The Guardian February 26, 2003

Howard Government killing Medicare

Since coming to office the Howard Government has undermined the Medicare 
system, not by openly cutting its funding, but by failing to increase 
funding to keep up with increases in prices and population. The Government 
now plans to means test bulk-billing and apply a co-payment for a 
consultation with a GP to everyone else. Such a move would sound the death 
knell of Medicare.

Already more and more doctors have been dropping out of bulk-billing 
because they simply cannot operate their practices economically, and more 
and more patients are being forced to defer seeking medical treatment until 
their condition becomes unbearable.

Country areas are particularly hard hit. Many country towns now have no 
bulk-billing practices, and those who seek such a service must face hours 
of driving to another town.

Last Friday federal Health Minister Senator Kay Patterson took another step 
towards finishing off the Medicare system by boycotting planned 
federal/state public health discussions, announcing that she would not 
attend the state/federal health meeting to negotiate agreements on funding.

This is part the Howard Government's strategy to withdraw from its funding 

The talks are held every five years. This month's meeting was due to 
discuss the crisis facing Medicare as a fee-free and universal health care 
system, and the Howard Government's proposed new Australian Health Care 
Agreement between the Commonwealth and the States. The current five-year 
agreement ends in June.

Last November angry State Health Ministers let it be known they would be 
demanding increased funding for Medicare.

The effect of Senator Patterson's boycott, and postponement of the meeting 
until after March, is that the States will have virtually no time to 
negotiate, and will be faced with a fait accompli from the Howard 

Under the Government's proposed means tested co-payment fee system, the 
consultation rebate provided to doctors would increase  but only for 
those on the lowest incomes.

Consultations with patients on higher incomes would only incur the same 
paltry rebate as at present. As a result, a means tested/co-payment 
Medicare would continue to be starved of adequate funds.

Bulk-billing would become a "safety net" provision, striking a decisive 
blow to the key principles of Medicare: universal access and fee-free 
services. As well as spelling the end of Medicare it would result in a two-
tier system of health care based on ability to pay.

An increase in funding is essential. The rebate paid to doctors when they 
bulk-bill needs to be increased immediately so that doctors can afford to 
bulk bill.

This, and the additional funding required by the public hospital system, 
could be provided by scrapping the $2.3 billion government subsidy (through 
tax rebates) of the private system, and redirecting the money to the public 

Last week more than 100 doctors, chairpersons of Medical Staff Councils at 
public hospitals around Australia, and representing thousands of doctors 
who work in Australia's public hospitals, published a joint statement in 
The Australian newspaper.

Denouncing the current crisis in Medicare and public health, they demanded 
that action be taken immediately to rectify the situation.

"Currently the Commonwealth is resisting the most important elements of a 
broad-ranging reform agenda produced by clinicians and endorsed by State 
Governments. Given that it is the Commonwealth that controls the purse 
strings, and much of the structure related to health care delivery, reform 
without Commonwealth co-operation is impossible", said the statement.

The doctors have organised a National Public Hospital Clinicians' Taskforce 
to communicate with the public and politicians in order to address "the 
many serious problems" facing the public health system.

"We see patients and their needs on a daily basis. We cope with the sadness 
and the frustration of the many Australians whom the system fails. We are 
fed up."

The Taskforce is calling on the public to add their voice by contacting 
their Federal Member of Parliament.

If a broad strong campaign is not mounted quickly to defend Medicare, it 
will be destroyed  by the failure of governments to adequately increase 
funding and through privatisation and government subsidies to the private 

Trade union involvement in particular would strengthen the campaign to 
defend Medicare. After all it is their members and families who will be hit 
by the loss of Medicare  as both workers in the sector and as patients.

The 2000 ACTU Congress adopted policy supporting universal access to bulk 
billing and the need to lobby for increased funding for public health 

The Howard Government was elected in 1996 with the promise to preserve 
Medicare, but since that time it has set about dismantling the system, 
while retaining the name.

As Dr Con Costa of the Doctors' Reform Society warns: "If the co-payment 
system comes in, it will change Medicare to a two-class system. The 
government will lose control over health costs, which will go through the 
roof, and we will eventually end up with a private health system."

"The government wants to cut Medicare, in order to fund its war ambitions", 
said Dr Costa.

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