Medicare under attack


Medicare under attack

A newly formed lobby group, the General Practice Forum, has called for the end of bulk-billing, free consultations and the free at-point-of-service provision of such items as vaccines and bandages. This is the opening shot by the conservative medical establishment in a renewed war against Medicare.

Interestingly, the response from both Labor and Liberal parties has been to reject co-payments (whereby patients contribute directly to the cost of their care). The co-payment idea was floated by the Labor government itself as recently as 1991 and dropped only because of its electoral unpopularity. The Liberal Party has traditionally allied itself with, and done the bidding of, the reactionary elements in the medical profession.

"Co-payments are completely regressive and against the spirit of Medicare, providing services based on financial well-being rather than clinical need", says federal health minister Dr Carmen Lawrence. Opposition health spokesperson Bronwyn Bishop described the proposals as "regressive" and claimed a Liberal government would not consider such a move. We will see.

But the forum, which claims without justification to represent Australia's 23,000 doctors, has powerful friends. The editorial writer for Rupert Murdoch's Australian says the co-payment idea has "merit", although it too notes its unpopularity. However, the editorial worries aloud that under the forum's co-payment proposal, "pensioners and healthcare card holders would be exempted. But given that the poor tend to be sicker than the rich, and visit the doctor more often, such an exception may partially defeat the objective of discouraging overuse."

Canberra "might be wise to consider resurrecting its co-payment plan — or something like it", the Australian suggests.

The conservative medical establishment has never accepted Medicare and never will. It argues strongly in favour of fee-for-service medicine and proposes that doctors should be able to set their own fees, with patients free to haggle. The forum's allies in the private health insurance industry are equally concerned at the near universal community support for Medicare. They are approaching panic in the face of the rapidly declining numbers using their profit-making services.

There has always been a ratbag element among doctors, who it should be noted, are trained at public expense. This element is more interested in money than in health.

But not all doctors, by any means, fall into this category. The Doctors' Reform Society, for instance, disagrees entirely with the forum. Society spokesperson Dr Con Costa says that the forum doesn't reflect the view of most doctors, who are happy to bulk bill their services. Co-payments, he insists, will only increase doctors' incomes.

There is a greater community of interest between Labor, Liberal, the Australian and the medical establishment than meets the eye. All want to further open up the provision of health services to private enterprise, for private gain, although currently they disagree on how to achieve this.

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