Medicare under attack — again
by Kerry Ans The Australian Medical Association (AMA), a medical lobby group which in the past has mainly looked after the interests of high income specialists, is stepping up its attack on the Medicare system. Last week it called for the means testing of Medicare rebates for general practitioner (GP) visits. Dr Kerryn Phelps, President of the AMA, claimed that bulk-billing is failing its customers. Her argument is that the low rebate paid by the Federal Government to GPs who bulk-bill puts pressure on those GPs to churn patients through, thus lowering the quality of care. Dr Phelps suggests that the Government has three choices in solving the quality of care problem. Means testing Medicare is one option; increasing the GP patient rebate from $22.50 to $44 is the second; doing nothing and eliminating bulk billing by attrition because GPs will refuse to provide access to it is the third. Given that in some lower income areas of Australia, GPs rely very heavily on the Medicare rebate for their income, the third option is not realistic and the fact that it is being put forward by Dr Phelps has put many GPs at odds with the AMA. The second option is preferable, from the point of view of retaining Medicare. The level of rebate — which has been virtually frozen for the last 10 years — should reflect a reasonable rate of income for GPs. While publicly ruling out the call to means test Medicare rebates, the Howard Government continues to undermine the public system, via its 30 percent rebate on private health insurance and the Lifetime Health Cover system. In electoral terms, the Government can't be seen to be attacking Medicare, but it is doing so by stealth. Good for patients and doctors Suburban and rural GPs have been picking up the gaps in public health provision over the past decade. The rundown of public infrastructure and loss of funding for many community health facilities has put additional strain on GPs. More funding for the public system would help them access the services they require for their patients. A fair remuneration for GPs as a part of Medicare provides the basis for a good health system for both patients and GPs. The AMA could make a considerable contribution to public health services if it campaigned for the Federal Government to lift rebates paid to GPs through Medicare to the $44 level which is put forward as one of the AMA's options, rather than speculating that Medicare is "on the way out". Medicare as a universal health system is highly popular with the Australian people and is supported by 78 percent of doctors according to a recent survey of GPs.