The prognosis isn't good
The Medicare system is in trouble and, with Dr Howard and his privatisation practitioners in charge, the outlook for public health isn't good at all. Having failed to adequately fund Medicare, the Pharmaceutical Benefits Scheme (PBS) and the public hospital system, the Federal Government is proposing to adopt policies that will make patients pay. Their major objective is the destruction of Medicare. While the majority of doctors supported bulk-billing when Medicare was introduced and still do, those who continue to bulk-bill for their patients have been steadily declining. This is a direct result of the failure of the Howard Government to provide extra funding for Medicare standard fees to allow for inflation and the increased costs facing doctors. The extra load this has placed on medical practices has been exacerbated by the collapse of insurance companies, resulting in a huge rise in the cost of medical indemnity insurance. The Government has left them with no alternative than to charge their patients for an amount over and above what they recoup through Medicare. According to Tim Woodruff, National President of the Doctors' Reform Society, the nation's sickest patients are spending on average $750 more per annum on medical treatment. "Patients are putting off seeing their doctor because of costs, and ending up sicker and going to the overcrowded public hospital emergency departments.", he said. AMA President Karryn Phelps stated, "Unless the government acts to address the inadequacy of the MBS, it won't be long before bulk-billing GPs in Australia are extinct." In reply, Federal Health Minister Kay Paterson claimed that the number of specialists who bulk-bill has risen. This is, however, a desperate red herring as specialists who bulk-bill comprise a small proportion of the total number of doctors. The Minister acknowledged that the overall number of doctors who do not bulk bill is now over 25 percent of the total. The latest rise of 0.7 percent in non-bulk-billing practices means that some 2.5 million more patient calls to doctors in a 12 month period will now not be able to access bulk-billing. The situation is particularly acute in the country. In many towns there is no bulk-billing medical practice, and in some towns there is no medical practice at all, resulting particularly from the crisis in medical insurance. Dr Woodruff commented: ".in the country [people are] simply not going because the doctors have left. That means patients are not getting treated properly, or [are] simply not going for treatment. Many will suffer. Some will die." To make a living some medical practices may be tempted to favour "quick turnover" consultations, such as those for recurring asthma and diabetes, rather than to drop out of the bulk-billing system altogether. The general insurance crisis in Australia has been reflected in medical insurance costs which, for some practitioners, have risen 400 percent. Melbourne's Footscray West Medical Clinic, which opened last year with the specific purpose of providing a bulk-billing service for local residents, may have to alter its policy because the shortfall in Medicare rebates and the rise in insurance premiums are making the practice economically unviable. The clinic is considering limiting Medicare billing to students, pensioners and healthcare cardholders, for week day attendance only. Governments are considering several steps to deal with the insurance crisis. They include subsidising premiums for high-risk medical practices, reimbursing medical defence businesses for 50 percent of claim payouts greater than $2 million, and imposing a special levy on half of Australia's doctors, to pay for medical insurer UMP's shortfall of $390 million. In short, governments want to subsidise the medical insurance industry. Further support for Medicare is, apparently, out of the question for the Howard Government. Pharmaceutical benefits The Government has also failed to provide adequate funding for public hospitals, and interfered with the independent running of the Pharmaceutical Benefits Scheme (PBS), the operating costs of which have increased substantially since the enforced replacement of most of the PBS Board. Some of the new Board members appear to be far more sympathetic to the pharmaceutical companies than their predecessors, when it comes to determining what drug to be put on the PBS list. One of the Howard Government's key responses to the developing pharmaceutical crisis is to propose legislation to increase the "co- payment" (i.e. the amount that consumers must pay for subsidised pharmaceuticals). Concession cardholders and pensioners must now pay $4.60, a 28 percent increase, for PBS listed medicines. Others will pay $28.60, a 20 percent increase. Although not originally intended to do so, the PBS is of benefit to pharmaceutical companies as well as to patients. It broadens the consumer base to include those who previously could not afford the medication and would have either sought alternative medication, adopted a healthier lifestyle or simply gone without. As a result the pharmaceutical firms sell more of the subsidised medications. The PBS was established to make available to the public at reasonable cost crucial pharmaceutical products needed to deal with life-threatening or painful diseases. However, under pressure from the drug companies, the PBS list of subsidised products has now been expanded to include drugs that can scarcely be included in this category. As a result, the cost of funding the PBS has risen substantially. Although this situation was a result of opening the floodgates to the drug companies, the government now wants to relieve the financial pressure on the PBS by making patients pay more. The Government's previous attempt to introduce these savage increases was blocked in the Senate. Significantly, the Government has now decided to reintroduce the legislation. It has already held talks on the issue with former Democrats leader Meg Lees, of GST infamy, and is believed to have also discussed the issue with other right-wing rebel Democrat senators. Treasure Peter Costello stated recently that if the rising cost of PBS was not reined in, the system would "break" and "we will not be able to make available to Australians the kind of pharmaceuticals they want." However, the Treasurer's statements on PBS, which he describes as "the fastest-growing area of government expenditure", is deceptive. PBS is of enormous benefits to the Australian people, and its cost pales into insignificance compared to Government's blank cheque for military expenditure. This is particularly so in view of the extra amount now needed to fund the Government's role as sidekick to US overseas military operations, an expenditure of no public benefit.