Put people's health first
Media reports heralding the death of our public hospitals are premature. There is no crisis in the public hospital system — the crisis is in the private health insurance industry. None of the media reports state the obvious: there is no blow-out in Medicare or public health costs. Public health spending has been stable and cost control in the public system has been incredible through all of the 1990s. In addition, Medicare remains extremely popular and the most fair and equitable health system in the world. But the public hospitals are under pressure and the constant stories about a lack of funding for public health are very real. They are frightening for the community and, left unanswered, they can only undermine confidence in the public hospital system. Private health funds crisis Prime Minister Howard repeatedly asserts that "Medicare stays in its entirety". As recently as two weeks ago he again dismissed calls by the Liberal Premiers to scrap Medicare, saying "Medicare is the best health system in the world". But the Howard Government is also ideologically committed to saving the private health insurance industry. It is now widely accepted that the 30 percent private health insurance rebate will fail and is already failing dismally. The response of the Liberal State Premiers, with the Australian Medical Association (AMA) yapping at their heels, is to declare war on the public hospitals. They are demanding even more extreme measures to shore up the private health insurance funds. Their latest call is for means testing of public hospitals, and/or co- payments on patients to use public hospitals. Co-payments would be a tax on the sick. Research in the US shows that it would not in any event contain health costs. Means testing of public hospitals would be de facto privatisation of our public hospital system. (Means testing of Medibank by the Fraser Government in 1981 — when John Howard was Treasurer — resulted in two million Australians not being able to afford private health insurance or qualify for free care.) "The private health funds are the golden goose for the private doctors, particularly the private procedural specialists", says Dr Con Costa of the Doctors' Reform Society. Dr Costa points out that a gastroscopy, colonoscopy, arthroscopy or other relatively routine procedure is bulk billed at around $250 directly to Medicare. At most, a public patient might have a $100 or so out-of-pocket cost for the anaesthetic. For the same procedure a privately insured patient is billed around $600 and the private insurance is billed a further $600 for bed-day-fee and surgery fees — even though the patient may have only occupied the bed for an hour or two. "We do need a debate on how to pay for our health system", says Dr Costa. But he stresses that debate should focus on improving the system that works — Medicare — not on how to force Australians into a system that doesn't work i.e. private health insurance. Indeed, there are a few pertinent questions that need answering which would go some way toward addressing the needs of the health system: * If the Howard Government can "throw away" $1.5 billion annually on the public health insurance rebate, why can't we find $1.5 billion from the current large budget surplus for our public hospitals? * Why is the extra one percent Medicare levy on higher income earners who have not taken out private health insurance going back into consolidated revenue rather than going to Medicare where it belongs? * After squeezing the States in the last round of Medicare funding agreements, why has the Howard Government not come up with the extra $150 million they promised the States? * Why are we being railroaded into a debate about privatising the health system at a time when Medicare is working and costs are controlled, compared to the private system which is not working and where there is no cost control? Who sets the agenda? Any inquiry into funding of the health system should be predicated on the continuation of Medicare. This is clearly the desire of the great majority of Australians and the often stated position of the Prime Minister. In other words, any inquiry into health should focus on the people's system, Medicare, and how to improve it — not on formulating the ways and means of privatising the health system.