BY CHRIS SLEE
MELBOURNE — "We are facing the murder of Medicare", Doctors Reform Society president Tim Woodruff told 50 people at a public meeting in the town of Dromana, near Melbourne, on December 1.
Woodruff pointed out that Medicare was intended as a system of public health insurance available to all. The federal Coalition government wants to transform it into a "safety net" for those who can't afford private health insurance. "But if we have an adequate public health system, we don't need a safety net", Woodruff said.
The government's plan to increase the bulk-billing rebate to doctors for treating pensioners and children by $5, while not increasing the rebate for other patients, is aimed at discouraging doctors from bulk-billing everyone.
Woodruff argued that Australia is moving towards a three-tier system, in which the rich can afford to pay for good quality health care, pensioners get bulk-billing but a poorer service while people in the middle struggle to pay for health care.
Kerrilie Rice, a policy and research officer with Women's Health Victoria, spoke of the growing inequality in access to health care. In some rural areas people who can't pay up front are denied services by their local doctor, she said. GPs are refusing to see people at home or in nursing homes unless they receive an up-front payment of about $160.
Dr Joe Toscano, a joint convenor of Defend and Extend Medicare Australia, said that "we are involved in an ideological war" over whether we are "part of a community with a collective responsibility to our neighbours, or individuals whose only responsibility is to ourselves and our immediate family".
He said that the government's plan for a differential bulk-billing rebate for children and concession-card holders is aimed at destroying universal bulk-billing. Doctors will come under increasing pressure to cease bulk-billing other people as the value of the rebate falls behind the inflation rate.
Toscano argued that the government's proposal for a "safety net" rebate to people with high medical expenses is "illusory and dishonest". Supposedly, the plan will give patients an 80% rebate of non-hospital medical expenses above a threshold ($500 in some cases, $1000 in others).
Toscano argued that the rebate is likely to be tied, not to the actual fee charged by the doctor, but to the recommended fee. Otherwise doctors could charge what they like and the government would face unlimited payouts. But if, as Toscano expects, the rebate is tied to the recommended fee, this would mean that if the doctor charges above the recommended fee (as many do), the extra amount will not be covered.
From Green Left Weekly, December 10, 2003.
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