BY
SARAH STEPHEN
The decline in bulk-billing by doctors has been making headlines for weeks. In February, it was revealed that the percentage of doctors who bill Medicare directly and do not bill patients has dropped dramatically under the Howard government, from 80% to 70%.
A central reason for this is that the government has starved Medicare of funds. The Medicare rebate has not increased in line with the cost of living, nor with increases in the cost of running a medical practice, particularly with recent blowouts on the cost of medical indemnity insurance.
The Australian Medical Association (AMA) estimates that if the Medicare rebate was to reflect the real cost of providing health care, it would have to rise from $24 per consultation to $50. Currently, the law forbids doctors who bulk-bill from charging patients a fee.
Dr Margaret Perrott from the South Coast Workers Health Centre told 91×ÔÅÄÂÛ̳ Weekly: “The present Medicare rebate is preposterous. Vocationally registered doctors [who are eligible for the full $25 Medicare rebate, as opposed to non-VR doctors who receive only $17.95] are only just making ends meet, and those who do not hold VR have not had a pay increase since 1993. Out of this, they must deduct the cost of the practice — salary for a receptionist, accounting, rent, equipment, medical defence insurance, insurance of the practice, maintenance and equipment, disposable items such as band-aids. It's just not possible!”
On March 2, it was revealed that the government is considering two major changes to bulk-billing: allowing doctors to charge patients a co-payment as well as receiving the Medicare rebate and letting patients take out private health insurance to cover all out-of-pocket medical expenses, including the “gap” between the $25 rebate and whatever their GP charges for a visit.
In a March 3 media release, AMA president Kerryn Phelps said she agreed with Prime Minister John Howard's claim that bulk-billing was never intended to provide free, universal access to medical consultations. “Bulk-billing was to protect the less well-off”, Howard said during the previous day's parliamentary question time. It was not meant for people on “generous incomes”.
The March 8 Australian commented: “Mr Howard's hatred of Medicare was no secret back when he was Opposition leader in 1987. Medicare, he argued then, was: 'an unmitigated disaster', 'a financial monster', 'a human nightmare' and 'an absolute rort'. He said he planned to dismantle it other than for 'pensioners who really need it'."
Dr Tim Woodruff, president of the Doctors Reform Society, argues that the changes being considered by the government and backed by the AMA would spell the end of Australia's system of universal health care coverage. Woodruff told ABC radio on March 7: “Inevitably, all that does is introduce a US-style health care system where patients pay if they've got the money. And there will be no control over how much they pay.”
The AMA's support for the undermining of Medicare has also come under strong criticism. In a March 4 media release, Dr Tracy Schrader, secretary of the Queensland Doctors Reform Society, said: “The AMA has been undermining the public's confidence to set the stage to provide an excuse for the government's plan to get rid of bulk-billing and Medicare.”
Schrader accused the government and the AMA of attempting to “rewrite history” with their claims that Medicare was always only intended to provide a “safety net” for pensioners and the desperately poor.
“Medicare never has been a safety net and was never meant to be”, Schrader said. “Medicare was designed to be universal, for everyone.”
Woodruff is also angry at the stand being taken by the AMA. He told ABC radio on March 7: “They believe ... that doctors must be allowed to charge as much as they want and they must be the ones who decide who they will charge more to and who they will charge less to.”
In a March 4 doorstop interview, Phelps called for an “uncapped co-payment depending on the practice's particular needs”. The Australian Consumers Association argues that such a change would make it “very easy for doctors to put up their prices”.
Adding an element of farce to the debate, the March 8 Sydney Morning Herald reported Liberal MP Ross Cameron's spirited defence of the government's plans: “I think we are a bunch of hypochondriacs and we need to be weaned off our addiction to general practitioners.”
Victorian Medicare Action Group spokesperson Rod Wilson told the March 8 Melbourne Age that the government “was flying a kite” by floating various plans to gauge community reaction. “They're putting ideas out there to see how the community reacts. Well, I think the community is going to react very negatively.”
From 91×ÔÅÄÂÛ̳ Weekly, March 12, 2003.
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