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Issue #1738      July 6, 2016


Starving Medicare to death

When Medicare was set up, the Medicare rebate to general practitioners was 85% of the AMA recommended fee. At $37 it is now less than half – and a freeze on the rebate proposed for another four years and probably indefinitely. Doctors are finding they can no longer maintain bulk billing their services at this much lower rebate level without introducing a co-payment to patients and thereby becoming the nasty tax collectors for the government.

Australian Nursing & Midwifery Federation Union (Tasmanian) protests against cuts to Medicare.

While the PM is making claims that he will not privatise Medicare, essentially he is doing so, by incrementally ensuring that a progressively greater percentage of healthcare spending comes from the pocket of the patient, whether directly or through private insurance. The only difference is that he is forcing GPs to do the dirty work and take the rap for ending universal bulk billing – which is another major step in privatisation of our health system.

By privatisation of Medicare we are not talking about selling Medicare to the private sector – although Mr Turnbull seems anxious to impose such a limited and self serving definition. Privatisation is to be achieved by deliberately pursuing Abbotts’ co-payment policy through the GP rebate freeze as well as cuts to pathology bulk billing incentives.

The freeze on the Medicare rebate and the cuts to pathology bulk billing incentives will only worsen an already critical funding issue for bulk billing doctors – as many general practitioners also currently dependant on the deregulated system of pathology collection licences which allows them to subsidise their incomes through rentals from pathology and radiology. It is disingenuous of Mr Turnbull to pretend that his policies are not a double whammy for bulk billing general practitioner funding.

Reduce the current sources of funding, Medicare rebate and rentals from pathology, and there are only two other sources of funding available to general practitioners – direct charging the patient or private health insurance. Forcing GP’s to go down this road will result in an end to Medicare as we know it. Over a short space of time this policy will inevitably lead to bigger and bigger co-payments for patients to see the doctor.

The Prime Minister is deliberately confusing voters on what is meant by privatisation of Medicare. By limiting the definition of “privatisation” to selling off Medicare or parts of it, the PM is strictly speaking, not lying, but he is being less than honest. His policy will not only open the way for the private health industry (PHI) to move into GP care and a two-tier primary care system. It will also normalise co-payments to see the doctor.

Legislation is already in place to allow doctors to swipe credit cards at the same time as they swipe the patient’s Medicare card – all in the one seamless transaction. While this has been marketed as increased convenience for the patient, it’s merely another step in facilitating a user-pays system of health in this country.

What’s worse is that the initial $7 co-payment initiative of the 2015 budget that we all feared is becoming an inevitable scenario, evolving like a slow train crash, and will be far graver than the initial co-payment model proposed by Tony Abbott. Once GP’s stop bulk billing, they will be more likely to charge the AMA rate of $76 – so the co-payment will initially be the difference between the AMA rate and the Medicare rebate – which is $39.

Patients will live in fear, hoping that their consultation is not thorough or lengthy, or after hours, because as the minutes tick away so will the dollars in the fee. If the consultation goes to 15 minutes then the AMA fee is defines as a long consultation and recommended at $140. An after hours call at the GP’s office is recommended by the AMA at $450! Add to this any additional pathology and radiology tests and patients will again need to hand over the credit card together with the Medicare card, prior to paying again at the pharmacy.

Starving Medicare to death may not be a direct form of privatisation by government, but it is the same outcome via indirect means. Mr Turnbull will be able to sit and watch as the doctors do the privatising for him. And once the general practitioners start swiping the credit card along with the Medicare card, it is the patients who will be the only losers from the Medicare rebate freeze – with an increasingly shrinking Medicare refund on their increasingly rising doctor fees.

Authorised by Dr C Costa, Dr R Marr, Dr A Chesterfield-Evans on behalf of the NSW Doctor’s Reform Society.

Next article – Tony Blair’s toxic legacy

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