The Guardian April 30, 2003


Hands off Medicare!
Medical care is right not a privilege

by Andrew Jackson

Universal access to free medical care is a right. All Australians, no 
matter how wealthy or how poor, are entitled to the same treatment in a 
public hospital or from a medical practitioner.

Prior to the last Federal Election Howard promised to maintain Medicare and 
retain bulk billing. This week John Howard promised Australians a "Fairer 
Medicare".

What he has in fact announced is the end of universal access to bulk-
billing and the eventual complete destruction of Medicare.

No one, but no-one, believed Mr Howard's rosy spin.

"The impact of it . I believe will be very beneficial on bulk-billing 
rates" , Mr Howard told an astounded audience.

Dr John Deeble, the original architect of Medicare said he expects a 
dramatic decline in bulk-billing from 70 per cent to 50 per cent over the 
next two years.

"I don't think there's anything in this package to encourage doctors to 
inflate their fees", said Mr Howard with a straight face.

Dr Costa of the Doctors Reform Society tells us: "The new changes will make 
it easier for doctors to charge a hefty co-payment  and this co-payment 
will continue to grow over time".

Health Minister Kay Patterson said that under the Government's scheme, 
"nothing will change, except it will be more convenient for patients".

Disagreeing, Dr Kerryn Phelps of the Australian Medical Association said 
the package represents a "seismic shift" in Medicare.

David Rivett, the AMA's spokesperson on General Practitioners said simply: 
"I don't think it's going to work".

What is clear is that the "Fairer Medicare" package will be the largest 
single backward step in Medicare's 20-year history.

Co-payments

Mr Howard insisted there would be no means testing and no "co-payments"  
but this is exactly what his plan entails.

The Australian public will be separated into two distinct groups when 
seeking medical attention  those who hold Health Care Cards and those who 
don't.

Eligibility for a Health Care Card is already means-tested.

Australians who don't hold a Card will now almost certainly lose access to 
bulk-billing for a medical consultation.

Under our current Medicare system if the doctors want immediate payment 
they have to insist on full up-front payment and get the patient to claim a 
rebate from Medicare.

Originally, this was designed to make bulk-billing attractive.

Under Mr Howard's "Fairer Medicare" the attending doctor will be able to 
bill Medicare for the subsidised portion of the fee, but then also charge 
the patient a co-payment on top.

"The Government proposal to allow doctors to directly charge Medicare plus 
charge an up front co-payment simply makes it quicker and easier for 
doctors to charge what they like and retain bulk-billing just for the 
'needy'", says Dr Tracy Schrader, Qld Secretary of the Doctors Reform 
Society.

Back of the queue

Mr Howard will then be offering an "incentive" of $1-$6 per patient, 
depending on geographic location, for doctors to bulk-bill Health Care, 
Veteran and Pension Card holders.

"The private charging person will be paying $50 or more and the pensioner 
will be rebated at $26, so the poor and the elderly who really need to 
spend time with the doctor will be getting less time and less health care", 
said Dr Costa.

"The concept that bulk-billing should only be for pensioners and health 
care card holders will lead to many of those patients being treated as 
second class citizens, left to wait at the end of the queue behind the 
'paying' patients", said Andrew McCallum, President of the Australian 
Council of Social Services.

"One of the major attractions of the present universal system is that such 
discrimination is much less likely."

Caught in the middle

"Low income families and the working poor will be the big losers", says Dr 
Costa.

"The bigger the family the more expensive the health care."

If a family is just $1 over the Health Care Card cut-off line, then they 
will be hit with the same co-payments for health treatment as the very 
wealthiest in Australia.

Families, average and low-income earners will struggle to pay, queue in 
hospital emergency departments or end up not seeking medical treatment at 
all because of their inability to meet the co-payments on services.

Not just your GP

The changes will impact beyond bulk-billing by GPs. It also opens the doors 
for extending co-payments to other medical services currently bulk-billed.

The President of the Combined Pensioners and Superannuants Association of 
NSW, Bill Whiley, said, "This package will encourage co-payments not just 
on GPs fees, but on other medical services such as pathology."

This fear was confirmed immediately when the Royal College of Pathologists 
of Australasia said it was about to start negotiations on a new funding 
agreement, and bulk-billing "will certainly be on the agenda, particularly 
in light of the changes announced today", said Dr Debra Graves, CEO of the 
College.

Also in line for co-payments would be operators of other services that are 
currently bulk-billed such as radiologists conducting x-rays and CT scans

Push to the private system

Despite years of hard campaigning by the Howard Government less than half 
of Australians have chosen to take out private health insurance.

Mr Howard's "Fairer Medicare" package is designed to force more people into 
the private system.

For the first time, private insurance companies will be able to offer "gap" 
insurance to cover the co-payments paid to a GP.

This co-payment insurance will be set (only initially, no doubt) at $50 per 
annum. The catch is that the insurance will only kick in after $1000 in co-
payments have already been made!

Mr Howard says only in "catastrophic" cases would the $1000 limit be 
reached.

This $1050 for medical expenses (instead of fee-free bulk billing) is not 
all.

The cost of a prescription under the Pharmaceutical Benefits Scheme (PBS) 
rose this year to $28, and the government plans to increase it by $10 to 
$38.

Of course Howard would say, there is the safety net. But this kicks in at 
$708.40. After that it is $3.70 a time if your medication has not already 
been removed from the PBS list.

Two-tiered system

Mr Howard's "Fairer Medicare" plan will actually destroy Medicare and set 
up a two-tiered system.

First class health treatment will be available to the wealthy who can 
afford access to private health services and facilities, where the quality 
of treatment is based on your ability to pay.

A second-class health system will be available to the extremely low income, 
non-paying patients. Their services will be provided by the remnants of a 
run-down public health system or contracted out by the government to 
private operators.

Millions of middle and low-income workers and their families will be left 
hanging between the two systems, excluded from the public system because 
they are not impoverished enough to qualify for public health treatment, 
but unable to afford the high-priced private services.

Medicare  fight for the future

The only "universal" aspect of Mr Howard's Medicare plan is the 
condemnation of it.

Since its introduction in 1984 the Australian public have overwhelmingly 
supported the Medicare system. And before that the supported just as 
overwhelmingly its predecessor Medibank in the 1970s.

The Howard Government's plans can and must be defeated in the Senate.

While all opposition parties have declared they will block the changes, 
history has shown us how easily deals can be done.

A massive campaign and struggle is required outside Parliament, involving 
all forces who support the retention of universal access to bulk-billing, 
and our state-funded health care system.

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