Medicare – Has Abbott the nous of Howard?

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.

Go slowly
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.

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11 comments on “Medicare – Has Abbott the nous of Howard?

  1. Can someone tell me why bulkbilling is considered a important part of Medicare. Labor governments over the years has worked hard to increase bulkbilling numbers.

    Coalition take great pride in numbers disappearing. Abbott worked hard in doing this, during his four unspectacular years as health minister.

    AMA has always hated bulkbilling.

    I can understand why some doctors hate it, as all their income would be seen at a glance, looking at Medicare records.

    Over the years, it appears Medicare rebates to doctor has become stagnant, leading to bigger share coming from patient, at the same time, saving government money.

    I was always under the impression, that bulk billing was a more efficient way of distributing Medicare funds. That bulkbilling ensure cheaper overheads for doctors in running their surgeries.

    If I am mistaken, what was the original aim of bulkbilling. I feel it was never as this government claims, to be restricted to the poor and those who cannot pay. I always seen bulkbilling as being universal.

    Does the government pay anymore for each visit that is bulkbilled. It is my belief, that when a doctor charges up front, it is the patient that pays the difference.

    When a doctor does not bulkbill, they reserve the right to charge as much as they feel fit. Believe me, with some, this is as high as the market will stand,. Nothing to do with cost.

    Be aware, the AMA will do nothing to ensure that bulkbilling stays. In my area, bulkbilling for anyone is scarcer that hens teeth. I know, I pay every time I visit my doctor. Sadly, the few that do bulkbill are lacking in what I consider to be reasonable skills. Did use them in the past, during my working life, to obtain that wasteful doctor’s certificate that bosses seem to need.

    Please what is the real role when it comes to bulkbilling. I believe this question to be important.

    Just for the record, myself and family suffered badly, back in the days when one relied on private insurance, back pre Medibank. IT DID NOT WORK.

  2. As we know, the government has backed down on the $20 rebate change which was to start on Monday.

    This doesn’t change the thrust of this excellent piece by Ad astra though – we still have the same government intent on dismantling Medicare with the same lack of nous Ad astra is talking about.

    He’s had more to say in comments over here:
    The Political Sword
    (January 15. 2015 04:15 PM)

  3. I am saying the main reason Abbott has to back down was the realisation, the mechanism was not in place to allow the changes t happen.

    As for the HM Ley announcements, they become more confused, every time she opened her mouth., Was not able to support any of her assertions in any way, except to fall back on her own observation and anecdotal evidence.

    Kept saying Medicare was not sustainable, when all available evidence point to the opposite.

    Good article. We need many more, revisiting why and what Medicare was meant to address in the beginning.

    LNP, with the aid of Dutton, in my opinion has set up a straw argument with no basis on fact or reality, which many seem to be buying. Yes, Labor back to basis.

    Examine all, with the aim of identifying what is important. What needs to be kept. What needs to go. Move on from reacting to Abbott’s move and shit, onto resetting Medicare in a way that deals with today’s needs and realities.

    The public bought it in the past. They just need to be reminded why. Nothing about it being as welfare measure, that this mob is attempting to turn it5 into.

    If bulkbilling goes, government has not control over managing cost or preventing huge increases.in services.

  4. Florence nee Fedup

    First, I do not pretend to be a full bottle on bulk billing.

    Like so many issues that seem straightforward on the surface, complexity complicates.

    Ideologically, bulk billing aligns with the Labor philosophy of universal health care, ready access for everyone, and the notion of a ‘fair go’ for all. Reducing bulk billing aligns with the Liberal philosophy of user pays, self-sufficiency, and not being a ‘leaner’. Labor prided itself whenever bulk billing rates went up. The Coalition prefers to see them go down.

    As far as doctors are concerned, the decision to bulk bill is both a philosophical and commercial one. There are three approaches. Some practices bulk bill certain patients, such as the unemployed, pensioners, or those receiving government support such as a Health Card; some add children and indigent patients. All other patients pay the full fee and receive a Medicare and/or a private health insurance rebate. Other practices rarely or never bulk bill; patients pay the full fee and receive what Medicare and private insurance rebates apply. The third approach is to bulk bill all patients. Some bulk billing practices believe philosophically in affording fee-free access to all seeking healthcare. Others see the practice as commercially attractive because it relieves them of the cost and burden of billing and fee collection, and because it attracts a clientele who would find it difficult to pay the full fee, or any fee at all. For some bulk billing practices, all these reasons apply. Of course millionaires who attend such practices also pay nothing, something that user-pays advocates abhor. It is common for pathology and imaging practices to bulk bill most or all patients, irrespective of their capacity to pay.

    When the Coalition made its recent move to impose a $7 co-payment, and more recently when it threatened to reduce Medicare payments for bulk billed patients, practices that solely bulk billed were horrified as it meant they would have to establish a mechanism for collecting the $5 for each consultation, often from those who could not afford it, or accept the loss of $5 per consultation from their practice income. Some said they would have to close their practices or discontinue bulk billing on the grounds that their profit margin would be too seriously squeezed. The veracity of such a claim could be ascertained only if the accounts of the practice could be inspected. Some see GPs as raking in large incomes, but they might be surprised to know that while they are not poor, most are not notably wealthy. They are at the bottom of the medical income totem pole.

    Politically, we see that the application of the Coalition’s user-pays approach and its pejorative attitude to those it likes to label as ‘leaners’, is driving its Medicare agenda, which has a sharp budgetary focus. It does not mind screwing doctors, or patients for that matter, in pursuit of its budgetary goal of saving money. Yet it eschews revenue raising through increasing the Medicare levy, a progressive tax that does not hurt the poor while it collects more from the wealthy. Nor has the Coalition taken steps to reduce concessions to the well off.

    Personally, I favour bulk billing for those who would be unreasonably burdened by having to pay the full fee, and there are plenty of those in the community: the unemployed and low income workers with families, pensioners and those receiving other entitlements, who find it so difficult to find the money for the doctor that they would chose not to go to one if they had to pay. The consequences of that for the patient and the healthcare system are obvious. On the other hand, those on good incomes are the ones who can afford to pay the full fee and receive their Medicare and other rebates.

    In summary, while the Coalition is in power we will see a continual assault on Medicare that will ease only when Labor is restored to power.

    I hope this answer satisfies your query.

  5. Thanks for that Astra5. Not many in my area bulk bill for anyone. Mine does, only if they want you to come back to check up on treatment. Only happened once, Also long waiting lists.

    I am not sure if you answered my question. Does Medicare pay more for those who are bulkbilled. I suspect it costs Medicare the same. It is the doctors who missed out, especially as Medicare payment in not being indexed.

  6. PS Millionaires should be expected to pay more through a progressive taxation system, not at the doctors. Most would have private insurance as well. They should not be given a rebate for doing so. Money better put back into the health pool.

  7. I agree Florence – bulk billing at the GP level should be universal. This makes the system cheaper to administer, for both doctors and government. Of course, the rates for consultations also need to be set at a level that provides GPs with fair payment for their services – perhaps a tribunal to set rates, rather than leave it up to governments.

    Where I live, you’d be hard pressed to find a GP who doesn’t bulk bill everyone – one advantage of a low socio-economic area and free market competition.

    Where my parents (both pensioners) live, very few doctors bulk bill – it costs them about $15 every time they have to go to a GP, and significantly more for specialists.

  8. Cost me nearly $40. On Central Coast. Specialist gap payments are becoming a real problem. Medicare Local in my opinion is not that successful here. Shame really.

    Time for Labor to come out, explain what we really have. Seems to have no connection with what is coming out of the likes of Dutton.

    I must admit, the doctors I have access to over the last couple of years have been first class.

    Bottom line is, that Bulkbilling does not seem to cost government more. It is the patients and doctors that have to meet the difference where there is no bulk billing.

  9. Florence nee Fedup
    Doctors who bulk bill a patient accept a discounted rebate from Medicare; in other words, they do not receive the full fee. I don’t have any current information about the extent of the discount, which varies with the length of the consultation.

    Allowing everyone, including millionaires, to be bulk billed might be reasonable if the Medicare levy were to be increased substantially so as to make this affordable to the health system. With the present levy, it is not. Which is why I contend that the well off should pay the co-payment that currently exists in many general practices, particularly those in affluent areas.

    The only explanation I can muster for the apparent reluctance of politicians of any persuasion to talk about increasing the Medicare levy, is that Abbott’s effective Great Big New Tax mantra, one he used so effectively against Julia Gillard, has scared all pollies, including himself, about ever mentioning it.

    Of course, universal bulk billing would have an impact on the private health insurance industry, which no doubt would try to preserve its income stream. There are always flow on effects from policy changes. They ought not to be ‘unintended’ as our government is claiming now about the $5 schemozzle, as flow on effects can and should be exposed during consultation with stakeholders well beforehand, a process this ‘adult’ government seems not to understand.

  10. What does private insurance actually cover? Does not cover doctors visits I believe. What does Medicare cover?

  11. Ahh medical ideology 🙄 .. I guess it’s different strokes for different folks….. I hope Abbott enjoys his… 👿 It’s just MORE proof that RWNJ’s don’t give a stuff about ‘the people’ or anything ‘for the people’, for them it’s all about ‘buy the people’……… mean while …back in Cuba……. ➡
    ….” The infant mortality rate in Cuba is lower than it is in the United States and is among the lowest in the world. [5] “….
    ….”In praising Cuba, the World Health Organization stresses that it is possible for Third-world countries with limited resources to implement an efficient health care system and provide all segments of the population with social protection worthy of the name. This is possible if the political will exists to put human beings at the center of the project. ”
    http://www.huffingtonpost.com/salim-lamrani/cubas-health-care-system-_b_5649968.html

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