Issue # 1405 1
A new public health care system needed
The government has widely publicised its “education
revolution” but far less is known about its “health reform” plan. The government
has emphasised that it will “maintain the principles of universality of
Medicare and the Pharmaceutical Benefits Scheme, and public hospital care”.
The question is what will people have universal access to and under what
conditions? At present Medicare and public hospitals are administered and
run by the federal and state governments respectively. The private health
industry is dying to get its hands on the public health system and they
may well do so if the government’s health plans takes off.
Soon after coming to office the Rudd Labor government set
up a number health inquiries, including the National Health and Hospitals
Reform Commission (NHHRC) which is to deliver a long-term health reform
plan by June.
Like all governments planning radical changes, the selection
of committee members is the key to getting the intended outcomes. There
is no need to look beyond the Chair of the Commission to determine its ideological
direction. Dr Christine Bennett is the Chief Medical Officer of BUPA Australia,
better known by private health insurance brand names it owns in Australia
– HBA, MBF and Mutual Community. BUPA is a transnational corporation, with
global operations in health insurance, aged care and other health related
The other Commission members have a range of experience
in the private sector, academia and government departments and one as president
of the pro-private sector Australian Medical Association. Health unions
and other trade unions, the Doctors’ Reform Society, the Australian Health
Care Reform Alliance (AHCRA), the Australian Consumers’ Association and
other progressive organisations have no voice on the Commission.
Backdoor privatisation of Medicare
There are fears that the government has plans for people
to belong to a private health insurance fund, even if they have no private
health cover. The government would pay the private health fund a certain
amount per member and the company, instead of Medicare, would hand over
refunds for medical expenses and fund hospital visits. Those wishing a higher
level of service beyond the most basic of treatment would be able to top
up with additional medical and hospital cover. Public hospitals would provide
basic services for the poor who do not have any top-up insurance.
The end result would be a private managed health care system
along similar lines to that in the US. The national health insurance provider
Medicare would in effect be privatised as its operations are taken on by
competitors in the private sector.
The NHHCR released an interim report in mid-February allowing
one month for its distribution, “a national debate” and feedback! It presented
three options for discussion. None of these options promoted a fully integrated
public health system centred around Medicare and a well-funded public hospital
system. Nor did they address the billions of dollars of public moneys that
prop up an otherwise unsustainable private hospital system.
In fact, Health Minister Nicola Roxon made it absolutely
clear from the start of the inquiry that the retention of the 30 percent
rebate on premiums paid to people who take out private health insurance
(PHI) was non-negotiatable. This subsidy to the private insurance companies,
and through them to the private hospital system, costs taxpayers an uncapped
$3 billion plus per annum.
Delegates to a recent AHCRA conference were stunned when
the Health Minister Roxon unequivocally declared her personal support for
private health insurance and the private health sector. She declared that
the PHI rebate would be a fundamental plank of her government’s health reforms.
AHCRA is a coalition of 46 organisations representing consumers and health
care providers, including the DRS and health unions. It is a strong advocate
of the public health system.
The PHI rebate plays an extremely destructive role, diverting
billions of dollars away from the public hospital system and from other
areas such as primary health and community care. The private health system
is a drain on the public purse with its higher costs and layers of profit.
It has become a means of queue jumping for those who can afford it.
In addition to the $3 billion plus in PHI rebates, it drains
millions more dollars from the public purse with a one percent discount
in the taxation rate paid by the rich who take out PHI. Those on very high
incomes save many more thousands of dollars with the tax cut than they pay
in private health cover. It is an absolute rort and should be ended.
The minister is supportive of the private sector running
the new super clinics when tenders are called for, “as long as they provided
the services that were required”. Will the public sector be competing with
the private insurance and other corporate and church agencies, or will it
just be bypassed altogether?
The NHHRC’s interim report recognises the importance of
dental care as a health issue, but seeks to separate it from general health
care and Medicare. It proposes Denticare, a dental scheme that would be
funded by the government and administered by private health insurance companies.
At present people with chronic illness can receive full
rebates through Medicare for dental treatment where their dentist has agreed
to be part of the system. Instead of extending the scheme to make it universally
available, the government intends replacing it by a scheme for the poor.
The three options presented by the report take up different
approaches to federal-state roles in the provision and funding of health
services. They talk about strengthening primary health care and take up
Indigenous, rural and aged care services – all important areas which are
in crisis. At the same time they fall short on how to do this.
All options fall short on the immediate priority of fixing
the public health system which is chronically under-funded and under-staffed.
Pubic hospitals need more funding. At present their funding is capped at
an unrealistically low level by federal and state governments. This chronic
under-funding is political. It has the objective of driving people through
fear and desperation into the private system. The PHI rebate is to make
it financially possible. After all, who wants to risk being on a waiting
list for months with cancer or wait weeks or months for a test when in pain?
Funding is not the only issue that needs addressing. Hospitals
have become the default destination of patients who are not necessarily
in need of the high cost services and high level of care that they provide.
It is estimated that on any one day 2,000 or more public hospital beds are
taken up by elderly people who are stuck there because of the lack of available
beds in other more appropriate institutions.
Existing nursing homes are chronically understaffed and
many of the staff under-qualified. GP shortages and lack of doctors prepared
to bulk bill place additional pressures on public hospitals. Some rural
and remote areas are without GPs. The lack of provision of suitable Indigenous
health services is nothing short of scandalous and criminal.
Primary health care services are either unaffordable or
lacking in the mental health area. The community care programs that were
supposed to support people with mental health conditions when de-institutionalisation
took place are totally inadequate.
If these issues were addressed and preventative and community
health care improved, then many of the conditions that lead to hospitalisation
could be avoided.
The Communist Party of Australia is calling for major reforms
to the health and community care services in Australia. These should be
based around the following principles:
- universal access – regardless of income or locality
- free services at the point of delivery
- services to be of the highest quality
- services funded through central taxation revenue
- services provided by the public sector
- planned system of training, staffing and provision
Funding and planning are critical. The economic crisis does
not preclude finding the necessary funds to build a public health system
on the above principles. The present under-funding is ideologically based
and a matter of lack of political will.
The 30 percent (40 percent for older people) PHI rebate
should be abolished. This would free up more than $3 billion to provide
a quality health care program. A 10 percent cut in military expenditure
would not endanger Australia’s security, but if redirected to health and
other social services including education, would improve the well-being
and security of the Australian people. That would free up another $2 billion.
Funding to public hospitals must be increased as a matter
of urgency. As an initial step, while rebuilding the public hospital system,
private hospitals would be directly subsidised for private patients at $300
a night per patient. This would be phased out over several years.
The question of how doctors are paid needs reviewing, with
a focus on components for salary and other costs to replace the present
focus on payment per patient consultation. Funding per visit through Medicare
rebates has lead to rapid churning of patients in some practices and made
it more difficult for doctors to give the time needed and for the elderly
and chronically ill, in particular, to receive the attention they need.
Dental health should become an integral part of Medicare.
Aged care should be taken out of the hands of the private
sector and philanthropists.
Measures are needed to overcome the shortages of qualified
nurses, GPs, medical specialists, aged care, and other health professionals.
This needs planning in conjunction with universities and other training
institutions. It cannot be left to “the markets” any longer. It is scandalous
that nursing homes and hospitals are largely staffed through a brain drain
from poor nations.
Substantial increases in funding are required for preventative
health care and community care services, for Indigenous health programs,
for aged care, mental health and rural and remote areas.
These goals can only be achieved through planning and coordination
by the public sector. The development and provision of services needs community
Next article — Ferry
privatisation not in the publics interest
Back to index page