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Thursday, 8 February 2007
Page: 8


Mr HATTON (1:08 PM) —This is a very significant combination of bills. As the previous speaker, Mr Slipper, and others have indicated, here we are dealing with a colloquium of bills, seven in all. Of course, the largest and most important bill, the Private Health Insurance Bill 2006, was introduced, I think, on the last day of sitting, 12 December 2006. It makes a significant number of changes. In particular, the extension of what is coverable by this legislation is the foundation of it. There is a broadening of the range of services which can be covered by private health insurance. They include out-of-hospital services that are a substitute for or prevent hospital care. This is fundamentally important. When Labor were in government we understood this type of approach in the aged care area. This is why Labor, year on year, extended its hostel program by 15 per cent. This is why we concentrated our funds, not where they had been previously—that is, in the nursing home area—but on the 96 per cent of people who were still in their own homes and who did not need to receive that level of care.

Labor provided an interim step with hostels, but we also recognised that immense savings could be made not only to the Commonwealth but also in terms of people’s quality of life if we could deal with people in situ at home by taking services out to them. The modality of this first intent with respect to private health insurance is to do the same sort of thing: recognise the dynamic change within the community in terms of dealing with people. Australia wide, it is hard enough to get a bed in a hospital; it is very difficult to actually stay in a bed these days because they have you out on your feet and into the general community as quickly as possible.

The fact that the length of stay in hospital has been shortened is also a reflection of the dramatic changes in medical technology and techniques—for example, a hip operation. The member for Dobell has just been through that process, and I am glad to see him back in the House well and recovered. If he had undergone that operation 10 years ago, he would have ended up with a very long scar of 20 or 30 centimetres. These days, leading exponents in surgery have a minimalist and less invasive approach. Because there is a smaller scar, there is less disturbance. They also use a computer in order to put a prosthesis in. A section of these bills actually deals with prostheses, and I will come to that later. The surgeons are able to site the area more accurately than in the past.

This combination of a range of different technologies, new approaches and an attempt to use a keyhole method with regard to this quite difficult surgery means two critical things: (1) there is a pretty dramatic reduction in healthcare costs because the length of stay in hospital is shorter; and, (2) the length of the voluntary stay within a rehabilitation hospital can also be shorter because there is less impact on the major muscle groups. Of course, there is also a commensurate saving: getting over the operation is quicker, and that is important for the patient. This is a very good and a very sensible measure because it is reflective of the dynamism of those changes. We know that flexibility has to be at the core of so much of what we at the federal government level do, because we are dealing with a dynamic area.

Anyone with experience, like you, Madam Deputy Speaker Bishop, in the aged care area, would appreciate that a number of the elements of this bill are fundamentally critical. For me, as a baby boomer, they will continue to be fundamentally critical. Given that we are the most difficult cohort that this Commonwealth has had to deal with, we will double the size of the aged cohort from about 12½ per cent to 25 per cent of the population. That will no doubt be the case if we are, as we have been in the past, loud, demanding, insistent and without the reticence, the forbearance or the willingness our parents had to go without in order to give to us. If that is the case and there are greater demands and more expectations on our health care, a dynamic change also has to be taken account of within the parameters of these bills and Australian health generally—that is, the increased life expectation has dramatically changed the profile of our health system. We know that, so far, we have succeeded in keeping about 96 per cent of people at home and have been able to deal with them at home by providing intensive services and out-of-hospital services. This is directly affected by the bill and that is why I welcome it.

There will be more of that in the future because of people’s increased longevity and the capacity of the health system to keep people alive who otherwise would not have survived, through a pharmacological approach and the availability of very sophisticated drugs, the combination of different drug therapies or an attack on the major causes of mortality in that age group. Or an effectively prophylactic approach could be taken, based on the notion that we should be concentrating a lot more on keeping people healthier and fitter, whatever their body size and shape; that we should be doing more to aid our own good health and assist the community generally; and that we should do good things such as giving up smoking, like I did about five years ago now. I wish I had never started in the first place. It is a great cost to the country and it is a great cost to the individual who is shackled to that dreadful addiction. One of the fundamental things we can do with an ageing population to cut mortality from lung cancer and from other associated cancer is (1) knock off the smoking and (2) increase the exercise. For people to do that they need mobility, as the member for Dobell found out.

There are more people now, at a younger age, who are finding themselves up for something dealt with in one of the other bills that we have got here: prostheses. I have an interest in literature—I was an English history teacher—and about the most I knew about prostheses, I think, apart from the fact that it was an unusual word that you could use in spelling contests, was from My Brother Jack, when David and Jack’s father returned from the First World War. He had been injured, and he had a prosthesis. That was a dominant thing in their early childhood. I suppose the other one was very early: ‘Tin legs’ Bader, and his problems with learning to use his tin legs. They were a very primitive kind of prosthesis.

What is most interesting about this is that as the population ages but also as the profiles change—as the capacities and technologies change—we can do what we could not do before, because of those different technical approaches. But we are also in a position to do it at different ages. That has a cost but also a benefit, or a series of costs and a series of benefits, to the community at large. An example of that is someone like Kenny Ticehurst, the member for Dobell, having his operation. I am about to get the needle to go a few months more before I will inevitably have a hip operation, at the very young age of 55. But at least it explains a series of problems I have had and have tried to address over a 10-year period or so. There is some certainty, at least.

But it is also an indication that if you look not only at me and Ken but worldwide—Jimmy Connors has just had a double hip operation, I think, in two goes, and George Bush Sr has had it—people are having it at a relatively younger age. Some of that, of course, is because of direct injury. For the rest of it there are genetic factors and so on, affecting the breakdown of the cushioning material. But this brings me up against something as well, and it is one of those marvellous things in life. I never thought I would need to know anything about prostheses at all, but thankfully other people do. It is a case of how dependent we are on others in general, and also how dependent we are, directly within the health system, on the training, expertise and capacity of others. But it is also the fact that what we do at the government level—those things that we think we will never have to deal with at all—can come crashing very close to us. It is then that you realise the importance of the maintenance of the arrangements of things that you never thought would impinge on you or on others, and of ensuring that we have a proper, well-regulated and efficient approach to these things. Those elements are important.

The other key purposes of the principle bill are: the removal of the Lifetime Health Cover loadings for members with 10 years continuous service, which is fine; the requirements on insurers to provide standard information statements for consumers about their private health insurance products; and a clarified and simplified legislation. All of those things are good.

The fundamental problem for a lot of my constituents has been partly addressed in the rise of some of the larger organisations that have operated in the hospital system—for instance, within Mayne Health when it arose and took over a series of private hospitals and so on. There was a direct impact. Because of the understandings and agreements between the surgeons and the other people in the hospitals—the ancillary services, anaesthetists and so on—it was possible for the first time to get a package of charges and for that to be fundamentally covered under Medicare combined with some private health insurance to cover the other elements. People could walk into a hospital, have their elective surgery and walk out without having busted their pockets, because they had chosen to have elective surgery and chosen, because of their particular circumstances way back—or the prospect of the circumstances—to buy private health insurance.

One of my constituents is now struggling with the effects of Parkinson’s disease, which is a very difficult thing to deal with. We have better control than we had in the past, but the ravages of that disease are evident in the greatest fighter the planet has ever seen, Cassius Clay, who changed his name to Muhammad Ali. A constituent of mine, Cec Moore, had a heart operation. He was privately covered. He went in and had the job done and, despite being on the highest level of private cover, came out with a $4,000 impost on himself. This was about 10 years ago or so. The deficiency in the system there was apparent. At that stage you had people who would not pay into any cover at all; they would just rely on the Commonwealth to do it through Medicare. Throughout long periods in their lives, people had put into private health cover and therefore should have had cover themselves and the community should have had cover. But at the end of that it was pretty tough to whack them with a bill that was very big for someone on the pension.

There are so many pensioners who have maintained private health cover. The arrangements that have been put in place by the larger providers, such as Mayne when it was central to the whole show, are very welcome. It is the sort of thing we need to make the system more workable, make it fairer for people and make it fairer for those people who go the extra yard and lessen the burden on the general community by providing for themselves.

I would like to come to the opposition’s amendments and, in doing so, commend the shadow minister for the comprehensive way in which she dealt with this bill today and the sensible argument that she put forward—a recognition of the breadth and importance of what is covered here. She reiterated Labor’s approach with regard to the 30 per cent rebate. Like it or not—we supported it at the last two elections and we will do so at the next—the world has changed.

We need to manage the whole of this, but in dealing with the whole of it it is important that we look at what the deficiencies are, from our point of view in opposition, and what our intentions are so that they are known to people when we come to government. The first item in the amendment is:

... while the expansion of private health insurance to coverage of services provided outside of hospital will have benefits for the 44 % of Australians who have private health insurance, it will not provide access to the same kinds of services to the majority of Australians who don’t have private health insurance.

You could reply and say: ‘That is gainsaying. If they do not have private health insurance then they are not in it—that 56 per cent are out.’ But, if you have a problem there, maybe you have a problem in the broader community. We need other mechanisms to operate there as well because there are the same kinds of problems for those people and there are imposts on people who generally do not have a great capacity to pay for them. That is what modern societies are about: spreading the risk and spreading health coverage to include everyone.

The second item out of the five amendments is:

... the expansion of private health insurance to cover a broader range of services will likely lead to further increases in private health insurance premiums.

That is a simple and straightforward statement. One could argue that if you could entirely trust the Minister for Health and Ageing with regard to his prognostications on health insurance premiums you could have absolute faith that this would not be a problem but—sad to say and, going from past experience, time and time again—that is the last thing one could say.

This is a fundamental concern. We were promised previously that there would be reductions and that the increasing charges would be held back significantly. That has not happened, and with the impending sale of Medibank Private, the prospect of the 37 or so private organisations out there increasing their charges, and not being brought to book and reigned in on this, is great. We need more than assurances which prove hollow from the minister.

The third item is:

... that the Bill pays scant attention to safety and quality issues for services provided under the rubric of Broader Health Cover.

That amendment speaks for itself. The fourth is:

... that the Bill does not include sufficient protections for the freedom of doctors to make clinical decisions about the treatment/s that will be in the best interests of their patients in relation to services provided under the rubric of Broader Health Cover.

This has been substantially dealt with in the shadow minister’s contribution. The last point goes to a criticism in relation to the wastage of money on advertising. It is:

... that the $50 million the Howard Government provided to the private health insurance industry in the last budget to advertise their products is a wastage of taxpayers’ money and an appalling use of scarce health resources.

I could not but agree. The pockets of the private health insurance industry are very deep. They can provide for their own publications. They can provide for their own marketing and advertising. This is yet another example of a government that has an enormous amount of largesse. The government uses its own departments or outsourced organisations to spread propaganda messages. There is a fear about a third party or closely associated set of third parties where, effectively, they do the advertising on the part of the government in relation to the benefits they have gained from everyone at large. It is not right. It should not be condoned; it should be condemned, and I do so, along with all of my colleagues.

I just want to make a passing observation. This is my fourth speech today. That is not bad at 1.30, before question time! I am struck, time and time again, when I am in the chair or at the speakers rostrum, by how few government members are willing to get up and defend what their government does. They are lax and lazy in government.


The DEPUTY SPEAKER (Hon. BK Bishop)—I suggest the honourable member return to the subject of the bill.


Mr HATTON —Madam Deputy Speaker, if you want me to I will return to why many government members are not speaking on the Private Health Insurance Bill 2006 and are not supporting the government’s substantial legislation in this regard. It is an observation that goes to whether or not this government and its members are committed to supporting the legislation.

With regard to legislation after legislation that I have dealt with, it is the Labor Party people who keep the argument going and who do the debating in this chamber. We keep the parliament alive and we have demonstrated, on this bill and on others, that we are willing to take up the nitty-gritty of these subjects and to debate them—and to do it at length and do it well. The government is sitting on its hands. You cannot just rely on ministers, parliamentary secretaries and a couple of other people to front up and give it a tick. This has to be worked at. It is a demonstration that this government is out of puff. Despite the fact of some of the good work—like this—that has been done in this area by the people in the departments, this government is out of puff. (Time expired)