CANBERRA OBSERVED: by News WeeklyNews Weekly
Medicare a 'sleeper' issue for Liberals, Labor
, November 30, 2002
Occasionally serious political problems sneak up unnoticed on governments, but more often than not are due to neglect and a reluctance to face up to the difficult issues earlier.
For the Howard Government, riding high in the opinion polls and facing a dispirited, divided and directionless Opposition, one of those problems is health and Medicare.
And it has now arrived on Health Minister Kay Patterson's desk following the release of figures showing that the number of people being bulk-billed by Medicare is now in free-fall.
After homeland security and defence of the nation and tax, no political issue touches the lives of ordinary Australian families more than health. The September 2002 quarter statistics showed a fall of 2.7 per cent in bulk-billing rates - down to 71.2 per cent.
The latest figures show the number of people being bulk-billed has reached the lowest level in a decade.
Since the Howard Government came to power in 1996 the bulk-billing rate has fallen from over 80 per cent, but almost half of that fall has been in the past 12 months.
And it is the steepness of the most recent fall that is most alarming the Government.
Clearly, Australia's doctors are starting to dump their bulk-billing facility en masse. As each practice finally decides to cut its losses and end cheap consultations, this enables others to follow. And the brutal reality is that very often the better doctors are the ones who are able to charge more, while the mediocre rely on the high turnover of bulk billing.
Bulk-billing rates are also lowest in the poorest parts of Australia - in country and regional areas and in outer metropolitan suburbs. This is because there is less competition among doctors in these areas and practices are able to actually collude to put an end to cheap consultations.
Labor is acting in its usual blowhard manner, with spokesman Stephen Smith declaring the figures to be "catastrophic" for families and maintaining that it is "absolutely committed" to restoring bulk-billing.
But Smith has not said how Labor would fund the increasing gap.
The current standard rebate is $25.05 for a consultation, but doctors say they cannot run their practices profitably while delivering a proper service to patients on that amount of money without simply rushing patients through.
The Australian Medical Association wants the rebates to be lifted to $45 a consultation - which would cost around $2.7 billion to the Federal Budget.
The consequences of this on the budgets of ordinary families while not yet "catastrophic" can be quite dramatic, forcing people to avoid going to the doctor altogether, or seeking alternative means of treatment.
Pensioners and those on welfare in particular are finding it increasingly difficult to find a doctor who bulk bills. Tens of thousands, if not hundreds of thousands of patients, now use the emergency sections of already over-stretched public hospitals for out-of-hours treatments for minor sprains, cuts and fevers which could otherwise be done by their local doctor.
And the much-prized and fought-for pensioner Gold Card is also becoming tarnished because doctors are reluctant to have pensioner-only practices. The otherwise reform-minded Howard Government has avoided touching Medicare because, along with superannuation, it was a popular initiative of the former Labor Government.
Any threat to dismantle Medicare, as was done by John Hewson in 1993, would also give Labor the ultimate election scare weapon.Coalition support
Hence the Coalition promises solemnly to maintain the "universality" of Medicare despite the fact that the 1.5 per cent Medicare income tax levy nowhere near covers the cost of health benefits enjoyed by Australians.
Admittedly, the Howard Government has tried to encourage people to take out private health insurance bringing in a 30 per cent rebate as the carrot and penalties for late joiners as the stick.
But the benefits of this costly initiative remain seriously in doubt. The health funds are inefficient, expensive and suck an enormous amount of money from the health budget which could otherwise be invested elsewhere in the health system.
And while the superior public hospital system remains "free" to every Australian, the health funds' product continues to be unattractive.
Put simply, if you pay for health insurance, you pay more for your health care. If you don't have health insurance, you may be occasionally inconvenienced, but health care is cheaper and in most cases free.
Senator Patterson's predecessor Michael Wooldridge was adept at "selling" Australia's health system to the Australian public as the best in the world. This allowed him to avoid tackling the system's obvious failures and vested interests head-on for about five years, while concentrating on other popular public health initiatives such as immunisation.
On the other hand, Senator Patterson has struggled to establish herself in the onerous health portfolio and has a reputation of panicking over inconsequential matters and micro-managing others of no importance. However, as each month passes, the problems of the creaking system will become more obvious, and the Howard Government will have to make some tough decisions.
What is required is a serious overhaul of the system to deliver the federal funds to where there is greatest need, not where there is the strongest vested interest.
This may mean wealthier Australians will have to pay more than the poor for a visit to the doctor or an end to the idea of free hospitals. It may mean stricter controls on doctors, or more doctors from overseas. It may mean the establishment of widespread after-hours medical facilities as proposed by Labor at the last election.
It may even mean a form of universal self-funding for health care along the lines of Singapore's Medisave, whereby people save up for their own health needs in the same way they now do for superannuation.
The issues are complex and extremely difficult for any administration, but most of all the rapid decline of Medicare means the Government is going to have to start getting serious about health or face the electoral consequences.