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

I move:

That this bill be now read a second time.

The Health Insurance Amendment (Revival of Table Items) Bill 2009 amends the Health Insurance Act 1973 to provide for the revival of certain medical services items should later items be disallowed.

This bill is part of our efforts to stand up for patients across Australia in need of timely and affordable access to quality health care and is sponsored by the coalition together with Senators Fielding and Xenophon.

The aim of this bill is to address a serious shortcoming in the Health Insurance Act 1973, which has become apparent in the context of a majority of senators seeking to put a stop to ill-considered government moves to halve a series of Medicare rebates for cataract surgery.

On budget night in May this year the government announced that it would move to reduce Medicare rebates for cataract surgery by 50 per cent.

This meant in effect an immediate $313 increase in out-of-pocket expenses for the many thousands of mostly elderly patients accessing this surgery through the private health system.

The flow-on-implications for private health fund rebate arrangements meant further increases in out-of-pocket expenses as a direct result of the government’s actions.

The government owned Medibank Private for example announced that its rebates for cataract surgery would reduce by a further $290 as a direct result of the MBS rebate change, taking total additional out-of-pocket expenses to more than $600 per episode.

This would make this life-changing surgery unaffordable for many senior Australians.

There is no doubt that it would push many into an already overburdened public health system—a public health system in which the taxpayer would have to spend more than $3,500 for every cataract surgery procedure, providing those patients who are lucky enough to get in with free access to this procedure.

The government is in fact proposing to save $313 per procedure on one hand, and to force taxpayers to pay more than $3,500 for that same procedure in the public health system on the other.

It does not make sense.

Furthermore, cataract surgery is clearly a very cost-effective preventative health measure, helping to prevent falls, fractures and mental stress.

Affordable and timely access to this treatment can mean maintaining an independent life—continuing to live at home, continuing to drive a car, continuing to remain active. In short, this is indeed a life-changing treatment.

For these and many other reasons to be detailed during the debate on the disallowance motion immediately after this bill has been determined, the coalition together with Senators Fielding and Xenophon announced that we would move to stop the government from going ahead with this.

Given the budget cut was to be implemented by regulation the only procedural option available to us to achieve that objective was to move a disallowance motion in relation to the items the government was seeking to reduce in the Senate.

That is why the coalition, together with Senators Fielding and Xenophon, announced back on 8 September 2009 that we would seek to disallow the government’s 50 per cent reduction of cataract surgery related Medicare rebates.

True to form the Rudd government left things to the last minute, yet again only coming to the Senate at the last minute, on this occasion by tabling the regulations to give effect to the reduction of cataract surgery rebates two days ago—even though those reductions were announced as far back as May this year and even though those reductions are to take effect from 1 November this year. That is, those regulations were tabled in the Senate with only four days to go before they are to take effect.

The government has refused to take any responsible action despite the well-publicised intentions of a majority of senators.

Consistent with our previous announcements the coalition and Senators Fielding and Xenophon gave notice yesterday of the notice to disallow as well as circulating two amendments to the Health Insurance Act 1973.

Faced with a lack of support in the Senate for its budget cut, the government at first did nothing, then the minister went for the scare campaign, and then with only four days to go the government recklessly pressed ahead with its ill-considered budget cut regardless of the consequences for patients.

The Minister for Health and Ageing, instead of opting for the responsible course of action, seeking to respond constructively to the clearly expressed wishes of a majority of senators, decided to ignore the Senate, to scare patients, to scare doctors and to threaten the Senate.

Indeed, for a number of weeks now the minister has effectively threatened the Senate by stating that if the Senate were to disallow the various reductions in cataract surgery related MBS items then ‘There will be no payment, no scheduled fee for a cataract procedure.’

She indicated that those items would disappear altogether.

There is no proposal to ensure that does not happen, and no initiative from the minister to ensure patients do not get hurt because the government is not able to get the support of the Senate for its ill-considered budget cut.

The problem with the minister’s interpretation and with her legal advice is that, if it is correct and if it is allowed to stand, it would in effect mean that governments can make any cuts they like to the Medicare Benefits Schedule without the Senate ever being able to stop them.

So, however ill-considered the budget cut, however many senators are opposed to it, however sound and well considered the reasons for disallowance may be, the Senate would not be able to do a thing about it.

If this situation were allowed to stand, any disallowance motion in relation to cuts to the Medicare Benefits Schedule, now or at any time in the future, would be completely ineffective.

Clearly that cannot have been the intention of the parliament when delegating the power to make regulations to the government.

If the Health Insurance Act 1973 as it stands delegates power to the government to make regulations reducing any Medicare item rebate without the Senate being able to do anything about it, then clearly that legislation needs to be changed.

By supporting this bill the Senate would formalise its view that the current situation is unacceptable and that the Senate wants the relevant legislation changed with effect from 26 October 2009.

When asked by governments to give them power to make regulations under various acts of parliament, the parliament, and in particular the Senate, is invariably told reassuringly by government representatives, ‘Don’t worry; if you’re not happy with what we’re doing, you can always move a disallowance motion and stop it from going ahead.’

We have heard that recently in relation to the extended Medicare safety net bill. But, of course, the Senate very wisely introduced a different process, where both houses of parliament have to formally agree rather than go down the fraught path of disallowance motions.

The reality we are now faced with very clearly demonstrates that in relation to government initiated reductions in MBS rebates that appears not to be the case under the legislation as it currently stands.

Clearly this is a serious issue and one which the coalition and Senators Fielding and Xenophon have very seriously considered.

Our intention is to stop the government from reducing the cataract surgery related rebates.

Our intention is not to create a circumstance where there is no rebate at all—of course not.

Last Wednesday during Senate estimates we put the specific question to the senior official responsible for the MBS in the health department: ‘If the Senate were to disallow the reduction in cataract surgery related rebates, what would happen?’

The answer was, ‘The items would revert to the previous rebates,’ in clear conflict with the public assertions of the minister up to that time.

This clearly points to confusion and doubt on this issue, even at the most senior levels of the government.

By last night the minister had pulled her department back into line and back onto message—who would have expected otherwise?

However, by yesterday afternoon, the time of giving notice of the disallowance motion in relation to cataract surgery rebate reductions, nobody from government had made any moves to correct the record of evidence given to a committee of the Senate.

That is, the evidence from the senior official on this issue has been allowed to remain on the public record uncorrected for nearly a week.

The minister this morning circulated very recent advice which she obtained yesterday afternoon and the departmental official very clearly is trying to cover her bases. She is trying to say she was right then and she is trying to say that she is still right now. She is trying to say that she was right in saying that if we disallow these items they revert back to the previous items and she is also trying to say, ‘Actually, no, if you disallow those items, the items will be deleted altogether.’

It is done in a very clumsy way. It is clearly an attempt to walk both sides of the street and cover up something that was a mistake, that was wrong and that was false evidence to a Senate committee.

In any event, the coalition and Senators Fielding and Xenophon had long decided to take the necessary legislative steps to put the matter beyond doubt through an amendment to the Health Insurance Act 1973—an amendment to make sure that any disallowed item would revert to the previous MBS fee/rebate for those items that have been disallowed.

Indeed, it had long been the intention of the coalition and Senators Fielding and Xenophon to pursue this amendment to the Health Insurance Act 1973 through two simple amendments to the government’s Health Insurance Amendment (Compliance) Bill 2009.

That bill had been listed on the Senate Red on both Monday and Tuesday this week.

The government had given clear and repeated indications to the opposition that the Health Insurance Amendment (Compliance) Bill 2009 was an urgent bill to be passed as soon as possible early this week.

This would have been a very smooth and much less disruptive way to achieve the objectives of the Senate in relation to this issue.

Yesterday afternoon, a day after the government finally tabled the regulations in the Senate on Monday, in very good faith, we circulated our proposed amendments to the Health Insurance Amendment (Compliance) Bill 2009.

What happened next is breathtakingly reckless and irresponsible.

The bill had been fully considered by the House of Representatives and agreed to without amendments. It was about to be put to its third reading vote when, in an unprecedented move, the government decided to stop the process only seconds away from final passage of the bill by the House of Representatives. The government’s aim was clearly to ensure that the bill would not be passed and would not make its way to the Senate before the impending disallowance.

This whole process could have been much more straightforward. If the government had taken a more responsible and constructive approach the Senate would have lost much less time.

We have repeatedly confirmed that we did not support what we consider to be an ill-thought-out, short-sighted budget measure, which would end up hurting many thousands of patients across Australia.

By passing this bill before dealing with the disallowance of the government’s reduction in cataract surgery rebates, the Senate is giving the government a way out.

This is a well-considered and responsible course of action which will protect patients’ interests.

We urge the government to give this bill precedence in the House of Representatives and to support it.

If the government decided to vote this bill down in the House of Representatives or decided to delay its consideration and passage beyond 1 November 2009, the government would effectively be causing the deletion of the Medicare rebate for cataract surgery altogether, consistent with the advice that the minister has received from her department last night and consistent with advice that had previously been provided by the Clerk of the Senate.

We urge the government to very seriously consider its next steps.

If the Senate passes this bill as well as the disallowance motion on certain items of schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2009 then the Senate is making its position very clear:

(1)

we do not support the government’s ill-considered and short-sighted 50 per cent cut in Medicare rebates for cataract surgery;

(2)

we want to stop the government from pressing ahead with that cut in rebates, which would hurt patients and put more pressure on our already overburdened public hospital system; and

(3)

we want the government to accept that, in the interests of the thousands and thousands of patients in need of timely and affordable access to quality cataract surgery in the private system, the rebates for cataract surgery should remain the same as they have been under the previous regulations.

We urge the Minister for Health and Ageing to come to her senses and listen to the Senate.

If she won’t, then we call on the Prime Minister to remember his solemn pledge to the Australian people that on health the buck stops with him.

I commend this bill to the Senate.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I rise to make a contribution in this second reading debate on the Health Insurance Amendment (Revival of Table Items) Bill 2009. The Greens have struggled with this issue. We will be supporting this bill because—as we have highlighted on other occasions in the chamber and in fact when the Greens made a contribution to the debate over the extended Medicare safety net—we are concerned about the issues around the rebates. We think that patients are being caught in the middle of a failure to resolve this issue. The government and, to our mind, many ophthalmologists have not engaged in a meaningful debate over the excessive costs that are being charged in some areas. There is no doubt that technology has decreased the amount of time that is required to do fairly standard operations; there is no doubt that some more complex operations require further time; and there is no doubt that some ophthalmologists are churning a number of patients through their operation in a single day. That has increased the rate and has led to the need for the government to start to look at issues around the rebates.

During estimates, as Senator Cormann referred to, there was much evidence presented. There was also a lot of evidence presented around the number of patients that are now being dealt with. There was some fairly convincing evidence about the reduced time it takes to carry out these procedures. But the point here is that people on low incomes and people in rural and regional areas in particular are being caught in the middle. There is no doubt that some patients will end up on the public waiting list. The government’s response to that is, ‘Well, ophthalmologists will be coming out of the private system. They won’t have as many patients in the private system, so they will then be working in the public system.’ I think that is a pretty haphazard way of dealing with patients who are not going to be able to access the private system to get treatment and who will have to go on quite long waiting lists in public hospitals.

The other issue here is that some ophthalmologists, not all of them, instead of engaging in a meaningful debate with the government—and the government has shown some resistance, as I understand it, to engaging in debate—have gone into a scare campaign. That has made the situation worse. They have chosen to engage in the debate through the media and through a media campaign. I do not think that has helped the debate. When the issue arose over ART procedures the government and the profession entered into some negotiations and came up with what seems to be a very reasonable outcome of changing some payments for some scheduling, agreeing to cut some payments for some scheduling and some rearrangement. It did require on that front the government bringing in a cap or threatening to bring in a cap without engagement with the profession. It required a fairly heavy hand in bringing everybody to the negotiation table. That does not appear to have happened here.

There are definitely issues to be resolved. There is not just blame on one side; I think there is blame on both sides. But this issue needs to be resolved because the bottom line here is that patients are getting caught in the middle. I think this is a very heavy-handed approach to dealing with what is a quite complex area. I think the government has been somewhat disingenuous by saying that it is dealing with this issue by bringing in the payment for complex procedures and that that might help in some way to deal with the rural and regional issue where there are more expenses involved as it is harder to access either public or private hospitals for the procedure. The item number for the complex procedure was in fact announced in the budget—it was not brought in as some concession to the ophthalmologists to try and show that the government has been listening and in fact will now be paying for complex procedures. As I understand it, it will be quite hard to access that complex procedure process. It will not deal with the issue that the ophthalmologists have been bringing up of some procedures taking longer, as I understand it from both previous discussion in estimates and talking to ophthalmologists.

There is no doubt that there are issues here. There is no doubt that there is an increase in costs to do with cataracts and that those costs can be reduced. Our concern is that the methods of reducing those costs are not being adequately dealt with by this fairly blunt instrument. The coalition previously, with Senator Fielding and Senator Xenophon, were bringing in an amendment to the compliance bill as a way of ensuring that the schedule item continued—because if a disallowance was moved and it was supported by the chamber then that item number would disappear completely, and that of course is an unacceptable outcome. We are left with an unacceptable outcome if this rebate goes through because we are not convinced that there will not be adverse impacts on patients.

The Greens absolutely recognise the need to deal with runaway health costs and we have also raised those issues. We do understand the issue around large cost increases for cataract surgery. We do not think this is necessarily the way to do it. We do think the government and ophthalmologists should be required to sit down—with an independent facilitator or negotiator if that is what it takes—to try and resolve this issue. Using these blunt instruments in this manner and trying to fix this through counterprocedure after counterprocedure in the Senate is not effective. It looks like this is going to have the support of the Senate. We know very well that, when it goes through, it will go down to the House of Representatives and they will knock it off or they will not support it.

Opposition Senator:

Opposition senator interjecting—

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

They will have to think about it, but they probably will not support it; and yet again patients are getting caught in the middle. This is not an acceptable way to deal with what are potentially very serious health outcomes for the people in our community who can least afford it. Let us face it: we are not talking about the people who can afford these procedures—the middle or higher income people. They will of course go and pay for it. The people who are being impacted are those who can least afford it.

The Greens were extremely concerned, as I indicated during the debate, about the extended Medicare rebate and the issues around the cap, but we are not convinced that this is not going to result in adverse outcomes for those who can least afford these operations and who will be most harmed by not gaining access to cataract surgery. The government has agreed to a review as a result of an amendment that the government agreed to under the extended Medicare rebate bill process that we already debated in this chamber, but we do not believe that leaving this process to a review down the track or people going onto the public list and ophthalmologists that are not engaged in private work getting work in public hospitals is a way to resolve this. We think that we need a more definite way to resolve it. We urge the government and the ophthalmologists—as I said, I think there are problems on both sides—to sit down and resolve this. This is a very clumsy way of resolving a highly complex issue. The bottom line here is that patients are getting caught in the middle. I do not think it is appropriate, which is why we were of a mind to support the disallowance, to cut the rebate in half. It is not an adequate way of dealing with these very complex issues. The government did show goodwill with medical professionals in the other sectors that we have dealt with, such as the RAT issue and the obstetricians. I know the obstetricians were not fully happy with the outcome of the negotiations, but I understand there was considerable support for some of those changes.

Those changes are not the issue here. The specific issue here is around cataracts. I do not think the government has got it right. I think the ophthalmologists have engaged in a scare campaign that is not appropriate, because it has scared people, particularly older people, into thinking that they are not going to be able to get access to cataract operations. We think there is concern on both sides. We need to sit down and we need to resolve this. This is not the appropriate way, but at this stage this is the only way that the Senate has of raising its concerns and forcing people to start negotiating this in good faith. We need to come up with an outcome that does not leave growing waiting lists, with those on low incomes and older people who cannot afford operations languishing on public hospital waiting lists hoping that ophthalmologists who are not engaged in providing private services will then switch over to the public system. Unfortunately, that is the very real scenario we could be facing. We do not think that is appropriate. It is not easy. If it were easy they would have sat down already and resolved this, but they need to try again to sit down and talk about it. We need both sides to come to those negotiations in good faith. It is not beyond the wit of the people engaged in this issue to come up with a solution that does not require this blunt instrument we are being forced into using.

John Williams (NSW, National Party) Share this | Link to this | Hansard source

I will only take a few minutes to say that we support Senator Cormann in his actions today on the Health Insurance Amendment (Revival of Table Items) Bill 2009. As Senator Siewert just said, this is the only action we can take on this issue. I just want to bring to the Senate’s attention the situation in the regional area where I live. We have an ophthalmologist from Armidale who comes to Inverell one day a month. He has to pay two staff and he has to rent the hospital facilities. It costs him a lot of money for his travel—an hour-and-a-half drive there and an hour-and-a-half drive back, plus paying those staff. To halve the rebate would put Dr Mark Morgan in a situation where he would have to reconsider whether he actually travels to our regional area to carry out that cataract surgery.

This is typical in regional Australia. This is a dollar-saving issue by the Minister for Health and Ageing from the May budget that is going to have very negative ramifications in regional areas. That is why we strongly support Senator Cormann and what we have done today. Some might not like the way it has been approached but, as Senator Siewert said, it is the only option we have to get a message back to the government that we will not tolerate this situation. Our elderly and those in Indigenous communities at high risk of cataracts need attention and services, and we should have those services in regional areas, not just in the cities. That is why we strongly support the action being taken here today.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

In one sense, we have been debating the Health Insurance Amendment (Revival of Table Items) Bill 2009 for some time this morning, so I will try not to take up my full time, but I think some of the issues need to be put on the table. One is that this is ultimately a position that Senator Cormann has decided to embark on. The truth is that the course he has adopted is in effect to seek political cover for the position he has adopted in relation—

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

You are still on the same argument. It is getting boring.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

Again, Senator Cormann interjects because he really objects to the truth of what I am saying. I understand why he interjects. He interjects because he is disappointed that his own strategy is being exposed for what it is. It is completely and utterly a pantomime that he has constructed and it is being exposed. I can understand he does not like that and that is why he is interjecting. It is quite usual for him to interject, but I ask in this instance that he contain himself and stop demonstrating how bad the position is that he is now adopting. The truth is that he is now effectively trying to underpin the argument that he has put forward. The opportunity to disallow a regulation is certainly the Senate’s prerogative. That is the choice he made; he decided to do that. However, there are always consequences. The consequences are the quite unprecedented position of disallowing this regulation. Nevertheless, that is the choice the opposition has made. In doing so that table is then taken away and that leaves the Senate with the choice of either agreeing to the disallowance and removing the item or not agreeing. That is the choice that is available.

What we now have is a stunt. It is a political cover to try to say, ‘No, it’s not really me who’s doing this; it’s the government doing it.’ They are trying to shift blame, but in fact this whole circumstance has been constructed by Senator Cormann. It is ill thought out, ill prepared and ill executed, quite frankly, because in doing so he has driven over a range of long-accepted principles in this place—quite disappointingly so—and he has dragged the minor parties with him.

I can understand the homily from the Greens, but the real point is that there is a choice to be made around this. It is not about a last, desperate act to encourage the parties to negotiate. I have no doubt the parties have negotiated. Senator Cormann has come up with a strategy to try to effect the opposition’s will, and now we have Senator Xenophon, Senator Fielding and the Greens following behind him. The difficulty always is that once you start on this course it is very hard to change course. Once you hitch yourself to this wagon, you have to see where it goes, and the Greens, Senator Xenophon, Senator Fielding and the opposition have hitched themselves to Senator Cormann’s caboose.

Yesterday the opposition announced that they would take steps in this place which will mean that no rebate will be payable for cataract procedures performed from Sunday onwards. This action, of course, will throw cataract procedures into disarray. Australians scheduled to have this procedure will now face the uncertainty of being billed for the entire procedure without any government rebate. The opposition have been provided with very clear advice that this will be the effect of their actions. The opposition understand the position that they are in, clearly, and they are choosing to head down this path.

The opposition’s actions are not about putting patients first. They can bleat about putting patients first, but these actions are not about that—they are not about that at all. This is about putting the interests of a small group of specialists first, a group who earn over half a million dollars a year from Medicare alone. The opposition’s thoughtless actions will only hurt the patients seeking to have cataracts removed. Ophthalmologists will continue to charge their high fees for the procedure while the opposition’s actions will prevent the government from paying any rebate to the patient. That is the position that the Greens, Senator Xenophon, Senator Fielding and the opposition have now hitched themselves to.

It is time the opposition stopped siding with the specialists and started supporting taxpayers who are being slugged with unreasonable fees. In fact, the opposition may wish to respond to this comment—and I mentioned it earlier in the debate in relation to the suspension, but I will refer to it again. The CEO of the Consumers Health Forum was asked about this in the Age today, 28 October, and this was the answer:

I would like to know why the Opposition is seeking to support medical specialists who are seeking to retain high incomes at the expense of consumers.

That is what the opposition stand for. Unfortunately, it seems that the Greens now wish to hitch themselves to that as well, with Senator Xenophon and Senator Fielding. Let me say that I do not blame the Greens for that—I understand the position that they have found themselves in—but the truth of the matter is that that is what is now being debated here today.

The government wants to pay an appropriate rebate for this procedure and thinks that the opposition can reconsider this insane position and support these changes. The government’s proposal is to have a schedule fee of $416 and to introduce a new complex item of $850 for when the procedure takes longer. We are adjusting these fees to better reflect the time and the complexity of these procedures. Most people in the community would think that $416 for a procedure that typically takes 20 minutes is a reasonable position to adopt, recognising the skills and abilities of the specialists who undertake these tasks.

What it also means, though, is that if this continues to be resisted we cannot reform our health system. We must make hard decisions. This includes decisions about where we can best direct our finite resources. This is also about the opposition agreeing at budget time but then reneging on that and choosing different courses as they go. On the one hand, they complain about spending and on the other they encourage it, particularly directed at specialists. This is the difficulty they get themselves into. If they do not want savings in this area then they do not need to come up with stunts in this place; they need to point to where they say the savings should come from, if there are to be savings in this area—and there need to be savings, especially where technology changes and improves, allowing savings to be found.

But it seems, to use a well-worn phrase, they want to have their cake and eat it too. It seems that the opposition are all care but no responsibility. If you look at the responsible position, responsible government is about governments passing bills in this place. It is about effecting our policy. It is about having regulations that support executive action. If they do not like the executive action then they have the ability to come in here and disallow it. But that is the responsible government framework that we exist in. It is the Westminster system. Its principles I enunciated earlier during the debate on the suspension motion. What they are now doing is trying to run policy from the floor of the Senate, using stunts to effect a policy outcome, using parliament to provide that policy outcome and directing the government and the executive in how they should deal with their budget and all of those matters. It is quite unprecedented. It should not be allowed to stand. Not only is the position they have adopted ridiculous; it is also unsustainable, because it will be exposed for what it is, which is nothing short of a stunt.

The other decision the opposition needs to make today, and they have an opportunity to do so in their summing up of their private member’s bill, is whether or not they are standing by the commitment of their shadow Treasurer, who said:

We said we’re not going to block any initiatives other than the private health insurance initiative. So that’s our position. We’re not changing from it.

That was from Mr Hockey in the Press Club on 20 May 2009. So it is the position of the opposition. It certainly does not appear to be the position of the opposition health spokesperson here today. On the government side in this chamber we want to continue to support new and emerging technologies, not continue to support specialists who can rely on the system. We want to look at how we can provide for the new maternity service incentives. These are the choices that you get in government. If the opposition does not like that then they can work with government. They are the alternative government and they should act responsibly as the alternative government in this place, not irresponsibly. They should not pursue—if I could be unkind, Senator Xenophon—political stunts. That is usually the preserve of Independents and small parties. I will accept the actions of the Greens for the moment; I think the Greens have broadly been acting, although perhaps not this time, in a responsible way. To do this, of course, we do need changes, and these are the changes we are putting forward and which we want the opposition to support.

Senator Cormann appears to be captured by a small group of specialists who want to continue to have high incomes based on a medical item that has not changed. We heard in estimates Senator Cormann’s position regarding the fee structure that is being provided. His position is that you can never change the fee structure, not even with improvements in technology which would make the procedure less expensive. So we would be stuck in a position of keeping regulations and an unsustainable payment in place. The community would ultimately be outraged at that—that the opposition would support holding these rebates in that way. Anyone would be. Any sensible person looking at this would say that these things do have to change over time with the introduction of new technologies. A mechanism does need to be provided, and that is what the mechanism is. Every year regulations are made for a new MBS schedule. We have gone from the sublime to the ridiculous when they then use this tactic to try to cover up what I would, in the first place, have called an error in strategy.

The key savings that would have come out of that would have been $98 billion over four years, or $24.5 billion per year. The MBS fee for the most commonly performed cataract service item, 42702, would be reduced from $831.60 to $416. New complex items would then be introduced to ensure that those with complex issues could be addressed and that would be at $850. So there is an increase for the more complex items. It is recognition that there are complex issues. Ophthalmology MBS spend would be about $317 billion. This is a saving of about 7.7 per cent of the total, and the average ophthalmologist receives about $585,000 from Medicare each year. This is an area that looks like it needs reform, smells like it needs reform and should be reformed. But the opposition want to continue to support specialists, not patients.

One wonders about the reasoning behind that, other than perhaps that it was a poor political strategy adopted by the opposition which is now being exposed for what it is. On average ophthalmologists conduct about 243 cataract operations per year. The full-time equivalent is 100 per cent of the Medicare schedule fee: 75 per cent through MBS rebate and 25 per cent covered by the private health insurers. An average of $1,700 was paid by private health insurance funds for hospital cover per procedure on top of the MBS rebate for cataract operations performed in hospital. So it is about both ensuring that the dollar spend of the Commonwealth in this area is aimed and adjusted appropriately and making sure that consumers get a good deal out of this. This is why the government has travelled down this path.

In 2008, the highest earning 10 per cent of ophthalmologists earned at least $1.8 million each, with $1 million through Medicare benefits including $45,000 through the extended Medicare safety net. What the opposition are now saying is that they support the continuation of that indefinitely without it ever being addressed and considered—

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

That is not our position, and you know it.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

and the policy mechanism that we have pursued is through this.

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

How many times has it been cut before?

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I am sure the opposition will get an opportunity to provide comment when they sum up, but I think the interjections from the opposition really portray their ignorance about how this chamber works, about the procedures that should be adopted and how an alternative government should act. This is an extraordinary stunt to do—to eat up significant time that the government requires to get its legislation through. Notwithstanding that yesterday the opposition were complaining about not having sufficient time to debate these matters, to come in here without notice to perform what you could not call anything other than a political stunt is just extraordinary.

But the choice is for the opposition, the Greens, and Senators Xenophon and Fielding to make. We will clearly not win this debate—the numbers are not with us. The choice will be what you do with the disallowance motion: whether you agree or disagree with it. If you agree to disallow the MBS item, that is the choice you have clearly made—to remove the item from the schedule—but let us be clear about this: there is no other course, no other position and no halfway house. You cannot legislate from this chamber to direct government policy on the run. That is not permissible, it is not responsible government and it is not the Westminster system within which we exist. We do not operate under that principle. In this chamber you do have a clear right to either agree or disagree to a disallowance motion. Those are the choices this chamber has. The alternative government is not the government and should not be encouraged to undertake this madness that is now being perpetrated in the chamber of trying to direct the executive government away from making appropriate decisions on policy which were clearly made some time ago and which were clearly enunciated in the May budget. That is the position that should be adopted, recognised and understood.

In conclusion, I would like to reiterate that this bill should not be supported. It is nothing short of a stunt. It will have no effect. The opposition know that and the Greens should also be aware of that. Senator Xenophon clearly knows what it is and he recognises something that is always close to his heart as well—a political stunt.

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

in reply—I thank senators for their contribution to this debate on the Health Insurance Amendment (Revival of Table Items) Bill 2009. In particular, I thank Senator Fielding, Senator Xenophon and the Greens, represented by Senator Siewert, for their expressions of support for the bill that we have put forward today.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

Senator Ludwig interjecting—

Mathias Cormann (WA, Liberal Party, Shadow Parliamentary Secretary for Health Administration) Share this | Link to 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.