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

Again, Senator Cormann interjects because he really objects to the truth of what I am saying. I understand why he interjects. He interjects because he is disappointed that his own strategy is being exposed for what it is. It is completely and utterly a pantomime that he has constructed and it is being exposed. I can understand he does not like that and that is why he is interjecting. It is quite usual for him to interject, but I ask in this instance that he contain himself and stop demonstrating how bad the position is that he is now adopting. The truth is that he is now effectively trying to underpin the argument that he has put forward. The opportunity to disallow a regulation is certainly the Senate’s prerogative. That is the choice he made; he decided to do that. However, there are always consequences. The consequences are the quite unprecedented position of disallowing this regulation. Nevertheless, that is the choice the opposition has made. In doing so that table is then taken away and that leaves the Senate with the choice of either agreeing to the disallowance and removing the item or not agreeing. That is the choice that is available.

What we now have is a stunt. It is a political cover to try to say, ‘No, it’s not really me who’s doing this; it’s the government doing it.’ They are trying to shift blame, but in fact this whole circumstance has been constructed by Senator Cormann. It is ill thought out, ill prepared and ill executed, quite frankly, because in doing so he has driven over a range of long-accepted principles in this place—quite disappointingly so—and he has dragged the minor parties with him.

I can understand the homily from the Greens, but the real point is that there is a choice to be made around this. It is not about a last, desperate act to encourage the parties to negotiate. I have no doubt the parties have negotiated. Senator Cormann has come up with a strategy to try to effect the opposition’s will, and now we have Senator Xenophon, Senator Fielding and the Greens following behind him. The difficulty always is that once you start on this course it is very hard to change course. Once you hitch yourself to this wagon, you have to see where it goes, and the Greens, Senator Xenophon, Senator Fielding and the opposition have hitched themselves to Senator Cormann’s caboose.

Yesterday the opposition announced that they would take steps in this place which will mean that no rebate will be payable for cataract procedures performed from Sunday onwards. This action, of course, will throw cataract procedures into disarray. Australians scheduled to have this procedure will now face the uncertainty of being billed for the entire procedure without any government rebate. The opposition have been provided with very clear advice that this will be the effect of their actions. The opposition understand the position that they are in, clearly, and they are choosing to head down this path.

The opposition’s actions are not about putting patients first. They can bleat about putting patients first, but these actions are not about that—they are not about that at all. This is about putting the interests of a small group of specialists first, a group who earn over half a million dollars a year from Medicare alone. The opposition’s thoughtless actions will only hurt the patients seeking to have cataracts removed. Ophthalmologists will continue to charge their high fees for the procedure while the opposition’s actions will prevent the government from paying any rebate to the patient. That is the position that the Greens, Senator Xenophon, Senator Fielding and the opposition have now hitched themselves to.

It is time the opposition stopped siding with the specialists and started supporting taxpayers who are being slugged with unreasonable fees. In fact, the opposition may wish to respond to this comment—and I mentioned it earlier in the debate in relation to the suspension, but I will refer to it again. The CEO of the Consumers Health Forum was asked about this in the Age today, 28 October, and this was the answer:

I would like to know why the Opposition is seeking to support medical specialists who are seeking to retain high incomes at the expense of consumers.

That is what the opposition stand for. Unfortunately, it seems that the Greens now wish to hitch themselves to that as well, with Senator Xenophon and Senator Fielding. Let me say that I do not blame the Greens for that—I understand the position that they have found themselves in—but the truth of the matter is that that is what is now being debated here today.

The government wants to pay an appropriate rebate for this procedure and thinks that the opposition can reconsider this insane position and support these changes. The government’s proposal is to have a schedule fee of $416 and to introduce a new complex item of $850 for when the procedure takes longer. We are adjusting these fees to better reflect the time and the complexity of these procedures. Most people in the community would think that $416 for a procedure that typically takes 20 minutes is a reasonable position to adopt, recognising the skills and abilities of the specialists who undertake these tasks.

What it also means, though, is that if this continues to be resisted we cannot reform our health system. We must make hard decisions. This includes decisions about where we can best direct our finite resources. This is also about the opposition agreeing at budget time but then reneging on that and choosing different courses as they go. On the one hand, they complain about spending and on the other they encourage it, particularly directed at specialists. This is the difficulty they get themselves into. If they do not want savings in this area then they do not need to come up with stunts in this place; they need to point to where they say the savings should come from, if there are to be savings in this area—and there need to be savings, especially where technology changes and improves, allowing savings to be found.

But it seems, to use a well-worn phrase, they want to have their cake and eat it too. It seems that the opposition are all care but no responsibility. If you look at the responsible position, responsible government is about governments passing bills in this place. It is about effecting our policy. It is about having regulations that support executive action. If they do not like the executive action then they have the ability to come in here and disallow it. But that is the responsible government framework that we exist in. It is the Westminster system. Its principles I enunciated earlier during the debate on the suspension motion. What they are now doing is trying to run policy from the floor of the Senate, using stunts to effect a policy outcome, using parliament to provide that policy outcome and directing the government and the executive in how they should deal with their budget and all of those matters. It is quite unprecedented. It should not be allowed to stand. Not only is the position they have adopted ridiculous; it is also unsustainable, because it will be exposed for what it is, which is nothing short of a stunt.

The other decision the opposition needs to make today, and they have an opportunity to do so in their summing up of their private member’s bill, is whether or not they are standing by the commitment of their shadow Treasurer, who said:

We said we’re not going to block any initiatives other than the private health insurance initiative. So that’s our position. We’re not changing from it.

That was from Mr Hockey in the Press Club on 20 May 2009. So it is the position of the opposition. It certainly does not appear to be the position of the opposition health spokesperson here today. On the government side in this chamber we want to continue to support new and emerging technologies, not continue to support specialists who can rely on the system. We want to look at how we can provide for the new maternity service incentives. These are the choices that you get in government. If the opposition does not like that then they can work with government. They are the alternative government and they should act responsibly as the alternative government in this place, not irresponsibly. They should not pursue—if I could be unkind, Senator Xenophon—political stunts. That is usually the preserve of Independents and small parties. I will accept the actions of the Greens for the moment; I think the Greens have broadly been acting, although perhaps not this time, in a responsible way. To do this, of course, we do need changes, and these are the changes we are putting forward and which we want the opposition to support.

Senator Cormann appears to be captured by a small group of specialists who want to continue to have high incomes based on a medical item that has not changed. We heard in estimates Senator Cormann’s position regarding the fee structure that is being provided. His position is that you can never change the fee structure, not even with improvements in technology which would make the procedure less expensive. So we would be stuck in a position of keeping regulations and an unsustainable payment in place. The community would ultimately be outraged at that—that the opposition would support holding these rebates in that way. Anyone would be. Any sensible person looking at this would say that these things do have to change over time with the introduction of new technologies. A mechanism does need to be provided, and that is what the mechanism is. Every year regulations are made for a new MBS schedule. We have gone from the sublime to the ridiculous when they then use this tactic to try to cover up what I would, in the first place, have called an error in strategy.

The key savings that would have come out of that would have been $98 billion over four years, or $24.5 billion per year. The MBS fee for the most commonly performed cataract service item, 42702, would be reduced from $831.60 to $416. New complex items would then be introduced to ensure that those with complex issues could be addressed and that would be at $850. So there is an increase for the more complex items. It is recognition that there are complex issues. Ophthalmology MBS spend would be about $317 billion. This is a saving of about 7.7 per cent of the total, and the average ophthalmologist receives about $585,000 from Medicare each year. This is an area that looks like it needs reform, smells like it needs reform and should be reformed. But the opposition want to continue to support specialists, not patients.

One wonders about the reasoning behind that, other than perhaps that it was a poor political strategy adopted by the opposition which is now being exposed for what it is. On average ophthalmologists conduct about 243 cataract operations per year. The full-time equivalent is 100 per cent of the Medicare schedule fee: 75 per cent through MBS rebate and 25 per cent covered by the private health insurers. An average of $1,700 was paid by private health insurance funds for hospital cover per procedure on top of the MBS rebate for cataract operations performed in hospital. So it is about both ensuring that the dollar spend of the Commonwealth in this area is aimed and adjusted appropriately and making sure that consumers get a good deal out of this. This is why the government has travelled down this path.

In 2008, the highest earning 10 per cent of ophthalmologists earned at least $1.8 million each, with $1 million through Medicare benefits including $45,000 through the extended Medicare safety net. What the opposition are now saying is that they support the continuation of that indefinitely without it ever being addressed and considered—