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

I, and also on behalf of the Leader of the Family First Party, Senator Fielding, and Senator Xenophon, move:

That items 42698, 42701, 42702 and 42718 in Part 3 of Schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2009, as contained in Select Legislative Instrument 2009 No. 272 and made under the Health Insurance Act 1973, be disallowed. [F2009L03329]

We are moving this disallowance motion to stop the Rudd Labor government from halving Medicare rebates for cataract surgery. We consider this to be one of a series of ill-considered and short-sighted budget cuts in the health portfolio. It is a budget cut that would hurt mostly elderly patients in need of timely and affordable access to high-quality cataract surgery. It would make access to this life-changing surgery unaffordable for many. It would force tens of thousands of Australians to join lengthy public hospital queues. What is worse is that it will see people go blind, when it is entirely preventable through this life-changing cataract surgery. It will hurt, in particular, patients across rural and regional Australia. I will now read an email I received from an ophthalmologist from regional New South Wales:

Just to let you know, I am one of the ophthalmologists who provide services to rural areas—Bourke and Griffith. I have just given my notice of resignation for Bourke, as I can no longer provide the services under the proposed new arrangements. My last operating list in Bourke will be October 29-30. Similarly, I am seriously considering not entering into a new contract with Greater Southern Area Health Service for Griffith—I am the only bulk-billing eye surgeon in Griffith—on the basis of the proposed cuts.

So here we have somebody who is saying that, on the basis of the cuts proposed by the government, she is no longer going to provide any services whatsoever into the rural area around Bourke and she is no longer going to provide bulk-billing services into the area around Griffith.

As I am in receipt of Commonwealth funding to cover the trouble for my trips to Griffith and not Burke, this may allow me to continue to provide the Griffith service a little longer.

I will read another email from the same region. This is from an ophthalmologist who was quite happy for me to use his name. His name is Ashish Agar and he works for the Outback Eye Service at the Prince of Wales Hospital in Sydney. He says:

I wish to highlight some of the public surgery at risk if this funding cut is not retracted. This is an often overlooked aspect of the discussion—how much so was revealed in discussions with the federal health department only last week.

I received this email late last night. He goes on to say:

In response to a query regarding how regional and remote areas will cope with the cutbacks, we were advised ‘not to worry’ as the proposal is ‘all about private surgery’. This degree of misunderstanding would be laughable (worthy of the best of “Yes, Minister”), were it not from our principal public health body, and so close to the date of the proposed change. As it stands though, this statement was simply frightening. The government really have absolutely no idea of the tsunami about to hit public cataract surgery in Australia.

May I give our own service as an example—the Outback Eye Service is based at the Prince of Wales Hospital, Sydney, and evolved from the pioneering efforts of a former Professor, Fred Hollows in the 1970s. It is a free, completely publicly funded comprehensive ophthalmic service covering the Far West of NSW. The most important health intervention we provide these remote communities is cataract surgery. We are in fact restoring sight to over a dozen citizens in Bourke District Hospital with Sydney-based surgeons and nurses as well as local staff, at this very time.

Unfortunately, this now appears to be the last surgical trip we will be making offering this life changing procedure. The funding cut of 50% makes our service unviable, and there is no ‘private’ option for us to recoup our costs from the patients (which on a matter of principle we would not entertain in any case). Decades of arguably the most cost effective public health intervention is about to be denied to those who need it most; the elderly, isolated, indigenous and socially disadvantaged.

This is what this debate is all about. These are the people that the opposition, with the support of Senators Fielding and Xenophon and the Greens, is standing up for.

Cataract surgery is a truly life-changing procedure. It prevents blindness, through removing the natural lens of the eye, when it has developed an obfuscation, and replacing it with a synthetic lens to restore visibility. That makes cataract surgery, as I have mentioned before, a very effective preventative health measure, helping to prevent falls, fractures, mental stress and isolation. Affordable and timely access to this treatment can mean maintaining an independent life, continuing to live at home, continuing to drive a car and continuing to remain active.

This impost on our mostly senior Australians is particularly offensive given the reckless government spending in most other areas of government. The Rudd Labor government have been spending like drunken sailors. We have spending spree after spending spree, cash splashes, stimulus payments—you name it! And yet here we are. We have the Rudd Labor government forcing elderly Australians in need of timely and affordable access to this procedure to pay the price for that reckless spending. This is not about a sensible, well-considered saving based on real efficiencies. The reality is that it would have worked like this: the Prime Minister, the Treasurer and the Minister for Finance and Deregulation would have gone to Nicola Roxon as the Minister for Health and Ageing on winning government and said, ‘We want $6½ billion out of your portfolio.’ The first $3.1 billion they thought would be easy: ‘We’re going to run up this 70 per cent tax grab on alcopops and we are going to sell it as a health measure. So that one is in the bag.’ But they hit a snag. The Australian people were very suspicious, because they pretty well realised that this was about revenue raising and was not a health measure.

Since then we have had about $3.5 billion in spending cuts to the health portfolio while there has been reckless spending everywhere else. Australians in need of timely access to affordable health care have to pay the price for the Rudd Labor government’s reckless spending in every other area of government. We were told that health was going to be a high priority. You have got to be kidding. I will give you some examples: a $960 million saving from the changes to the Medicare levy surcharge; $1.9 billion being sought out of the private health insurance rebate reductions; $100 million being sought in savings from a very ill-considered cut to chemotherapy funding; a further $450 million saving through cuts to be extended Medicare safety net; a $150 million saving through cuts to Medicare rebates, which includes the $98 million in cuts to rebates for cataract surgery—and there are others. Do you know what they have in common? They are all targeted at one portion of the Australian population. This divisive, ideological government is targeting those Australians who access their health care through the private health system. We on this side of the parliament believe in both a strong and well-funded public system and a strong and well-supported private system. Before the last election the Rudd Labor government promised that they believed in the same thing, but we have seen again and again that that was nothing but pre-election rhetoric.

I will go through some of the facts that came out from answers given by Department of Health and Ageing officials in Senate estimates last week. Firstly, we know that nearly 200,000 cataract surgery procedures are performed across Australia every year. More than 70 per cent of those procedures are performed in the private system. The Minister for Health and Ageing, Nicola Roxon, wants us to believe that this rebate for cataract surgery only covers the 15-minute, easy, cheap, simple procedure at the time of surgery. The reality is that it also includes—and the department conceded this—a period of postoperative care, including further consultations. Contrary to any assertions by the minister, as I mentioned in my speech on the Health Insurance Amendment (Revival of Table Items) Bill 2009, the government actually has no idea how long cataract surgery takes, given that they do not collect such data through the MBS or otherwise. Departmental officials did not dispute the findings of an AMA survey that 70 per cent of ophthalmologists take between 25 and 40 minutes for cataract surgery, not the 15 to 20 minutes advanced by the minister without any tangible evidence.

Health department officials talked about the period since the rebate was first introduced—and ‘since the rebate was first introduced’ is a very important phrase because the government, in answers to questions on notice, said when the rebate was first introduced it took 45 minutes to perform the surgery, but since then the government wants us to believe it is now much more simple, cheaper and quicker to provide the surgery. Have you ever heard Nicola Roxon talk about the fact that there have been major cuts to this rebate in the past? Have you heard that, Mr Acting Deputy President? I bet you have not. Let me inform the Senate that health department officials confirmed that since the rebate was first introduced cataract surgery rebates have already been cut twice, by 30 per cent in 1987 and by 10 per cent in 1996, undermining assertions by the minister that this further 50 per cent cut is necessary to cater for improvements since the rebate was first introduced.

The value of the MBS fee rebate has reduced even further over time, given the average indexation of around two per cent per annum in other years was well below the health services cost index, the health CPI, increases in average weekly earnings, or even just CPI—you name it. The Special Minister of State, Senator Ludwig, mentioned that ophthalmologists earn half a million dollars: I am not sure whether Minister Ludwig has run a business, but I am certain that Minister Roxon has not run a business because income and revenue is only one part of the equation in running a business—there are also costs. If costs go up—costs go up in the real world—they do not rise by less than the CPI; wage costs do not go up by less than average weekly earnings. That is something that the minister has not even acknowledged. There is actually an important point to be made here. In 1996 the government made a deliberate decision to index the Medicare benefits schedule by less than CPI. Why? Essentially to include an assumption for productivity gains. So there is an inbuilt assumption of productivity gains in the way the indexation of the MBS works. Since the item was first introduced when surgery took 45 minutes, we have had a 30 per cent reduction in rebates in 1987 and a further 10 per cent reduction in 1996, and since 1996 there has been a deliberate decision to keep indexation below CPI to essentially build in those productivity gains.

Having imposed all these productivity gains over the past 22 years, the government is now turning around and saying it wants to squeeze another 50 per cent out of this lemon. There comes a time when there is nothing left to squeeze. There is a very interesting Access Economics report on all of this. It is dated 2004, so it came out after this particular type of indexation had been in place for 12 years. It deals with the impact on general practice, but the principle is the same. I urge Minister Roxon to have a very close look at how the indexation of the MBS works and how productivity gains are built into the way that indexation is worked out.

The reality is that the government had a political strategy, and the government’s political strategy was again on display in the minister’s comments in the Senate today. The two main arguments are (1) ophthalmologists earn too much and (2) the procedure is now much simpler, faster and presumably, according to the government, cheaper to perform. Let us consider those arguments in turn. Firstly, the attack on doctors and ophthalmologists: the minister’s main argument in favour of these cuts to Medicare rebates for cataract surgery is that ophthalmologists earn too much. True to form the Minister for Health and Ageing is running yet another campaign demonising a group of Australians. Incredibly, she even enlisted the support of the Australian Labor Party organisation, making the government’s attack on ophthalmologists extraordinarily party political. Does she realise that she is a minister of the Crown, that she is no longer involved in student politics? In her ham-fisted determination to push this through, she was completely oblivious to the invaluable contribution ophthalmologists have made and will continue to make to our community, alongside all of our many hardworking and dedicated healthcare professionals across other areas.

Again today the government attacked the opposition because we are siding with the specialists. The reality is that we are standing up for patients, first and foremost. That the government considers it a good idea to run a campaign against a group of healthcare professionals that is based on the politics of envy is a matter of great concern. A month or so ago it was a campaign against community pharmacists, as part of the budget cut on chemotherapy; then it was Australians with private health insurance; and this week it is ophthalmologists. Who is going to be in the minister’s sights next week? The government says this is about doctors earning too much. The government is not doing a single thing about doctors’ fees. Doctors’ fees will not change as a result of the cut in the rebate that is payable to patients. The only thing that will change is the out-of-pocket expense faced by patients, which will go up. There will be no change to doctors’ fees as a result of what the government is doing.

One of the sources mentioned by the government was an article in the British Medical Journal and it is where the minister took a quote out of context. In fact, that is the only source the minister gave as to where she got that 15-minute reference. I want to quote from the author of the article referred to by Minister Roxon, Professor Tien Wong from the Centre for Eye Research Australia, University of Melbourne. He states:

I would like to state categorically that my British Medical Journal editorial is misquoted in this context. First, it is an opinion editorial piece on how cataract surgery has evolved. I did not conduct a formal research project to evaluate specifically cataract surgery time. Second, the surgical time of course is only a small part of the cataract surgery procedure. There are pre and post op assessments. Cataract surgery is very cost-effective, even at the current price, and there are major significant adverse effects of not doing it. For example, the Blue Mountains Eye Study has shown the impacts of visual impairment on falls, hip fractures, earlier institutionalisation, loss of self rated health, depression, earlier mortality et cetera. The minor savings will be eaten up many times over by the cost of not doing cataract surgery.

The government have not thought this through. I want to quickly touch on the item for complex cataract procedures because we have included it in the disallowance and I think it is important for the Senate to understand why we have done it. Everything here with this government is smoke and mirrors. Just because they describe something as a complex procedure and a complex item, they think that people believe that it is. Do you know what they have done? They have taken item No. 42702, the most commonly used item—95 per cent, perhaps even more, of cataract surgery is claimed under this item—and applied the two per cent increase that is applied every time the MBS is indexed, and they have renamed it. They have taken the old standard rebate, applied the usual two per cent indexation which was applied across the board to the MBS, and renamed it ‘complex surgery’ and then they cut everything else by 50 per cent.

We consulted with the profession about including this in the disallowance motion. If this disallowance motion is successful in relation to the three other cataract surgery MBS items then essentially this complex item becomes redundant. This complex item was only ever part of the minister’s political strategy. To use Minister Ludwig’s terminology: this was part of Minister Roxon’s ‘political cover’. She wanted to say that she was doing something reasonable. They are taking $98 million out of this service, they are forcing tens of thousands of patients into the public system where this procedure costs more and she says, ‘But, look, aren’t we reasonable, aren’t we wonderful, because we have created this new complex item?’

You know what? She tried to announce it twice. It was announced on budget night and then, when the government was trying to crank up its scare campaign, all of a sudden it was reannounced in October as if it was a new revelation. I have had question after question from journalists about this. Every now and then journalists do not do enough research. Some of them are really good and do a lot of research; others are not quite as good. When they see a press release from the minister and after the spin doctors walk through the press gallery, they might take the minister at her word. In October, the minister said: ‘Look at this. We’ve got this compromise proposal. We’ve got a new complex item.’ After you scratch the surface, you realise that it is just a reannouncement.

If I had more time, I would have gone into how the minister refused to provide us with answers in relation to the constructive proposal by the ophthalmologist profession on achieving savings using Avastin instead of Lucentis. The reality is that the department told me today that the minister has had advice from them since 26 June 2009 in relation to that matter. What has the government done? Nothing. This is yet another matter in relation to which the Minister for Health and Ageing has been sitting on her hands.