I rise today to speak on the Private Health Insurance Amendment (Income Thresholds) Bill 2021. It was only a few weeks ago that I last rose in this House to speak on the last private health insurance amendment. We constantly seem to be coming into this place and discussing health care but tinkering at the edges without really addressing the major problems that are plaguing our healthcare system.

I'm pleased the member for Bowman has made some comments about the importance of private health insurance, and I, indeed, believe in it as well. I think that our system has functioned very well with a balance between private and public health care, and of course I started my private medical practice in the same week that Medicare started in Australia. It really has been a gift to the Australian people from the Australian Labor Party. I'm a great believer in a universal healthcare insurance scheme such as Medicare complemented by a private health insurance scheme, as we have in Australia and have had for many years. I encourage everyone who can afford to pay for their own health care to take out private health insurance.

Unfortunately, this is a government that fails to understand the deep problems that we're having in our healthcare system, and I admit that most people in this place get pretty good health care. We're on high incomes, we can afford to pay for private health insurance, we get very few problems in the way of access to health care in our major cities and, for us, elsewhere, so I think there is a lack of understanding on the other side of the importance of universal equity in health care—and that's not what we're seeing in Australia at the moment. We're seeing huge differences in mortality and morbidity between the inner city, outer metropolitan, rural, regional and isolated areas.

We know that people who live in rural and regional areas have life expectancies for males and females at least 10 years less than those that live in the inner cities. We know that people are suffering much more in the way of poorly treated chronic illness in rural and regional areas, and we know some of our Indigenous populations who live in remote areas have health care worse than in many Third World countries, and this is something that this government has failed to address. Some of the state governments also, I must say, have failed to address this issue.

There are major advances in how we manage things like cardiovascular disease and stroke and some of the common surgical problems, such as gall bladder disease et cetera, with laparoscopic surgery. Yet many people in rural and remote areas cannot access these modern treatments, and very little thought has been given to how we can get these modern 21st century treatments to rural and remote areas.

We know that only about 50 per cent of people who have had a cardiac event such as a myocardial infarction, or, in layman's terms, a heart attack, will be able to access regular cardiac rehabilitation post event. That's particularly true for people who live in rural and remote areas but also, I must say, in some of our outer metropolitan areas, because not enough thought has been given to how we can provide equitable care and not enough thought has been given to providing those services in areas where it's most acutely needed. We know people who don't have access to regular cardiac rehabilitation post a myocardial infarction have a much poorer prognosis with higher morbidity such as chronic cardiac failure, which impairs the ability to work, to mobilise and to even care for yourself.

We know they have much worse morbidity and, unfortunately, there is much worse mortality for those who have not done regular cardiac rehabilitation. In modern stroke management, the treatment of choice these days for stroke due to blood clot is clot removal on an urgent basis, which can protect the brain from damage. We know that many people in rural and regional areas and even people in outer metropolitan areas cannot access this 21st century treatment, leading to a much worse prognosis of, maybe, hemiplegia and even death. This government has not really addressed those issues.

This bill seeks to keep the same income thresholds for the Medicare surcharge for those who don't take out private health insurance to similar levels in the last four years. That is a reasonable thing to do, but it doesn't address the major issues with people failing to pay for private health insurance, even though they can afford it, and it doesn't address the real issues around our public hospital system with the gradual deterioration of our public hospital outpatient system. I'd like to see this government recognise the importance of a fully supported and fully functional public hospital outpatient system so that everyone who needs it can access outpatient care. At the present time in many of our rural and regional areas, and even in our outer metropolitan areas, people who require specialist review—for example, from neurologists for people with multiple sclerosis or Parkinson's disease or who are post-stroke; or people who have chronic cardiac conditions, congenital heart disease in children or cardiac failure in adults—have to access private treatment through a private doctor's rooms because our public hospital outpatient system is either overloaded or non-existent in many areas. That means that many people can't afford the cost of private review in rooms. For example, to see a cardiologist privately the gap fee can be as high as $250 or $300; it's similar for a neurologist.

Many people in our outer metropolitan areas and in rural and regional areas cannot afford that fee, so they often forgo care, and that leads to much worse prognoses and much worse health care. This is something that needs to be addressed urgently so that everyone gets equity of care. It's okay for me. I can afford to pay to see any specialist I need to privately. It's okay for many of the people in this House. But for people who are struggling to put a roof over their heads or who are struggling to put food on the table, this bill will do nothing. It will not provide them with the health care that they need and deserve.

Labor has always stood for equitable health care, and that is something that those on the other side fail to understand. Good health care equals a good economy. We know that from the pandemic. It has taught us that very well. With this pandemic, unfortunately, the poorest, the sickest and the most disadvantaged are the ones who are suffering the most. We must make sure that our healthcare system provides equitable care to all, not just to a select few.

There is another issue I will speak about and hold the government to task on. I have long been a supporter of immunisation. Immunisation has dramatically changed our health in the 20th and 21st centuries. The government's response to the immunisation of people for COVID-19 unfortunately leaves a lot to be desired. It's pretty obvious that many on the other side are immunisation deniers and promoters of immunisation hesitancy. The health minister himself has been telling people that if they wanted to wait for a messenger RNA vaccine it was fine.

There is a government senator who has been going around telling everyone he was going to wait until there was evidence of the effectiveness of immunisation. There are many on the other side who have failed to promote immunisation the way they should. I hope that the government gets away with this. I hope that what's happening in Victoria at the moment settles down and, fingers crossed, the Victorian contact tracers will be able to get the spread of COVID-19 under control. If they do, it's no thanks to this government. I hope the government escapes. But, if they don't, if the present COVID-19 outbreak spreads, at least part of the reason will be that the immunisation program has been so poor. Every member of this House and every member of the Senate should be out there actively promoting immunisation for COVID-19. We should have trustworthy third parties promoting immunisation.

This is a government, I believe, that does not understand health care. The fact that we did so well initially in the pandemic is down to the health minister's initial response—it's not down to the Prime Minister. Remember: he was off to the footy. At least the health minister was able to make the medical advice reign, and that's why we've done so well up until now. This virus can escape from hotel quarantine. We know that aerosol spread happens. We know you only need a small initial spread for the virus to explode. The newer variants appear to be much more infectious and much more likely to be spread by aerosol. We need to be very careful. We must have purpose-built quarantine and we must have a health system that provides equitable care for all, and that will lead to a strong economy.

We support this bill. It is a reasonable thing to continue. We should all be responsible, if we can afford it, for our own health care. But we must remember that our healthcare system is predicated on the best care we can provide for all, not just a few. This is a government that fails to understand that and is doing nothing at the present time to address the inequities in health care throughout our country.