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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.
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An increase in the Medicare levy will be paid by the taxpayer, while the increasing number of patients on Centrelink will continue to use an increasing proportion of the health budget. without paying, so will not solve the problem. Centrelink fraud is another budget-draining political minefield which impacts negatively on the health dollar.
Let us look at the entire health budget, of which doctors cost a small percentage.
Health service administration cost , public and private , is the problem, not just the Medicare levy, which could never fund the increasing cost of administration.
Bulk-billing doctors do so because of the signicant reduction in administration costs compared with private billing. Introducing a compulsory co-payment for GPs will increase the cost to EDs and public hospitals. The health service administrators do not care, as Directors of Medical Services, Directors of Nursing, Health Service Managers, do not get called in at night like we do.
What is needed is a radical cut to administration costs in many areas of the health budget, and a restructuring of the Medicare rebate system, with input from health service providers rather than administrators.
Well Warren, I’m an older generation doctor but I am with you all the way on this! There is way too much dogma in these considerations and not enough use of evidence or compassion.
I am a younger generation doctor, and I became a doctor to treat sick people and maintain health. Unfortunately, the ABS and AIHW tell us that the sickest people are also those least able to pay for healthcare.
I don’t want a health system where the only people I will be paid to see are the healthy and wealthy. I want to be paid fairly to work in the areas of most need, and most benefit to society. I understand this means that the pay-per-service system in General Practice might not be the most sustainable nor affordable, and that other methods are worth a look. Like the NHS. I’m not afraid of informed debate on this, as these authors seem to be calling for.
My father’s cousin, Dr Mary Esslemont, was the only Scot and the only woman on the committee to begin the British National Health Service. Forty years later, she said “What a monster have created.”
In “Scottish Medicine – an Illustrated History”, David Hamilton writes: “With a Conservative government in power from 1979, Thatcherite free-market ideas for the NHS were aired. Though the Conservatives retained power until 1997, and moved to deregulate state industries, they hesitated to bring in major changes in health care, and although under increasing scrutiny, as a result of its popularity the NHS survived largely intact.”
Like the NHS, MediCare is a politically ploy. The government is unlikely to try to lose its members’ income!
Dr Mary’s opinion was that a small fee should be charged so that the patient has some financial input to the transaction, and thus, some responsibility.
The government cannot afford Medicare as it stands and an increase in the MediCare levy is not without reason.
Look well ahead !
Any governmental clique that has already shown itself to be capable of extremely vindictive destructiveness against its opponents can reach a point at which it will tell the AMA and medical profession what to do rather than agree to what the latter would wish to see changed.
How would you like the oligarchy to appoint a military person to oversee you one day ? Or are you not old enough to remember dictatorships ?
What particularly need an overhaul are the punitive, grandstanding organizations AHPRA and HCCC, which are there, I suspect, politically anyway, as windowdressing to show how much the Government cares for the little Aussie battler.
The day of the Little Aussie Battler has passed – we are somewhere else now – I don’t know where – and these organizations do not seem to be particularly efficient in their hunt for vicious wicked doctors – so they make much of persecuting (to the max) many doctors who have fallen by the wayside a little, and in relatively minor ways.
I think it is high time we looked at a co-payment for all services- perhaps small on basic consulting, and at a higher level for expensive imaging. This would tend to make patients consider the cost. Long term the concept of everything you want, at no cost, is unsustainable.
It is high time that the Medicare levy is increased to around 5%. The existing Levy is far too insufficient, what with the escalation in high technology use ( CT Scans / MRIs / Cardiac Investigations / etc ) & increasing use of Surgical modalities of therapy.
If the Populace wants the ‘ Latest ‘ Tests & the ‘ Latest ‘ modalities of Therapy, then they must pay a higher Cost, by way of a modest increase in Medicare Levy. The Pensioners / HCC Holders will not be affected by this increase.
I’d sooner a review of MediScare under a conservative government than under one likely to enhance its evolution into a UK style NHS with dictatorial powers. While they are at it, abolishing AHPRA and restoring the older, simpler, less expensive, state medical boards,with some federal superstructure to allow national, rather than only state by state, registration would make sense.
In a huge debt scenario, I doubt that the new government has any will to increase its financial commitment. I suspect that there will be a freeze on Medicare rebates, let alone a paltry CPI adjustment. While bulk billing levels are high there will be little incentive to tinker with the Medicare system.