Bruce Billson (Dunkley, Liberal Party, Shadow Minister for Sustainable Development and Cities) Share this | Hansard source

I rise to add some comments to the debate on the Private Health Insurance Legislation Amendment Bill (No. 2) 2009. As it has indicated, the opposition is not opposed to this bill. We see some virtue in it but, as with many things that the Rudd government does, the virtue in the bill is not matched by dexterity in its execution. That is one of the areas I would like to touch on today. Essentially, the bill will amend the Private Health Insurance Act to allow the minister to list a prosthesis on a conditional basis that specifies the purpose for which it can be utilised and, once it has passed a number of new tests aimed to ensure that it is of a life-saving characteristic, that the prosthesis has cost and clinical efficacy—all perfectly reasonable factors—and that it has been assessed as fit for the purpose for which it is intended to be implanted in the body.

This is achieved by adding a new listing beyond the current listing arrangements which provides for the general use listing of prostheses. Broad, unconstrained use of prostheses has in some cases seen prostheses not listed because of the specificity of their intended use, and the only scope available for the current listing is on a general use basis. That of itself seems a reasonable thing to do with new technology bringing new devices, with the progress of health and medical innovation seeing new opportunities for prostheses to improve the standard of living of people to carry forward and nurture their health and wellness. We need to accommodate the new technologies where they can be listed for a particular purpose. As I said, at the moment there is only a general listing provision. This amendment seeks to offer a conditional listing facility to accompany the private health insurance industry’s funding of those particular devices.

The thing that is quite strange is that, whilst that is all positive, you would have thought some internal consultation would have been worthwhile. It is ironic and, frankly, quite worrying that we have this bill before the House to give that new power to the minister. The power is a coathanger power. It does not specify precisely what devices it applies to and how it will be used. There is a whole lot of subordinate legislation in the form of regulations that will give effect to those listings, so that is all still to come. What is strange, though, is the imposition of limitations on the clinical use of prostheses. That is something that I would imagine many in the medical profession would be wary of. They would be concerned about the government mandating particular applications of technologies where they, in good conscience and driven by the patients’ best interests, might see another opportunity for the application of that technology for lifesaving health and wellness improvement. We do not know how that will work because these are very early days. We are assured that there will be sufficient safeguards, that the clinicians will continue to be very patient centred in their approach and that where they see an opportunity for improved health outcomes which involves a prosthesis there will be some machinery there to make that case.

We hope those safeguards, though, will not see a relentless process of clinicians lobbying the government to recognise the application which they, in good conscience and considered clinical judgment, think is in the interests of the patient but is not covered by the conditional listing as it stands. They will have to say to the patient, ‘Just wait for a sec. The technology may have been designed for the purpose for which I am recommending it be used. This prosthesis is available. It is something that will have very positive and cost-effective clinical outcomes that will advantage your wellness and health. We can argue that it is cost-effective but it has not got the tick yet from the Commonwealth to allow it to be covered by your health insurer.’

We hope there will not be another group of lobbyists beating a path to Canberra. The place is jam-packed with lobbyists at the moment. It seems nothing can happen in this country unless you have sucked up to and spent a lot of time bonding with the government. Private enterprise seems to be dwindling, as businesses now need to get the Rudd government imprimatur for everything that goes on in this country. That is why the biggest growth industry in Australia at the moment is lobbyists, coming to see whether some of the taxpayer largesse that is being doled out in abundant volumes can come their way. Clinicians will have to make sure, as they come to lobby to get a prosthesis conditionally listed, that they can at least get a flight on a plane, to have the chance to get up here. They might need to arm wrestle and bump off some other people, as they all want to come to Canberra because all knowledge is here, apparently.

It is quite amazing that, with that abundant knowledge and perpetual wisdom that we have now in Canberra under Prime Minister Rudd and his team, they have not quite managed to join up some dots. We see this in so many areas of government policy. You, Deputy Speaker Washer, were instrumental in releasing yesterday the report of a parliamentary inquiry into the impact of rising sea levels on the coastal zone. It is a very interesting report. I have enjoyed reading it and I commend you for a number of the measures in it. But it did make the point that we have not quite managed to join up government decision making. It is still very bitsy. It is even bitsier in the health portfolio. The diligent professionals in the health portfolio seem to have missed that there is a health technology assessment review going on and it is due to report later this year. You would have thought that the machinery that is being enabled by this legislation would have taken account of that review. The scope of the review includes:

… listing of prostheses for private health insurance coverage, as currently informed by the PDC—

that is, the Prostheses and Devices Committee. I would have thought that the work going on in that review would have informed this bill, but the bill is pushing on without having the benefit of that review’s findings. I hope some synchronicity can be achieved at some point down the track. You would have thought it would be sensible and wise to wait for the release of the review’s recommendations before acting on something that the review is designed to address. But this is the way things happen now at the ‘Kremlin’ here in Canberra, where so much is going on.

That disconnection is worrying. That is not a reason for the opposition not to support the bill. It just highlights the abundant lack of consultation, the lack of detail and the lack of connected, coordinated decision making that seems to be very much a character of this Rudd Labor government here in Canberra. On that machinery, we will have conditional listing capability that will not remove the general listing provision that is there now but add a new listing capability. That should be a good thing, but, as I mentioned earlier, how clinicians will interact with it is another matter.

As a former Minister for Veterans’ Affairs, I was highly exposed to some of the issues that the previous speaker spoke of. I regularly was approached and informed about insights clinicians could bring to the care, treatment and wellness of the veterans community, which in some cases involved the innovative use of clinical technologies and practices that had been developed and carried forward. We were very keen to accommodate that, as we aimed to give world-class health care and support to our veterans community. Here is an example where some of that innovation might run into a little bit of a roadblock with the listing process. However, the good thing is that conditional listing presents more opportunities than general use listing, which might not have seen some of these new technologies embraced in the first place.

The second part of this is the listing of the insulin pumps. I am pleased that this has again come to the government’s attention. It is quite fascinating that the government announced its own scheme after initially resisting the opposition’s case, and the opposition’s election commitment, to introduce a taxpayer subsidy for insulin pumps for people coping with the challenge—and in some cases the despair—of type 1 diabetes. We had to drag the Rudd Labor government kicking and screaming to actually pick up that national campaign, which I am pleased to say was launched by the then Leader of the Opposition, Brendan Nelson, in my electorate back in April 2008.

It was a great campaign launch. The then shadow health minister, Joe Hockey, was there, along with Richard Colbeck, the senator from Tasmania who was then opposition parliamentary secretary for health. It was a really good launch and a key outcome of the listening tour that Dr Nelson had undertaken. We had made an election commitment, one that the Rudd Labor government had not matched. We then had to go and make the case again in the lead-up to the 2008-09 budget to try and highlight to the Rudd Labor government not just the moral case for giving people with type 1 diabetes optimum opportunities to live full, rich and enjoyable lives but also the health case and the cost-effectiveness of supporting the deployment of the latest insulin pump technology.

Thankfully that message was heard by the Rudd Labor government, and I for one was encouraged to hear welcoming noises in the 2008-09 budget about a subsidy program for insulin pumps. What has been most disturbing has been the fact—and I am sure the Australian public must be waking up to this—that the publicity, the headlines, the stunts and the media spin are just like a warm-up act. What actually happens afterwards looks very different in many cases. Sadly, in the case of this insulin pump subsidy, that is exactly what has happened. We were reassured, on the back of the opposition campaign for 5,000 children, particularly, to benefit from government subsidies, that the Rudd Labor government would pick up that measure. What has happened, though, is that the implementation has fallen so far short of the promise, the hype and the headline hunting of the announcement in the first place. That is not only a political travesty; think of the implications for the people involved.

On the listening tour and at the launch that happened in a hospital in my electorate, we met parents and children who were so supportive of what the Liberal and National parties were trying to do, so encouraging of us taking the pressure up to the Rudd Labor government and bringing the case to Canberra to demonstrate the cost benefits as well as the lifestyle advantages of insulin pumps, particularly for children.

There were examples that moved us. I remember a wonderful woman from Dingley who had two children that were type 1 diabetic and insulin-dependent. She was describing to me the emotional and financial obstacles that she had to face and the demands on her parenting. Her children were some of the most stoic and spunky little humans I have seen. They had so much go to them, even though every day started with an injection, every day they had to monitor their condition and every day their blood sugar levels were uppermost in their minds, even when they were trying to work out what Dora was talking about in Spanish on the latest episode of Dora the Explorer. Such gripping things that would occupy most kids’ minds were secondary; these young kids had to keep themselves healthy. She broke down while describing to me how much it was going to cost and what a difference these insulin pumps would make to her children’s lives and how there was no way on earth by which she could possibly afford to buy one. She was totemic of why we mounted this campaign—so totemic that no-one could come away other than completely convinced that this was the right way forward.

So we have had the announcement that the government would provide these subsidies, but the subsidies have not been delivered up to what was promised. The Minister for Health and Ageing claimed the subsidies would benefit some 700 children and young adults. That was in Minister Roxon’s media release back in July 2008. The government had a budget estimate—it was about $1 million—and yet less than half of that has been claimed. Only 38 insulin pumps out of an anticipated 700 have been provided to eligible participants. That is from evidence tendered at a Senate estimates committee.

How do we explain this to that mother from Dingley? How do we explain the eligibility criteria that see the subsidy so out of reach for people, even for those on regular incomes; that they cannot access it. She must be wondering, ‘Such promise; such hope.’ It is a campaign that was led by the Liberal and National parties and is one we continue with in opposition, making the case. Then we get the announcement from the minister and, typical of the Rudd Labor government, it is all announcement and no follow-through. And we have this appalling situation.

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