I was a pretty lucky young doctor. I started my medical career at the time of Gough Whitlam and free university fees, and I subsequently opened my private paediatric practice at the time of Medicare, brought in by the Hawke and Keating government. The reason it was so important to have a universal healthcare insurance scheme was that medical costs were the commonest cause of bankruptcy in Australia. People just couldn't afford to get adequate care, and Medicare was resoundingly popular because what it did was introduce this concept of the community paying for what was an essential service for everyone. It was very popular and did very well.

But the simple truth now is that we are approaching a similar watershed time. People are now being faced with huge gap costs to pay for medical care. There has been an effective collapse of the public hospital outpatient system. There's a huge discrepancy in life expectancy between those living in inner metropolitan areas and those living in rural, regional and remote areas. Just as an example, people living in the inner city of Sydney have an average life expectancy in the mid-80s for males. If that is transcribed to outer regional areas, it's 67. So there is almost 20 years difference. It's a tragedy.

There has also been an extreme polarisation of medical workforces in our communities—from inner metropolitan to outer metropolitan, rural and regional areas—and that's not being addressed. I see it every day. Just as an example, on Friday of last week I was contacted by a constituent, who doesn't want to be named, but I'll just call him Ray. Ray is a self-funded retiree. He required a prostatectomy for prostate cancer. He had been paying insurance all his married life. He's a guy in his late 70s. He was treated by a very good local surgeon in a private hospital and had all of the treatment. He contacted me not by way of complaint but just to explain that the Medicare rebate for his surgery was $2,200. The cost of the surgery billed by the surgeon was over $13,000. He was also faced with over $1,000 in extra gap fees to pay for the anaesthetist and to pay for a number of other hospital and rehabilitation fees for his surgery. Now, the reason that he contacted me is that he thought it was very unfair that he'd paid his private health insurance all his married life—over 50 years—yet was now faced with this huge bill of $15,000 to have surgery. But he did also note that, if he'd wanted to have his surgery done in the public hospital, he would have been faced with a waiting period of some months. So, really, this huge discrepancy is affecting people every day.

People are also being faced with large payments to see specialists. In my particular electorate, our public hospital outpatient system is incredibly overstretched. Some of the waiting times for urology, for example, are over 12 months, so people are being forced to go to see people privately in their private medical rooms and are faced with huge gap costs. In fact, less than 30 per cent of people seeing specialists in my electorate are bulk-billed, and most of them are faced with large gap costs.

I realise that we are in the middle of a pandemic, and the pandemic exacerbates all those health issues. It exacerbates all the social determinants of health—housing, education, work—and it exacerbates the cost for poor people. We have reached a watershed time in Australia. My questions for the minister are: what does the minister plan to do to finally address the rising disparity that exists in terms of health outcomes in our communities? We have a two-tier health system; that is quite obvious. Does the minister concede that the cost of health care is rising on his watch, and when will he finally take steps to address this? Thirdly, will the government finally take heed of our advice and take steps to address the abysmal state of public hospital outpatient services in our country?

There are other issues that need to be addressed as well. The member for Higgins spoke about mental health. There is a real hotchpotch of treatments available. What we need is coordination. We need help and support for those with severe mental illness, with things like housing and education.