HEALTH: by Ian H. McDougallNews Weekly
Labor's campaign against doctors' private practices
, March 7, 2009
Will the family GP be a thing of the past, asks Ian H. McDougall.Some political campaigns roll around as regularly as hot weather in summer. The Australia Card, or national identity card, surfaces under every federal government, be it Labor or Liberal, and is eventually abandoned due to public pressure.
But one policy particularly beloved of Labor administrations is a salaried medical profession. It has just surfaced again, under the guise of regional medical centres.
Why is this policy so persistent? The doctors' lobby is up in arms and seems to be fighting turf wars on all fronts. If it's not nurse practitioners, it's midwives wanting a greater role in birthing.
Is this so terrible? During a trip to Stewart Island, New Zealand's "third island" in the extreme south, my wife was taken ill. She went to see a nurse practitioner, who gave her a prescription that resolved the problem.
Similarly, I was working on the Robe River iron ore mine in the workshop and a hammer dropped on my head. The only medical care available then was from the mine's nurse, as no doctor was on site.Chronic shortage
The chronic shortage of doctors in rural and regional Australia is well known, and the best form of care is from a doctor; but for minor ailments it would seem that care from a nurse practitioner is better than nothing.
But if one thing drives doctors berserk, it's the prospect of a salaried medical profession. This would be bad for doctors, as they would be reduced to the status of public servants.
But would this be bad for us, the patients? The answer is an unequivocal "yes". It would be a disaster for patients.
First, take privacy concerns. If there is one thing that can impinge on one's ability to lead a normal life, it's having one's medical history revealed. In theory, discrimination in employment on the basis of one's medical history is illegal. No-one really believes this.
Such confidential data is handled by public servants, and time and time again they have leaked such data. Centrelink leaks like a sieve.
Often, it's relatively harmless things, such as a public servant finding out how much his neighbour earns. But, as anyone who has worked in the bureaucracy can readily confirm, a determined base-grade clerk can find out almost anything he wants.
Labor sources frequently leak opposition political candidates' personal data, such as criminal records, traffic offences and other confidential information. The hope that medical data would remain confidential is not worth taking seriously.
Then there is the principle of subsidiarity. Doctors mainly work as independent professionals. They understand their area and their patients. If patients don't like the treatment they get, they can go elsewhere.
Under the Britain's National Health Service, each doctor has a list of patients. If you don't like your doctor, too bad. This is what is contemplated in Australia.
As in any profession, some doctors are better than others. It may be their relationship with their patients; it may be simply a matter of competence. In any event, if you don't like your doctor, you can go elsewhere or get a second opinion. Either way, patients have freedom of choice. Medical practitioners have a financial incentive to give the best care they can.
As independent professionals, doctors are free to conduct their practices as they see fit. To date, Australia's doctors have enjoyed the freedom to conduct their own practices.
Australia combines universal health care with a degree of independence for practitioners and patients. Doctors will often say that the amount of money they make is controlled by the government, but under the present system they have a choice of charging a co-payment, working longer hours and taking time off for family reasons.
Half of the current crop of medical students is female, and a salaried position may be attractive to young women who would welcome a regular pay-cheque and the other benefits of working for the government. But the result would be a bureaucracy like any other bureaucracy.
The current debate over medical care should be seen in the context of a government determined to expand its control over Australian society. The two main areas of state government responsibility are health and education, both of which are steadily being taken over by the Federal Government.
The idea that a federal takeover of the medical and hospital systems will somehow miraculously improve service levels is a mirage. The bureaucratisation of medicine and health will mean less responsiveness and more government control.
It's bad for patients and bad for the medical profession.- Ian H. McDougall is a Melbourne writer.