Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to 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.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

The Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009 amends the Health Insurance Act 1973 to enable the Minister for Health and Ageing to determine the maximum benefit payable under the extended Medicare safety net—I will refer to it from here on in as the EMSN—for each Medical Benefits Schedule, MBS, item. The bill creates a mechanism by which the government can responsibly manage the expenditure on the EMSN. I need to state very clearly at the commencement of my contribution to this debate: this legislation does not remove any item from the MBS; all items remain on the schedule. What it does do is put a cap on the MBS item which is determined in line with the median cost or charge that is made by specialists. Median cost means that that is the midpoint in the cost schedule. There are some specialists who are charging rather exorbitant fees, but I will come to that later in my contribution to the debate.

As I have already mentioned, the EMSN benefit cap will apply to benefits for MBS items, which will be payable in addition to the standard Medicare rebate once a patient reaches the EMSN threshold. Each patient will be eligible to receive up to the EMSN benefit cap each time they receive a service. No limit on service; each time they will be able to receive that benefit. Once an individual or a member of a registered family reaches the applicable out-of-pocket EMSN threshold, the person is entitled to an increase in the Medicare benefit equal to 80 per cent of their out-of-pocket expenses for that claim for the rest of the calendar year. I am sure that members on both sides of this House are acquainted with constituents within their electorates who fall into this category.

The increased amount of the Medicare benefit payable under the EMSN is commonly referred to as EMSN benefit. A different level of EMSN benefit cap can apply to different EMSN items. The EMSN benefit cap would be a dollar value. For example, an EMSN benefit cap of $100 may apply to one item and for a different item it may be $500. There are three things that I have sought to establish here: (1) no item is excluded from the MBS, (2) the caps can vary according to the item number and (3) those people who reach the EMSN threshold will continue to receive a refund equal to 80 per cent of their Medicare benefits.

Currently there is no limit on the amount of benefit payable under the EMSN and a person will receive 80 per cent of out-of-pocket expenses for services, which means that, if a doctor chooses to charge an exorbitant fee, that patient will still receive an 80 per cent refund. One patient may go to a doctor who charges $500 for an item on the MBS and another patient may go to one who charges $2,000 for the same service. This legislation provides for the fact that some doctors are charging three or four times what other doctors charge for the same item number. Taking a midpoint from the example I just gave, the median figure would be $1,000.

This legislation enables the minister to determine the cap on the EMSN benefit, which will be set out in the legislative instruments. The bill will cover 15 obstetric items, which will generate a saving of $451.6 million over four years. As has been mentioned in the debate so far, these savings were part of the 2009-10 budget. The implementation date for the bill is 1 January next year.

As the shadow minister for health and ageing rightly pointed out, one area that will be impacted is IVF. As a member of this parliament, I am very supportive of IVF. Assisted reproduction has helped many people, including people I know—family and friends—to have that much sought after child. This legislation in no way seeks to stop that. The shadow minister gave an example in relation to a woman who underwent eight cycles. She will still be able to undergo eight cycles under this legislation. There is no limit on the number of cycles a person may undergo. If members on the other side of this House are going to argue that the legislation limits the number of cycles, they are misrepresenting the legislation. I emphasise yet again: what it does is put a cap on particular MBS services.

The extended Medicare safety net service will continue for all Australians and for all services currently covered. The safety net threshold has not been changed from the $555.70 for Commonwealth concession card holders and $1,111.60 for all others in each calendar year. It is indexed each year, and will continue to be indexed each year, in line with the consumer price index. The government is not seeking and will not seek to means test access to the EMSN. It seems to me that a lot of the speakers on this debate from the other side of the House have sought to scare people in the community. I find that the approach of the opposition in relation to this has been less than optimal.

Another matter was brought up by the member for Dickson that I would like to touch on. He referred to ophthalmic surgeons. Yes, that is one area upon which a cap will be placed, but he also referred to how that would impact on Indigenous Australians, linking it into private health insurance. I suspect that the member for Dickson should undertake a little research into how many Indigenous Australians will actually be affected by this. The answer would be: next to none. To come into this House and use that as part of his argument shows that he has very limited knowledge of health and very little knowledge particularly of Indigenous health and the needs of Indigenous Australians. I would like him to consult with experts in this area, people who work on a day-to-day basis with Indigenous Australians, to put some facts to the fiction he has been putting forward in the parliament today.

The government chose to put this measure in place, to cap benefits at a level which covers average payments. Reasonable amounts will not be affected. If a person visits a doctor who charges a reasonable amount, an average fee, they will receive a refund of 80 per cent. There is no cycle limit and no items are being removed. Another thing the opposition were touting is that it is going to affect cancer patients, but cancer patients will not be affected.

This measure has been well researched. The government commissioned a review to which evidence was given. The opposite side are saying that those in greatest financial need will miss out on the benefits. It is the patients with higher incomes who are claiming higher out-of-pocket expenses. The review found that for every EMSN benefit dollar paid to patients 78c went to meeting the doctor’s higher fee rather than to reducing the patient’s out-of-pocket expenses. I put very strongly to this parliament that the EMSN is about making services that Australians need more affordable, to enable them to purchase services, to undertake IVF or to have a cataract operation. I would strongly argue that, if 78c of each benefit dollar goes to meeting the doctor’s higher fees rather than to reducing the patient’s out-of-pocket expenses, this scheme is not working in the way it was meant to. Putting the cap in place will ensure that patients benefit rather than doctors. As I mentioned earlier, those who have benefited most from the more affordable services have tended to be wealthier and in a better position to access some of the more expensive services in the first place.

The EMSN did create some problems for the Howard government, who raised the safety net expenditure threshold so that they could reduce the number of people who would qualify for the EMSN and they did that to rein in the cost. We are not doing that; in this legislation, we are putting in place a cap designed to come into play at the average fee point.

I do not support what those on the other side of the parliament have been saying—that this is about stopping women or families receiving IVF assistance; rather, it is about ensuring that they see doctors who charge an average fee. They will still get 80 per cent of the EMSN. This is only about the high end, about doctors who charge exorbitant fees. There are doctors involved in IVF who earn incomes in excess of  $4 million a year—rather a large salary. We support women continuing to receive funding for an unlimited number of cycles and we support all items remaining on the MBS, but we do not support paying 80 per cent when doctors charge exorbitant fees.

I support the legislation and I encourage those on the other side of the House to look at what the legislation does, rather than putting out a smear and fear campaign, as they always do. I encourage them to provide the correct information to their constituents, telling women or pensioners who visit them, ‘Yes, you can still get 80 per cent of your fee back, but you must go to a specialist who will charge a median fee and not an exorbitant fee.’

Scott Morrison (Cook, Liberal Party, Shadow Minister for Housing and Local Government) Share this | Link to this | Hansard source

The Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009 is a cruel bill. It is a heartless bill. Contrary to what has just been suggested in this House, it has nothing to do with people having any restriction placed on them as to how many IVFs they can undertake. This bill will put up the cost by between $1,500 and $2,000 a cycle for those who are looking to use assisted reproductive technologies. That is what the impact of this bill will be and, for many Australians, that will mean the end of the road of their dream to have children. It is a heartless bill and it is a cruel bill, and to sit here in this place and listen to the suggestions put forward by those on the other side that this is all about overcharging doctors and there not being caps on how many times you can do it says one thing to me: they just do not get it. Those opposite really do not understand what the impact of this bill will be on people who are desperate to have children.

Infertility is not a choice. It is not something you wish for. It is not something that you elect. It happens to you, like many things in life happen to you. Just under one in six couples of reproductive age in this country have a fertility problem. IVF is responsible for some 11,000 births each year. Around 40,000 treatments were provided in 2008. Around one child today in a classroom of 25 is in that classroom because of IVF and other related treatments. Forty per cent of fertility problems relate to men, 40 per cent to women and 20 per cent are of non-specific cause, which is one of the hardest things to deal with when you just do not know why. IVF and related assisted reproductive treatments are the only hope for people afflicted with infertility. I make reference to a statement made by Sandra Dill, the Chief Executive of Access Australia, which is the group that supports, represents and provides assistance to those who are going through this horrendous ordeal. She says:

IVF is the last chance for many to have a child of their own and the Medicare Safety Net has ensured that every Australian has that opportunity. The Government’s decision has taken away many Australians last chance to have a baby.

This is a cause which sits very close to my heart. I have taken the unusual step today of returning from leave. My wife gave birth to a child last Thursday—our second child, Lily Alice. Our first child, Abbey Rose, was born on the 7th of the 7th of the 7th—14 years from when my wife and I began assisted reproductive treatments, which consisted of 10 IVF cycles. It was a horrendous ordeal. My wife had very difficult surgery and we were finally able to conceive a child without the ultimate assistance of IVF. Everything we learned along the road—every day, every lesson, every treatment and every piece of advice—was critical to our path and to the process of having children.

The desire to have children is the most positive, life-affirming instinct we as human beings have. The desire does not go away when you are told that you cannot have children or that you will have difficulty having them. The feeling of loss at every failed attempt is indescribable. Others, removed from the emotional hell, rationalise the failure of embryos failing to take, while parents and want-to-be parents grieve the loss of children. We console ourselves with the thought that one day we will be reunited with our unborn child beyond this life. Added to this physical and emotional torment is the pressure that it places on extremely fragile relationships working through these very difficult issues.

Most families understand the sacrifice involved in having children. They understand that as they have those children and see them growing up in their homes. It means many changes to our lives—many welcome changes, I must add. But one of the reasons we as parents can deal with those sacrifices is that it is accompanied by the sheer joy of parenthood—and there is nothing to match it. Some people go through fertility treatment over extended periods of time. You would have heard the member for Dickson recount an incredibly moving story, which I am so pleased had a happy ending even though so many of these stories do not. For those going through the hell of fertility treatment over an extended period of time, their first experience of parenthood is only sacrifice. That is all that many will ever know; the joy of parenthood never comes. The pain of these experiences is not altered by your level of income. It does not change how you feel and what goes on inside you. Regardless of how much or how little you have, you do whatever it takes to make this work. You make the sacrifices. You take out the extended loan or the second mortgage. You do whatever you need to do to try to realise that dream. For families going through this very dark chapter of their lives, it is all consuming.

The reason I am pointing this out is that I do not believe that those in the government have got a full handle on the depth of this issue or a real appreciation of the pain that they are going to inflict on their fellow Australians as a result of this measure. When you go through this, everything comes into question. You are challenged spiritually, emotionally, physically and financially. You question everything—God, each other, your priorities, your future. Nothing escapes scrutiny when you are going through this treatment and this ordeal. Along this road you will find the wreckage of shattered lives, marriages and families. But when you do this you know the risks you take, because you are so committed to and so passionate about the fact that one day you might be able to realise that dream of bringing a child into the world, which I believe is a very pure dream.

Against this background, the government has introduced this bill and has moved, as the previous speaker said, to cap payments under the Medicare safety net for IVF and related fertility treatments. The bill also imposes caps on a range of other services—including obstetric services, pregnancy related ultrasounds and cataract surgery. I will not touch on these; the shadow minister has already mentioned these. The saving that is expected to be gained from this measure is $475 million. Just to put that in context, that is less than two per cent of what the Labor government borrowed and gave away in cash payments. So what we are seeing right here before us in this bill is one of the many costs of the spending that this government has engaged in.

As I mentioned at the start of my remarks, the cost for couples is estimated to rise from $1,600 or thereabouts—and for many it is far more than that—in out-of-pocket expenses to around $3,000 to $3,500. So when the previous speaker, the member for Shortland, makes the assertion that this measure will not end the dream of Australians seeking to have children, she clearly does not understand what the consequences of the cap will be. The cost will go up significantly. It will more than double for some families and some couples—for many couples, I expect.

I think Labor are in complete denial when it comes to this measure. I think they are looking to run and hide. I think they want this legislation to move through this parliament as quickly as possible because they are, frankly, ashamed and embarrassed about it. They have taken a position on this matter which is in complete contradiction to what is outlined in this bill, so they sit here in denial and put forward these arguments, but, frankly, they should sit silent because this is an indefensible measure, particularly as it relates to IVF and related procedures. The pressure on these couples is hard enough—and I have given some of my own insight into that—without the added anguish of having to find that extra money. It is bad enough. It is hard enough. The relationships are already under enough stress. Having watched my wife go through these procedures many, many times and seen the health impacts on her as she dealt with them, to know that she then would have to also endure additional financial stress would be simply too much to bear. It will be too much to bear for many, and they will just say, ‘I can’t go on.’

I know what it is like to have reached that point: after 10, we actually did reach that point. At some other time, we thought, we might go forward again. Thanks be to God, we had the situation where, after the surgery and some years later, things happened. But that is not a normal story; that is actually quite a miraculous story. That is why we refer to our little girl, Abbey Rose, as our miracle child. It does not always work out like that—in fact, it rarely does. So I ask the government to be kind enough to listen. A week or so ago I recounted the story of Jenny and me in the Sunday Telegraph and I have had an enormous response from people going through the same situation. I want to read out some of those responses. One said:

My husband and I are currently going through IVF and it is not an easy path. Even with government subsidies, it is expensive. I can’t believe that the government is going to implement changes which will make it even more difficult for couples who are already going through great emotion in their lives.

Unless you’ve experienced the grief of infertility and miscarriage, I doubt that anyone would be quite aware of the impact it can have on a person’s day-to-day life. The grief is ongoing, mourning because of a failed cycle, utter devastation at yet another miscarriage. Yes, some people go on to live fulfilling lives without children, but for my husband and I this is not an option we want to consider without first exhausting all possible options, including IVF first.

I strongly encourage those affected by Mr Rudd’s heartless decision to keep fighting this as it is the only way that we can even try to stop this very cruel funding cut.

Again in 2008, another said:

My husband and I had four unsuccessful IVF attempts. This year is now a recovery year, emotionally and financially, and we had all intentions of starting up again in 2010. This now looks to be unlikely due to the new changes the government will be putting in place. Unless we win Lotto, the government has forced us to accept the fact that we could well remain childless forever. Not an easy realisation.

These are not my words. These are the words of those who are affected by this measure, and their voices should be heard. Another said:

I think a lot of people do not realise that, even with the existing rebates, IVF is not free. Far from it, in fact. Not to mention all the in-between appointments, tests and exploratory procedures that seem to come with the territory. And no-one ever thinks that they will need to go to IVF once, let alone four or 10 times, so how can you properly save or prepare for that expense when everyone including the doctors, nurses, friends, families tells you to never give up, the next cycle just might be the one that works. How can you simply give up and walk away from that hope or possibility?

I wonder if Kevin Rudd or Wayne Swan would have made the same decision if any of their own children or friends needed fertility treatment.

And again:

We are the unlucky ones: 13 cycles, one with a miscarriage of eight weeks, nearly $80,000 poorer. I would have kept going too. We borrowed money on three credit cards then finally had to extend our mortgage because we could not keep up with the payments. It would have been worth every single penny if we had conceived successfully.

And another:

I think the Rudd government did a good beat-up of IVF in the months coming into the budget with false facts that were made to look like IVF companies were profiting and the community was paying 80 per cent of the IVF when in fact they only pay for a quarter of the total bill. Partly as a result of this beat-up, the general community are indifferent to the cause. The cost that is included in the statements to the media only included the Medicare part of the cost of IVF and not the day surgery, fertility specialist, appointments, non-refundable tests like the SSA, which we had done. This test cost approximately $800 alone, but made us realise we had a problem and contributed to us changing some vitamins, succeeding in our second ISCI.

These are the stories of those who deal with this problem every day, and they understand what the impact of this bill is.

Those who practise in the area also understand that it will put increased pressure on the actual medical procedures themselves, because those who are going through these procedures will not want to risk the loss of an opportunity of going through a further cycle for financial reasons and they will ask to have additional eggs put back in. That increases the risk to a mother and increases the risk to both children in a multiple birth. This has not come from the opposition; this has come from medical practitioners in the area. I know, as a parent now but as one who went through this process, that these are the things that go through your head. These are the issues that you have to try to resolve. You do not want to have to take that extra risk. You do not want to have to go through that process again if you can avoid it. But you also have to try to maximise your chances of success—and if you do not have that next chance, then you will take greater risks.

I think what makes this measure even more disgraceful is the hypocrisy of the government in bringing it forward. In 2005, the then shadow health minister, now the Deputy Prime Minister, said:

Labor completely opposes any cutbacks to Medicare funding of IVF. Labor will be launching a petition against the changes to Medicare funded IVF by the Howard government, tomorrow in Canberra.

Then, in a doorstop interview in 2005, she said:

Tony Abbott and John Howard before the election, were wandering around saying the best thing about Medicare is that it’s an uncapped scheme, a patient-driven scheme. The Prime Minister went so far as to say that’s fundamental. Well, what was fundamental before the election is expendable after the election with this plan to cap Medicare funding for IVF.

John Howard and Tony Abbott should listen to the Australian community, to the Labor Party and to women within their own ranks, and back down today on this proposed very cruel cutback. And at the same time they should rule out capping Medicare for other things that Minister Abbott deems non-essential.

Frankly, the Deputy Prime Minister and the government should take their own advice, because on that occasion the government did listen and did change their policy. They listened and they understood. They became sympathetic and understood the challenges that were faced by couples in this situation. They showed a heart and reversed the measure.

That measure is in this parliament today, brought forward by those who gave that advice to the previous government. I can think of no more bitter hypocrisy than that. But it went further, because not only did they say those things in the press; they took up petitions. They collected, in total, 1,759 signatures, including those in a petition lodged by the previous speaker, the member for Shortland. I am interested to know whether she is going to write to the 240 citizens who signed her petition to oppose cuts to Medicare funding for IVF and tell them that her government are now going to do exactly what she was trying to get their support to stop the then government from doing. Is she going to write to those 240 citizens? Is the Deputy Prime Minister going to write to the more than 1,300 citizens whose signatures she collected and apologise to them for her act of hypocrisy in being supportive of this bill coming before the House? She would not even answer questions, when put to her in this House, about whether she supported this bill, given the fact that she had collected more than 1,300 signatures opposing the measures that she in fact has brought before the House. There were also petitions from the Treasurer, from the Minister for Agriculture, Fisheries and Forestry, from the Minister for Small Business, Independent Contractors and the Service Economy, and from other members. The government said one thing and are doing another. Either they were being deceitful and disingenuous at that time or they are being heartless today. They can take their pick, but either is abominable. Either should bring them to the table, as the shadow minister was saying before, to talk to the opposition about how these things can be avoided.

The government’s budget is dripping with spending, yet they put through a cut like this which will deny a person the opportunity to become a parent. For that, I think they need to take a good, hard look at themselves in the mirror. There are savings that can be found in this budget. In my shadow portfolio alone, the first home saver accounts have underperformed by 96 per cent. Even if we just capped the scheme at 10 per cent of what its projected take-up was going to be, the savings over the next three years would be $700 million. The Minister for Housing did not bring to the table one dollar1 of savings in the housing portfolio that could have avoided the government bringing forward this measure. She did not do that, and it was left to the Minister for Health and Ageing to find savings. I must say that on other matters I have found the Minister for Health and Ageing to be very encouraging, particularly in relation to epidermolysis bullosa and the support given in the budget to children suffering from that condition. I welcome that and I applaud and commend the minister for taking what I think is a very compassionate position. It cost $16 million and she was very supportive of our representations on the matter. I encourage her now to speak to her colleagues and encourage them to be compassionate on this matter. When in opposition, the government opposed the very thing they have brought forward in this House. They cannot justify it on the basis that they have lost control of their budget. They should get control of their budget. They should avoid the inclination to bring in such heartless and hypocritical measures. Most importantly, they must listen to the people who are affected and they must come to the table and change this measure immediately.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009. First, I want to congratulate the member for Cook and his wife on the birth of their second child. I have two daughters myself. Fortunately, we did not have any difficulties with my wife, Carolyn, falling pregnant. My daughters are now 18 and 19. They are the love of our lives and we rejoice in their development spiritually, educationally, socially and intellectually. It is wonderful to have children. They are a great blessing and heritage. Those of us of the Christian faith accept that scriptural injunction.

In relation to this bill, I say to the member for Cook that the trouble is that there is a great deal of inconsistency between what the coalition are saying and what they did in practice when they were in power. The truth is that in my area alone they effectively defunded health and hospital services. That is the reality. We have one GP for every 1,609 people in my area, the Ipswich and West Moreton area in South-East Queensland. Even the former Minister for Health and Ageing, the member for Warringah, admitted before the last election in October 2007 that the Australian Institute of Health and Welfare had got it absolutely correct in saying that the previous coalition government, under John Howard, had actually defunded health and hospitals in this country and that the states had had to take up the slack. The much-maligned state Labor governments had to take up the slack because the previous coalition government failed to fund health and hospital services. They capped the number of doctors in this country.

Labor has increased the number of training places for doctors. We have put $1.1 billion into that to increase the number of training places and to encourage more people to go into medicine and the allied health professions. We want to encourage nurses to go back into the system—into health and aged-care services. We want to try to get them working in regional and remote areas. One of the first things that the Rudd government did was to put in more money for elective surgery. About $1.6 billion was put in, in accordance with agreements with the states. The member for Dickson said that there was little or no money put into health by the Rudd government under our Nation Building and Jobs Plan. I looked around on budget night and saw him in the chamber when the Treasurer was talking about what the Rudd Labor government were doing to fund our health and hospital system. The Treasurer said:

… Australians deserve a world-class health and hospital system.

That is what we are doing. We are spending a lot of money not only locally in my electorate but also nationally. What we are doing under the legislation that is before the House today is in accordance with the report that was delivered on this matter. What gets me is that those on that side of the House think they have a monopoly on family values, on compassion, on heart and on care. But they do not. This legislation that is before the chamber is not about us being against women and men who struggle to have a child. It is not about that at all. I congratulate the member for Cook for having two children and contributing. From what he had to say, you could tell the love, the affirmation, the care, the wonder of birth and how fantastic it is that he and his wife have had children. We are not about punishing people in these circumstances. In fact, the inconsistency here is that in 1996, 1997, 1998, 1999, 2000, 2001, 2003 and up to 2004 those opposite actually agreed with the idea of having caps on Medicare. Do not come into this place and say that by putting caps on funding we are heartless, cruel, mean and nasty. It is simply not true. Through most of the time of the Howard coalition government it supported the idea of having caps. Before the introduction of the safety net in 2004 there was a limit on the amount of government contribution for Medicare services—that is, the Medicare schedule fee—but I did not hear the member for Dickson or the member for Cook say that. That was the policy of the Howard coalition government. That is what it took for most of its tenure in office.

The truth is that we are doing what we need to do to save $450 million to better fund our health system, our hospital system, our roads, our schools and other sorts of things. That is what we are doing. We are not about punishing people who cannot have children. It is simply untrue for the member for Cook to come in here and say and imply that. What we are doing here is in response to a report that we had commissioned. Under the Health Legislation Amendment (Medicare) Act 2004 the Minister for Health and Ageing tabled a report entitled the Extended Medicare safety net review report 2009 and it looked at the effectiveness, the operation and the implications of the safety net with respect to a variety of different things. The report was carried out by the Centre for Health Economics Research and Evaluation at the University of Technology in Sydney. That report said a number of things, and I think that the report’s existence and its recommendations seem to have washed over the opposition entirely.

The report was very clear. What we are trying to do here is stop doctors charging excessive amounts by effectively taking advantage of the safety net. That is what the doctors are doing. We want to make sure the safety net is sustainable. The report recommended and noted a number of things which are very important to note. The report noted that the safety net had helped patients that had very high costs and reduced the out-of-pocket expenses for some patients with cancer. Nonetheless, the review showed that there were some real concerns in obstetrics and assisted reproductive technologies, including IVF and other Medicare services. The report noted that 50 per cent of safety net benefits were paid to obstetrics and assisted reproductive technologies, and the Medicare benefits had more than doubled for both of those groups since the safety net had been introduced.

The reported noted that between 2003 and 2008—and the Minister for Health and Ageing has reported this in her speech—the fees charged for obstetricians for in-house hospital services went down by six per cent. However, the fees for those obstetricians outside of hospital, in private practice, and who charge people like the member for Cook and his wife, had increased by 267 per cent. How can it be possible to justify increases of that nature? Similarly, the fees charged for assisted reproductive technology services fell by nine per cent for in-house hospital services while the fees charged for out-of-hospital services increased by 62 per cent. It is very clear that some doctors were taking advantage of the safety net. It is crystal clear. The figures say very clearly that it is the case.

What are we going to do about it? Are we going to have a sustainable safety net? The unlimited nature of the benefits available through the safety net has led some doctors to take advantage. The truth is they knew that the majority of their expenses were being paid for by the taxpayers. That is what it was all about. Lest anyone says that somehow we are opposed to the safety net and that somehow we are making massive changes that will adversely affect Australians, I just point out that the government is supportive of the safety net. The truth is that the safety net operates in this way. Once an annual threshold has been met, Medicare pays 80 per cent of any future out-of-pocket expenses for all out-of-hospital services for the remainder of that calendar year. In 2009, the annual threshold for concession card holders and people who receive family tax benefit part A is $555.70. For singles and families the threshold is $1,111.60. That is indexed every year. The bill before the House allows the minister for health to determine by legislative instrument the maximum increase in benefit payable under the safety net for specified items. These are items that are specified in the Medicare Benefit Schedule. If it is not specified it does not apply. The total out-of-pocket costs incurred by a person for services will still count towards the safety net threshold amount. Once a person has reached that threshold, they will continue to be eligible to receive the benefits, equal to 80 per cent of their out-of-pocket expenses, for those items that are not specified by legislative instrument.

That is what is happening. We are actually putting a cap on certain things. We are doing it to maintain the integrity and sustainability of the system. In 2008, expenditure on the safety net was $414 million, 30 per cent more than in 2007. Why is that? The truth is that doctors are charging too much. That is the reality. And, if we do not do something, it is going to get out of control in such a way that the whole future operational sustainability of the safety net will be adversely affected. The government is not means-testing access to the safety net; the government is maintaining the safety net. The truth is that we are trying to get the health costs charged by doctors back under control.

We are doing a lot of things when it comes to health and hospital services. In my electorate, we are bringing in a GP superclinic. We have announced that, and negotiations on that are currently underway. We are trying our best to ensure that we get more doctors in the local area. Before I was elected to this place, I was on a health community council for a long time, and we struggled to get more local doctors to the area—and Ipswich is a fast-growing area. It is growing at about four per cent per annum. It is the fastest-growing area in Queensland at the moment. We need more and more doctors and so we are seeing a lot more overseas-trained doctors in the local area. But we need to get more local doctors. We need to train more doctors and we need to spend more money locally. So the $450 million we are saving here will go a long way towards helping my community and helping the communities in the 150 electorates represented in this place.

Unlike what the member for Dickson said, the Rudd government is working with the states to improve the health and hospital system in this country. Through COAG we are putting $64 billion over five years into the public hospital system in this country. That is an increase of $20 billion, nearly 50 per cent, over the previous Australian healthcare agreement and it is an indictment of the previous government for letting the health and hospital system run down. That is the reality of health and hospital systems in this country under the Howard coalition government. We are also improving participation in the health workforce as well as increasing access to health care.

One of the things that I think this government has done very well is the change we are making in relation to maternity services. The 2009-10 budget included a great provision which was warmly welcomed in my electorate, and that is funding of $120.5 million for maternity services. It is a reform package that will allow women greater choice. One of the most precious things a woman can experience in life is, of course, the birth of her child. My wife tells me that she will never forget the birth of our child, and I will never forget holding my eldest daughter in my arms. It is a wonderful experience. We are not about to punish women and families in this regard by this legislation. We are giving women the option of a home birth or having their child in a hospital. That is their choice. We need to increase freedom of choice for women when it comes to the birth of their children. It is a precious and wonderful experience.

So the Rudd government, through our last budget, are improving the options and opportunities for women. In this country we have a strong record in providing high-quality maternity services, and I know the women in my electorate, including those in the maternity coalition groups I have met who have been arguing for such a long time that we need to improve maternity services and improve the options for women, warmly welcome this funding. Cas McCullough, who is very well known locally and a very well known advocate for home births, has been arguing for this for a long time. I warmly welcome this funding. I support the legislation that is before the House and, once again, I congratulate the member for Cook and his wife on the birth of their second child.

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

It would have been kind of the member for Blair to have taken just a little bit longer! But as I am now on my feet I will take the opportunity to speak—for the three minutes before the debate is interrupted—on the issues before us with this Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member need not rush; you can speak in continuation if you want.

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

I am enormously concerned about some of the services that are being capped through this legislation. The concerns that I have revolve primarily around obstetric services, assisted reproductive technology and types of cataract surgery that will be capped under this bill. I would also like to go further and speak about the concerns that I have that are not directly related to this bill but are yet to come into this House, particularly to do with cataract surgery. While only one type of cataract surgery is affected by this particular bill, there are significant issues yet to come that are associated with cataract surgery in general. In particular, there is the decision to reduce by half the payment to ophthalmologists for cataract surgery. It is an issue that ophthalmologists will have to start to contend with.

Over the years, it seems that ophthalmologists and cataract surgeons have had their payments cut significantly. The schedule fee for cataract surgery in the early 1980s was around $800. In 1996 the then government cut that fee by around 30 per cent. Now this government wants to cut that fee in half again. In late 2009, I believe, the fee for cataract surgery will be cut by at least half, and that will bring the fee for doing cataract surgery back to half of what it was over 25 years ago in real dollar terms. That is still to come, but I think that is going to be of even greater significance than what is being put in place under this bill before us today. I will speak further on that issue later.

The issue of assisted reproductive technology—

Harry Jenkins (Speaker) Share this | Link to this | Hansard source

Order! It being 2 pm, the debate is interrupted in accordance with standing order 97. The debate may be resumed at a later hour and the member will have leave to continue speaking when the debate is resumed.