It took the federal Coalition government three attempts and 10 months of negotiations to finally get its Medicare legislation passed by the Senate — by 33 votes to 31 on March 11. This was only after health minister Tony Abbott secured the votes of four "independent" senators with a range of bribes — more bulk-billing incentives for Tasmania, more medical training places in Queensland.
John Deeble, the original architect of Medicare, declared that his system of universal medical care was officially dead, predicting that only around 5% of Australians will benefit under the new system. The Doctors' Reform Society predicts that the changes will inevitably lead to a blow-out in health care costs, and argues that safety nets aren't needed if there is a quality public health system which guarantees access for all.
The inclusion of some non-GP services under Medicare appears to be a major improvement in the system, but it is purely window-dressing that will be of benefit to a small minority of people. Under the MedicarePlus legislation, bulk-billed patients, if referred to by their GP for chronic health reasons, are allowed a maximum of three visits to a dentist, and only $220 of the costs of the dental work done will be covered by the government.
If the Howard government had a serious interest in the dental health of the most disadvantaged Australians, it would never have abolished the Commonwealth Dental Health Program when it came into office in 1996.
The CDHP, introduced in January 1994, injected $100 million into state and territory provision of public dental services. Three million Australians with health-care or seniors cards were eligible for free dental care under the short-lived scheme. In its final year, 816,000 Australians received treatment through the program. Almost two-thirds of those people had to wait less than a month for a checkup, while only one in 10 had to wait 12 months.
Dental waiting lists are now out of control. More than half a million people are on public dental waiting lists across Australia, and only about 11% of those eligible for treatment receive it each year.
The "safety net" will enable those with concession cards or receiving Family Tax Benefit to get an 80% rebate on out-of- pocket medical expenses once they spend $300. The government claims that this will apply not only to GP visits, but to allied health services as well, and is expected to cost $174 million over the next three years.
This safety net is nothing more than a subsidy to the private sector, and could become an ever-increasing cost just like the private health insurance rebate. It would be much more cost effective to employ allied health professionals in the public sector, to which GPs could refer patients.
Medicare has kept Australia's health costs low. The ease and convenience of bulk-billing was set up to give doctors an incentive not to charge more than the rebated fee. The introduction of token bulk-billing incentives of $5 in the cities and $7.50 in regional areas will make it much easier for doctors to increase their fees. The irony is that by abandoning universal cover for a two-tier safety net, the government is risking a huge blow-out in the cost of medical care.
The Howard government's goal is not to restrict health spending as such, but to accelerate the transfer of health care to the private sector and promote a user-pays health system. Abbott envisages a system where the majority of Australians pay for private health care, and Medicare and public hospitals operate as an under-funded "safety net" for the poor.
John Deeble is right — MedicarePlus is the death of Medicare as a universal system of health-care provision.
From Â鶹´«Ã½ Weekly, March 17, 2004.
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