I acknowledge the traditional owners of the land on which we meet, the Gadigal people of the Eora Nation, and pay my respects to their elders past, present and emerging.

Im going to speak today about what the Budget included, but also what it left out.

There was no more serious omission than the health of First Nations peoples.

It is less than three months since we reset the Closing the Gap framework.

But re-setting the targets achieves nothing without real accompanying action.

The Budget contained no serious measures on the three health targets on First Nations life expectancy, birthweights or suicide.

As a nation, we can and we must do better.

Thanks to the Australian Institute of Policy and Science for hosting todays Health Budget Reply, and to our sponsors Johnson and Johnson and Medicines Australia.

After a year spent on Zoom, its good to be with many of you in person again. And hello to those watching online, particularly from Victoria.

Whether youre here or online, I want to thank you for your efforts throughout 2020.

By global standards, and with tragic exceptions as in aged care, Australia has responded well to COVID-19. I give all governments, federal and state, due credit for that.


The bulk of the credit for what we have achieved, though, belongs to all Australians, and particularly to the health sector.

Youve been under enormous pressure since February, and youve stepped up every time. Thank you for what you have done, and what you continue to do, to keep us safe.


2020 Budget


The Budget included a number of necessary health measures, and I want to begin by welcoming them.

Most obviously, the Government confirmed ongoing support for telehealth consultations, COVID testing, GP respiratory clinics, public and private hospitals, and other elements of the COVID-19 health response.

We welcome their almost inevitable extension into next year, and note that they may well need to be extended further.

In relation to telehealth in particular, there will need to be a conversation as to how to make telehealth a permanent feature of our system.

We also welcome the Governments recognition of the mental health impacts of the pandemic.

Since May, weve been arguing that those impacts dont stop at the Murray River, and that Medicare mental health consultations need to be doubled nationally.

We were glad to see that happen in this Budget.

And there were other welcome measures.

I particularly want to welcome long-overdue support for Australias thalidomide survivors.

Until the Senate inquiry that reported 18 months ago, we as a nation had not focussed on the ongoing needs of these survivors.

Ive enjoyed getting to know them and advocating on their behalf over the last 18 months, and will continue to listen to them on the adequacy of the proposed package.

But I recognise, as they have, that this measure is a big step forward and I thank the Government for it.


Gaps

In general, though, I think the health budget was more notable for what it omitted than what it contained and so do the experts.
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The Australian Medical Association said the Budget left most other challenges in health care for another day.

The Public Health Association said it was a huge disappointment, bordering on disastrous.

Professor Ian Hickie said that mental health reform had once again been left in the waiting room.

And so on.

Now, Im the first to acknowledge that the Minister and his Department have had a lot on their plate this year.

But many of us have participated in the Dont Wait Mate campaign.

Its an important message: that we as individuals shouldnt ignore other health risks during COVID-19.

And the same is true for us as a country. We simply cant ignore the health challenges that were with us before the pandemic, and will be with us afterwards.

Kicking necessary reform perennially into the long grass is no way to handle the health system.

If we do, Australians will continue to suffer needlessly.

Now, the window for the next federal election opens next August less than 10 months from now.

And so today, I want to give you a sense not only of my criticisms of the Government, but of my own priorities as the alternative Health Minister.

In my mind, there were three broad omissions in the health budget and theyre the three things that would provide a framework for my approach as Health Minister.

First, a recognition of the social determinants of health, and of the benefits of prevention.

Second, an acknowledgment of record costs and waits for care, and an effort to restore the universality of Medicare.

And third, the resolve to tackle big challenges and pursue necessary reforms.

Or to put it more simply: equity, access and reform.

Let me take those three in turn.


Equity

When we talk of health, the conversation moves quickly to health care.

But any serious effort to improve Australians health must begin outside the health care system.

I wrote about this in my 2013 book Hearts and Minds. (If you havent read it, you can get it at very competitive prices on the remainder desk at all good and some not so good bookstores.)

In particular, I wrote about the epidemic of diabetes that was then sweeping my Western Sydney electorate and is now overwhelming it.

I wrote about its correlation with income, with socioeconomic background, with educational attainment.

And I posed the question: whether we, as a nation, will continue to tolerate a situation in which less well-off people live sicker and shorter lives than the wealthy?

Unfortunately, in this Budget, and under this Government, the answer appears to be yes.

Because we have taken no serious action on the social determinants of health what Michael Marmot calls the causes of the causes.

Those forces have their strongest and most tragic impact on First Nations peoples.

As the National Aboriginal Community Controlled Health Organisation put it in response to this Budget:

When you have, on average, 17 people in a small house, how do you expect children to get a good nights sleep, do their homework, be fed and healthy?

The Australian Institute of Health and Welfare says more than half of the First Nations health gap is due to the social determinants and health risk factors like smoking.

And the same is true more broadly.

The Institute also tells us that one in two Australians have a chronic disease but that 38 per cent of that burden is totally avoidable.

Yet the Government is just now developing a National Preventive Health Strategy.

That change of heart is welcome. But to be of any use, the Strategy must seriously confront the broader forces that are threatening our health.

Earlier this week, I gave the 2020 Earle Page Politics Lecture at the University of New England.


Australia already has among the most casualised workforces in the OECD.

We are facing a pandemic of insecurity in the workplace. That impacts on the health of individual workers and the health of our society.

And this trend is set to worsen during the first recession in three decades.

Im very concerned that as people return to the workforce after we come out of recession, they will be returning to insecure jobs, forced into the gig economy, with all the negative implications for their mental and physical health which are now well understood.

To address challenges like these, we need to move much closer to a health in all policies approach, where we recognise the health impacts of forces beyond the health portfolio.

Or to take another example: as no less than 30 health groups have highlighted, the draft Preventive Health Strategy fails to even mention climate change.

Despite the World Health Organisation calling climate change the defining health issue of the 21^st Century.

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Thats why Ive announced that as Health Minister, Id designate the health impacts of climate change as a National Health Priority Area.

And more broadly, these drivers of health are part of Labors commitment to an Australian Centre for Disease Control.

Anthony and I have made that commitment essentially for two reasons.

First, as of January, Australia was badly unprepared for a pandemic. We had less than one mask per person in our National Stockpile, and hadnt run a preparedness drill since 2008.

We need to be better prepared for next time (and we all in this room know that there will be a next time, and it may not be a long time away) and we see an Australian CDC as a key element in that.

But second, as in other countries, we want the Australian CDC to treat other health threats with the same urgency as COVID-19.

We want it to focus on non-communicable as well as communicable diseases, and the forces that make some Australians more vulnerable to both.

I see this as a significant commitment, and an important addition to the architecture of the health system.

Experts have called for an Australian CDC for more than three decades but this is the first time a Government or alternative Government has committed to one. Im very glad we have done so.


Access

Now of course, even if we get all those things right, even if we start to make real progress on prevention and the social determinants of health, Australians will always need health care.

And that brings me to my second broad point, on access.

One of the striking lessons of COVID-19 is that Australians still expect universal access to health care. It is part of the fabric of who we are.

In February and March, we looked around the world and saw health systems overwhelmed, and clinicians making impossible decisions.

The Australian community rejected that sort of rationing here, rightly demanding testing and treatment for everyone who needed it.

And governments listened. Notwithstanding some delays and failures, they dramatically expanded the capacity of our health care system to cope with COVID.

We took measures to bend the curve like lockdowns and quarantine, but we also took action to expand capacity like the laudable expansion in intensive care beds across the country from 2,000 to 7,000.

At its heart, thats the promise of Medicare: universal access to care based on clinical need, not capacity to pay.

But outside of COVID, its a promise we all too often break.

I no longer refer to Medicare as universal right now, it isnt.

Because the costs of care have never been higher, and waits for care have never been longer.

It may sound like a slogan, but its true.

And those barriers of cost and time cause millions of Australians to miss out.

Let me give you a couple of examples.

For COVID, we not only introduced Medicare telehealth rebates, but also doubled incentives to allow GPs to bulk bill.

But outside that context, the average GP out-of-pocket fee is now $39.

1 in 5 Australians have less than $1,000 in their savings.

Many people dont even have $100 in their accounts.

And it can be a choice of heading to the GP for a niggly cough, or dinner for the kids.

So its understandable then, that even before the recession, that cost forced almost 600,000 Australians a year to delay or avoid seeing their GP.


And thats not to mention the services that are largely excluded from Medicare like dental care, which two million Australians a year cant afford.

Or take hospitals.

We may have more than tripled the capacity of our intensive care units for COVID 19.

But in our public hospitals, one in three emergency patients are not seen on time, and elective surgery waits are at record highs.


The bad news is that costs and waits like these have been exacerbated by Government policy, most particularly the Medicare freeze and the cut in the Commonwealths share of hospital funding.

But the good news is that they can also be improved by Government policy by a concerted effort to restore the universality of Medicare.

Well have more to say about that before the next election.

But its fair to say that the health system has always been and will always be better off under Labor.


Reform

Thats not just a matter of investment. Which brings me to my third point.

Its also a matter of reform of a willingness to tackle the big challenges head on.

As of last Estimates, there were 55 action plans in some stage of development or implementation in the Health portfolio. Fifty-five.

So, lots of activity.

But what of delivery? What of the big, complex, sometimes contentious discussions we need to have to improve our health system?

If First Nations health was the worst omission from this Budget, mental health was a close second.

One in two Australians experience mental ill-health. One in four dont access services. It costs our economy up to $180 billion a year.

That demands comprehensive reform, across portfolios and across levels of government.

The Government ordered the Productivity Commission inquiry into mental health more than two years ago, and the report has been with them for almost four months.

Yet it hasnt even been released.

And were told not to expect a response until the 2021 Budget next May .

Similarly, the Childrens Mental Health and Wellbeing Strategy the Governments promised response to the fact that half of all serious mental health issues begin before the age of 14 has also been delayed by months and months.


We have no time to waste on mental health reform, and this Budget was a massive missed opportunity.

And under this third point of reform, I of course have not forgotten about medicines.

I welcome the announcement that the Government and Medicines Australia are working towards an extension of the Strategic Agreement.

But at this stage, the Government has only agreed to do what it already does to list new medicines within the average fiscal envelope of recent years.

Its good those listings wont have to be offset. But nor will $481billion in deficit spending on other programs.

And as Anna Lavelle has said, the devil is in the detail. The mechanics are a bit opaque and we have to look at how thats going to work.

So I wish Medicines Australia luck in its negotiations over the coming months. Youll have my attention and my support.

But the more fundamental issue in the Governments approach to medicines is the lack of reform.

The review of the National Medicines Policy is way behind schedule it hasnt started, yet alone reported or been implemented.

And so we still have 20^th Century systems for registering and subsidising medicines systems that simply dont match the 21^st Century of personalised medicine.

Thats not just my view. Its also been expressed by the likes of Andrew Wilson.

The same is true of the MBS. Its essentially a system of episodic rebates for acute illnesses and injuries.

But, thats no longer the world we live in.


For decades now, governments and the sector have been talking about new funding models to encourage coordinated care that prevents and addresses chronic disease.

The time for talk is over. The time for meaningful reform of primary care, to better cater for the widespread chronic disease in the community, is here.

I could go on. Private health insurance coverage is at record lows, and calling minor changes in the budget a second wave of reform doesnt make them so.

Conclusion

I dont say these things as a starry-eyed optimist.

Ive been an MP long enough and a Cabinet Minister long enough to understand the challenges of reform.

But we as a country and frankly, we as a Party established Medicare. Universal superannuation. The NDIS.

They were all hard. They were all worth it.

And in recent months, weve been reminded again what governments can do with focus and resolve.

Because our response to the pandemic shows what is possible when governments actually apply force of will to seemingly intractable problems.

What if we resolved to apply the same force of will and singularity of purpose to some of the other problems in health which have been regarded as intractable?

Martin Luther King talked of the fierce of urgency of now. We have all been living the fierce urgency of now this year.

When this approach is applied, when ideology is set aside, when prime ministers and premiers of good will work together to fix an urgent problem, a lot can be achieved.

We should no longer accept challenges being left in the too hard basket.

We cannot rest on the past achievements of Medicare, now almost forty years old, or the comparatively low death rate in Australia from COVID-19 and say there is not much to do in the Australian health system.

There is a lot to do. A lot to reform. A lot to improve.

And I look forward to working with all you to do so.