BY DAVID SCRIMGEOUR
The federal Liberal Party has realised that being too blatant about dismantling Medicare is electorally dangerous. After widespread negative reactions to its fraudulently named "Fairer Medicare" package, on November 18 the Coalition government presented a new package which is also intended to deceive the public by using a misleading title: "Medicare Plus".
As the government intends, at first sight this new package may appear more palatable. However, closer inspection reveals that it is still intent on dismantling Medicare.
New health minister Tony Abbott claims that the government is committed to Medicare, and that Medicare Plus will "strengthen Medicare for the future". This package will not strengthen Medicare — it is a step towards its destruction.
Medicare is an internationally respected universal health insurance system, funded by progressive taxation — which means people pay what they can afford for health care which is accessible to everybody. This is what the Australian people have demonstrated they value, at the polling booths and in opinion polls, during the past two decades. It is what PM John Howard and Abbott are determined to destroy.
By re-jigging Medicare as a "safety-net" instead of a universal health insurance system, Howard and Abbott are intent on setting up a two-tier health system, in which the majority of people will be expected to rely on private health insurance, and the "deserving poor" will get some protection from catastrophic medical bills. This is not good health policy.
The original "Fairer Medicare" package included an incentive to doctors to bulk-bill concession-card holders, of $1 per consultation. In Medicare Plus, the government has increased the incentive to $5 per consultation, and has widened the incentive to include children as well as concession-card holders.
Non-bulk-billing GPs, however, generally charge a gap of $10-$20 (specialists usually charge much more), and so the $5 incentive would amount to a loss of income. Abbott has stressed that the decision to bulk-bill is a matter for "the doctor and the patient" (although the decision is the doctor's and the patient has no say in it).
It is unlikely that most doctors would accept the "incentive": even the government admits that no more than 50% of doctors are likely to take the option. This initiative is not likely, therefore, to significantly affect bulk-billing rates.
The government is attempting to soften the attack on Medicare by adding a safety net. For concession-card holders and families who receive Family Tax Benefit (A), if out-of-pocket non-hospital medical expenses exceed $500, 80% of their further costs will be covered by the government. For all others, the 80% kicks in after $1000 spent on medical expenses. This initiative will only benefit a small minority of Australians, about 200,000 people. It may however be a windfall for high-charging medical specialists such as radiologists, and could act as a disincentive for such doctors to bulk-bill.
The Medicare Plus package also includes a component to increase the numbers of doctors and practice nurses, especially in under-resourced areas. Such efforts are needed, but it is important to realise that this has nothing to do with Medicare.
The government's methods are also questionable: having reduced the supply of doctors by restricting provider numbers, it is now attempting to redress the problem by poaching overseas-trained doctors — particularly from Third World countries, which, after paying for the training of their doctors, can ill afford to lose them.
Australia can afford to provide high-quality primary health care to all. We do not want a US model of health care, which allows access to the best medical care that money can buy for those able to buy it, and the devil take the hindmost. The irony is that such systems are ultimately more expensive — the US health system costs 15% of GDP compared to 9% in Australia (already up from 8% since Howard took office). But this is the direction in which Howard and Abbott want to take us. The Australian people must show that they will not stand for it.
From 91×ÔÅÄÂÛ̳ Weekly, November 26, 2003.
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