- by Anna Pha
- The Guardian
- Issue #1989
The Liberal-National Coalition has never supported Medicare, constantly undermining it since its introduction. Coalition governments have frozen bulk billing rebates for doctors for years on end; items are now being removed from the Medicare schedule; and in 2014 the Abbott government attempted to introduce a gap payment for “bulk billed” patients. Fortunately, public pressure put a halt to that.
Medibank, Medicare’s predecessor, was introduced by the Whitlam Labor government. It should be recalled that following the coup that ousted Whitlam the Fraser Coalition government immediately abolished Medibank. For-profit, private provision based on free-market greed is the Coalition’s ideal health care system. The battles for Medibank and supply were the most bitterly fought political and constitutional struggles of the Whitlam government. Repeatedly blocked by the Coalition in the Senate, the parliamentary gridlock over Medibank legislation provided a trigger for the 1974 double dissolution election.
Whitlam won the election, but not the Senate. Another rejection of Medibank led to the only joint sitting of the two houses of Parliament – finally passing the bills. This drawn-out process, and prolonged negotiations with the states to end means testing of public wards in their hospitals, meant Medibank only came into effect in July 1975.
After 1975, despite promises to preserve Medibank, Malcolm Fraser’s Coalition government undermined the new scheme. Medibank was abolished and only later reinstated as Medicare Private offering private health insurance.
Universal access to medical care is fundamental to building a healthy society. Medical expertise, medical institutions, and medical research are part of Australia’s social aspirations for a physically and psychologically robust community, and should not be as capitalism would have them, mechanisms for generating profits. Access to health care is a right, not a privilege.
A nationalised health scheme providing a quality primary care system with GPs, nurses, allied and community health working together must become our frontline for maintaining people’s well-being with emphasis on preventing disease, including early detection of illness.
The privatisation of Australia’s health system is socially iniquitous, it leads to the wasteful private health insurance rebate which is driving further privatisation of Australia’s health system, and which will lead ultimately to the restriction of health care to those who need it but cannot afford it and the means-testing of public hospitals.
Our public hospitals are under extreme pressure. The CPA rejects the privatisation of the system and stands for a health care system that first and foremost meets the needs of working-class Australians and other marginalised and disadvantaged groups – especially Indigenous Australians – in their local communities, local health clinics and local hospitals. We strongly oppose the introduction of a co-payment or means testing of access to Medicare or public hospital treatment.
A planned expansion and development of the health system has the potential to create more jobs in research and service areas.
The CPA advocates:
A nationalised health system under local control, with high quality and “free” at point of delivery care, according to need rather than the ability to pay.
Accessible quality medical and dental treatment for all Australians, bulkbilled under Medicare, centrally funded through progressive forms of taxation and focused on the needs of working Australians and their families, the elderly and the sick.
Team-based care focused on early intervention and providing care in the community and in the home.
Priority emphasis on preventative medical services including campaigns by governments to educate people about healthy lifestyles, the importance of vaccinations, regular tests and check-ups. Preventive medicine should also encompass restrictions on corporate advertising and on the production and sale of unhealthy products.
An expanded Pharmaceutical Benefits Scheme (PBS) so that all effective medications remain affordable for all Australians. PBS scripts should be free for all unemployed, pensioners and other card-holders, and the cost for others reduced. This must include the Pacific region that benefits from the lower costs of medications as a result of the high purchasing power of the PBS.
The public control of pharmaceuticals, diagnostics and medical supplies along with the employment of salaried staff specialists, and public hospitals.
The development of a publicly owned pharmaceutical manufacturing industry so that Australia has some independence from shortages in overseas supply, and during critical moments such as major pandemics. Australia should withdraw from agreements that prohibit such production and not sign new ones; in particular the Comprehensive and Progressive Agreement Partnership (formerly TPP) with its intellectual property provisions.
The improvement of the public system in outer suburban, rural and remote areas with measures put in place to ensure the health system caters first and foremost for working families and the sick and the elderly in these communities.
Strong health and safety rules in the workplace to prevent worker injury.
The support of a system of generous workers’ compensation benefits for all injured workers and their families.
The retirement age for those on shift work to be set at five years before the rest of the workforce due to increased aging effects of their work patterns on the body.
The opportunity for workers and local communities to have a say on where their health facilities are placed and how they are managed, including having a voice on local hospital boards.
The urgent expansion of the provision of mental health services.
Funding increases for people with disability should be brought forward, and NDIS services provided by the public sector.
One of the health privateers’ most recent tactics is a push for certain individuals to be denied access to Medicare because they refuse to be vaccinated, creating a dangerous precedent. Medicare is based on the principles of free, universal access and no-fault insurance. Everyone contributes through the centralised taxation system and Medicare levy based on their taxable income.
Any proposal to undermine the fundamental principle of Medicare – universal access to medical treatment and care – is music to the ears of the Morrison government.
The public health system was under considerable pressure well before the pandemic. The pandemic has exposed the lack of funding, understaffing, under-resourcing, shortage of public hospital beds, and decades of neglect by successive governments, which has been a political football between state and federal governments.
There is no doubt that in NSW and Victoria the pandemic has placed extra strains on the public health system. It should be ringing alarm bells that two thousand NSW nurses have not renewed their registration, no doubt many of them burnt out from years of being overstretched. COVID was the straw that broke the camel’s back.
The Australian Nursing and Midwifery Federation (ANMF), is calling for urgent funding and resourcing of Australia’s overstretched public hospital system to ensure that health professionals can deliver safe, quality care to the community.
Beth Mohle, Secretary of the Queensland Nurses and Midwives’ Union, makes the point: “Nurses, midwives and health care staff see firsthand the impact of unprecedented demand on our health services and beds. Invaluable staff are burning out trying to provide quality care under extreme conditions. Our governments need to urgently address these issues and listen to our solutions so we can continue to provide the quality care Queenslanders deserve.”
The solution does not lie with denying sick people hospital beds or ventilators if they cannot afford them or undermining Medicare. Federal and state governments have a responsibility to adequately fund and staff the public health system. It is a clear pointer as to federal priorities that the federal government hands out more than $6 billion a year in subsidies to the private hospital system through private health insurance (PHI) rebates.
Even more so that at the same time it has gradually been winding down its share of the public health bill, leaving the states to carry a greater proportion.
There is a creeping Americanisation of the health system in Australia towards a two-tier system by starving the public sector of funds. The US’s mostly private health system consumes 17.7 per cent of Gross Domestic Product at the same time as treatment and private health insurance cover is unaffordable for tens of millions of citizens.
FUND THE PUBLIC SECTOR
Even the conservative Australian Medical Association (AMA) notes that the current agreement with the States has taken out $14 billion in Commonwealth funding since 2015-16, and $32.4 billion in total when combined with the States’ contribution, due to indexation below health CPI and the cap on growth.
Apart from the past two years, the population has been increasing and ageing during that period – i.e. demand was increasing.
In Australia long waiting lists and fear of not gaining access to public hospitals and specialists when needed are driving many people to take out some form of private health insurance.
Instead of spending billions on nuclear submarines, missiles and other weapons of mass destruction (the military budget is set at more than $1 trillion over twenty years) the government should instead be focused on saving and improving the lives of the people.
If public hospitals and public health services were funded as a priority, then the system would not be under the pressure it is. It would also be equipped to cope with surges in demand such as during a pandemic.
Dr Tim Woodruff, President of the Doctors’ Reform Society, points to the failed US model which is now seeing declining life expectancy and increasing infant mortality because of its emphasis on privatisation, including having employers pay for employees’ PHI. “It’s a disaster,” Woodruff says.
Woodruff asks: “Why not just support the public health system better rather than giving tax rebates for employers to give private health insurance to employees?”
As the AMA noted: “The COVID pandemic demonstrated just how important a strong, resilient public health system that is properly funded to cope with surges in demand is. We need to ensure that we don’t now neglect the system and cause unsustainable pressure on our healthcare professionals.”