BY SARAH STEPHEN
The nightmare of US health care — where medical bills are the highest cause of bankruptcy and 42 million people have no access to care — may be around the corner for Australia, as the Coalition government prepares to use the May 13 budget to assault Medicare.
In a March 7 press release, the Doctors Reform Society (DRS) pointed out that it now costs hundreds of dollars to see a GP in the US. "Most cannot afford it and usually skip the GP and go straight to the specialist in order to try and save money. This means an even greater explosion in health costs. On top of that, routine medications in the US can cost $500 to $1000 per month for a typical patient with diabetes".
While he won't now admit it, Prime Minister John Howard supports the US model of privatised health care. He wants to reduce Medicare to just a welfare system for the poor. But because of the huge support for Medicare, his government is trying to sell its dismantling as "improvements".
On April 28, health minister Kay Patterson revealed the government's Medicare plan, which it has given the Orwellian title, "A Fairer Medicare — Better Access, More Affordable". In fact, the package will reduce access and make health care less affordable.
The package is valued at $917 million over four years, but not all of it is new funding. According to Australian Nurses Federation federal secretary Jill Iliffe, the $64.2 million for 457 extra nurses is merely an extension of a plan announced almost two years ago.
There is $42.1 million for an extra 234 medical school places, but these doctors would be bonded to work for six years in a designated rural area. There is also $189.5 million for additional GP training places. Initiatives in the "fairer medicare" package to improve bulk-billing access account for only 41% of the $917 million.
The federal government has also revealed that its offer of $42 billion over five years to the states' public hospitals is $1 billion less than projected in the budget forward estimates. The money to "restructure Medicare" has simply been taken from hospitals!
The package offers doctors the choice of opting in to a scheme in which they would continue to bulk bill concession card holders: pensioners, health care card holders, self-funded retirees and families earning less than $32,000. In return, the government will give doctors a top-up for each bulk-billed patient, ranging from $1 in inner-city areas to $6.30 in remote areas.
Australian Medical Association (AMA) representative David Rivett predicts that fewer than 20% of doctors will sign up for the "opt in" package. Many are already charging pensioners and health care card holders a small co-payment, and the government's minimal offer, with the likely associated paperwork, is not likely to be attractive.
Less bulk billing
Doctors who join the scheme are not compelled to bulk bill all patients. It will make it easier for doctors not to bulk bill. At the moment, only doctors who bulk bill can claim the rebate directly from the government. Those who don't must charge the patients the full cost of the consultation, and the patient can claim the rebate back directly.
Under this scheme, doctors will be able to bill the government directly for the Medicare rebate while still charging non-concession patients an additional fee. The patient would only pay the "gap" up-front.
In response to AMA president Kerryn Phelps' claim that $20 would not be too much to expect a middle-income earner to pay for a trip to the doctor, DRS vice-president Con Costa told ABC radio's The World Today on April 28: "I work in general practice; a lot of consultations are long consultations. What are we talking about here, a $30 or $40 co-payment? A lot of times you need a cardiograph, or a blood test, or a pregnancy test, or to remove a mole. How much is the co-payment going to be on every one of those things?"
In a further gift to the private insurance industry, private health funds will be able to offer gap insurance on the out-of-hospital costs for patients. The insurance would cost around $50 a year. For that, you will get a rebate of 80c in the $1, but only after you've spent more than $1000 ($500 if you are a concession card holder).
Private health insurers are looking forward to attracting an additional 1 million customers through gap insurance. The government estimates that 40,000 people would now be eligible for some rebate under the scheme.
Preventive health care would be dealt a substantial blow by these changes. For example, Australia has an excellent record of early detection of cervical cancer, because so many women have pap smears every two years. This could drop dramatically if women have to pay for the procedure.
"Pensioners and the poor may still get their bulk billing but they will become second-class citizens and stigmatised as the 'non-paying' patients", said Dr Tim Woodruff, president of the DRS, in a March 29 media release.
John Deeble, one of the original architects of Medicare, claimed in the April 29 Sydney Morning Herald that the scheduled fee has dropped, in real terms, by about $6 since the scheme began. It would cost just $1.1 million a year to increase it by $15, bringing it to the $40 that many doctors are now charging. "The government could easily pay for [bulk billing] and so it should. It just does not want to", Deeble argued. The private health insurance rebate costs nearly $3 million a year.
The Howard government is committed to dismantling the public health-care system by transferring more money to the private health industry. The next step would be to allow wealthier private patients to "opt out" of the public health system and stop paying the Medicare levy. This would see a rapid decline in the quality of the public health system.
When people have a choice, they leave the private health system in droves. Why else would the proportion of people with private health insurance have fallen from 50% in 1986, three years after Medicare's inception, to 30% in 1998? The government has been busy trying to force people back into private health, most successfully by introducing penalties for those who postponed joining a health fund until they were older.
War budget
This year's federal budget, released on May 13, will be a war budget, implementing cuts to social services in order to bolster defence spending. The Howard government wrote a blank cheque for the war on Iraq, which is rumoured to have cost at least $700 million. Defence spending is already projected to rise this year by $1 billion, bringing it to almost $14 billion a year, equivalent to $700 per person.
The amount spent on the invasion of Iraq could have re-funded the public dental health scheme for the elderly and disadvantaged that Howard abolished, and in the process blew dental care waiting times out by five years. The $1-2 million spent on upgrading Australia's six faulty Collins Class submarines could have increased doctors' scheduled fees enough to dramatically expand bulk billing.
If the Australian military confined itself to defence, and did not wage predatory wars and invasions overseas, it would require only a tiny fraction of its current budget. It is morally obscene that half as much as the $30 million health budget can be spent on this.
As a wealthy country, Australia could fund a world-class health-care system which everyone has access to. But we do not have a government that is willing to make this a social priority. This is just another reason that the opposition parties should block the war budget!
From Green Left Weekly, May 7, 2003.
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