March 7th 2009

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Articles from this issue:

EDITORIAL: Behind Malcolm Turnbull's pitch for green votes

CANBERRA OBSERVED: The Costello question that refuses to go away

ECONOMIC AFFAIRS: China's spending spree: our sovereignty at risk

GLOBAL FINANCIAL CRISIS: Targeted spending needed to promote Australian jobs

NEW ZEALAND: Kiwibank goes from strength to strength

QUEENSLAND: Premier Bligh calls snap election

PUBLIC ACCOUNTABILITY: Shooting the messenger undermines democracy

HEALTH: Labor's campaign against doctors' private practices

UNITED STATES: The nightmarish cabinet of President Obama

FOREIGN AFFAIRS: UN whitewash of China human rights abuses

GLOBAL WAR ON TERRORISM: What to do with Guantánamo detainees?

SPECIAL FEATURE: The agnostic who took on Darwin and Dawkins

MARRIAGE AND FAMILY: Sexual suicide of Western society

AS THE WORLD TURNS: Social websites harm children's brains - top neuroscientist / Conspiracy theory? / 'Right to die' can become a 'duty to die'

Euthanasia and dementia sufferers (letter)

Wilson Tuckey I (letter)

Wilson Tuckey II (letter)

CINEMA: Stylised miniature of feminist mythology - Revolutionary Road

BOOKS: ATTILA THE HUN: Barbarian Terror and the Fall of the Roman Empire, by Christopher Kelly

Books promotion page

Labor's campaign against doctors' private practices

by Ian H. McDougall

News Weekly, 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.

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