By Peter Boyle
MELBOURNE — Labor "left" Deputy Prime Minister Brian Howe's image minder probably thought it wasn't very good to have a picket of community health workers, their patients and a few leftists outside his electorate office the day after the federal budget was announced. So we were invited in to speak to the man himself about his cuts to Medicare.
The press was excluded from this "unique opportunity to speak to the community so soon after the budget was released", as Howe put it. He had a different story to tell them.
He wanted to explain to us concerned members of the community that the cut in the Medicare rebate by $3.50 per consultation was really part of a grand plan to expand community health services and defeat the nasty, greedy, overservicing private general practitioners who, he said, were rorting and wrecking the Medicare system. The cut to the rebate was an attempt to save Medicare, he claimed.
If this was his plan, why didn't he hit the rorters and increase funding for community health? That would be too simple, he said. We can't take on the Australian Medical Association head on, and there isn't the money to throw around, so instead he decided to whack on the $3.50 (rising to $5) co-payment.
Since there was a huge oversupply of GPs in the major cities, he said, many will be pressured to absorb the cut in rebate and not pass it on to bulkbilled patients. The cuts were aimed at curtailing overservicing by some GPs.
But even as Howe concluded his monologue with a thick-lipped smile to an unconvinced and infuriated audience, his flickering eyes and folding hands betrayed him.
The cut in rebate aims to shift $163.9 million of health-care costs onto poorer non-pensioner patients this year, followed by a further $306.1 million next year. Medicare architect Dr John Deeble says the budget measures did not shift resources to where they were needed but only transferred some costs to some users.
Howe's cuts were "ill-advised, unjustified and ultimately destructive" of the Medicare system itself. They were an attack on the two most progressive aspects of Medicare — its universality and bulkbilling.
Deeble's criticism and objections from with the federal Labor caucus and the ACTU forced the government to submit the proposal to a three-person caucus committee. However, the committee is unlikely to come up with much better, even if it doesn't end up
endorsing the co-payment.
Howe argues that the money must come from somewhere to fund Medicare costs, which were growing 15% in real terms every three years, and that no extra funding can be allowed within the budget. The "alternative" proposal from within the Labor caucus and from the ACTU is for an increase in the 1.25% Medicare levy — a measure that will make Medicare more unpopular.
According to the budget papers, federal outlays on medical services and Medicare benefits grew from 23.3% of health outlays in 1982-83 to 34.6% in 1985-86 to 36.7% last year. Allocations to hospitals have dropped from 38.3% in 1985-86 to 34.2% last year. Overall outlays on health since 1983 (excluding initial rises with the introduction of Medicare) rose only by an average of 2.1% per year — small compared to rises in other industrialised countries, according to Deeble.
Howe claims that the figures prove overservicing by GPs and some private pathology services. However, a drift towards more expensive medical technology and more expensive drugs is also a factor. According to the budget papers, it accounts for 75% of growth in volume of medical benefits, and population growth accounts for a further 20% — leaving a mere 5% that might be explained by overservicing!
But aggregate figures do not tell the whole story. Community health workers claim that the entire system is in a shambles. Hospitals and community health centres are understaffed and overloaded while many private medical centres offer superficial and poor quality service and bulkbill Medicare for millions of dollars.
"Our consultations last an average of 20 minutes or more", a doctor in a community health centre in an inner suburb of Melbourne told Green Left, "while in the private 24-hour centre across the road, they rush patients through in 5-10 minutes on average". Meanwhile, the budget allocated a mere $4 million to the Community Health Program (compared to $10 million in 1974).
Anyone who has tried outpatient services in a hospital recently can tell horror stories of long waits in corridors and staff at the point of collapse or on the edge of madness. But expenditure on hospitals is boosted by a mere 1.2% in real terms.
While these problems are not addressed in the budget, the government proposes a measure that will hit poor patients with extra charges and affect GPs who bulkbill, in what is supposed to be an attempt to cut down overservicing. But a study by the Australian Consumer Association found that there is no significant difference in the number of services per patient between GPs who bulkbill and those who don't. It concluded that any restriction on bulkbilling would penalise poor patients
more than it would stop overservicing.
The problem lies with the nature of Medicare itself. Medicare falls far short of Labor promises in the 1970s of a comprehensive and universal health care system.
Built into the Medicare levy is a dynamic that leads to a running down of the public health system. Imagine if spending on the military was covered by a separate tax that was raised with every submarine and high-tech warplane that was bought. Public pressure to cut military spending would rise dramatically.
The encouragement of private health insurance further weakens support for public health and leads naturally to two health systems — one for the poor and another for the rich.
Medicare is an adaptation to profit-based health care, so it should be no surprise that some profit-makers seek to rort the system. Howe's proposals simply seek to reduce community responsibility for health care. An alternative course would be to end the Medicare levy, dramatically increase funding for hospitals and community health-care centres, tighten scrutiny of rebates paid to profit-oriented health bodies and fund health from general revenue.