A TPS Extra opinion piece by Ad astra originally posted in comments on The Political Sword.
We ought not to be surprised that the federal Coalition is once again messing with Medicare. It was never enamoured of it, and PM Howard would have deleted it if he were able. But being a consummate politician though, with his ear to the ground, he came to realise that it would be political poison to remove or damage an iconic institution that the electorate values and wants to retain. Taxpayers readily pay the Medicare levy; they know what good value they get for their money.
So why is the Abbott government making a play that will diminish Medicare and harm the less-well-off who depend on it for their health care? In my view the reasons given are spurious. The pretence that they must curtail its use and the cost of it for budgetary and sustainability reasons is a facade, behind which lurks their ideological imperatives of user-pays and opposition to welfare and the ‘leaners’ that ‘exploit’ it. They are doing what Howard wanted to do; instead killing Medicare by stealth.
As so far they have failed to get their $7 GP co-payment past the Senate, they are now resorting to ‘back-door’ methods of forcing GPs to accept $5 less for for their consultations, and where they refuse to accept this, to charge that to their patients, a virtual co-payment. They are also changing the length of the consultations that will attract the usual short consultation Medicare rebate from six to ten minutes on the pretext that it will stop or reduce ‘six minute consultations’, which by implication are deemed undesirable. Yet this time interval is all that is needed for many consultations, such as, for example, a blood pressure check and repeat prescription, or an immunisation shot. In other words, the Abbott government is dictating to doctors how long they need to spend with their patients, irrespective of the patient’s needs, an exercise in gross presumptuousness.
There is no need here to furnish the details, which are well documented in a January 14 article by Julia Medew in the SMH. Read all about it there.
What are the implications?
General practice, or family practice as we prefer to call it, is a business. Those who run family practices have the costs of rent, staff and supplies to pay, like all other small businesses. While GPs are not poor, nor are they noticeably wealthy. Few drive expensive cars (take a look at their car parks) or live in mansions. Like all small businesses, when changes to their income stream are arbitrarily imposed upon them, their ability to survive is jeopardised. Wholly bulk-billing practices assert that the proposed changes will force them to charge co-payments or go out of business. The electorate would be wise to listen to what they say, especially those who rely on their services because they can afford no other. These folk will have no other option than to seek care in emergency departments of public hospitals. The consequence of a surge in ER patients are so obvious that they need no elaboration.
What does all this mean for the electorate? The Coalition is messing with Medicare, and attempting to do it by regulation because it can’t persuade the Senate of the merits of its case. Left untrammelled, it will destroy Medicare. Like a cancer, the affects of the government’s moves will multiply, metastasise, and eventually overwhelm the basic structure of this Aussie institution. And all in pursuit of a neoliberal ideology, a user-pays mindset, and the intent to punish Hockey’s ‘leaners’ whom he believes rip-off welfare entitlements. We can only hope that the intent of some senators to disallow this move is successful.
As if it was not inherently hard enough to institute these draconian measures, Abbott appoints Peter Dutton to do the job, a man recently voted by doctors as the worst health minister in 35 years and described as “…the dullest, least innovative and most gullible for swallowing the reforms from his think tank…” . Read the awful details here.
Are there no better solutions to the task of making Medicare sustainable in the long term? Yes. That’s for next time.
What do you think?
Ad astra is a retired academic with years of experience in rural family practice.