this is going to affect them the most. We are asking for patients access to GPs to be payroll tax exempt. We need urgent action on this. There are already practices and patients being affected by this immoral tax. Now, I'd like to introduce Dr Aaron Chambers, he's a GP and practice owner in Brisbane. He's been one of the practices that has been affected unfairly. His practice was actually deemed to be compliant before there was a change in the way that they interpret this law. And he's one of our members that has been affected similar to other members and we thank him for actually speaking out. Dr Aaron Chambers.

Journalist: Can I please ask you a very quick question? When you're saying that payroll tax, obviously a lot of other businesses pay payroll tax and GPs are quick a crucial service. Apart from GPs being known crucial service, is there any other reason that a GP clinic should be exempt from payroll tax?

Dr Maria Boulton: GP practices already pay payroll tax on our employees. The fact of the matter is that there's been a change in the interpretation of the law as pertains to patients being seen by their GPS and accessing healthcare services. When a patient goes to a public hospital, that service is payroll tax exempt. It's payroll tax exempt for a very good reason. It's because it is healthcare, it's an essential need that humans have in Australia. And that is why it is so important... And this is why we're here. We're here for patients. We're here because patients deserve to have access to their GPs.

Dr Aaron Chambers: Hi there. My name's Aaron Chambers. I'm a GP in Brisbane, on Brisbane South at Grow Life Medical, and the founder of Grow Life Medical. I'm happy for any questions if you'd like to ask. And first of all, I guess up front, I don't sit on any side of the political spectrum. Really my sole focus when we started our clinic is to look after our community. We do not make much money, if any, out of running a general practice. The whole idea is that a general practice exists in a community, a bit like a hospital exists, to connect patients with their doctors. And that's why, for very long historical reasons, GPs are not employed by general practices. The general practice is simply a location where patients can meet their doctor and GPs are actually customers of the practice, in the way this works.

You can imagine, to answer your question before, how crazy it is to be levying a tax on a company on the earnings of their customers. It just makes no sense. And there are very good reasons why that's historically been the case, because GPs are all about looking after the individual in front of them. They're highly trained autonomous individuals and they have to have the independence to be able to look after that patient in the way they see fit. And the relationship between patient and doctor and Medicare is predicated on that being a direct relationship.

So any argument where you say that a GP works for a practice, it simply is not true. That's the first point. The second point is that this work now, across the state of Queensland, across political lines, any GP or general practice owner understands the impact that this is going to have. And it's pure and simple. It is tax on patients when they come through the front door. It is a tax on the federal Medicare levy, which is intended to support patients to see their doctor. And even more importantly and from the State Government, and I recognise the State Government is doing an excellent job at working with the Federal Government to increase the desperately needed change to Medicare rebates to patients, but what isn't a good idea at this time is that general practice is actually the economic solution to the problem that the State Government is facing in the hospital system.

The roots of the issues that we see in the hospital system are to do with long waits in general practice and difficulty with accessing continuity of care. Now, the worst thing you can do when the problem in your hospital system has its roots in underfunding of primary care, is to put even more tax on patients seeing their GP. Because GPs, they know the individual, we're able to look after your problem in a longitudinal manner and we can nip things in the bud before they become a big problem and before they come so costly to the state system. So that's why we're calling for this to be abandoned, because it's not good economic policy for Queensland. It's not good policy for individuals. I don't know about you, but my cost of groceries has gone up astronomically in the last 12 months, and we see that in patients. And if they have to choose between the cost to see their GP going up 15 per cent versus putting food on the table, I'm pretty sure food's going to come first. But healthcare is also essential. So that's I guess the crux of while we're here.

Journalist: Can you just speak to the idea of the increase that you would pay [inaudible 00:15:51].

Dr Aaron Chambers: The mathematics are quite complex for this because of the way that the tax is being levied on the customers of the practice. But effectively it's going to mean that every patient in Queensland is going to have to pay around 15 per cent more to go and see their doctor. And the big challenge of that is that Medicare rebates are fixed, and so the most, most vulnerable people in our community are the ones who rely on bulk billing. And GPs, for a very long time, we don't do this because we want to be on some highfalutin specialist and get paid a gazillion dollars. We do it because we care about the individuals who we look after, we care about our communities and historically we redirect anything that we can into supporting the most vulnerable. And governments aren't able to see down to the microscopic level as to who is genuinely most vulnerable in our community.

I know plenty of single parents, or even dual parents where they've got a couple of kids, they don't have healthcare cards, they don't get any government subsidies and it's really a struggle to make ends meet. Someone who's come from a good job and then lost their job, it's also difficult. A good GP will generally try and compassionately bulk bill that individual, but this decision makes it just impossible because you can't adjust that rebate.
Journalist: Are you understanding for payroll tax to be suspended on purely the income of those contracting doctors and GPs? Or would you like to see it across all staff working in the GP? How broadly would you like this-

Dr Aaron Chambers: Sorry, I'm not quite clear your question. What do you mean?

Journalist: The treasury officials have told us this particularly only changes [inaudible 00:17:28] fact that the payroll tax is now levied on the contracted doctors in the GPs.

Dr Aaron Chambers: Yes.

Journalist: Staff within the GP have always-

Dr Aaron Chambers: Yes. We already pay payrolls tax on those staff.

Journalist: Will you be wanting the payroll tax holiday on those [inaudible 00:17:40]?

Dr Aaron Chambers: I think we'll be happy for a decade's long status quo, to remain as it is. This is really a new way that tax is being levied on general practice. That's the problem. I think everyone's happy with the status quo, although admittedly Medicare rebates are too low. But we're not asking for special exemptions around our employees, we're just asking for a fair go to look... These are our customers, not our employees.

Journalist: [inaudible 00:18:06].

Dr Bruce Willett: Do you mind if I interrupt this?

Dr Aaron Chambers: Yeah.

Dr Bruce Willett: Quite clearly what we're asking for is not an increase in the tax, so the tax not to change. Currently, practices do pay payroll tax on the employees that are in our practices. And fundamentally we're happy to do that, like any other business in the country. But what's changed is the way that the tenant doctors who work within the practice, who buy services from the practice that essentially their entire income is now being considered as subject to payroll tax. That's a bit under five per cent off the top of every patient's Medicare rebate. Every payment that any patient makes to the practice now goes directly to the State Government, and that's just not tenable. It can't be absorbed by practices.

The RACGP has done some surveys, and only three per cent of practices said that they could absorb this tax. 87 per cent of practices said that they would have to pass it on. And one in five practices said that they would feel that they would probably go broke with this new tax burden. Unfortunately, this comes on the back of decades of chronic underfunding of Medicare for general practice. And so, as everyone knows, general practice is already at breaking point, this is more than the straw that's breaking the camel's back.

Journalist: [inaudible 00:19:34].

Dr Bruce Willett: So to be quite fair to the Queensland government, I think that they are being honest in being upfront about the way that it's being interpreted. My sense is that the other states are really proceeding on very much the same lines. And so this is a national issue across all of the states, in my opinion, where I think Australians right across the country will be paying significantly more. I do think the Queensland government has shown some leadership about being honest and upfront about the way they're approaching this tax. I would call for them to continue that leadership and really stop this really regressive tax on all Australian citizens and on a sick tax on our healthcare system.

Journalist: There's lots engagement between the government and GPs to reach a [inaudible 00:20:35]. Is that breaking down or are you still open-

Dr Bruce Willett: Yeah, look, we're still talking to the Queensland Government, still talking to the Queensland Revenue Office, hopeful for a reasonable outcome. But really the best solution is that there's legislative change that really protects patients from this increased tax burden, and certainly calling on the treasurer to introduce that legislative change.

Journalist: Dr Chambers, I have one more question. I know you were here last year-

Dr Aaron Chambers: Last year, yeah.
Journalist: ... talking about this. Can you tell us what has changed materially in your practice prices, number of patients you have received? What has changed in your practice since then?

Dr Aaron Chambers: Look, essentially at the moment we haven't increased patient fees. But with the ruling just before Christmas, we're actively talking about what we're going to do about this because it puts a massive even further hole in how to proceed forwards. It essentially means we're looking at probably a 15 per cent increase in patient fees, and it's going to mean probably having to abandon bulk billing, possibly for everyone or possibly for only a very tiny few circumstances of exception. And I know there are practices very close to us where they've historically bulk billed everyone, and they've literally just given up on that based on this ruling just before Christmas. It inevitably means that there's going to be increased fees to patients. This is a tax on patients and their Medicare rebate.

Journalist: What's the things you [inaudible 00:22:08] patients, the people who are taking that [inaudible 00:22:09]?

Dr Aaron Chambers: Look, I'm really worried about the people we don't see because I know it's exactly the people who most need healthcare and are most vulnerable. We know that the people who have lowest income are at most risk of adverse health outcomes, and they're also exactly the people who are less likely to come because of that financial barrier. They're the ones I'm most worried about and we want to be able to support, but without sufficient federal funding to Medicare and with an added tax on patients, it just becomes impossible. And we can't do it and make a loss as you, no business can work like that.

Journalist: I've got a question for Dr [inaudible 00:22:46] on another issue.

Dr Nicole Higgins: Before we go to the other issue, can I just jump in, if that's okay? And then I'll go to Maria. My name's Nicole Higgins. I am the National President of RACGP. I am also a GP from Mackay, and a practice owner. This is a tax on Medicare. This is a tax on patients. And what this is now going to do is undermine any national reforms that the Federal Government is trying to implement with Medicare.

But more importantly, what it means for our patients is that it will increase the gap. It will kill bulk billing. It's going to put increased pressure on our hospital systems, our ramping and our overflowing emergency departments. This is a national problem. I would like to see Queensland take the lead, but we have national cabinet on Friday and this is having discussions with Minister Butler on Thursday pre that meeting.

Journalist: Dr Higgins, [inaudible 00:23:53] further on about how this becomes [inaudible 00:23:58]?

Dr Nicole Higgins: So payroll tax, it is harmonised amongst the states. It has been discussed as a case started in Victoria, New South Wales and this will be rolled out nationally. What this will do is break the general practice system. It will break being able to see your GP. And it's going to mean that across Australia, and across Queensland particularly, people are going to struggle to see their GP.

Journalist: Just one for Maria. You talk about the status quo, other sectors of the medical industry, how are they being affected by tax [inaudible 00:24:48]?

Dr Maria Boulton: You'll find that this will affect not just the medical industry, but also allied health. And everyone's seeking their own individual advice at the moment given the recent QRO ruling in December.

Journalist: So it could be that you're not paying more just to see your GP, but other services?

Dr Maria Boulton: I'm a GP, so that's where I live. And I think everybody else, they're all just getting their advice to see what's going to happen in the future. But the critical point about general practice is that it's already at the brink. You already have patients who they can't afford to buy medication at the pharmacy. Do you want to add another stress on them where they're not going to be able to access a visit to their GP? No.

I think a reminder that general practice is amazing. Having a relationship with your GP is like having a super drug. They keep you healthy and they keep you out of hospital. And basically what this tax does is that it goes against all of that, and it's immoral.

Journalist: Wouldn't it actually cost Queensland tax payers more in the long run?

Dr Maria Boulton: Most definitely. So if Queenslanders become sicker because they don't have access to their GPs, it'll cost more money in managing those chronic illnesses, in emergency department presentations. GPs are really cost efficient. We love what we do. We love looking after our patients. Please, please ensure that patients continue to have access to see their GP.

Journalist: On another issue, the failing corruption report [inaudible 00:26:18] yesterday [inaudible 00:26:20] lobbying, and they named those like the AMA, the [inaudible 00:26:26], lobbying regulations and you kind of have the policy and legislation. Do you have any reactions to that, and how it's different [inaudible 00:26:36]?

Dr Maria Boulton: Yeah, I haven't had a chance to read the report so I'll take the question on notice. I've just been very busy with GP issues and also the logjam hospital report that came out of AMA Federal this morning, but I'll take it on notice.

Journalist: Can I ask you a- [inaudible 00:26:59]. Oh sorry. Yeah. [inaudible 00:27:00].

Journalist: Quickly on some of the meeting stuff before we move on. The government says that it helps [inaudible 00:27:22] they may pay by tax on contractors. You get the security, cleaners, aspects like that. If we start seeing tax exemptions for one practice in the GP sense, does it open up whole can of worms on what [inaudible 00:27:39] exempting other big corporations?

David Crisafulli: We are asking for nothing more than business as usual. And these people have built a business model where the GP operates as a contractor in that facility. And it's been like that for decades and decades. The only thing that has changed has been the interpretation of the Queensland Government. And yes there's been a ruling in another state, but on the back of that the treasurer decided in the shadow of Christmas to send a present to the tune of asking medical practitioners to charge more for their patients to see a doctor.

I can understand, like all businesses, they will have to pay payroll tax on their staff. They have a business model that for ever and ever has allowed doctors to be independent of that business, and that's the way it should be. And no one's asking for a payroll exemption. They're asking for the law to be applied the way it has for generations. And without it Queenslanders will pay more to go to the doctor in the middle of a health crisis. That doesn't make sense.

Journalist: Can you understand why other business might be even jealous of this trust that GPs get [inaudible 00:28:49]?

David Crisafulli: And if the government changes the rules for other businesses, we'll go into bat. That'll always be my style. What I'm doing here is fighting a change, a retrospective change after businesses have made a business model which allows patients to be the beneficiary of that, and that's worth fighting for.

Journalist: Do you support that deal for other businesses?

David Crisafulli: Anytime the government breaks its promise to charge new or increased taxes, we will go into bat, and we have done that consistently. And the treasurer said 26 times before the election, that wouldn't occur. 26 times, including when asked directly. And since the election, I think Queenslanders have seen what has occurred, because they have raided every honey pot, because they have wasted money. Things like Wellcamp has been an unmitigated disaster and a proof that this government doesn't respect money. And as a result, they have to find new ways of trying to prop up their bottom line.

Every time an infrastructure project blows out in time and budget, they need to find new ways. And make no mistake, this is retrospective. It has changed the way that something has been interpreted for decades. That is a new tax, and it is a new tax on patients and they're feeling it. And the government is going to feel it, because doctors are communicating with their patients as we speak. And in the same way we went to bat when the broken promise on the renter's tax, because it would flow through and we saw the humiliating back down, the same playbook will occur. But it shouldn't have to take months on end, because people are making decisions now. Businesses are making decisions about their viability. Patients are making decisions about whether or not they can afford to take their child to see a doctor. That isn't a modern Queensland.

Journalist: The government says it's really only impacting a small number of GPs. They're really only levy perhaps less than $1 million. So that bigger a million of above group [inaudible 00:30:52]?

David Crisafulli: Well, I'd trust the doctors over the Palaszczuk government. And yesterday I was with the deputy leader in Caloundra, and on a moment's notice there was representatives from half a dozen clinics. And you heard the most passionate response yesterday about what it means to patients there on the ground. The government has not said what this change in their interpretation, this new tax, will raise. They don't know. But I know, having spoken with doctors in Harvey Bay, at Paradise Point, at Beaudesert, Brisbane today, I think they've picked the wrong fight on the wrong issue.

Right now, cost of living is the prism that every Queenslander is viewing every interaction with their government. And when they go to their trusted GP and they can no longer bulk bill, or it is costing them more to go and see the GP, and the reason is because of a new tax, I believe that there will be some very strong points made. And I have every faith that if we conduct the argument in the same way we did with the unfair renter's tax in the middle of a housing crisis, we will be able to have a win on a patient's tax in the middle of a health crisis.

Journalist: If you're elected next year, just to be clear, you won't make an exemption for GPs, but there'll be a reverse in the interpretation?

David Crisafulli: Well, let me answer that exactly the same way I answered when you asked me the question about the renter's tax. It shouldn't be for these guys to have to wait nearly two years for an interpretation that they have built their business model on for decades. Now, if we get to the next election and it's a choice between whether or not I'm going to slug GPS more to do business and have patients have to pay more, you probably know what side of the ledger I'm going to fall on. But I'm not going to let the government off the hook, and I'm not going to make it easy for them. This shouldn't be a decision that Queenslanders get to make in October, in '24. This should be a decision the treasurer makes today, because nothing has changed from their business model. Nothing. And all of your questions were completely valid, but the answers were too.

They have built a business model around providing low-cost care for people in need. The only thing that has changed is Cameron Dick's desire to get into their hip pocket of their clients. Nothing else has changed. Now yes, there have been rulings in other parts of the country, but a government here that is very short of money, because it can't manage its money so it comes after yours, has made a decision to charge patients more in the middle of a health crisis, and we are going to continue to expose it. I hope it doesn't take another humiliation on the floor of national cabinet, because in the meantime patients won't go and see their doctors and guess where they end up? In the emergency department. And do I have to remind the government how bad the emergency departments are functioning after eight years of underinvestment, of doctors and nurses feeling battered and broken and bruised, the worst ambulance ramping in the country, and you're going to go and ask people to go and sit in an ED because they won't be able to afford to go and see their GP?

Only Cameron Dick could think that makes good economic sense, and don't talk about social sense. It's wrong.