Families must come before profits

Every Australian family should be concerned about the proposed GP and Hospital tax.

It’s an assault on Australia’s world-class universal healthcare system, Medicare.

But the proposal’s also fraught with problems for families whether they use bulk-billing services or not.

It would certainly disadvantage the poorest and the sickest, and could affect all Australian families, including those with private health insurance.

Tony Abbott’s Health Minister, Peter Dutton, all but confirmed the Coalition is preparing to take the axe to Medicare. That’s despite making no mention of cutting Medicare prior to the election just 4 months ago.

Around 81% of GP consultations are bulk-billed. Any proposal to impose fees on those appointments is of obvious concern to people who rely on bulk-billing. But those who are already used to paying for GP appointments should also stop to consider how moving costs from the public sector to the private might ultimately affect them too.

Abbott confidante and former health adviser Terry Barnes is the author of a submission to the Abbott government’s Commission of Audit. The submission advocates a new fee for bulk-billed GP services: an idea that has received the very public backing of Bill Glasson, my opponent in the Griffith by-election.

The likely effect that more people would turn to already stretched emergency departments, looking for care has been put to Mr Barnes. His response was to suggest that fees be imposed on emergency visits as well. And it’s been reported that a Howard-era senior health bureaucrat turned academic, Andrew Podger, has now called for a fee of $30 for GP and emergency department visits. That would directly affect people who pay upfront for their GP consultations but are also accustomed to publicly-funded emergency departments.

And we should be skeptical of any claim that the fees would not increase beyond inflation. In 2005, Pharmaceutical Benefits Scheme co-payments rose by 21% under the Howard government.

And most importantly, research shows that imposing or increasing “co-payments” can discourage people from getting help. Health professionals and experts – including the AMA – have expressed serious concerns about this possibility. It is also the principal risk that Mr Barnes identified in his submission, and he went on to say that “if people miss or received delayed treatment for significant acute and chronic conditions because of co-payment factors, obviously these will become controversial and sensitive.”

Putting aside that the primary concern should be the effect on people’s lives, not the controversy for the government, we should consider the broader consequences of people not seeing GPs.

For example, will there be a heavier burden on the hospital system as a result of illnesses worsening after being left untreated? How will the additional cost be borne?

And what other changes might come next? It’s possible that once we’ve got bulk-bill and emergency department fees, governments could look to other services and asking insurers and patients to bear more of the costs.

Australians are right to be concerned about the dismantling of our universal healthcare system. We can look to the United States as a cautionary tale. The OECD’s health data released in November shows the extent of the healthcare funding problem facing the US.

That OECD information shows the US is one of only three OECD countries where the private sector bears more than half of the healthcare costs.

The US spends 17.7% of GDP on healthcare – almost twice the OECD average. (Our expenditure came in at 8.9% of GDP, slightly shy of the average.)

Health expenditure per head was a whopping $8,508 USD, two-and-a-half times the OECD average of $3,332. (Ours was $3,800 USD, a touch above the average.)

And a Harvard University study in 2009 concluded that 45,000 Americans died each year with a key factor being delayed treatment due to patient cost considerations.

It would be too simplistic to claim that the US’s healthcare costs problem is a direct result of the fact that private funding sources – predominately health insurers and individuals – bear the majority of the cost in that country. But looking at the rate of inflation for health costs in the US would give any prudent policy-maker cause for concern.

While our health inflation has been fairly consistent with general inflation over the past twenty years, in the US it has been much higher than general inflation for almost all of that time.

RAND Corporation – the same organisation whose data Mr Barnes referred to in his submission – has said “the main force driving growth in health care spending is not the purchasing choices of consumers, but the clinical decisions of providers. Unfortunately, nearly every actor in our health care delivery system — hospitals, physicians, other health care providers, insurance companies and the manufacturers of drugs and devices — is currently focused on maximizing revenue growth.”

It is a big step to increase the extent to which our health system is privately funded. A greater emphasis on private health funding means a greater emphasis on profit.

The Liberal Party voted against the introduction of Medicare and then attempted to repeal it.  In fact we would be celebrating Medicare’s 40th birthday this year if it weren’t for the Liberal Party’s ideological resistance to universal healthcare.

We deserve much better than that.

Our nation should exercise extreme caution before deciding to charge a fee on bulk-billed consultations and emergency department visits – it could be the thin edge of a very unpleasant wedge for the health of millions of Australians.


About Terri Butler

Terri Butler

Terri Butler is the Shadow Minister for the Environment and Water, and the federal Labor Member for Griffith, Queensland.

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