Mathias Cormann (WA, Liberal Party, Shadow Parliamentary Secretary for Health Administration) Share this | Hansard source

The minister talks about time wasting. The minister has just spent 20 minutes not talking about this bill but talking about the merits or otherwise, in his view, of the disallowance motion. I will leave my detailed remarks on why we do not support the government’s savage cut to Medicare rebates for cataract surgery when we discuss the disallowance motion. But let me just remind the Senate what this legislation is all about. It is about ensuring:

(3) If an item in a table of medical services prescribed in accordance with subsection (1) is disallowed under section 42 of the Legislative Instruments Act 2003, the corresponding item, if any, in the previous regulations is taken to apply in place of the disallowed item from the time of disallowance.

The legislation is proposed to take effect from 26 October 2009, which is of course the day when the government finally tabled the relevant regulations.

If the minister’s argument were to stand, if the Senate were not allowed to go down this path in moving that disallowance motion, then the minister is really saying that the government can do anything to the Medicare Benefits Schedule. The government could cut the rebate by 80 per cent. The government could delete 1,000 items. The government could do all sorts of things. The government is really saying that the only decision senators have got, when faced with a proposition by the government to dramatically reduce a rebate like this, is whether or not we want to delete an item, when clearly the intentions of the Senate are to disallow the government’s move to drastically reduce the cataract surgery Medicare rebate.

If the government’s argument were to stand then essentially the Senate would not be able to do anything in relation to whatever the government does to the Medicare Benefits Schedule. I do not think that that is a satisfactory situation for the Senate to be in. Given the legal advice and the advice that the minister has finally released this morning, given the understanding that we had—which is why we prepared these amendments initially to the Health Insurance Act through the Health Insurance Amendment (Compliance) Bill, and subsequently through this private senator’s bill—and given that the legislation appears to be flawed, as it currently stands, it is very clear that the Health Insurance Act 1973 desperately needs to be amended. It cannot possibly be the case that the Senate should be left in a position where the only decision we can make is whether ‘to delete or not to delete’ an item when, in fact, what we clearly want to do is stop the government from reducing, by 50 per cent, the rebate for a life-changing surgery.

The minister mentioned in his contribution to the second reading debate the commitments made by the shadow Treasurer around budget time. That was at a time when we thought we could believe what Nicola Roxon was telling us about the impact of the various budget measures. But the sad thing is that, when you start scratching the surface, when you realise there had been no consultation, that clearly the government had not thought through the implications, that there were going to be drastic consequences for thousands and thousands of patients across Australia, in particular, patients in regional Australia, we clearly had to reconsider. And the coalition made an announcement in a very upfront fashion, together with Senators Xenophon and Fielding, on 8 September 2009. So the government have known about this matter for more than seven weeks.

What a cheek for the government to lecture us about commitments! Remember that this is the government which went to the last election promising the world in the health portfolio. It was going to fix public hospitals. Labor supposedly had a plan to fix public hospitals by the middle of 2009. What have we had? A 20-month review, undertaken by the National Health and Hospital Reform Commission, which is now being followed by a review into a review and a whole series of photo opportunities for the Prime Minister and the Minister for Health and Ageing. The Prime Minister gave the most solemn commitment regarding private health insurance to 11 million Australians who take additional responsibility for their own healthcare needs that his government would retain the existing private health insurance rebates. Everybody knows what has happened: one of the most brazen broken promises in the history of the Commonwealth. Everybody knows that Labor do not like private health. Everybody knows that the ideological crusade against private health is part of Labor’s DNA, so everybody was understandably suspicious in the lead-up to the last election as to what the federal Labor Party’s true intentions would be if they won government—and it is here for all of us to see.

This government have absolutely no credibility when they try to lecture us about keeping commitments, because in the health portfolio we have had broken promise after broken promise after broken promise. The Minister for Health and Ageing, the Prime Minister and the government as a whole have not yet been able to make any tough decision. Whenever they have to make a tough decision, all they do is set up another review, another committee, another agency, another inquiry. If in doubt, they set up a review into the reviews and have another consultation round and a few photo opportunities. I apologise to the Senate for getting a bit agitated about this; however, the government have had the cheek to come in here and try to lecture us about commitments made. Very clearly, our decision to reject the government’s proposed 50 per cent reduction in the Medicare rebate for cataract surgery is based on the best interests of patients. This is life-changing surgery. It is a very cost-effective preventive health measure. It is a measure that helps prevent falls, it helps prevent fractures and it helps prevent mental stress—which helps prevent social isolation. It has a positive effect on the quality of life of our senior Australians.

The government are acting unilaterally, based on no evidence at all—and I will go into this in a bit more detail when we discuss the disallowance motion. The minister has been out there saying, ‘This surgery now takes a shorter period of time. It is about 15 minutes.’ In Senate estimates I asked: ‘Out of the 187,000 procedures that you fund every year, how many take 15 minutes? How many take 15 to 20 minutes? How many take 20 to 25 minutes? How many take 25 to 30 minutes?’ Do you know what? The government were not able to provide an answer. The reason they were not able to provide an answer is that the government do not collect that data. They have got no idea. That is the answer we got from the government. Through the Medicare Benefits Schedule the government do not collect any data on how long the surgery takes.

I will tell you what we did have. We had an AMA survey of 334 ophthalmologists who responded as to how long their average cataract surgery would take. Seventy per cent of them indicated that it takes between 25 and 40 minutes. I thought that perhaps the government would be very keen to put the finger on some flaws—perhaps the government would explain to me why the AMA survey does not stack up. I said to them: ‘Are you aware of the AMA survey of ophthalmologists which found that 70 per cent of ophthalmologists take between 25 and 40 minutes for that particular procedure?’ The official at the table was the senior official responsible for the Medicare Benefits Schedule, the same official who also told us that, if the Senate were to disallow this particular item, it would revert back to the old rebate—but never mind. When I asked her, ‘Do you want to comment on this particular AMA survey?’ she said no. Here we have got the minister running a political argument saying, ‘Oh, well; the process is much shorter now, it is cheaper, it is simpler.’ But when you actually ask for some evidence, the government say, ‘We have none.’ I propose to go into this in more detail in the context of the debate on the disallowance motion; however, in relation to this bill, this is a very carefully considered, responsible course of action undertaken by the opposition, Senators Fielding and Xenophon and, thankfully, also now with the support of the Greens. This will ensure that if future items are disallowed by the Senate, we will revert back to the rebate that was in place immediately prior to the time of the disallowance.

I will not hold up the Senate for the full time. I think it is very clear what the intentions of this legislation are. I thank all senators for their contributions to the debate and I commend the bill to the Senate.

Question agreed to.

Bill read a second time.