Michael Gliksman: Risky policy

IT’S almost 40 years since the Whitlam government introduced a publicly funded universal health care scheme called Medibank, which became Medicare almost 10 years later.

We were the twelfth nation in the world to introduce universal health care.

Now an Australian government seems intent on destroying the battered principal of universality — access to health care that responds to individual need, not individual income — that has survived despite the gradual erosion of the real value of rebates by successive federal Labor and Liberal governments. And it is set to do it with the perhaps unwitting assistance of the AMA.

Under the government’s proposal, Medicare rebates will be cut by more than $3.5 billion, with GPs to collect a $7 copayment from each patient for each occasion of service. The proposals are deeply unpopular. The effect on the less well off would be devastating.

In an attempt to ameliorate the worst of those effects, the AMA has proposed changes that include:

•  No cuts to the Medicare rebate
•  No obligatory copayment for children, concession card holders, chronic disease and mental health
•  Elimination of the 10-visit threshold for children, concession card holders, chronic disease and mental health.

These exemptions from the proposed copayment represent a thinner, more acceptable wedge with which to cleave Medicare asunder. It terminates Medicare’s universality as effectively, if less cack-handedly, than the government’s proposal.

I have no objection to those who can afford it paying more for their medical services as an arrangement between themselves and their doctor. In fact, given the sustained assault on the real value of Medicare rebates, it is essential that doctors have this option so they can afford to continue to bulk bill those in need, as the majority of doctors already do.

However, patients paying according to their means should not be at the expense of access according to need. That is the principle that lies at the core of universality, and that is what is at stake.

The AMA represents a profession whose primary concern is the health of its patients and the government is seeking to introduce a policy that directly attacks that concern. There are other means to address the issue of inadequate rebates and underfunding. In my opinion, the AMA has no legitimate role in seeking to make the copayment more palatable if that is at the expense of universality.

All this may prove moot as the Senate is tipped to reject the government’s proposals, although there is always a chance deals will be done with the crossbenchers.

In the current political climate, given the unpopularity of the copayment proposal, one thing is certain — if the AMA had opposed it, this policy would have been delivered to the Senate already stone dead. Instead, it may have facilitated the delivery of Rosemary’s baby to the electorate, attractively disguised in silk wrapping.

Who do you think the government — and more importantly the people — will blame when the full effect of the loss of universal health care hits home?


Dr Michael Gliksman is a physician in private practice. He is a past vice-president of the AMA (NSW) and a past member of the AMA Federal Council. The views expressed here are his own.
Find him on Twitter: @MGliksmanMDPhD