A TPS Extra opinion piece by Ad astra originally posted in comments on The Political Sword. This is a follow up to yesterday’s Messing with Medicare
When John Howard tried to change Medicare many years ago, he soon picked up the unmistakable message from the electorate: ‘Don’t mess with our Medicare’. He had the nous to listen to the people and pull back. The question today is: ‘Has Abbott got enough of Howard’s nous to do the same?’ Sadly, I doubt if he has. When did he last allow the voice of the punters to override his ideological intent?
The clarion call from both the users and the providers to withdraw his changes to Medicare are likely to be ignored. Abbott is stubborn, ideologically driven and vengeful. The only hope is that his newly-appointed Health Minister, Sussan Ley, a smart politician with an abundance of common sense, will persuade him to back off before the implementation date of 19 January, especially now that the numbers in the Senate indicate that the proposed changes to the regulations are likely to be disallowed later in the month. If Abbott proceeds, it looks as if his punitive changes will have a very brief and inglorious life.
Yet there is a need to make Medicare, now a revered Australian institution, sustainable in the long term and able to accommodate the accumulating needs of an ageing population, many of which will suffer dementia or other disabilities, and to adapt to a healthcare system that offers more and more with each passing year, but at great expense. There is a better way to achieve this, but Abbott, Hockey and Co. seem to know only the punitive. What alternatives are there?
Listen to the doctors
This nasty assault on Medicare seems to have ignored the advice of the very people who provide healthcare: the doctors and those who work with them. The Abbott government, in an exercise in arrogant presumptuousness, has declared war on ‘six minute consultations’, which by inference they regard as ‘bad medicine’. Yet doctors with many years of experience assert, correctly, that some GP consultations require only six minutes, or less. How long does it take a doctor who knows the patient very well to check a hypertensive’s blood pressure and renew a script; how long does it take a doctor to review their patients with type 2 diabetes and their medication; how long does it take to check the response of a skin rash to treatment; how long does it take to give an elderly person a flu shot? As anyone who has ever attended a doctor knows, not long.
Of course some consultations need much longer: a new patient; a patient with important new symptoms; the initial visit for pregnancy; the annual health check; counselling of the worried and the mentally disturbed. That’s why there are graded consultation lengths that attract different Medicare rebates. But Abbott thinks he knows better when he makes what he regards as a virtuous move ‘to get rid of six minute medicine’. He would certainly need a consultation longer than six minutes to unravel his disordered thinking about consultation length. If he thinks he can force doctors to spend an extra few minutes with each ‘short consultation’ patient to attract the current Medicare rebate, what is that supposed to achieve medically? Doctors know how long patients need; what makes Abbott think he knows better? Longer consultations would result in fewer patients being seen each day, or doctors working longer, with no additional health benefits.
The president of the AMA, backed by the many thousands of GPs that he represents, is out today imploring Abbott to back off and scrap the proposed changes. Some will see this simply as promoting the self-interest of doctors, and will back Abbott; most will see it for what it is: a plea to Abbott to abandon his ideologically-driven move to punish the less-well-off in pursuit of his budgetary objectives, disregardful of the fallout for healthcare.
Listen, Abbott, Listen.
The Abbott government seems to have no sense of timing. Its bull in a china shop approach is applied to everything it does. The people are not unreasonable. They know that if they want our first class healthcare system to be sustainable, more revenue is needed now and in the long term. They are amenable to gradual solutions, to solutions that do not hit them like a sledgehammer. There is no need for a sledgehammer today or tomorrow; what is needed is long-run change to which the people and the economy can gradually adapt.
Review the Medicare levy
Remember how little protest resulted from a proposed increase in the Medicare levy to fund the NDIS; the people recognised the inadequate deal those with disabilities were receiving.
Then why not implement a gradual increase in the Medicare levy, a progressive tax that does not disproportionately disadvantage lower income earners. Why not increase it progressively, by say a half or a quarter of one percent each year until sufficient money is levied to cover costs. The people are much less concerned about paying more tax if they can see where the tax is going, where they can see the benefits flowing to them. What they resent are sudden tax hikes where the money disappears into a black hole where its use is a mystery, where it is used at the discretion of governments to pursue their ideological objectives.
Review Health Card eligibility
Millionaires with vast assets do not need a Health Card which affords the holder benefits, especially substantial pharmaceutical benefits. Are all holders needful? Could money be saved by restricting benefits to those who really need them?
Prevention is better than cure
This old adage is as true as when it was first uttered. Avoiding illness, especially avoiding hospital care, has been documented over and again as a way to contain and even reduce health care costs. Yet the Abbott government, which is burdened with an anti-science mindset, has reduced funding for preventive care, as if this established approach is a variety of green imposition. Encouraging and facilitating good nutrition, regular exercise, smoking cessation and moderation in alcohol use are all proven measures in maintaining health. The government should be strongly encouraging and properly funding prevention, knowing for certain that this will curtail health costs in the long term. Abbott and Hockey talk a lot about long term sustainability, yet ignore a powerful device for achieving it in healthcare.
Has Abbott the nous of Howard?
In my view, the answer is a resounding NO. His stubbornness in pursuing his ideological imperatives in spite of good advice and public protest has been evident since his election. Think about how he clings tenaciously to his Paid Parental Leave scheme, as if it was his favourite Teddy Bear, in the face of trenchant opposition, even among his own backbench.
Once more, I expect we will see him persist until yet again the Senate throws out another Abbott brain failure. But I suppose miracles are possible still.
What do you think?
Don’t miss out – make sure you also check out the current piece at TPS, ‘And that was . . . 2014‘. At this stage, the new more in-depth weekly pieces at TPS are due to return from January 25th.
Ad astra is a retired academic with years of experience in rural family practice.