By Peter Boyle
A Hewson victory at the federal election would be a health hazard. Fightback would abolish bulk billing for all except pensioners and other health care card holders. Constraints on doctors' fees would be lifted, and a combination of tax penalties and rebates would be used to pressure more people into private insurance.
Hewson plans to slash some $1.5 billion in Medicare benefits and payments and to force public hospitals to carry out even more cost-cutting.
The Coalition says that in the "medium to long term" federal- state hospital agreements should be abolished. In the short term new funding will be conditional on the states undertaking "micro-economic reform".
Some of the objectives of this "reform" are:
- "international best practice" in management and accountancy;
- financial incentives for administrators who go for contracting out and penny pinching;
- more use of private health sector resources;
- contracting out to private enterprise of services like catering, laundry, cleaning, porterage and maintenance;
- productivity-based employment contracts for staff.
A slightly less ferocious program of cost-cutting has been applied to public hospitals by the federal Labor government, and it has left a public hospital system plagued by long queues and staff shortages.
According to a January 22 article by the Melbourne Age's medical reporter, Jo Chandler, hospital waiting lists in Victoria are already in excess of 30,000. This is before the impact of the Kennett government's cuts to hospital ($40 million slashed in the October mini-budget and another $40 million cut possible in the March mini-budget).
Ambulances cannot find hospitals to accept critically ill
patients, the seriously ill are left waiting on trolleys in corridors, cancer patients have missed out on regular chemotherapy, and some 30 people died awaiting heart surgery in Victoria last year. The situation is similar in all states.
Even supporters of the Coalition's health policy — such as the Australian Medical Association, the private health insurance and private hospital lobbies — concede that the problem with health under Labor is one of underfunding. Yet they back a policy which would cut funding even more and turn health into just another commodity. These lobbies are interested more in their profits than in public health.
The horrors of a privatised health care system are clearly to be seen in the United States, according to Peter Botsman of the Evatt Foundation, who made a study tour of the USA last year.
A more privatised health care system is unlikely to be cheaper, more efficient or of higher quality. Botsman says that the latest figures reveal that the US spends 13% of its gross national product on (largely private) health services (compared to 8% in Australia), yet 100 million of its citizens have inadequate health coverage and access to care.
Australia also has a lower rate of infant mortality than the US, longer life expectancy for both males and females and a system of universal health care.
According to the Australian Council of Social Service (ACOSS), under a federal Coalition government the cost of health to the community as a whole, and to many individuals and families, would rise even though health will be exempted from the goods and services tax.
The abolition of bulk-billing would hit lower income earners not on welfare. It may also make it hard for pensioners to find a bulk-billing doctor, because the incentive for doctors to bulk-bill will be reduced. In addition, the number of doctors charging the scheduled fee is likely to shrink markedly, leading to greater out-of-pocket expenses for most people. This would be the main pressure to take out private health insurance.
Even with the tax rebates proposed under Fightback, private health insurance would still be out of reach for many low-income earners, according to ACOSS. Yet only those able to afford private insurance for basic cover plus the additional premiums for "gap" insurance (the "gap" is that between the scheduled fees and actual charges by doctors) will be able to contain out-of-pocket expenses if their doctor switches to higher fees, which may be negotiated between the AMA and private health funds.
The private health insurance companies have higher cost overheads than Medicare, according to ACOSS.
The fact that demands on health have been growing over the last few years has more to do with the rising costs of new medical technologies and the ageing of the Australian population than with mindless overuse of Medicare coverage — the impression the Coalition would like us to have. Federal Labor health minister Brian Howe also exploited this myth when he tried to push his ill-fated $2.50 Medicare "co-payment" last year.
But Australia should expect to be spending more on health, according to Di Quin, Democratic Socialist candidate for the seat of Melbourne and a member of the Australian Nursing Federation.
Some 11% of public hospital admissions and 23% of public hospital bed days are accounted for by the 2% of Australians who are 75 and over, according to National Health Strategy Issues papers produced in 1991. By the year 2001, it has been estimated, 50% of hospital beds will be occupied by patients over 65.
Any suggestion that further privatisation of health care will contain costs without reducing services is contradicted by the fact that health care costs per head of population in the more privatised US health system are much higher than in Australia. "Privatisation will simply make access more inequitable and distort the health care system in favour of the most profitable services rather than the most needed services."
Quin says there is also the question of the adequacy of traditional forms of health care, with their over-emphasis on treatment rather than prevention, on individual cases rather than social causes of ill health.
But none of these issues is a central feature of the "health debate" between the major parties. There is little recognition of the major impact of pollution and social inequality on health. The only "choice" they offer is on the scale of cutbacks and the pace of privatisation, Quin told 91×ÔÅÄÂÛ̳ Weekly. Only an expansion of public and community-based health services can begin to address the real challenges in health.