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

It is important to remember that what we are debating here today in the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009 is one of many broken promises of the Rudd Labor government in the health portfolio. Before the last election we were promised the world in health. The Prime Minister said he had a plan to fix public hospitals. The Prime Minister said that he would enter a new era of cooperative federalism in health. The Prime Minister said that he would maintain and retain the existing policy framework in support of the private health system. One other thing that the government said was that they would not reduce the extended Medicare safety net. I briefly quote from the Minister for Health and Ageing Nicola Roxon’s press release dated 22 September 2007, which said:

Federal Labor understands that Australian families are already under pressure … It is these costs of living pressures that have made the safety net necessary and with about one million people each year receiving some cost relief from the safety net, Federal Labor will not put more pressure on family budgets by taking that assistance away...

This legislation is about exactly that. The government is introducing caps. The government is taking action which will lead to increased out-of-pocket expenses for patients who seek access to certain healthcare services, such as those in relation to IVF, obstetrics, eye surgery and a series of other things. So it is a broken promise. After the government announced it during the budget, the minister said that it was only targeted at doctors charging excessive fees and that patients, such as IVF patients, would not be worse off. As soon as she made that comment, no doubt somebody would have actually sat the minister down and said, ‘Let us have a look through those figures; that statement actually does not stack up’—because, after having made that statement, she never repeated it.

We have some fundamental issues with this legislation. It is an empty vessel; it is a framework. What really matter are the determinations and the regulations that are putting flesh on the bone. In fact, 95 per cent of this debate has not been about the bill at all; it has been about what is in the determinations and the regulations. Non-government senators in this chamber—the Greens, Senator Xenophon, Senator Fielding and coalition senators—have acted together to force the government to table a final draft of the determinations and the regulations before the Senate would be prepared to consider this bill. That was important because, unless we were able to review and scrutinise what was in the determinations and the regulations, we could not make a proper judgment on the effect that this legislation would have on patients. This time round we have been able to do that. We have had the leverage, given the need for approval of this legislation. There has to be a positive vote in both houses of parliament to pass this legislation. Because we insisted on not dealing with this legislation until we were able to review the detail in the determinations and the regulations, the government had no choice but to comply with the Senate’s resolution. On this occasion, because of the pressure that we as non-government senators applied to the government and, more importantly, because of the pressure patient support groups and healthcare professionals applied to the government, the minister had to backflip. She had to do a significant backflip on those items under the determination relating to IVF and assisted reproductive technology treatments.

Despite what the minister said initially and despite her assurances, it became very clear that patients would be worse off. Families who needed access to IVF treatment would be worse off under the original plan put forward by the Minister for Health and Ageing. The Minister for Health and Ageing has a track record of getting it wrong. The Minister for Health and Ageing has a track record of saying one thing and then not being able to come through with it when a little bit of scrutiny is applied to it. This is because she does not do her homework. Again and again, because of the scrutiny that has been applied in this chamber and in the Senate estimates process, the minister has been forced back to the drawing board. There was the $105 million budget cut to chemotherapy treatment, which was supposed to come into effect on 1 July 2009. Because of the pressure put on the minister by healthcare professionals, cancer patient support groups and the Senate, the minister had to go back to the drawing board. To this day, she has not been able to come up with a way to make that budget cut work without hurting patients. To this day, there is no plan on the table as to how the government will implement that budget cut.

I want to make a broader reflection. The government made the following commitments before the last election: ‘We’re not going to water down the extended Medicare safety net. We’re not going to take the private health insurance rebate away.’ The government’s excuse to break that promise now is: ‘We’ve got a global economic down turn. There’s a global financial crisis. That is the justification as to why we have to make the billion-dollar cuts in the health portfolio.’ The government are spending like drunken sailors everywhere, except in the health portfolio. People who need timely access to affordable quality health care are being asked to pay the price for Labor’s reckless spending. We have waste and mismanagement in the education portfolio—the waste and mismanagement with the Julia Gillard memorial halls program. We have the cash splashes. We have the government borrowing money to give it away to people who are overseas, to people who are in jail and to people who are dead. The government are wasting money left, right and centre but, when it comes to the health portfolio, people who need access to quality health care are being asked to pay the price.

The opposition welcome the government’s backflip on IVF related Medicare items, in response to the impact that its legislation would have had on families needing access to IVF treatment. However, we do have some concerns with the figures. There is some magic pudding at play here. The government has agreed to increase the key MBS item No. 13200 in relation to IVF by about $1,000. There are about 36,000 IVF procedures a year. If you look at the figures for the last five to six years, the number of procedures goes up by about 3,000 every year. If you increase the cost of that rebate by $1,000, that is an additional cost of roughly $36 million to $39 million a year.

The minister announced the backflip. On 3 September, she announced that the government had reached an agreement with stakeholders to restructure items. This meant increasing the Medicare rebate for some items, increasing the caps for other items and introducing new Medicare rebate items in relation to IVF. We welcomed the backflip, but we said to the minister, ‘We want to have a discussion with you about the numbers.’ The minister said: ‘We’ve done all of this. Families are going to be better off but there will be no impact on the budget bottom line. We will preserve the $451 million saving from this measure, even though we have increased the Medicare rebate for people needing access to IVF treatment, even though we have introduced new Medicare items and even though we have increased the caps for some items.’ We said: ‘That’s great. You’ve obviously come up with a very creative way of doing this. Can you please explain it to us?’ After the minister tabled the regulations, we said that we would like a briefing from the department. That briefing took place the next morning. We asked the department the very simple question, ‘Can you tell us what the impact is going to be on a yearly basis for each year of the forward estimates?’ The department’s replied: ‘No. We don’t have that information. We were asked to come here at very short notice but we might be able to provide it to you on notice down the track.’

That was Wednesday a week ago, in the morning. Then came Wednesday, Thursday, Friday, Saturday, Sunday and Monday. No advice came back to us until the Monday. Of course, that advice did not include anything remotely close to an answer to the question we had asked. So we went back to them and said, ‘We want to know what the impact of the increased cost of the Medicare rebate is going to be and what the impact on your budget bottom line will be.’ We understood why the government tried to hide that this was a backflip. We understood why they tried to make people believe that this was going to be budget neutral. We had some suspicions. So we said to the government, ‘We want to see the detail.’ In the end, we got back some information, the historical data, for all of the IVF related Medicare items that were currently in the system—that is, utilisation, annual costs, et cetera.

Moving forward, item 13200 will be broken down into three items. The government made the point: ‘We have broken it up into three items and for one subitem we have reduced the rebate. We think we will make some savings and they can offset the additional expense.’ We asked the obvious question: ‘Can you tell us what you expect to be the utilisation for each of those items moving forward so that we can understand why you can make the point that this will not have an impact on the budget bottom line? Item 13200 is going to cost you nearly $40 million more per annum, based on the decision you have made, unless you can tell us where you think you are going to make the savings.’ The answer from the department was: ‘We can’t give you that information. That is secret information. We can’t share it with you.’

In the end, with prodding and testing, the only answer we were able to get from the government was: ‘Trust us. We’re from the government. We are telling you that the budget bottom line is not going to be any worse off. We are giving you our guarantee and our assurance that the budget bottom line is not going to be any worse off.’ For the opposition, quite frankly, that was not good enough. Given the track record of this government, given the number of budget measures that this Minister for Health and Ageing in particular has got it wrong on, we were not prepared to take the government on trust. In my opening remarks in the committee stage of the debate, I flag that the opposition will move an amendment. The effect of that amendment will be that, for any of the determinations the government want to make under this legislation to become effective, the government will need the approval of both houses of parliament—that is, we are not prepared to take the government on trust. This legislation is an empty vessel. It is framework legislation.

The thing that puts meat on the bone—the thing that determines what impact this legislation will have on patients and how much worse off patients will be—is what is in the determinations and regulations. Given that fact and given the experience even in the lead-up to this debate, the coalition is of the view that we as a parliament should not give the government a blank cheque. This time around we were able to force the government into a backflip in some areas where they got it wrong because they needed our support to pass this legislation—at least they needed the support of enough non-government senators to get it through this parliament. Next time around, once this legislation is in place—and unless our amendment is passed—the government will be able to introduce regulations, to make decisions that will result in patients being worse off, without us first having to give the government approval. We do not think it is enough to go through the process of disallowable instruments in relation to these matters. They are a bit clumsy in any event when it comes to MBS items because it is very difficult to unscramble bad decisions in the context of MBS regulations. I hope I will get a further opportunity to contribute to this debate.