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

I was not going to make an additional contribution; however, given some of the statements made by the minister, I cannot leave them unanswered on behalf of the opposition. Firstly, the government do not seem to be able to look past partisan politics. They do not seem to be able to look past the Labor Party and Liberal Party divide. It was not the Liberal Party who made a decision two weeks ago to disallow the government’s cold-hearted actions in relation to patient rebates for cataract surgery; it was the Senate. Nobody but the Australian Labor Party—if the minister wants to talk in those terms—voted in favour of those cuts; in fact, everybody but the Australian Labor Party supported the actions of the Senate in relation to the Rudd government’s cold-hearted 50 per cent cut in patient rebates for cataract surgery. These are cold-hearted cuts which will hurt mostly elderly patients, which will impose significant additional out-of-pocket expenses on them, which will make life-changing surgery unaffordable for many of them, and which will push many of them into the public system—where the taxpayer will have to pick up the whole bill, which is in excess of $3½ thousand. We have a minister here who wants to save about $300 at a Commonwealth level and cost-shift it to the states and territories, who will have to pick up about $3½ thousand for exactly the same procedure. It is completely ill-thought-out policy—and patients are getting caught up in the middle of it.

The minister here mentioned the assertion—and I think he should have been a bit more careful about this—made by the Minister for Health and Ageing that this procedure now takes 15 to 20 minutes. The Minister for Health and Ageing has been very good at making assertions—like she has been promising that she would provide a copy of the legal advice indicating that the actions of the Senate were unconstitutional—but she is not very good at backing up her assertions with evidence, facts or documents. We have been asking questions about how this supposedly now takes 15 to 20 minutes—and every now and then the minister has let the 20 minutes drop and has talked about 15 minutes. We have been asking her for evidence and she has not been able to point to any Australian data. She was able to quote a specialist who wrote an article in the British Medical Journal, and that specialist has approached us to say that he was quoted completely out of context and that he had not relied on any Australian data whatsoever for the article.

We also know that the AMA has done a survey of ophthalmologists which indicated that, for 70 per cent of specialists, the procedure takes between 25 and 40 minutes. We also know that it was only after the Senate disallowed the government’s drastic, massive, 50 per cent cut that the minister, her office or her department went out there and did a ring-around and asked some health stakeholders how much time it actually takes. I believe that the government has been told that the procedure takes about 30 minutes on average. The Senate has asked the minister to come clean and table some of the information that she has been collecting, but of course again today she has been refusing to do so.

The minister also raised improvements in technology—and I cannot leave these assertions unanswered. There have been improvements in technologies and the procedure is now shorter than it was when it was first introduced. Since the rebate for this procedure was first introduced, it has been reduced twice. This is not disputed; the department confirmed this during Senate estimates. It was reduced by 30 per cent in 1987 and the rebate for this surgery was reduced again by 10 per cent in 1996. Since 1996—and even before then, I believe, but certainly since 1996—indexation of rebates for this procedure has been below the CPI. That was intentionally so because of an inbuilt assumption of productivity gains. The minister has not acknowledged any of these facts. She has not answered any of these questions. Instead, when the Senate passed the disallowance to prevent the government from going ahead with a further 50 per cent cut in patient rebates for cataract surgery, she turned around the next day, thumbed her nose at the Senate and replaced the massive 50 per cent cut with a massive 46 per cent cut.

This is not the way to do business. This is not the way to be accountable to the parliament. I will say it again, and close on those remarks: we have a minister here who thinks that she is a minister in a dictatorship. She does not understand her responsibilities as a minister in a parliamentary democracy with a bicameral system, where there is both a House of Representatives and a Senate. The minister has not given us a copy of her legal advice. We have put it all on the table, but all the minister has provided us with is some departmental advice to say that what the opposition is doing is unconstitutional. Since when can the government give advice to itself about how much power it has? I have a message, as I have said before, for minister Roxon: no departmental briefing note to the government will be able to limit the constitutional powers of the Senate and no departmental briefing note to the government will be able to expand the government’s powers under the Constitution.

This is an important change to the Health Insurance Act. Clearly, this government is intent on persisting with abusing the powers that it has been delegated so far under the Health Insurance Act. There has to be a limit put on it. Incidentally, the minister has referred to a meeting with ophthalmologists earlier in the week. Again, I advise the Senate: I have been advised on how this meeting went. One of the things the minister said in that meeting to ophthalmologists was that, if the Senate were to disallow it again, she would reintroduce another determination regulation immediately afterwards—and that the next one could well be lower, so she was threatening ophthalmologists. The Senate has made its views very clear. We do not want the government to reduce the patient rebates through Medicare for cataract surgery—as the Minister for Veterans’ Affairs has not; he has increased them. So the government is all at sea. The arguments are totally inconsistent across the board.

For exactly the same item number, exactly the same procedure, we have one minister in the Rudd government saying rebates should be increased, we have another minister saying they should be reduced—but without putting any evidence forward—and we have a minister who promises to release legal advice to the House of Representatives but then backs out of it, because clearly she has something to hide. And here we have a government that think that, if they tell themselves they have more power than everybody else think they have, somehow that gives them a divine addition to government power. This is what dictatorships do. Dictatorships say, ‘We’ve got all these new powers, which nobody ever thought we had.’

We are ruled by the Constitution. Section 53 of the Constitution enables the Senate to do what it is doing. I urge the government to very carefully reflect on what they do next with this, and on their threats to ophthalmologists. This is not actually about ophthalmologists; this is about patients. This is about patients who the Rudd government want to slug with $600 to $900 in additional out-of-pocket expenses. And these are mostly elderly patients. These are people across Australia who for decades have done the right thing, putting additional resources into the healthcare system through private health insurance. And, at a time when they think they can use their private health insurance to get timely and affordable access to this surgery, this cold-hearted government turns around and say, ‘No, we’re going to cut this rebate by 50 per cent; we are going to increase the out-of-pocket expenses to such an extent that you will not be able to afford it.’ Then this government have the cheek to say to the Senate: ‘Even though you think that our actions are inappropriate, you won’t be able to do anything about it. All you can do is pass a disallowance of the motion itself, which takes the rebate to zero. You won’t be able to do anything about us reducing this.’ These amendments are a very effective legislative way to ensure that the intentions of the Senate can be practically implemented.