Jane McCredie: Friending Medicare

IN 2005, then Health Minister Tony Abbott famously declared that the Coalition government of which he was part was “the best friend Medicare has ever had”.

The comment related specifically to a recovery in bulk-billing rates (which had initially plunged under the Howard government) but it also signalled a shift in the long-running ideological wars over Medicare.

Thirty years on from the Whitlam government’s introduction of Australia’s first universal health insurance scheme, Medibank, it appeared the conservative side of politics had finally made its peace with the concept.

Perhaps it’s more accurate to say the supremely pragmatic Abbott and his colleagues had finally accepted there are some things it’s just too politically risky to take on.

Medicare is an unwieldy beast, but there can be little doubt that Australians are attached to it. Politicians — particularly those on the conservative side — mess with it at their peril.

Attempts by previous Coalition governments to wind back universal health insurance left them vulnerable to Labor claims they had a secret plan to destroy the public scheme.

An unfortunate consequence of the charged atmosphere surrounding Medicare is that it has put serious reform of the system pretty much off the agenda for both sides of politics.

In a book released this month, Making Medicare: the politics of universal health care in Australia, healthy policy analysts Dr Anne-marie Boxall and Dr James Gillespie argue the politicisation of Medicare has prevented rational debate about some of its structural problems.

“[The] sustained political battles over health care in Australia created an atmosphere in which serious discussion about reforming Medicare became difficult, if not impossible”, they write.

“Any suggestion that there were serious flaws in the system, or even just that some tinkering with its architecture was needed, caused Medicare’s supporters to fear the floodgates were being opened to the barbarians and that the end of Medicare was nigh.”

There’s been some fiddling around the edges, but Australia’s universal health scheme remains at its heart a product of 1960s and 1970s policymaking, as the authors make clear.

We were younger then (and thinner). Most of us only sought medical attention when we had a specific illness that needed treating and we either got better, or we didn’t.

Today we are far more likely to be living with a chronic complaint: we’re not going to get better, and we are going to need ongoing, and preferably multidisciplinary, care.

Both sides of politics have tried to adjust Medicare to meet this new reality, though Boxall and Gillespie describe the attempts so far as “halting”.

The demographic changes of the past 40 years are not the only cause of the structural problems in the system.

The Medicare rebate system is complex, confusing, slow to respond to technological change and evidence-based medicine, and often inconsistent in the levels of remuneration it provides for different kinds of services.

Any attempts at reform tend to come up against vested interests of one sort or another, with professional or other groups prepared to whip up a storm of controversy at the slightest encroachment on their turf.

With both sides of politics now having stated their commitment to universal health care, it’s time we did more to ensure Medicare delivers on that promise.

For all Abbott’s claims as Health Minister, bulk-billing is a pretty limited measure of that, as Boxall and Gillespie make clear.

It doesn’t take into account, for example, the difficulties people in rural and remote areas have in accessing care in the first place, or the cost of other components of care such as medicines (and don’t get me started on dental care).

It will be interesting to see whether our newly elected Prime Minister can move beyond the political wrangling of the past and prove himself a true friend of universal care by addressing the shortcomings of the current system.

Jane McCredie is a Sydney-based science and medicine writer.

COI: Jane McCredie commissioned Anne-marie Boxall and James Gillespie’s book in her former role as a publisher at UNSW Press.
Professor Stephen Leeder, editor-in-chief of the MJA, wrote the forward for the book.