Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Hansard source

The Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009 represents yet another Labor attack on health care for Australians. The measures contained in this bill will put a cap on payments under the Medicare safety net for a variety of medical services, putting those treatments out of the reach of a great many Australians and imposing yet another burden on ordinary Australians at a time when they can least afford it because of this government’s reckless spending, which is pushing this nation into record debt.

The government will make savings of $450 million over four years as a result of this measure. This bill comes just days after the Prime Minister and his Minister for Health and Ageing shredded the solemn promises that they made over a lengthy period of time not to change private health insurance rebate regimes which encourage Australians to take out health insurance and in doing so relieve some of the pressure on the nation’s public healthcare system. Not content with that attack on one of the fundamentals that have given Australia one of the best health systems in the world, the government is now intent on bringing more pain to Australians requiring various medical treatments—in the main to elderly Australians needing cataract surgery and young couples either having children or needing help to do so.

Health featured heavily in this government’s campaign for office with a lengthy list of the things that it would or would not do. Before the House now is a bill that does exactly what this government said it would not do. This bill represents yet another broken promise on health from this government and Australians are now starting to realise that Mr Rudd would clearly say anything at all or do anything at all in his pursuit of power. Let us look at what the health minister was saying with regard to the Medicare safety net in the run-up to the last election. Here is what she said to the Meet the Press program in September 2007:

We are setting out a comprehensive plan and the safety net is part of that plan that we are committed to and we will be running on for the election.

Today we see what the minister’s commitments mean. Let us look back again to September 2007 and to one of those now infamous joint media releases from now Prime Minister Rudd and Minister Roxon:

A Rudd Labor government will retain the Medicare safety net as Australian working families—

Let me repeat that: as Australian working families—

have come to rely on it for help with their family budgets.

The document goes on:

Federal Labor will not put more pressure on family budgets by taking that assistance away.

One can only wonder what working families think right now. There has been no other period in recent times when working families have been under more pressure than they are right now. One million Australians earning less than $26,000 a year have private health insurance. This health minister says they will not be hurt by her attack on insurance rebates. Wait until premiums rise by more than would have been necessary and let us see if they are not hurt then. She also says that the measures in these bills which cap payments under the Medicare safety net will not hurt. Tell that to Australia’s senior citizens and pensioners, one of the groups most impacted by this government action.

The extended Medicare safety net was introduced by the former coalition government in 2004 to protect Australians from high out-of-pocket expenses for medical services provided out of hospital. About one million Australians each year receive payments under the safety net to help them with their large medical bills—among them, no doubt, many working families, many senior Australians and pensioners and many young people starting or seeking to start a family. They are the ones who will be hit hardest by the caps the government now seeks to put on the Medicare safety net.

Caps are to be put on: all obstetric services; some pregnancy related ultrasounds; all assisted reproductive technology, including IVF; varicose vein treatment; and cataract surgery. Cataract surgery gets hit twice by this government—in these measures and elsewhere in the government’s budget. It is unbelievable. Now the government blames doctors for the need to impose these changes to the Medicare safety net and Australians who incur high medical costs and benefit from it. ‘Doctors are taking advantage of the safety net; doctors are charging excessive fees’ has become the somewhat repetitive refrain. Of course, it has nothing to do with the government’s debt splurge that now requires them to find every cent of saving they can in this budget to fund the $300 billion of debt this nation will be saddled with in a few short years! Senior Australians needing cataract surgery must pay for this government’s reckless behaviour, so too must young couples seeking to start a family.

These changes pose very important questions. Did the government really think through what these changes would mean? Are they sure what they are doing here? Let us have a look at cataract surgery. Under this bill a cap is going to be placed on one cataract procedure but this will combine with other budget measures to bring about significant changes. The government will halve the MBS rebates for this medical procedure from around $600 to around $300. Patients, many of them senior Australians—pensioners and retirees—will have to pay hundreds of dollars out of their own pocket and for some procedures only a small part will now be recoverable from the safety net.

Around 120,000 or more Australians undergo surgery each year, with 200,000 cataract operations. The majority of cataract operations—70 per cent—are done in the private system, with only 30 per cent done in public hospitals. There are substantial waiting lists for treatment in the public system. The effect of this would seem to be to drive patients to the already congested public health system. That is at the core of so many of this government’s ill thought out decisions in health. At the last election they promised they would fix public hospitals by mid-2009 and now, if we reflect on the 18 months since they made that announcement, every decision they have taken in health will put only more pressure on the public health system.

The Combined Pensioners and Superannuants Association of New South Wales has described these changes as ‘disastrous’. The association says that the costs will prove impossible for pensioners and other low-income earners to meet and they will not receive what is an essential medical service. They believe services in regional and rural areas could be cut altogether. Noted eye surgeon Dr Bill Glasson agrees. He has restored the sight of thousands of people in rural and remote areas of Australia. It is worth hearing what he has to say about what this government is doing. He told the ABC:

The impact really is going to be on the battlers across Australia, particularly those in rural and regional Australia, particularly Indigenous and it’s just going to make things tougher and tougher.

They’ve given the pensioners $30 on one hand and effectively taking $300 with the other hand—it is a very short-sighted decision and all this is going to do is drive more and more people out onto the public waiting list.

That is what this minister and the Prime Minister—this government that promised to fix health—are doing to the battlers, to the working families and to the pensioners of our country.

Seventy per cent of people aged in their 80s will suffer cataracts. Surgery that restores vision has other beneficial outcomes. Of course, if people who are ageing have difficulty with their sight they are likely to have falls, fractures, hospitalisation and treatment for other outcomes of poor vision. This government is going to block those people from having this life-saving, and life-changing in many cases, surgery. It is inconceivable that this government could believe that this is a measure that ultimately will result in savings.

The Society of Ophthalmologists has described the government’s action as a ‘huge blow’ to patients. It says it will put the cost of private cataract surgery beyond the reach of average Australians. Remember, 70 per cent of all current cataract surgery is carried out in the private sector. What does that say for the public sector from here? More patients waiting longer. Ophthalmology already has the longest waiting times of any specialist surgery. That is the result of this government’s broken promises. This is hardly what you would call fixing health. There are the broken promises and then there is the hypocrisy.

This bill is going to cap payments to Australian couples who need help in starting a family. Assisted reproductive technology and IVF will be hit hard. More than 40,000 people accessed IVF services last year with the support of the Medicare safety net. It is estimated that 11,000 babies were born in this country as a result. Medical sources also estimate that one in six couples will have fertility problems of some sort and need assistance to start a family.

I do not need to speak against this measure. I will let members of the Rudd cabinet do that. Their hypocrisy in putting this measure forward is astounding. Only three years ago none other than the Deputy Prime Minister was extremely vocal in her support for IVF. Now she sits on the sidelines it seems in silence as this measure is pushed through by her own government. Julia Gillard presented petitions to this parliament in support of IVF treatment. At that time she spoke out against mooted changes to Medicare and said, ‘Labor opposes any cutbacks to Medicare funding of IVF.’ Let me repeat that for the benefit of the House and for all Australians listening to this debate: ‘Labor opposes any cutbacks to Medicare funding of IVF.’

What a cruel hoax that was, Deputy Prime Minister. What a disgrace that you are now part of a government which is ripping apart the support to those people who are most in need. The Deputy Prime Minister also said only three short years ago:

It is a cruel thing to do to Australian women particularly older Australian women, whose only hope of falling pregnant is through the IVF process.

That was the Deputy Prime Minister’s view, which was reflected by many who are now in government when they were on the back bench of the Labor opposition. Clearly, they have done a complete about-face. That is what makes this government such a joke when they talk about their commitment to fixing health. Everything they have done over the last 18 months in the health program has put only extra pressure on an already overstretched system.

No less than four Labor members presented petitions to this House four years ago, among them Ministers Emerson and Burke, and perhaps even the current Treasurer, Mr Swan, joined the campaign in favour of IVF. Where are these people now? That is not my question but the question of thousands of people who feel betrayed by this government, thousands of Australians who feel ripped off by this government. This clearly is a policy driven by Treasury, not by Health. It is a policy driven by Treasury and Finance, and it cannot have any basis in good health outcomes. It cannot be the basis for this government’s decision to rip away support for needy Australians, for people who rely on that safety net.

I have met, spoken and corresponded with thousands of Australians in relation to their experience on IVF. I want to bring to the attention of the House one compelling case. I read from a Friends of QFG Newsletter which was presented to me by one of my constituents. For the benefit of the House, I will read some excerpts from a letter to the editor of that particular newsletter:

Brian and I had been married for about 7 years and although he had been ready for children from day 1 I was now finally ready. It was June 1998 … I was only 27. We tried with no success and Brian had a sperm test with his GP that came back perfect. I then went to my GP and was told to relax and have a holiday “you’re young” don’t worry about it.

The letter goes on to say:

We managed to get in to see Dr Bob Watson in February 2004. He asked an enormous amount of questions and sent both Brian and I off for more dreaded blood tests that seemed to never end, this was the start of attempting to overcome my fear of needles …

               …            …            …

Well we rocked up refreshed and eager to get this over with even though we were told that IUIs probably wouldn’t work for us but it’s worth giving it a go. Two attempts at that was more than enough for me, bring on the big guns that should work. Off to Wickham Terrace to meet with Gail for the details about IVF and all the drugs.

We started out the first of what was to be all 8 full stimulated IVF cycles on 11 June 2004, the first FSH injection (125 units) was on our 13th wedding anniversary 29 June 2004. That first cycle, although in hindsight one of the worst, was good because we really didn’t know what we were doing or what to expect. I knew that the chance of success on the first go was slim but I was very positive and when it failed before I even had my blood test I fell in a heap. I just sat on the bathroom floor and cried.

               …            …            …

Brian and I picked ourselves up from that cycle and thought if we went back quickly that would be the best way to cope. The second cycle started in September we got 9 eggs (due to 600 units of FSH) but none fertilized …

November 2004 was to be our third cycle … This cycle also was the first time we used ICSI, we couldn’t have coped with another cycle with no transfer so we hoped this was the answer … By this stage we had never had any embryos good enough to freeze so we had 3 transferred, but again it wasn’t to be.

I changed jobs because the stress at work was too much and we thought that this would help, well it didn’t. It was easier though as I decided it was easier not to tell my workmates. This was one place I could go and not think about IVF, it was great. I also joined the Friends of QFG committee, I felt they had helped me so much that if I could help one person the way they had helped me it would be great.

We started our fourth cycle in April 2005. This failed and to top it all off I got a nasty infection. Still not willing to give up, our 5th cycle began in June 2005, Bob did the pickup, we got 14 eggs, that was the most so far and 9 fertilised, surely it would work this time, Dr Kilvert transferred 2 of our precious embryos and I still didn’t make it to a blood test.

                        …                   …                   …

The sixth cycle this was the worst EVER. I got 13 eggs and 10 fertilised. Bob said they were the worst quality yet, but we had 3 transferred.

This lady goes on to say:

Maybe 7 was the cycle for us, a new year a new attitude. Three were transferred this time, with the works, ICSI, hatching, embryo glue and more drugs Cardiprin, Prednisone and HCG injections after transfer. We went on holidays and relaxed, it had to work this time. We made it to the blood test, but it wasn’t to be. A week later I was so sick I had stopped the prednisone the same as I had on previous cycles but this time it was a higher dose and my body could not deal with it. Brian touched me on the arm and I sobbed because my skin hurt intensely …

                        …                   …                   …

I had begun to have severe pain on day 2 of my cycle the previous September, so I asked Bob what he could do about this and he scheduled laparoscopy etc on 10 March 2006, this only discovered mild endo.

Brian and I were starting to get quite down about the whole IVF thing by now, so I decided we would try everything.

This lady goes on to say, ‘We tried boot camp,’ and:

… walking group 2 nights per week. Bob had suggested that losing a bit of weight might help … I also saw a Dietician …

               …            …            …

This lady continues, ‘I wanted to see this particular doctor and was referred by the specialist.’ She goes on to say:

(the immunologist) phoned me on day 2 of what was to be our 8th cycle (8 has always been my favourite and lucky number). He told me to take Cardiprin, Caltrate, Folate and Vitamin E and get some tests done the next day. The test took 13 vials of blood. The cycle went well … and I had the transfer on Good Friday, then came the dreaded 2 week wait with the added bonus of Fragmin injections daily from day 3 after transfer and 2 lots of HCG top ups. I made it to the blood test on the Friday of the Labour day long weekend. I felt good, but the test came back negative … Bob convinced us to talk to one of the scientists and then come and see him as he wanted to discuss “donor eggs”  with us again. At the end of the appointment Brian mentioned that the dreaded period had not arrived yet, so Bob sent me for another blood test the next morning. It came back positive, Bob thought maybe it was ectopic so I went back 2 days later, it had doubled and then again the next week it had more than doubled each day. Then finally a scan and the look on Bob’s face when he saw the heartbeat was priceless. Brian and I couldn’t believe it. We were pregnant. Many scans later I was finally an obstetrics patient, I never thought I would see that day … 18 weeks and Brian found out what we were having, I didn’t want to know it as I had always from the transfer felt I was meant to have a girl. 24, 28, 30, 32, 34, 36 week scans finally whether I wanted to know or not it was obvious we were having a girl. It still felt like the 2 week wait, the Fragmin was coming to an end, for a needle phobic like me it was about time, 8 months of injections every day. Yuck. The Cardiprin finished on week 37 and Emily Charlotte was born at 1.46pm. 22 December 2006 (my Dad’s birthday) at five pound 10 ounces by caesarean. Bob declared she was perfect and Brian and I could finally breathe a sigh of relief, she was here.

We have met some fabulous people throughout our journey, people who truly understand just what you’re going through. Our thanks go out to all of them …

There is a little bit more to the letter, but I will finish there. That was by two amazing Australians, two people who represent the stories of so many thousands. It is very tough to read for any of us who have been involved in this debate. It is an emotional debate because people’s lives, their futures, their perspectives on life are changed as a result of this particular cruel outcome by this government.

No contributor to this debate could sit opposite and say honestly to the parliament this is a good health outcome. That is why the Deputy Prime Minister, when she was Deputy Leader of the Labor Party in opposition, stood up and rallied against any proposed changes. She railed against those changes because she knew that support should not be taken away from families who needed that support at their most desperate hour and deserved to have that continuing support. This is a government that, of course, has gone into incredible debt—that is not a political statement; it is a fact. The economic certainty is not there at the moment; it has changed significantly over the last 12 or 18 months, at the same time that the government has spent $42 billion—not one of those dollars in health. Why would they continue with these cruel cuts when they know that they have the capacity in other areas to allocate the money to save these people the extra stress? The story that I just read out completely and adequately represents the feelings of many of these people who have gone through IVF to create a family, to make their mark on the world, to bring a child into the world. There is no better reason for our existence than to bring new life into this world. This government’s cruel attack on the ability of families to be able to access that support really should stand condemned.

I say to the government the coalition will offer bipartisan support in trying to find other savings to offset this measure if the government sees fit to reverse it. We will work in a bipartisan way to see that this support is kept for those thousands of Australians who deserve this support from their government. We will work with the government to make sure that we relieve the burden that is now being put on these families at a time when they need anything but more burden. The story that I just read is compelling because it describes in some detail the incredible pressure that these families—in some cases for years and years and years—and, in particular, the women involved in these processes endure. Why on earth we as a parliament, why on earth this government would put extra pressure on those families in a time of most need is completely beyond any reasonable voice as part of this debate. We say to the government: ‘Please reconsider your position. Reconsider your position in light of the comments made by the Deputy Prime Minister when she was sitting in opposition as Deputy Leader of the Labor Party.’ None of the facts have changed in relation to this debate from the time that the Deputy Prime Minister made her comments to this debate today. None of the facts have changed when petitions by the thousands were presented to this parliament by other members who now sit on the front bench of the government. None of the facts have changed which would lend any credibility to a change in the position and the arrival at what the government now proposes.

That is the position of the coalition. We offer support to the government to see a more rational outcome. We want to make sure that these families who have incredible pressures on them already have some of that pressure relieved, not more put on them. That is our call on the government, and that is what we will continue to fight for on behalf of so many Australians over the coming period of this debate.

See this speech in context