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

Steve Fielding (Victoria, Family First Party) Share this | Link to this | Hansard source

As co-sponsor of the Health Insurance (General Medical Services Table) Regulations 2009 disallowance motion, I thought I would make sure I spoke. If this disallowance motion does not go through, you will find some ordinary Australians out of pocket 300 bucks. This government have taken not only the Australia public for granted on this issue but, quite clearly, the Senate for granted on this issue. They have taken them for granted. They have been mischievous at best in trying to manoeuvre a way around to not allow this disallowance motion to have effect. They have to come to the reality that this is a concern for the Australian public and they have to make sure that they sit down with various people to get to a common-sense arrangement rather than saying: ‘Stuff you all. We’re going to put this thing through and the only people this is going to hurt are the Australian public and they are going to be out of pocket 300 bucks.’ It is the wrong way of doing it.

They have taken the Australian public for granted and they have tried to take the Senate for granted, and it clearly has not worked. They cannot see through their own spin that quite clearly this is going to hurt those Australians who want to have the operation done and, if this disallowance does not go through, all that is going to happen is that people are going to be charged more for the surgery. They will be out of pocket. If they think that overcharging is going on, they need to find another way of addressing it, rather than making sure that the Australian public end up paying more.

Cataract surgery is the most common surgical procedure performed on older Australians and it is seen as a vital element in preventing falls, fractures and loss of mobility in the elderly. Do not take the elderly for granted. They value their health and they value the insurance that gives them peace of mind. The government are at a stage where they are undermining people’s trust in them with regard to health. This is another issue that the government have taken for granted, and this disallowance motion is very important in getting them to go back and look at other ways to address the problem as they see it.

Do not pass the problem on to those vulnerable people who will be charged more for cataract surgery if this disallowance motion does not get through. I make it clear that the government have to go back and do some work. They should stop trying to do nothing—believing in their own spin, not seeing through it—and do something that will actually address the problem, rather than just passing it on to the Australian public and saying they are doing something. That is wrong. I encourage all members of this chamber to support the disallowance motion.

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

I am not going to reiterate the arguments I made a short time ago other than to highlight our belief that this issue is about patients. They are being caught in the middle. I am concerned that the government is trying to hide behind the argument that wealthy practitioners are seeking to line their own pockets. I have highlighted the fact that we are concerned about some of the high costs and that this rebate probably does need to be reviewed—but in finer detail, not by just slashing it in half. We do not wear the argument that the only reason we should support the cut to this rebate is that there are practitioners who have high incomes. As I said, we acknowledge that there are issues there; equally, we think there are issues on the side of the ophthalmologists, who are concerned about it being slashed to just one rate, and that there needs to be some finessing of that.

The government have also highlighted, as has the opposition, the point that if the bill we have just dealt with does not pass the House of Representatives and this disallowance motion goes through we may be in scenario where we do not have any rebate for this procedure. I have sought advice on this and, as I understand it, the government could bring in a new rebate tomorrow. In other words, they have had plenty of time to sit down and talk to the ophthalmologists about this and plenty of time to deal with it, yet it still has not been resolved. As I said, there are issues on both sides; it is not the fault of one side or the other. However, patients are again being caught in the middle. The government could bring back a new rebate today. There is plenty of room for the government to manoeuvre.

It is unfortunate that we have had to go to these lengths to achieve this. I do take slight offence that this is being termed a stunt. The Senate is here to debate these issues. These concerns have been firmly on the agenda for months and months—since May. The government is right; it put this on the agenda in May—and people started raising concerns then. This was raised at budget estimates in May and early June, so it should come as no surprise that these issues are of concern. The Greens have been very careful to listen to both sides of the debate on this. We have heard the ophthalmologists, we have heard the government and we have sympathies for both. The point is: this issue has not been resolved, so we are reduced to this process in the Senate. Unfortunately, it is a mess.

The Greens want to see a way forward out of this. We have been trying to negotiate a way forward but unfortunately it has come down to this. We do not want to have issues of a complex nature such as this one on rebates sorted out in this chamber. It would have been much better if it had been resolved earlier. Unfortunately, it has not been and we have come to crunch time. The Greens have not been convinced that just halving the rebate in this way is the way to go. As I said, we have concerns about the impact of these cuts on those on low incomes and on the ageing in our community.

We are not convinced by the government’s call on this. We are extremely sympathetic to dealing with this issue but we have not been convinced by their arguments. Equally, we are not convinced by the arguments of the ophthalmologists that we should do nothing; we do think there should be some refinement of this rebate. We do not support the process to date and believe the government need to go back and rethink it. Equally, ophthalmologists need to be prepared to enter into negotiations about how we can resolve this in a way that causes the least pain to the people caught in the middle—that is, low-income Australians and the ageing in our community. We urge the government to rethink this and, if this disallowance motion is successful, to come back immediately with new rebate figures that can be supported by both sides—in the same way that they entered into negotiations with health professionals, the community and consumers to come up with a satisfactory outcome in the ART debate. The government do not have to leave this languishing. The ball is back in their court to show some maturity in this debate and come back with rebates that meet everybody’s requirements.

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

I have articulated the nub of the debate a couple of times this morning and I will not take up the full time allotted me. We need to get onto Senate work. Let me make this statement right at the outset and then I will deal in short form with the content of the debate: this is Senate obstructionism, clear and simple. The opposition are simply blocking the legislative program of the Senate. They have hijacked the Senate to allow this mad debate to proceed. It is a silly position that the opposition have adopted. I am sorry that the Greens have brought themselves into it as well. Senator Fielding and Senator Xenophon might try to hide behind it as a serious debate about forcing the government to negotiate, but it could only fairly be described as a political stunt.

Let me correct the record. Senator Cormann knows that the public hospital system does not access the MBS. He was referring to the hospital system. He knows that he was in fact misleading—

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

But what about the specialists working there?

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

Again he interjects to cover up his mistakes and misleading of the Senate. There is always difficulty with these types of debates. I know that sometimes the opposition may not like to hear the truth in these matters, but it does not give them the right to interject. They know interjection is disorderly and it only extends the debate unnecessarily. Of course, Senator Cormann knows the truth of those matters. He should make it plain, rather than reading great slab of words which he knows are misleading.

Earlier, Senator Williams made a contribution about rural and regional consumers, and it is worth responding to Senator Williams in kind. There are two issues—firstly, Commonwealth assistance to support regional and rural delivery of cataract services. The government supports eye services through a number of mechanisms such as the Medicare program, the Medical Specialist Outreach Assistance Program, the Visiting Optometrists Scheme, the PHI and the Macular Degeneration Foundation. These are important government initiatives in rural and regional Australia. In addition, there are Indigenous matters. For many Indigenous patients, the pathology means that cataract surgery is difficult and time consuming, and they will benefit from the new higher fee. Items will be available to any patient with similar difficulties and complexities, and $58.3 million is being allocated to improve eye and ear services in Central Australia. In his contributions to the debate today, they were the two issues that Senator Williams engaged with in a genuine sense, and I answer him in that way.

As I have indicated, the position this chamber is faced with is clear. If you support the disallowance motion then, stunts aside, you are clearly supporting a motion that will remove the item from the schedule. That is what the Senate can do. That is within the legislative ability of this chamber and that is what, if this motion is carried, it will do. That will be the position that you will have put yourselves in. The sensible course is to oppose the disallowance to ensure that the government can continue to have an MBS schedule which provides this support for patients and consumers. We can debate backwards and forwards about the merits of it, but this is the position that the minister has arrived at through, I suspect, difficult decision making. If you look at the statistics and the position that this government has arrived at, it is about ensuring that cataract procedures are remunerated appropriately under the MBS. That is the nub of the issue. To agree to anything else in this chamber would be to ensure that MBS item numbers cannot be altered, that you maintain specialists on MBS item numbers as you want. That puts Senator Cormann in the position simply of supporting specialists; there is no doubt about that.

The position that we urge the Senate to adopt is to reject this disallowance motion. The clear advice of course is that the opposition’s actions today will throw cataract procedures into disarray. That is the position that they have advocated and they will allow to occur today. The opposition should not try to hide behind or cover up their ineptitude in this area. This is the position that they are going to put patients and consumers in.

Mitch Fifield (Victoria, Liberal Party, Shadow Parliamentary Secretary for Disabilities, Carers and the Voluntary Sector) Share this | Link to this | Hansard source

It is about putting patients first!

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

Of course, they can complain about that not being the position, but that is the position that will eventuate. They have been provided with very clear advice. That will be the effect of their actions, let there be no mistake about it. That is the position that the Senate will adopt if it supports the disallowance motion. It is not about putting patients first; it is about putting the interests of a group of specialists first, a group which earns over half a million dollars a year from Medicare alone.

As I indicated, I am not going to extend the debate on this any longer than necessary. In dealing with one other matter, the impact on waiting lists, in the rant that was provided by Senator Cormann, who covered a range of matters that were in some part related and in other parts unrelated to the debate that is before us, it is important to remember that the impact of the decision is purely dependent on whether ophthalmologists mitigate their charging practices. If Senator Cormann wants to talk about the real world than he should also understand how the real world operates. It is important to remember that they are earning more than half a million dollars from Medicare alone and will still be doing so after this change. That is before any gap fees or private health insurance contributions. We know the community wants government to fund new medicines, new technologies and new services, which means that, when new technologies lead to efficiencies, the funding should be adjusted accordingly. That is the real world; that is how it operates. Of course, there is not a pot of gold at the end of every rainbow for Senator Cormann to draw upon.

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

They go to the Julia Gillard memorial pot—that is where they go.

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

These are choices that have to be made and savings have to be harvested. Senator Cormann interjects again, but it only really highlights the challenge that Senator Cormann has in trying to explain his position. The opposition is always confronted with the difficulty of trying to persuade us on the merits of this argument. There is no merit in the argument and there is little merit in the procedure that has been adopted this morning, which can only be described as Senate obstructionism. I will not take up all the time in dealing with this issue and will close at this point.

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

I briefly indicate in reiterating my position that I support this disallowance motion, for the same reasons that I supported the Health Insurance Amendment (Revival of Table Items) Bill 2009, introduced by Senator Cormann this morning.

I take issue with what the minister has said. Ultimately the government can fix this mess. To say there will not be any rebate whatsoever and that people will be out of pocket does not ring true to me. Ultimately this is something that the government have the ability and the power to sort out. I think they can sort through this mess in goodwill and in good faith, because I do not think the way these proposed changes are to be implemented is satisfactory. To say that they are going to leave hundreds of thousands of Australians potentially without cataract surgery or having to shift to the public health system—which will cause taxpayers to bear a huge burden and cause increased pressure on an already stressed system—is not good enough.

I urge the government to sit down and negotiate in good faith so that this can be resolved. To say, ‘We are going to abandon any rebate’—have no rebate whatsoever—just does not ring true and I do not think it will ring true out in the community. This is about a fair way forward. If the government is worried about overcharging and if it is worried about informed financial consent, those issues should be dealt with separately, not in the context that the government has dealt with them in relation to this measure. This is a measure that is simply too blunt and that is too brutal in its effect on senior citizens.

I think that Senator Cormann is unfair in his criticisms of the Minister for Health and Ageing. I think she has done a lot of good things and I think there are a number of measures that she has implemented and that she is trying to implement that are worth while. But in relation to this particular measure I think there is a better way forward and that is why I support this disallowance.

Stephen Parry (Tasmania, Liberal Party) Share this | Link to this | Hansard source

I again place on record that this is not a political stunt, as Senator Ludwig has outlined in his contributions. How can it be such when you have the Liberal Party, the National Party, the Greens, Senator Fielding and Senator Xenophon all disagreeing with the government? Senator Ludwig is starting to sound like a spoilt child who is not getting his own way.

The only reason that the coalition have acted in this way, with the support of the crossbench, is simply that this has become an urgent situation. The implementation of this measure was going to occur this weekend. The government had ample opportunity on Monday or Tuesday to bring their bill forward so that we could amend it. They were scared. They knew that we would amend the bill and that it would have passed this chamber, so they deliberately withheld the bill, forcing our hand to create an emergency situation which other senators from the crossbench and my colleague Senator Cormann have indicated is a last resort. That is what the government have forced us to do. We have rearranged the business to facilitate the passage of this legislation and the disallowance of these regulations to assist thousands of Australians.

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