Moving beyond Mediscare


One of the reasons Mediscare worked, if it did, was because of the Abbott government’s record on broken promises. After being in government for eight months, by May 2014, the Abbott government had chalked up at least nine broken promises. Abbott had promised no cuts to the ABC or SBS, no cuts to education, no cuts to health, no shutting any Medicare locals, no one’s personal tax will go up, no changes to pensions, foreign aid would go up in line with the CPI, on Indigenous affairs Closing the Gap activities would be sustained at former levels, and ARENA (the Australian Reneweable Energy Agency) would have over $2.5 billion in funds to manage.

Another reason was that the LNP government had consistently undermined Medicare. A co-payment of $7 per GP visit was proposed, then withdrawn, leaving the status quo as:

    Medicare rebates remain frozen until 2020, incentives to bulk-bill pathology services will be abolished, and rebates for child dental services are being discontinued. A measure to increase Pharmaceutical Benefits Scheme co-payments still sits on the books, with the savings claimed in Coalition election costings, even though it’s a zombie measure, rejected by the Senate.

That was from a piece by Stephen Duckett and Hal Swerissen Reshaping Medicare, of which more later.

Labor’s campaign would have got no traction if the public had not thought it was credible, based on recent experience.

Turnbull said after the election that the Coalition needs to establish its credibility as a defender of Medicare. Yet the next day both Scott Morrison and Alan Tudge said that unfreezing GP payments, which would cost more than $1 billion each year, could not be afforded while the budget was in deficit. GP’s, it seems, need to be paid less than physiotherapists and iridologists for the benefit of the budget.

Health minister Sussan Ley at one time said she would like to end the freeze as soon as possible, but the money men would not let her. After that she was gagged, according to Patricia Karvelas and Phillip Coorey, and we heard little from her. I think the idea was that the LNP campaign decreed that they simply should not talk about health.

Today in the press there was speculation that Ley will be replaced by someone who is ‘stronger’, like Josh Frydenberg, Christian Porter, Simon Birmingham or even Greg Hunt, all of whom have proven their worth in defending the indefensible.

By evening Coorey told us the buzz was that she’d get to stay. However, this says nothing about the Coalition’s commitment to Medicare.

Stephen Duckett, now Health Program Director at the Grattan Institute, wrote an open letter to Malcolm Turnbull last Thursday.

He said it would be “hard but not impossible” for the Coalition to establish credibility on Medicare, given their record and the fact that Tony Abbott had declared that “private health insurance is in the Liberal party’s DNA.” Turnbull needs to elevate Medicare to the same status, he said.

First Turnbull needs to make a Prime Minister’s statement in which he repositions Medicare in the Coalition’s priorities, committing to it’s universality:

    You have to throw out language about Medicare being a safety net. It’s not just for the poor, it’s for everyone. You have to throw out language about people making a personal contribution – we already do, through tax. You have to throw away the idea that “savings” can be made by cost shifting onto states and consumers. Your statement has to do away with the idea that, in health policy, public equals bad and private equals good. And you need to accept that the public sees bulk billing as a core part of Medicare.

Second he needs to revise his policies with probably all of the ‘savings’ coming off the table.

Third he needs to trust the public to be willing to pay what is necessary.

Duckett has written much on health policy, with the aforementioned Reshaping Medicare a brief account. In it Duckett and Swerissen point out that:

    For those who are not bulk-billed, average out-of-pocket costs for each visit have increased by almost 50 per cent over the past decade. Patients now pay $34, on average, to see a GP and $64 for a specialist medical practitioner.

Present bulk-billing rates, with the rebate frozen from 2012, are unlikely to last.

The big challenge, however, is from “the complex chronic diseases – cancer, heart conditions, lung conditions, mental health and dementia” – which Medicare is not designed to address. Those conditions account for more than half of all disease costs, and the biggest users are the old and the frail.

To sum up what is needed, Duckett says in The Conversation:

On the latter, the idea is that:

    the focus must move away from fee-for-service payments for one-off visits. A broader payment for integrated treatment would help to focus care on patients and long-term outcomes.

Apparently there have been some trials already. My expectation is that the minister, with the public servants and the stakeholders, will continue to run around in circles with trials. However, the mainstream system will not change, because although there are efficiencies and savings to be made, if done well it will cost more. Turnbull, with Scott Morrison, Matthias Cormann and the hard heads will continue to blunder on.

Earlier posts: