Radio interview with Minister Butler, ABC Hobart – 26 February 2025

LEON COMPTON, HOST: So much to talk about in health. Last week, the announcement that Healthscope, the owner of the Hobart private hospital, would be cutting maternity services in six months time. It was a lack of midwives, according to Healthscope. What role can and should the federal government play? And this is an issue ultimately about private health insurers and private health providers. But of course, ultimately, it's Tasmania's expectant mums who are caught up in the story. Mark Butler is the Federal Health and Aged Care Minister. Minister, good morning to you.
 
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Good morning, Leon.
 
COMPTON: The Albanese Government this morning announcing $6 million in funding to the Tasmanian Government to help support both the private and remaining public hospital for maternity. Specifically, what are you giving to them?
 
BUTLER: This is money for capital. Jacquie Petrusma and I have had a number of discussions, and we're catching up again in a couple of hours. They've been really constructive, and we recognise the overwhelming priorities you indicated of both governments has to be to make sure that no mums and bubs and dads fall through the cracks, that essentially Healthscope has opened up here in Hobart and also in Darwin as well, just pulling maternity services. It was great to see on the front page of the Mercury, Calvary with their national leader, Martin Bowers, down here in Hobart, talking to Minister Petrusma about them being able to expand their capacity and take a big share of what otherwise would have gone to Healthscope. And I know that the state government is keen to expand their birthing units as well, to take the rest of that share. Our job is to provide some capital funding to them. I'll be standing up with the Minister shortly to announce that $6 million is coming their way from the Commonwealth. They'll use that as they see fit, between the Royal and also Calvary.
 
COMPTON: Will you have guidance on how that money can be used? I mean, how many more birth suites and more space in the Royal versus supporting the Calvary? Who's going to make the decision about how that money will be allocated?
 
BUTLER: We've decided that's a negotiation between the state and Calvary. As you see on the front page of the Mercury, that's going very well. Calvary is a big, sophisticated organisation. It operates right across the country, it's not for profit, it's been around for a very long time, and it ploughs all of its money back into services, unlike some of the for-profit operators like Healthscope that's run by global private equity firm. I have a very high level of confidence that the 2 hospital operators, we are not an operator the Commonwealth is a funder, Tasmanian Health and Calvary will be able to come to a solution that overall is in the best interests of families.
 
COMPTON: Are you frustrated by the behaviour of Healthscope in this? As you mentioned, a for-profit private equity firm from overseas to the extent that matters owns them. They've recently been in dispute with Bupa. They've recently been in dispute over who gets paid, what with the whole series of smaller providers that are grouped up under a health alliance that affects our firies and other workers in the state. Are you frustrated by the way they're running their business in this country?
 
BUTLER: My frustration isn't really that important, a whole lot of people who put their hard-earned cash into private health insurance are frustrated. Families down here in Hobart, up in Darwin, who paid a lot of significant money, they've got to have a gold product to get maternity cover, which is another question altogether. They've paid a lot of money for private health insurance on the understanding they'd have good private hospital cover for the birth of their beautiful baby, and they're frustrated. The fact that there are these difficult negotiations between insurers and hospitals, that's nothing new, that's part of the system. I've said to Healthscope and Bupa, really get around the table, fix it, or we'll have to look at shifting you into mediation. That worked, and they came to a deal. But you're right, Healthscope is still in dispute with this alliance of smaller insurers. I've said before, they've got to fix this. At the end of the day, yes, they have their own commercial interests, the hospital operators and the insurers, but they've got to recognise they receive a lot of taxpayer support, a lot of taxpayer funds to deliver essentially what is a public good. That is a whole lot of hospital services. They've got to fix it soon.
 
COMPTON: On mornings around Tasmania, if Healthscope are right and the issue is a lack of midwives, fundamentally a lack of access to midwives, what can you do to help sort that out?

BUTLER: There probably aren't as many midwives across the country as we would like. Systems, particularly outside of the very big cities, are experiencing difficulty getting enough midwives. It is more complex than just midwife supply, but there is no question that we could do with more midwives. On Sunday, when the Prime Minister and I were up in Launceston, we announced scholarships for additional advanced nurses and endorsed midwives as well. We recognise we need more workforce supply into the healthcare system trained here in Australia, not just relying on overseas trained doctors and nurses, as important as that supply is. Midwives is one area of challenge, but it's not the only. We want to see more GPs trained for example. But midwives are an area of focus that state governments and I are talking about.
 
COMPTON: Mornings around Tasmania. The Federal Health and Aged Care Minister, Mark Butler, is our guest this morning. Geoff’s in Launceston this morning. Geoff, good morning to you.
 
GEOFF, CALLER: Good morning, Minister.
 
COMPTON: What's your question for Mark Butler?
 
GEOFF: Why is it that people over 50 with no history of knee problems have to pay $300 upfront to do an MRI and there's no Medicare rebate? And why are some CT scans so expensive? Recently I had to cancel a scheduled CT scan because the operator wanted $600 plus upfront and the rebate is only a third, and I couldn't afford that. Not a chance.

COMPTON: It's interesting, Geoff, that ties into a story on AM this morning, and I know that Sabra and the team have talked about it a lot. The growing gap that you're expected to pay to see a specialist between what Medicare offers and what your specialist is charging. Mark Butler, is it fair that Geoff has to cancel stuff because he literally can't afford a specialist service that he needs?
 
BUTLER: Let me deal with this first question first, which is the age limit on MRIs. Our Medicare system reflects advice from doctors, from experts, from scientists, not politicians who decide at what age a Medicare rebate should or should not apply for, in this case, an MRI. The 5,800 items on the Medicare schedule all reflect the best possible expert advice, and I know that causes frustration from time to time about whether people fall in or out, but I think that is the best way to operate a Medicare system. Often, we'll ask them to review the evidence and see whether things should be changed, and they often are. But that item reflects the best possible expert advice. As for out-of-pockets for specialists, this is becoming a barbecue stopper. Really unapologetically, I have to say, our first term of government, what I hope is our first term of government, is very much focused on out-of-pockets for general practise. GP visits, which are the big bulk of Medicare. I've said to the AMA, if we're re-elected, we have to do something about out-of-pockets for specialists, they are just growing far too fast, meaning people aren't going to the doctor when they need to. And that was the core promise of Medicare, the idea that everyone would have access to the best possible healthcare when they needed it. No matter what.
 
COMPTON: Part of that falling to government and increasing the Medicare rebate to specialists so that there's a lower out of pocket, is that it's a simple but expensive answer at a federal level.
 
BUTLER: It's not a simple answer, Leon, for this reason. Some doctor groups have said to me, the way to fix general practice out of pockets is just increase the rebate. And my response to them has been, what are patients getting from that? How do they get a, how do they get a guarantee? How do I get a guarantee as Health Minister, that bulk billing rates will rise and the increase rebate won't simply be pocketed by the providers in this case, the doctors. And that's why all of the huge amount of money we invested in Medicare and Sunday was tied to bulk billing outcomes for patients. I understand that doctors might prefer that we just gave them the money with no strings attached, but there was no way I was going to do that. We want to see bulk billing rise. The same applies for specialists. I'm not just going to increase the specialist rebate without some guarantee, some really clear guarantee. I can look patients in the face and say, this will not simply be pocketed by specialists and not flow through to you in reduced out-of-pocket costs or, if possible, bulk billing.

COMPTON: How common are stories like Geoff's? What is the implication, potentially, of you cancelling your CT scan because you can't afford the upfronts?
 
GEOFF: Well, there could be something growing on my kidneys and I can't get it checked out because I can't afford it. it just keeps getting more and more expensive. And so much for universal healthcare.
 
COMPTON: I'm going to leave you to it, but I'm going to put that back to the Minister. So, there's Geoff. Maybe something growing on his kidneys needs a CT scan. Can't afford it.
 
BUTLER: We've got very high bulk billing rates still in pathology which still have quite high bulk billing rates. I accept that in some places there aren't a whole lot of providers to shop around between, but I want to see those rates come up as quickly as possible. We've invested an enormous amount of money in healthcare over our term of government, and it's been focused on 2 things: affordability and better healthcare. And those 2 things usually come together. More bulk billing, more access to free urgent care is not only going to be good for people's hip pocket, it's also going to be good for their health, because the idea people are deferring a visit to the doctor, deferring a scan, not getting their script filled because of cost is ultimately going to be terrible for the nation's health.

COMPTON: On mornings around Tasmania, Federal Health Minister Mark Butler is our guest this morning. Cheryl is in Warren and has just left the GP. Good morning, Cheryl.
 
CHERYL, CALLER: Good morning.
 
COMPTON: You’ve got Health Minister Mark Butler talking to you this morning. Cheryl, your experience, you have just walked out of the GP. Tell me about it without identifying the GP please.
 
CHERYL: I have, what looks like up-and-coming knee surgery. So, I went in to see him regarding, MRI and $109 with a $47 rebate. And the MRI is well over $200 with an exceedingly small rebate. According to workmates who have recently been, without even starting to talk about the surgery. So, I am in a huge amount of pain. It is affecting work. I cannot have time off. So, yes, not good. Life's not good at all with the way things are financially.
 
COMPTON: Cheryl, does that mean you might actually put off that knee surgery until you can afford it?
 
CHERYL: Well, I will get paid tonight. We get paid fortnightly. And by the pay cheque that I have seen, it won't. There will be no MRI this fortnight.
 
COMPTON: Cheryl, appreciate you sharing your feedback this morning. Thanks for telling your story. We appreciate it. Mark Butler is our guest. You heard Cheryl, $47 back and $109 up front. And she's clearly looking at what each pay cheque looks like coming into her family budget and working out whether or not she can afford to deal with that pain.
 
BUTLER: Cheryl's story is precisely what has driven everything we've tried to do to strengthen Medicare after real constraints in their funding over the last 10 years. It's what we did in bulk billing in 2023, which has led here in Hobart to a 10 per cent increase in bulk billing for GPs. We want it to go even higher, which is why we announced the record funding on Sunday. MRIs has been a particular challenge here in Australia. There has been a bit of a monopoly arrangement whereby only certain MRI machines had a Medicare licence, which meant that they were the only ones that could be funded by Medicare. I've got rid of that licencing system, it didn't make sense. What that's going to mean is, there's going to be a lot more competition between MRI providers. For too long there was, one or two MRI machines in a particular market that had the lock on the Medicare system, and it meant that they really could raise their gap fees, their out-of-pocket fees. Opening up competition for MRIs, which are really the high-quality scans we want people getting, in most cases, is going to put downward pressure on those gaps. I accept it's causing a lot of pain for people. Financial pain and actual pain for people out there like Cheryl's case.
 
COMPTON: On mornings around Tasmania. Cheryl, thanks for telling your story. Wherever you're listening. Appreciate you getting in touch. Sean's in Launceston. Good morning. Sean.

SEAN, CALLER: Hey Leon. How are you going?
 
COMPTON: I'm well. Thanks, Sean. You've got a question or a comment for the Minister?

SEAN: Yeah. Good morning, Mr Butler. You may have answered my question to an extent. I came from somewhere else to Tasmania, and a lot of scans that are available to one of the major operators that operate around the whole country are bulk billing. Yet in a jurisdiction like Tasmania, which has the lowest average incomes in the whole country, people are paying $600 to$800 out of pocket for these. Why can't we have an inquiry into this? To find out why this inconsistency exists and why something can't be done about it?
 
BUTLER: I think that goes right to the heart of what we decided at the last Budget, which was to open up this market, the licencing I'm not really sure why the licencing system was put in place many, years ago, presumably to control Medicare expenditure, that's what governments and departments sometimes do, but it has these awful outcomes for patients. If there's not enough competition in a market, there is on the mainland in most of the big cities, then providers do what providers do and they end up taking whatever profits they can get out of the system. I'm really confident that opening up the MRI system is going to put downward pressure on gaps or out-of-pocket costs, particularly in those markets where there's only been one or 2 providers who've had the privilege of being able to tap into the Medicare funding system.
 
COMPTON: Well, the places you go in your interviews, I didn't think MRIs were going to become the focus of this morning's chat. But here's Kate in Launceston. Thank you, Kate, for getting in touch. Good morning. I recently had an MRI on my liver. It cost me $630 with no rebate. I have top private medical cover but it doesn't cover this, says Kate in Launceston tuning in this morning. On mornings you can join us with Minister Mark Butler, our guest this morning. There's lots still to get to. You made a big announcement about an increase to Medicare rebates earlier in the week. But one of the issues for people in Tasmania, for our listener, wherever they're tuning in, isn't as much how much it costs, it's just getting an appointment in the first place. I want to play you an interview or an audio of the operator of the Cygnet Family Medical Clinic.  
 
CYGNET FAMILY MEDICAL CLINIC, RECORDING: The problem we have is actually getting an appointment on the day that we need it. At our practice it is now between 4 to 6 weeks to see a GP.
 
COMPTON: 4 to 6 weeks wait, in Cygnet in southern Tasmania. It's a story that we hear right around the state. Minister, is anything that you announced earlier in the week around boosting bulk billing going to make it easier just to get into a doctor in days rather than weeks or more than a month in the case of that example?
 
BUTLER: The message that we tried to project on Sunday when the Prime Minister and I made this announcement is at its simplest, we need more doctors and nurses, and we need more bulk billing. In addition to the very big investment in bulk billing that I'm happy to talk about, there was significant investment in doctor supply, also advanced nurses and midwives. But we need more doctors coming through our medical schools. There hasn't been an expansion of medical school places in the cities for a decade,  we've expanded that. We need more GPs in training. Not too long ago, maybe 30 years ago, one out of every 2 medical graduates would choose general practice and the rest would go into surgery and the rest. Now it's one in 7, just one in 7. We've been working really hard to boost that number. I'm pleased this year we've got more junior doctors training as GPs than at any time in our history, but that takes a while to come through the system. So again, we've funded a lot more GP training places to try start to backfill that amazing cohort of GPs that are in the process of retiring.
 
COMPTON: And increasingly in Tasmania, they're now being trained in places like Burnie, for example, where if you're from that region, you can study in that region, you're more likely to stay in that region and practice your medicine.
 
BUTLER: Tasmania was the first place we rolled out something called the single-employer model. Jeremy Rockliff, when he was Premier and Health Minister, and I announced that with the PM; and it means that there's not a whole lot of financial disincentives for a junior doctor to choose to train as a GP compared to training in the hospitals. For example, they don't get access to parental leave over the 5 years they're training, they earn a lot less. On Sunday, we announced that we'd pay an extra $30,000 a year for a junior doctor training as a GP to close that salary gap between them and the person they went to medical school with who happens to be training as a surgeon at the Royal or the LGH up in Launceston.
 
COMPTON: So changing conditions to make them more attractive for people thinking about going into study general practice as a specialities.
 
BUTLER: A lot of junior doctors want to be a general practitioner. It's a very different job. You end up with deep roots in the community, you know your patients, you know their kids. There's a lot attractive about being a GP, but we've just got to fix some of the disincentives.
 
COMPTON: Mark Butler is our guest this morning, the Federal Health Minister. Lindsay, good morning to you, Lynn.
 
LYNN, CALLER: Good morning. Minister Butler. Just to the theme about quality staff, I just want to tell you the story about my daughter, who's a really highly qualified midwife.
 
COMPTON: And, Lynn can you make it the super punchy version of this story, please.
 
LYNN: Yeah. She's a highly qualified midwife. She left Australia, and she's now working in Europe. She gets twice the salary, and the hospital supplies her with accommodation, and really competitive rates. She said that she couldn't handle the situation in Australia anymore or the difficulties around practicing as a midwife. And she's very happy and very, very pleased to be able to work in Europe and give them her skills instead of struggling here in Australia. Maybe we should be thinking outside the box and maybe we should be doing exactly that. We should be promoting these really highly qualified people, paying them a lot more and sorting out their accommodation because this is a big issue in Tasmania.

COMPTON: Lynn, a really great perspective. Thank you for sharing it this morning. Do we need to do more? In the olden days, teachers that went bush got provided with housing. If you went to the ABC in Darwin, you used to get provided with housing. Nurses used to get provided with housing. We've sold those models off. I'm sure there was a consultant's report that told us that was a good idea. And now we're struggling to find, workers in remote communities. Do we need to go back to some of what Lynn's talking about?
 
BUTLER: We are and it's much more ad hoc. I know state governments, local councils are often looking at housing options to bring health workers, nurses, doctors to their community. We're rolling out a whole lot of dialysis units on country in remote Australia, and the most expensive part of that program has been we've had to build housing there as well. So it is happening, but it's not happening in the systemic way. People as old as you and I, Leon, remember happening decades ago, a big part of our housing package that we've been struggling to get through the Senate, looks at funding the construction of houses for key workers, not just health workers, but teachers and police officers as well, who are finding it hard to get affordable housing, not just in remote Australia, but, a whole range of other parts of Australia as well.
 
COMPTON: This is a story from a few years ago, but a mate of mine was on the board of the Byron Bay High School, as a parent, and he said they were struggling to find teachers. Now, you'd think every teacher in the world would want to go live in Byron Bay for a while, but it was a housing issue. They literally could not find accommodation and said, we'll have to choose somewhere else. We'll keep moving on though. We've got you for a few more minutes and we appreciate you coming into the studio this morning. On aged care, you're also the Minister for Aged Care. We're going to talk about delays in home care, access to home care packages. How is it acceptable that somebody who's deemed as eligible for a category 4 home care package, medium urgency, is waiting up to 15 months to receive that package? How is that fair, Minister?
 
BUTLER: It's not acceptable and that's why governments have, including our government, have been adding packages every year to the system. On 1 July this year, a very new system will come into play with not only many, more packages, the largest number ever added to the system, but they'll also be much better packages. For that high level of care, you talked about a level 4 package, there will be an additional $20,000 available for people with very high needs. There is certainly funding for more packages. But I have got to be frank, as in so many areas, one of the constraints on rolling out new services, including home care packages, is workforce. One of the things we had to do was lift the wages of these workers. They were some of the lowest paid workers in the community, delivering some of the most important work and keeping them was a real hard job, because they were going to get paid more to go and work in retail, which I can tell you is important, but not as demanding a job as looking after someone who's frail and dependent.

Lifting the wages, expanding the number of packages at a time when there's a tight labour market is really hard for any government. We're committed to doing more. We're training more workers, and we're paying them much better. But we also know, and have known for a very long time, the as the oldest baby boomers are now, becoming eligible for home care packages in terms of the average age of entry to the home care system. In 3 to 5 years, that cohort, born in 1945 and 1946, will hit the average age of entry to residential aged care, and nothing happened over the last decade to reform the system. I started when I was Aged Care Minister under Prime Minister Gillard, a process that was supposed to improve aged care on an ongoing basis up until the baby boomers hit and nothing was done. We've had to cram a lot of reform and a lot of money. It's the biggest single item of our additional expenditure over the last 3 years has been aged care, not only to make sure it's working for people now, but importantly, that it's ready for that big lift in demand that's coming our way in 3 to 5 years.
 
COMPTON: Listen, I'm sorry, I know lots of you texting and calling in this morning. So sorry to everybody who's sitting on hold. We'll get to more of your calls after news, but the Minister will have to leave us. Just a very quick one, the Launceston General Hospital. There are wards where they can't control the temperature. If it's hot outside, it's hot. Inside the windows are screwed shut. There's not effective air conditioning. Staff are being offered, and patients are being offered icy poles while dripping in sweat. How is that acceptable in 2025?
 
BUTLER: That's not, and no-one in a country as wealthy as ours should be experiencing that at one of our major hospitals. We are working with, particularly the smaller jurisdictions who haven't had enough funding into their hospital system from the Commonwealth. Next year, we'll increase funding to Tasmania by 14 per cent. They need extra money to be able to do the sort of upgrades that should be a basic demand.
 
COMPTON: Mark Butler, it's been good to see you this morning. Thanks for being part of mornings and our audience right around Tasmania.
 
BUTLER: Thanks, Leon.