Bob Baldwin (Paterson, Liberal Party, Shadow Minister for Tourism) Share this | Hansard source

I rise to speak on the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2012. Medicare is the cornerstone of our nation's health needs, in particular for those who live in my electorate of Paterson. It provides access to health treatment for millions of Australians who otherwise would not have access due to affordability. In 2011-12 expenditure on Medicare benefits totalled just over $17.6 billion, making it the fourth most expensive Commonwealth government program. However, advances in medical technology and an ageing population mean that health costs can be expected to rise far faster than the average cost of living increases. One of the reasons the coalition oppose the government's changes to the Private Health Insurance Rebate Scheme is the potential increased burden on public health services. This is a particularly salient issue for my electorate, which has a higher than national average of retirees, many of whom are reliant on access to local health services, and they are not wealthy.

It was the Howard government that established the extended Medicare safety net, or EMSN, and it did so to provide further additional help on top of the existing original Medicare safety net. It was established for those Australians and their families who incurred high costs above the Medicare schedule fees for out-of-hospital services, the difference between the health professional's charge and the Medicare rebate being the patient's out-of-pocket expense. The level of the rebate was set at 80 per cent and covered any further out-of-pocket expense for out-of-hospital costs on a calendar year once the relevant thresholds had been met. At the beginning of this year, for concession holders and families whose income levels entitled them to family tax A the threshold was $598. Other Australians faced a threshold of $1,198.

The party opposite are fond of claiming the mantle of being the party of Medicare, but their approach to the extended Medicare safety net seems to be rather haphazard under this government. As the Kevin 07 election approached—do you remember that?—there was optimism and excitement that they were going to be on the benches. They had been out of power for so long, they thought government was easy. Now after making mistake after mistake and backflip after backflip—most recently this week—the litany of failure, ineptitude and broken promises has begun to stare them in the face. Under the Howard government there was a policy in place to ensure that Australia had protected borders and there was an orderly process for refugees. It took five years for the government to reverse their border protection policy error and realise that government involves hard choices. It is not simply about platitudes or changing your leader when the times get tough.

As I was saying, at the 2007 election Labor claimed that it would honour the safety net, that it would not put pressure on family budgets and that the then shadow minister for health, Nicola Roxon, would not take any assistance away. I think it was at the same time that they were promising they would help the Australian people with their fuel and grocery bills. Who can forget Grocerywatch and Fuelwatch? What rippers of successes they were! They promised to put downward pressure on the cost of living. Hard choices are required; hard decisions are needed to be made. After promising to honour the safety net in 2007, not two years later, in the 2009 budget, they proposed to cut $610 million from the extended Medicare safety net. In came the caps for a range of services, and these included obstetrics, assisted reproduction technology, treatment of varicose veins and, in particular, one that has massively affected my electorate, the injection of therapeutic substances to the eye and cataract surgery. As I said, I have a rapidly ageing, high age demographic in my electorate and eyesight is particularly important to them. This measure was going to affect my constituency. What was more amazing, and typically arrogant of this government, was that these changes were announced without any consultation. The government clearly was surprised by the storm of controversy that this break of their election promise to honour the safety net generated amongst patient groups and health professionals.

You would have thought that this breach of promise was something that the Prime Minister might have wanted to learn from and avoid, but then again at the last election we heard the Prime Minister say, 'There will be no carbon tax under a government I lead.' Say one thing before an election; do an entirely different thing after an election—and just blow the constituents. The constituents do not really matter to the Labor Party; to them it is all about being in power.

But, thankfully, on the EMSN the government has finally started to listen to the health sector, after being forced into negotiations. The coalition has secured some important concessions to ensure the passage of this bill through the Senate. These concessions include increases in Medicare rebates, increases in the proposed caps, and the addition of new items, in particular in relation to IVF. The coalition was also successful in preventing the capping of the item number for injections into the eye, which would have been detrimental to patients requiring treatment for macular degeneration. This is a concession that many in my electorate of Paterson are very grateful for. In my electorate, I took more constituency representations on this issue than any other health issue, such was the importance of this to my constituency.

As a member of the opposition, I believe that it is our role to hold this government to account. After the government's breach of promise on the EMSN, the coalition was not prepared to give it the benefit of the doubt, which is why, as part of the EMSN concessions, we introduced an amendment requiring any ministerial determination to change the caps to be approved through a resolution of both houses of this parliament. An independent review, conducted by the Centre for Health Economics Research and Evaluation showed that the EMSN had led to an inflation of doctors' fees in some areas, leading to a situation where the doctors' incomes had risen more than the reduction in patients' costs. This had led to an unsustainable growth in EMSN expenditure. The review showed that out-of-pocket expenses had increased for patients for those items that had been capped.

In this amendment bill, the government is seeking to make further changes to those it had already put in place. They include the capping of all GP, specialist and allied health services consultations, 38 selected procedures and one ultrasound item. If the government had understood its own legislation and had foreseen the changes back in 2009, it would not need to be making further changes to the EMSN now. This appears to be as a result of an error or an omission within the original bill enacting caps to benefits for the EMSN. However, the coalition is not seeking to oppose this bill. The proposed provision that, when more than one Medicare service is performed on the same patient on the same occasion, it should constitute one professional service and a cap under EMSN would seem to be a very sensible one.

I also welcome the removal of the requirement that families have to confirm in writing who members of their family are for the purposes of the EMSN. With this amendment, they will be able to notify Medicare in other ways approved by the chief executive of Medicare Australia. The only concern regarding this provision would be that there are structures to ensure that adequate identification and privacy issues are in place. I also note that this bill limits the Medicare benefit payable under the EMSN, so that the EMSN cap does not exceed the sum of the EMSN caps that would apply to the individual Medicare item. Furthermore, I see that the party opposite claims that this amendment bill will allow 'a more streamlined process and ensure faster payment of safety net benefits for patients', and that that should lead to a saving of $79.6 million. I hope this will be the case, but forgive us on our side of the House if we are not prepared to take the word of those opposite at face value. We will continue to hold this inept government to account. We are watching the changes carefully, for this government's record should not give Australians confidence that this government's claims will always be matched by its deeds.

Paramount in all of this is the provision of health care to our constituents. The legislation and actions of this government have been detrimental to the health care of my constituents. I, like my colleagues on this side of the House, will not stand by and allow that to happen.

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