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.