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

Again I thank all senators that have contributed to this very important debate on these two very important measures that we have before us today: firstly, the Health Insurance Amendment (Revival of Table Items) Bill 2009, which was passed earlier and, secondly, this disallowance motion.

I want to commend Senator Siewert for her very insightful remarks. They echo, I am sure, the sentiments of Senators Fielding and Xenophon and certainly those of the coalition. We never wanted to get to this point. We went out on 8 September and gave public notice that a majority of senators did not support what the government was proposing to do. We said that if the government went ahead with the 50 per cent cut to the Medicare rebates for cataract surgery, it would hurt patients. It would force them into long public hospital queues, where the procedure costs taxpayers more to perform, and it would in particular hurt patients in rural and regional Australia. What did we think would happen when we made that announcement on 8 September? What was our expectation?

Our expectation was that a sensible minister who understands parliamentary accountability and understands that executive government is accountable to both houses of parliament would have realised that she had a problem. The government announced this budget cut in May, and a majority of senators indicated that they did not support that cut. What did the Minister for Health and Ageing do? To start with, she ignored us. She did nothing. She put her head in the sand. What was the next step? The next step was to run a scare campaign, to frighten patients, to frighten doctors, to threaten the Senate and to say, ‘If you go ahead with this there will be no rebate at all.’ That is not the way to treat the Senate.

We have expressed a very serious position based on very serious consideration of all of the issues. The Minister for Health and Ageing has form on this. Senator Xenophon clearly has a higher opinion of the minister’s performance than we on this side of the parliament have. However, I urge the Senate to reflect on Minister Roxon’s performance when it comes to legislation and budget measures before this Senate. It is as if she is driving a truck at 150 miles an hour, heading straight for the wall and, instead of slowing down, turning right or left, picking up some additional passengers, keeps going until the truck hits the wall and it is too late.

Senator Siewert is exactly right: the government could very easily fix this. If the government came out now and said: ‘Okay, we understand that we played it hard, but we don’t have the support. So we will go back to the original rebates for cataract surgery as they are in the most recent previous regulations.’ The government could do it in a whole number of ways. Probably the easiest way right now would be for the government to support our bill when it goes to the House of Representatives, to give it precedence and to vote in favour of it. That would fix it and it would fix it not only for this occasion but for the future, because the argument that the government are putting forward is completely untenable. The government are telling us that they have got delegated power through the Health Insurance Act 1973 to do whatever they want with the Medicare Benefits Schedule and that whatever it is they want to do, whether they want to introduce 90 per cent cuts to it—even if the government did the most irresponsible thing—the only option for the Senate would be to delete or not to delete.

From a public policy point of view that is not in our national interest. Whenever the government come into this parliament and want to pass legislation and we on this side complain—because it is our role to test and scrutinise—and say: ‘Well, there is not enough detail in this; all of your detail is going to be in the regulations,’ do you know what the government say? The government say, ‘Well, don’t you worry about that, Jana, because there is this disallowance process.’ All you need to do is move a disallowance and all will be fine. What this exercise has proved, very clearly, is that everything is not going to be fine. If this Senate wants to stand up for patients and if this Senate wants to make sure that elderly patients across Australia in desperate need of timely and affordable access to this very important life-saving surgery get it then a disallowance motion will not do the job. That is just not good enough, and that is why the opposition, together with Senators Fielding and Xenophon, very carefully considered all of the procedural options available to us.

Quickly, in summing up, I will just refer to the advice Minister Roxon has circulated today. There is a particular comment in this briefing note, signed by David Learmonth, a Deputy Secretary in the Department of Health and Ageing, and signed as noted by Nicola Roxon, the minister. Point 5 says, ‘While the advice provided to Senator Cormann at the hearing on 21 October 2009 was correct, as a matter of general principle much depends upon the way in which this disallowance motion is drafted.’ Tell us something we do not know! The reality is this. I am not meaning to embarrass her, but I am sure the official now realises that she actually got it wrong in the answer that she provided at Senate estimates. I was a bit surprised at the firmness of her response and at her clear indication that if the Senate disallowed those items we would return to the previous rebates. I did not expect that answer.

I am concerned that, since having given what I believe was an incorrect answer, the department have not gone out of their way, and the government have not gone out of their way, to correct that information. The department are now trying to cover up their tracks. They are trying to have it both ways and are suggesting, ‘Oh, well, what we said was really right but, really, it depends on how it is introduced.’ That is just rubbish. The question was very specific: ‘What would happen if the government disallowed those rebates?’ The officer knew what I was talking about. The answer was:

I think that it would revert back to the previous rebate.

We did consider a whole series of procedural options to make sure we achieved our objective. We are not wedded to process; we are flexible with our process. We are focused on the objective we are trying to achieve, and that is to stop the government from cutting rebates for cataract surgery by 50 per cent and to do it in a way that will not leave thousands and thousands of patients and doctors out there without the certainty of having that rebate in place on an ongoing basis.

We do not want to be part of a circumstance where, because of this disallowance, the item numbers are all of a sudden deleted altogether. That is why we initially planned to move an amendment to the Health Insurance Act through the Health Insurance Amendment (Compliance) Bill 2009to be very flexible on process but very focused on the outcomes we wanted to achieve. When the government played its little tricks in the House of Representatives yesterday, we swiftly changed process but remained very focused on the outcomes we wanted to achieve. This has got nothing to do with obstruction; this has everything to do with standing up for patients. It should tell you something—that is, that government senators are the only ones in this chamber who think what we are doing here today is a stunt. It is not a stunt; this is very serious business. This is about standing up for patients.

I do have to respond to a few other remarks that Minister Ludwig made. The minister talked about private and public hospitals; he actually tried to sell as a virtue that this only applies to the private system, that it does not apply to the public system. Tell us something that we do not know. We know that you are targeting people who access the surgery through the private system, even though the only saving you will make is $313 per procedure, and the additional cost that you will impose on taxpayers is an additional $3,500 plus to provide the service in public hospitals. We understand that, and we understand that patients who will get access to this procedure through the public system—if they are lucky enough to get in—will get that access for free. But the thing that the minister does not understand is the reality of the health workforce across Australia. Ophthalmologists actually happen to work in both the private and the public systems. You pooh-poohed the quote I read out. This was a very dedicated ophthalmologist, and you totally dismissed anything he said. Here is an ophthalmologist who operates as a private practitioner in Sydney, and he happens to go and provide services in outback New South Wales. What does the minister not understand about this? If you make his private practice less viable it will make it more difficult for him to do some of the other things—for example, to provide services to regional New South Wales. I find it quite astounding that the minister is not able to understand such a simple fact.

I ran out of time before on the issue of Avastin and Lucentis. The minister and officials of the department have been running this line about how ophthalmologists have not come forward with constructive ideas on how we can achieve efficiencies. The reality is that they have. I am not going to hold up the Senate by going through all of those proposals again, but a specific one was in relation to exploring the use of Avastin as a much cheaper option to achieve similar clinical outcomes. I asked questions about this at the end of July and, as Minister Ludwig well knows, because he had to take the question on Minister Roxon’s behalf, after 90 days no answer was provided. We again had to use what the minister would describe as a ‘procedural trick’, a ‘stunt’—whatever he wants to call it—to force the government to the table to provide an answer that the Australian people are entitled to. I thought I would get a bit of information, and guess what? I asked:

Has the department received a Royal Australian and New Zealand College of Ophthalmologists working party recommendation that it is clinically appropriate to use medications such as Avastin and Triamcinolene to treat blinding conditions as part of an intravitreal injection …

The answer was yes, that they did get that advice. I asked what Minister Roxon was doing about it, and the answer to parts (c) and (d) of the question was, ‘The minister is considering this advice and has requested further information.’ I asked, ‘Do you know when the minister received that advice?’ The answer provided to the question on notice was, ‘On 26 June 2009.’ This is a minister who is not interested in constructively exploring positive ways of achieving efficiencies. This minister is not interested in achieving efficiencies in the health system in a way that does not hurt patients. If she were, she would not have been sitting on this for more than four months. In the interest of being able to conclude this debate, I will leave it at that. I commend this disallowance motion to the Senate.

Question put:

That the motion (Senator Cormann’s) be agreed to.