Radio interview with Minister Butler, ABC RN Breakfast – 27 March 2025

SALLY SARA, HOST: Mark Butler is the federal Health Minister, and I spoke to him a short time ago. Your government is reluctant to lower the tobacco excise to deal with this black market issue that has been increasing. Do you agree that a higher tobacco excise is contributing to the growth of the black market?
 
BUTLER: Well, it's probably contributing, but what I don't accept is the idea that if you make legal cigarettes cheaper, first of all, you're going to knock out illegal cigarettes, I don't think there's any evidence of that around the world. Markets like the US, many in Europe that have cheaper legal cigarettes, in the US case, quite cheaper legal cigarettes, still have rampant black markets. You're not going to get rid of the black market and organised crime in illicit tobacco just because you reduce the price of legal cigarettes. The other reason is we know that cheaper cigarettes will drive up smoking. It's no coincidence that Australia has some of the highest prices of cigarettes, but also some of the lowest rates of smoking in the world. I'm not going to raise the white flag on one of the most important measures around tobacco control, just because organised crime has got their hands into the illicit tobacco market. The answer is enforcement It's about tracking them down. It's about putting them in the dock, and it's about, at the end of the day, putting in place really serious penalties.
 
SARA: And here in Australia, when we're trying to figure out how many people are smoking, how do we measure that? Is it from legal tobacco sales or is it asking people? How do we get that number?
 
BUTLER: We've never done it through sales. We've always done it for decades, frankly, through very comprehensive household surveys. We're confident we've got a very clear idea of how many people are smoking. That rate is continuing to come down. It was starting to flatten a little over the last few years, which is why we essentially regenerated our tobacco control efforts with new legislation a couple of years ago, essentially redesigning our plain packaging reforms, putting in place measures to counter what big tobacco had done. Essentially what they'd done in the face of our plain packaging reforms of ten years ago. They found new ways to make cigarettes attractive, particularly to younger smokers, and we've dealt with that.
 
SARA: Earlier on the program, Minister, we were talking to Rohan Pike, who's a former federal police officer, and helped to set up Border Force's illegal tobacco taskforce. I was asking him about the increase that we've seen in the budget for enforcement to deal with the tobacco issue and he was saying, in his view, from his experience at least, that enforcement wasn't the way to go here. Why are you confident that it is?
 
BUTLER: Our additional enforcement efforts have resulted in a very big increase in seizures of illegal cigarettes at the border. A 50 per cent increase in one year, to the point where in 6 months we've seized 1.3 billion cigarettes, just an extraordinary number. Our enforcement measures are also working with vaping. We've seized millions and millions of vapes at the border, and I know that our measures there have led to a substantial reduction in vaping, importantly, particularly among younger people, teenagers and very young adults. Vaping rates are down about 30 per cent for adults over the age of 30, vaping rates are down about 50 per cent, and importantly for parents and school leaders, suspensions at school because of vaping are down 50 per cent in the last year because of the measures we've put in place. I accept this is not easy. I've never pretended this was going to be easy. We're not only fighting big tobacco here, we're also fighting organised crime, but we're determined to do this.
 
SARA: Let's have a look at pharmaceuticals. We're still waiting for what's going to happen out of the United States with tariffs or other measures. Have you had any update on how those negotiations are looking, given that we're expecting significant pushback from some of the big pharma in the United States?
 
BUTLER: Those negotiations are continuing. Obviously, Australian officials, the Ambassador in the US, Kevin Rudd, ministers as well here in Australia are working very hard to get the best deal for Australians. In terms of medicines, what the Prime Minister and I and others have made very clear is we will never, ever, negotiate around the fundamental designs of the PBS, which is getting Australians access to the best available medicines in the world at affordable Australian PBS prices. I know the US pharmaceutical industry has wanted for years to get their mitts on our PBS. Under a Labor Government, we will never, ever negotiate the design of our PBS scheme.
 
SARA: One of the concerns that the US pharmaceutical companies have raised is about the time that it takes for new medicines to get to market in Australia. Is there some room to improve that process in your view?
 
BUTLER: I think there is, and that's not particularly an issue raised by the US pharmaceutical industry, it's an issue the industry and more importantly, patient groups raised with me. It's why we put in place the first comprehensive review of our system, our assessment system for new medicines in 30 years. I've got that report. I've commissioned a group from industry and patient representatives to work on how we would implement that. As a general proposition, yes, I want to see those times reduced. It takes too long, in my view, to get medicines from being approved by our Therapeutic Goods Administration, on the one hand, to being listed on the PBS so that patients can access them at affordable Australian PBS prices. I want to see those times come down.
 
SARA: Let's talk about mental health. There was no specific mention of mental health in the Budget. Meanwhile, the Coalition is continuing to say that it will offer a return to the 20 bulk billed consults with psychologists. Couldn't you do more for mental health?
 
BUTLER: I don't accept there was nothing in the Budget. GPs do most of the mental health work in our health care system, and the bulk billing improvements that we announced in the Budget, the big investment in bulk billing affects the mental health items that GPs tap into for mental health assessment and treatment as well.  We're in the process of rolling out our workforce measures to train more psychologists, that's been a really serious bottleneck in the system for too long. Expanding the peer workforce as well, which has always been an important part, particularly of psychosocial care for people with mental illness. Expanding that workforce is an important measure. I just don't accept that doubling the number of sessions under Better Access, if you're not doubling the number of psychologists, is going to do anything other than create new bottlenecks that mean more Australians miss out on any psychological therapy.
 
SARA: Just finally, on aged care. Is there any consideration to give a bit more time for the aged care industry to reach milestones that it's expected to hit in the middle of the year?
 
BUTLER: We've put a lot of pressure on the aged care sector to do reform quickly. A lot of that reform should have happened over the last decade. That's what I had in mind when I started the reform process more than 10 years ago, as the Aged Care Minister under Julia Gillard, because we knew that the very large baby boomer generation was ageing, and at some point, in the second half of the 2020s would need aged care. That's where we are now and nothing happened under the former government. We have a position where aged care facilities are full, home care packages are full and we have a very big steep climb in demand coming ahead of us over the next, 2 to 3 years.
 
SARA: Is the workforce available, do you think?
 
BUTLER: That's really why we've put so much effort into paying aged care staff appropriately so that so providers can attract, and most importantly, retain those expert aged care workers, and that's making a real difference already. But we need to keep our foot on the pedal to reform the system and get it ready for that very big lift in demand that's going to happen over the next 2 to 3 years. It should have happened 5 to 8 years ago, it's got to happen now, and I'm really grateful for the work that the aged care sector has done with us on this reform journey. It has been quick, the expectations have been significant, but we've had no alternative given the neglect that the last government had in this area.
 
SARA: Minister, thank you for your time this morning.
 
BUTLER: Thanks very much.