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Wednesday, 17 June 2009
Page: 6374


Mr DUTTON (6:45 PM) —I rise to speak on the Private Health Insurance (National Joint Replacement Register Levy) Bill 2009. By way of background, on 6 July 1998 the then health minister, Dr Michael Wooldridge, announced funding for the Australian Orthopaedic Association to establish the National Joint Replacement Registry. This was an important initiative, as the Australian Orthopaedic Association had recognised the need to establish a national joint replacement registry as far back as 1993. Until the registry was established, there was a lack of information regarding patients who were receiving prostheses, the types of prostheses and the surgical techniques used to implant them. The Australian Orthopaedic Association should be rightly proud of the growth, success and benefits that have been derived from the establishment of the registry.

According to the Australian Orthopaedic Association, there are 70,000 hip and knee replacements undertaken each year in Australia, having increased from around 25,000 in 1998. This number will only continue to grow. Given the variability in joint replacement success, the registry has an important role in collating and analysing data regarding joint replacements. The registry collects data regarding patient characteristics, prostheses types and features, methods of prostheses fixation and surgical techniques used. The primary measure of outcome is revision surgery. The registry also monitors mortality rates, with the information being used by surgeons, other health care professionals, governments, prostheses sponsors, patients and the wider community. Armed with this information, real improvements can be made and have been made in joint replacement surgery.

This bill sets out cost-recovery arrangements for the operation of the registry. Levies will be imposed by this legislation on sponsors of prosthetic devices and will be used for the funding of the registry. Sponsors will be levied according to the number of joint replacement prostheses they sponsor. Different levies will be imposed for different joint replacement prostheses and rates will vary between zero and $5,000 per financial year. This variation in levies is supposed to reflect the different benefits applying to prostheses listed on the Commonwealth Prostheses List.

The explanatory memorandum identifies that the benefit applying to some joint replacement prosthetic devices ranges from less than $50 to as high as $67,000 per product. Whilst there is a legitimate debate to be had about cost-recovery measures, we know that this government clearly is not interested in a genuine policy debate on such issues; they are just looking for easy targets to cover the Treasurer’s economic incompetence. We have seen blatant revenue grabs time and time again from this government, irrespective of the policy implications and outcomes for the Australian public. We have seen it with the alcopops legislation, we have seen it most recently with the private health insurance rebates, and we have certainly seen it with caps to the Medicare safety net. These recent measures are blatant revenue grabs by a reckless government that after just half a term in government have destroyed this country’s hard earned wealth and good fortune.

All Australians will pay a price for the government’s ideologically driven changes, particularly in relation to the private health insurance rebate. Those who rely on public health treatment can expect waiting lists, with more people seeking treatment, and those with insurance will pay more through higher premiums. By the government’s own admission, the government’s recently introduced changes will affect some 1.7 million adult policyholders. It is inevitable that some of these people, especially given the current economic environment, will downgrade their cover and some drop it all together. This will place upward pressure on premiums, and so the spiral begins.

The government would like us to believe that only the very rich and privileged have private health insurance. But the minister does not really address what effect the upward pressure she is putting on premiums will have on the one million Australians earning under $26,000 per annum who have private health insurance. The government continues to blame the current economic circumstances for the country’s ballooning debt and deficit without taking any responsibility for their own poor economic management. The difficulty for this government is that the Australian public will soon tire of excuses. They will tire of the cuts to successful and carefully considered health policies. Sooner or later the Rudd government will have to stop cowering behind the global financial crisis and take responsibility for its actions in plunging this country into unprecedented debt. There is no magic pudding. The Labor government’s economic recklessness will have far-reaching consequences. And now we know that Mr Rudd has no hesitation in breaking key election promises, there is no certainty or stability for health policy in this country any longer.

This government’s list of broken promises is long. Their assurances regarding private health insurance are well documented in this House. As recently as 24 February this year, the health minister said to the Age newspaper:

The government is firmly committed to retaining the existing private health insurance rebates.

Yet this statement was made by the minister at the same time that officials from the Department of the Prime Minister and Cabinet were providing formal advice regarding the proposed changes to the private health insurance rebate. So the minister is saying one thing to the public whilst PM&C and her own department are looking at policy options which would go in the exact opposite direction to that on which the minister has just given, on that same day, a firm commitment. Health is a portfolio that requires careful and considered long-term planning, not frequent, ill-considered, ideologically convenient changes driven by a broke and incompetent Treasurer. Health policy in this country should be administered by the health minister, not a panicked and desperate Treasurer.

As I have stated previously, and on many occasions, there is a legitimate debate to be had on cost recovery. The coalition has engaged in that and is willing to further engage in that. Under any cost recovery measure, though, there needs to be genuine engagement with all affected stakeholders. There is no denying the significant benefit that has been derived from the joint replacement registry, and it is important that the good work continues to be funded appropriately. Whilst the industry would acknowledge that as sponsors they derive benefit from the registry, they are by no means the sole beneficiaries, and government should adequately justify such cost recovery measures. The information collated by the registry is of benefit to many stakeholders, including surgeons, governments and private health insurers. The levies proposed in this legislation are in addition to the application and ongoing listing fees already incurred by sponsors of joint replacement prostheses. There has been a lack of consultation on this measure—no question—and a lack of evidence presented by the government on what other funding mechanisms were considered. Or have they just gone for another easy revenue grab, ignorant of the impacts and policy outcomes? Whilst the bill acknowledges the differing benefits applicable to prostheses, there is a reasonable expectation that in determining appropriate levies consideration will also be given to the frequency in which prostheses are utilised in procedures.

A debate on health will unfold in the months before the next election. We know the government are desperate to go to an election before the next budget, before they release details of how much further debt they propose to go into—that is, how much more debt will be hung around the necks of all men, women and children in this country for decades to come. The important debate about health that is to be had will be crucial because the government promised at the time of the last election—only 18 months ago—that they would fix public hospitals by 30 June 2009. So there is less than two weeks to go. Yet the government have not even released any detailed criteria or benchmark by which they will determine whether or not they have met that election promise. In the Main Committee last night I asked three questions of the Minister for Health and Ageing. I asked her to please detail even just one criterion by which they could assess whether or not they had made sufficient gains over the last 12 months in public hospital management and outcomes to justify a claim that they would fix hospitals by mid-2009.

The Prime Minister was very definite in the language that he used. Despite the fact that he has pulled down that wording from his website, we have printouts of the website that show the commitment he made during the election campaign that he would fix public hospitals. He has walked away from that statement, and I think most Australians would be amazed by that. Most Australians would be amazed that the Prime Minister looked down the camera during the election campaign in 2007 and said to Australians, ‘I will end the blame game and I will fix public hospitals by mid-2009.’ He said that even though he had no interest or genuine concern in fulfilling that.

We know that over the coming months the government will receive advice from various reports, studies and commissions they have had working on this very important issue. That advice will be returned to government and in due course the government will be required to reply. This is an amazing process, because the government will no longer have the opportunity to hide behind the commissions and reports that they have put into the field over the last 18 months. Crunch time is coming for the Rudd government in relation to health. Frankly, they can delay no longer. They need to recognise that it is going to be a big call for them to say that they will not live up to their election commitment to fix public hospitals. If the Prime Minister walks away from that commitment then there will be a strongly-held belief in the Australian community that the Prime Minister is a fraud, that he says one thing because focus groups dictate it but when it comes time to deliver on a promise he is nowhere to be seen.


The DEPUTY SPEAKER (Ms AE Burke)—I think the member should come back to the bill before us.


Mr DUTTON —Of course, Madam Deputy Speaker. This bill goes to a very important part of the delivery of health services by this government—in particular, the services that are delivered in public hospitals. That is why I say to the House that it is incredibly important that the Australian public understand that when Kevin Rudd made a promise to fix public hospitals by mid-2009—


The DEPUTY SPEAKER —The member will refer to individuals by their appropriate title.


Mr DUTTON —As the then Leader of the Opposition, Kevin Rudd said he would fix public hospitals by mid-2009. Clearly, there was no interest in doing that or in fulfilling that promise.


Mr Gray —Madam Deputy Speaker, I rise on a point of order. I ask that the speaker refers to ministers and office holders by their office, not simply by their name. Also, I make the point that on occasions references have been made that are regarded as both unparliamentary and inaccurate.


The DEPUTY SPEAKER —I thank the member.


Mr DUTTON —The Prime Minister, the then Leader of the Opposition—and his name is Kevin Rudd; he is now Prime Minister Kevin Rudd—made a statement to the Australian people that he would fix public hospitals by mid-2009. That was a hollow promise. I do not believe that the Prime Minister ever had any intention of fulfilling that promise to the Australian people. As I say, we are less than two weeks away from the end of this financial year. It is fast approaching. The federal government, the Prime Minister, have not yet even put on the table the criteria they will use to determine whether or not public hospitals have been fixed. That is an amazing outcome.

On three occasions in the Main Committee last night, when I directly asked the minister this very question, she looked at me blankly. She looked at me like she had no idea what I was talking about, like she was thinking: ‘What? You would put criteria in place to assess whether or not you had fixed public hospitals?’ How else were the government going to determine whether or not they had fixed public hospitals by mid-2009? If Australians in either metropolitan or rural and regional areas have a public hospital in their area which has been fixed, I implore them to please contact my office to give me details of how the Rudd government has fixed even one of the 750 public hospitals over the course of the last 18 months. When this Prime Minister said 18 months ago that he would fix public hospitals, what did he mean?

The Christine Bennett review, the Health and Hospitals Reform Commission review, is due to come back to the government by 30 June. The Prime Minister cannot say, ‘We can’t declare that we have achieved our outcome of fixing public hospitals until we have seen the findings, the outcomes and the recommendations of that report.’ The two are completely separate. The Bennett review will return a report to the government, and Professor Moody’s preventative health task force will return some recommendations. Those people should be commended, as should the committees, for the work they have done in speaking to people and for the time and effort they have put into it. They will provide recommendations and considerations for government post 1 July this year. Their work is to look at how the system can be constructed in the future. Their task is to look at how the provision of health care for Australians can be made better at both the federal and state levels over the coming years.


The DEPUTY SPEAKER —The member for Dickson should return to the bill before us. I have allowed him to wander quite substantially, and I understand the link he is making. The bill before us is the Private Health Insurance (National Joint Replacement Register Levy) Bill 2009. I ask him to return to the bill before us.


Mr DUTTON —Madam Deputy Speaker, I know your long-held interest in the area of health, and you have been quite obliging. The point I make in relation to this bill specifically is that, as we go forward we have to think about how our public hospitals provide services. There can be no more important services for people than those provided by the surgeons and skilled clinicians in the public hospitals, particularly in relation to the devices we are talking about in this bill. The way in which services are provided through public hospitals, particularly for the devices we are talking about in this parliament tonight, is something the Prime Minister needs to examine. He could even use the successful delivery of prostheses over the last 12 or 18 months as justification for his claim that he has fixed public hospitals.

It would be remarkable if we went forward with the Prime Minister trying to use the excuse that he has to wait for these reports. As I said, they have nothing to do with what has taken place over the last 12 or 18 months and whether the federal government has fixed public hospitals. I say to those members opposite who intend to contribute to this debate: please tell me as part of this debate exactly how it is that public hospitals in your community have been fixed over the last 12 months. I say to the member for Shortland, who always has great delight in following me in these debates—


Ms Hall —I love it. It makes my day.


Mr DUTTON —Such is her want in life that she finds great pleasure in following me in these debates. I always welcome her worthy, considered contributions. As part of your contribution tonight, member for Shortland, please say to this House how the public hospitals in your electorate have been fixed over the last 18 months. Make the claim in the House tonight—this is the challenge to the Labor Party; meet this challenge—that even one public hospital anywhere in the country has been fixed over the last 18 months. Not only would I be astounded but I would take up immediately the invitation from the member for Shortland to visit that hospital. I would be very pleased to go to the hospital with the member for Shortland to discuss with the clinicians there, the doctors and nurses, exactly how that hospital has been fixed. That would be a revelation. If the Prime Minister can claim that he has fixed even one public hospital over the last 12 months then I will visit that hospital.


The DEPUTY SPEAKER —Either the member for Dickson will come back to the bill or I will draw him to a conclusion.


Mr DUTTON —Madam Deputy Speaker, thank you for the House’s indulgence tonight on this incredibly important issue. It goes without saying that the coalition have provided support and we have noted our concerns, concerns which are reflected by the stakeholders’ very real concerns. We will be monitoring this very closely. We will be looking at the Senate process. We will see exactly how this government operates this cost-recovery regime. We remain very concerned that many of these measures are nothing more than desperate revenue grabs by a government that has lost control of the economy in such a short period of time.

It is a remarkable feat that this government has been able to turn a $22 billion surplus, money in the bank, into such debt. To achieve this deficit after only two budgets is a remarkable feat even for a Labor government, and that is saying something when you look state by state. This conditional support has those reservations based on the concerns that have been raised by the industry. On that basis, we do not oppose this bill.