Interview: Staying Alive
Bad Boss: The Ultimate Piss Off
Industrial: Last Drinks
National Focus: Around the States
Politics: Radical Surgery
Education: The Price of Missing Out
Legal: If At First You Don't Succeed
History: Massive Attack
Culture: What's Right
Review: If He Should Fall
Poetry: If I Were a Rich Man
Satire: IMF Ensures Iraq Institutes Market Based Looting
The Locker Room
Charities Brace for Medicare Backlash
Court Throws Out Cole Prosecutions
Child Actor Dodges Broken Voice
Rio Tinto: $40 Million for Boss, Eviction for Workers
Winning Poster Shouts at Freeloaders
May Day Tragedy Claims Union Lives
Westfield Cleaners to Down Mops
Question Marks Over Nursing Home
Burn Payout Highlights Compo Fears
Costa Blows Whistle on Canberra Raid
Bob Gould Sprays Gerard Henderson
War and Peace
A Strange Light
A Little History
Does It Have To Be?
Labor Council of NSW
"We will be proposing change to Medicare which amount to its de facto dismantling ... we'll pull it right apart"
John Howard, Leader of the Opposition, June 1, 1987
Finally, 16 years after putting those words on the public record, Howard is set to deliver on his promise, reducing Medicare from a universal health insurance scheme to a safety net for the poor, and a flimsy one at that.
This month's budget will allow general practitioners to start charging upfront fees whilst still billing the public purse for every consultation.
The Government will make that conditional on doctors agreeing to bulk bill pensioner cardholders.
And that will be Howard's out. He will claim that a degree of user-pays is the only way to save a system buckling under the weight of increased expectation.
But the argument doesn't stack up. Deliberate Government policies, allowing bulk billing payments to doctors to fall behind costs, have created the faultline the budget purports to address.
Since Howard came to office seven years ago bulk-billing rates have plunged, from covering more than 80 percent of doctor visits to barely 69 percent. Hardly surprising, as payments to participating GPs have moved only marginally during that time.
Doctor organisations reacted predictably, holding lunches and dinners where tax specialists and private health officials lectured on how they could quit the Medicare system.
In at least one Victorian town where Australian Medical Association members staffed the local hospital's emergency department they refused, point blank, to admit patients of bulk billing doctors, forcing ambulances to travel to another township.
By drawing the purse strings Howard has created a crisis. He could have addressed it by putting the extra $500 million tagged for bulk billing in this budget towards improving doctor rebates but instead chose a dual system which strikes at Medicare's core - universality.
Co-payments, initially, are expected to be around $20 for the majority of Australians who will now be charged to visit bulk-billing doctors. But there is no limit and that figure is expected to escalate rapidly in much the same manner as private health fees have.
And just in case anyone misses the signpost, Howard will usher private health through the front door, inviting it to write policies to cover the gap.
This is a significant change of direction.
The Other Legs
But bulk billing is only one leg of the barstool on which private health is being encouraged to flaunt itself.
The first was the private healthcare rebate under which Government subsidised those who threw in their lot with private companies.
"A gigantic tariff protection scheme for an industry that was losing customers," is how Women's Health Victoria general manager, Marilyn Beaumont, characterises 30 per cent rebates that cost the public purse $2.3 billion a year.
Hundreds of thousands of Australians picked up that offer but only after Howard threatened them with the stick of steeply rising policies for the rest of their lives if they didn't sign up then and there.
Then there is the vexed issue of Australian Health Care Agreements, the five-year funding arrangements by which the Commonwealth funds states to run public hospitals.
There have been all sorts of shenanigans on this one. The latest stroke pulled by Federal Health Minister, Kay Paterson, being her refusal to attend the February meeting with state counterparts that was supposed to have signed off on the next agreement.
Instead, Government, last week, unilaterally announced its funding package ... and, it will chop this figure by four percent unless states and territories increase their share of the pool.
Every state and territory says it is being ripped off. NSW, alone, claims it will be underfunded by $875 million over the life of the agreement.
States and territories accuse the Howard Administration of:
- sitting on proposals from invited nurses, researchers and academics who had been asked to make recommendations on an improved national health system
- costing public hospitals $364 million annually by allowing private funds to pay much higher fees for patients in private hospitals than for members who undergo procedures in the public system
- further subsidising private health by making public facilities carry Emergency Department, chemotherapy and home-based services for the privately insured, without any contribution from their funds; and
- increasing pressures on the public system by introducing Bulk Billing co-payments which, they say, will see more Australians line up at emergency departments.
While $10 billion sounds like a truckload of money, AMA analysts value the rate of increase at 5.6 percent a year.
States and territories claimed they needed annual increases of 7.96 percent just to stand still. The same level of indexation, coincidentally, which Federal Government provided private health operators for the years 2001 and 2002.
This week's consumer price index found the cost of health services and products had risen by 7.2 percent in the 12 months to March.
This Federal Government gives every appearance of bending over backwards to give the privateers a leg-up while baulking at anything that might bolster the public system.
It is a concern shared by the ACTU, health unions, Doctors Reform Association, women's health organisations, aged care consumers, pensioners and superannuants associations, as well as Save Medicare groups springing up around the country.
They point to World Health Organisation figures to argue Australia's Medicare-based system stacks up against its US counterpart on every meaningful measure.
Health Not Wealth
Currently, the Australian system is universal, providing care on the basis of need rather than wealth. Its standards are world class, evidenced by the fact that when the country's richest man, Kerry Packer, needs serious treatment he goes into a public hospital, rather than any of the private clinics he could easily afford.
The existing system costs Australia 8.9 percent of GDP.
The US system, on the other hand, is privately-funded. More than 40 million Americans, including six million children, have no health cover and, hence, no entitlements. Health care costs easily outstrip the rate of inflation and, even then, insurance companies can refuse or reduce treatment.
Health costs eat up 14 percent of GDP in the US.
Little wonder then that open attacks on Medicare have come to be regarded, even by the Liberals, as political suicide.
The opening quote from Howard was made only three years after the scheme was introduced but it is doubly revealing because in the same interview with Sydney radio station, 2GB, he entered into specifics on how Medicare could be dismantled - pulled apart.
"The second thing we'll do is get rid of the bulk billing system. It's an absolute rort."
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