The following article was published in "The Guardian", newspaper of the
Communist Party of Australia in its issue of Wednesday, July 9th, 2003.
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Join the campaign to SAVE MEDICARE
A vigorous campaign in defence of Medicare is developing across the
nation as new figures indicate that, at current rates of decline,
bulk-billing will entirely die out in less than 14 years. The proportion
of doctors bulk-billing has dropped from nearly 80 per cent in 1996 to
70.4 per cent at the end of the September quarter last year, and that's
according to the Government's own figures!
by Bob Briton
A Senate Select Committee is currently examining the Federal
Government's "rescue package" for Australia's ailing health system.
Labelled "Fairer Medicare", the plan was announced by Health Minister
Kay Patterson in April and set in train by the Federal Budget in May. It
is a response to alarm in the community at the rapidly declining number
of GPs that bulk-bill their patients.
Prime Minister Howard and his Health Minister initially denied that any
problem existed with bulk-billing rates.
However, according to the Health Department's own figures, centres such
as Ballarat, in Victoria, have seen a dip of nine per cent in just three
months. In some centres no doctors bulk bill their patients.
Rather than go to the core of the problem - which remains the inadequacy
of the rebate paid to doctors by the Commonwealth under the Medicare
arrangements - the Government chose instead to advance its pro-private
health agenda. Doctors will continue (with a few exceptions) to receive
a $25 rebate when they bulk bill a standard consultation, a consultation
valued by a Government inquiry at closer to $50.
While making much of some uselessly small financial incentives for
doctors to maintain bulk-billing - ranging from $1 to $5.95 according to
geographical and other factors - the Government quietly set about
advancing a two-tier health system.
Under the proposed legislation, Health Care Card holders would be the
only patients who could be bulk-billed. These patients can expect "back
of the queue" treatment.
Currently, holders of these cards must earn less than $17,000 as
individuals or $32,000 for families. Incomes just $1 over those paltry
thresholds put low income earners in the same high cost bracket as
millionaires.
Co-payments
The restraint on doctors' fees built into the Medicare system would be
jettisoned. GPs would be free to charge patients a co-payment above what
they could recover from Medicare. Providers of other services - such as
pathology - are already talking about charging co-payments.
Private health insurance monopolies - already favoured by the Lifetime
Health Cover and the Private Health Insurance Rebate (PHIR) policies of
the Federal Government - are waiting in the wings to offer insurance for
the "gap" between the $25 Medicare payment and what the health
practitioner chooses to charge.
Readers of The Guardian would already know that such changes would spell
the end of Medicare as universal access to free medical care, a hard-won
democratic right. This awareness is growing in the community and giving
rise to a movement in opposition to plans that would effectively scrap
Medicare.
Of course, the opposition political parties have taken up their various
positions. Labor proposes to reverse the devaluing of the rebate paid to
GPs, but over time and starting in areas where bulk-billing rates have
been worst affected. The ALP, for its own closely shielded reasons,
would not scrap the Private Health Insurance Rebate (PHIR) - valued at a
whopping $2.3 billion - but would probably ditch the 30 per cent rebate
on "ancillary items" (Physio, dental, naturopath etc).
The $640 million saved would then be used to provide Commonwealth
funding of dental services and the like. It remains to be seen if the
new Shadow Health Minister, Julia Gillard, will strengthen or water down
these undertakings.
The Greens would expand services across the board by scrapping the PHIR.
The Democrats might come to some compromise with the Government on the
"gap" that GPs and other providers could charge over and above the
standard Medicare figure. Senator Meg Lees of the recently formed
Australian Progressive Alliance is also reported to be willing to negotiate.
Unfortunately for the compromisers, the Government is not interested in
compromise, as a memo from the first assistant secretary of the Health
Department's Primary Care Division instructing bureaucrats to avoid the
use of the term "bulk-billing", demonstrates. Such is the depth of this
Government's "reforming" zeal! The Government's reaction to findings of
the Senate Inquiry (due in August) will underline this fact.
Community campaign
In the community, a number of groups have sprung up in defence of
Medicare. While a range of organisations, like the Combined Pensioners
and Superannuants Association of NSW, have come out on their own in
strong defence of universal access to free health care, others have
pooled their resources to launch very active campaigns.
The Save Medicare Alliance in NSW has staged rallies, hosted public
forums, collected signatures to a petition and is leafleting Federal
electorates on the issue. Put yourself in touch by contacting
[EMAIL PROTECTED] .
There is also a National Medicare Alliance, which is a coalition of peak
community and health groups including ACOSS, the Australian Consumers
Association, the Public Health Association of Australia, the Health
Issues Centre, the Australian Nursing Federation and the Doctors Reform
Society.
For its part, the trade union movement has devoted considerable time and
effort to the campaign to save Medicare. The ACTU has launched a
specific campaign on the issue and hosted a national meeting in
Melbourne attended by opposition politicians and the many health,
welfare, church and other groups concerned at the proposed changes.
As it turns out, however, it is the union movement that is the source of
the most worrying notions held by some members of the popular movement
growing around the defence of Medicare.
Some union spokespersons have pointed out that sharply increased health
costs will have to be factored in to wage claims in future. This is
logical and reasonable. Even under current arrangements, health costs
have increased by 7.2 per cent to March this year. This is the biggest
increase of any CPI group including food, which at least has a drought
to explain part of its price hike.
The Australian Nursing Federation's Victoria Gilmore correctly explains
the future shock that is contained in the "Fairer Medicare" package:
"Working Australians on low to medium incomes will be hit very hard by
this package. They will be asked to pay just as much as the wealthy but
will not be able to afford the private health insurance cover for the
co-payments. Wage rises will be quickly eroded by rocketing health costs."
Others, including the NSW Labor Council, draw other conclusions from
developments, warning that, if the Federal Government goes ahead with
its proposed "reforms", the union movement will have to accommodate the
changes with "significantly higher" minimum wage increases to protect
lower paid workers.
"Universal health care is an integral part of the social wage and was
something workers invested in by trading off wage rises during the
Accord years", said a Labor Council statement on Workers Online.
Dangers for workers-
Another union leader already considering a political landscape without
Medicare in the accepted sense is Sharan Burrow, President of the ACTU.
In the lead-up to May 2 national Medicare meeting hosted by the ACTU, Ms
Burrow said that while Australian unions were loathe to write health
costs into employment contracts, they may yet be forced to consider it.
"No Australian employer will want to see unions bargaining for medical
cover, US style, but if we go down the American track, we will be forced
to look at an American response", said Ms Burrow.
To even be canvassing such an idea while, at the same time, trying to
show leadership to a national campaign to save Medicare is
counter-productive, to say the least.
In making those comments, Ms Burrow herself went on to give some details
of the US system. In an attempt to win the bosses to the side of
Medicare, she pointed out that the cost of medical insurance accounts
for up to 20 per cent of the wages bill in that country.
This is the least of the problems. The US system costs taxpayers 13 per
cent of GDP after the various corporate parasites have been fed.
Australia's arrangements take just 8.3 per cent.
The results of the two approaches are revealing, also. Australia has a
36.6 per cent lower infant mortality rate and a life expectancy two
years higher than the US. We have 30 per cent more acute beds available.
In the US, despite the best efforts of the union movement, 40 million
Americans including six million children, have no health cover at all.
A survey of health systems in developed countries shows a direct
relationship between indicators like infant mortality and the share of
the health cost being born by the state - the greater the state share of
responsibility, the better the outcome.
Unions have all sorts of additional reasons to avoid putting the US
model on the agenda. The results of a recently concluded struggle
between Kennecott Utah Copper Corp (KUC) and its workers contain a
number of important lessons for those looking at the American system.
In this better than average outcome, the United Steelworkers of America
were able to win continued health insurance for retirees from jobs with
the corporation. A union spokesperson summarised it thus:
"Only a few weeks ago, company officials sent around letters to our
retirees, telling them that they had no right to health insurance, and
maybe the company would not provide any, or maybe they would. It was an
absolutely outrageous and cheap fear tactic. But our retirees stood up,
and our union stood up, and we won a continuation - and even improvement
of - retiree health benefits." (See story page 9)
How would Australian workers like their access to health insurance to be
on the table every time an EBA expires and with the boss pleading all
sorts of hardship? What happens if you're not as strongly represented as
the retired steelworkers mentioned in the above example? What happens if
the boss prevails? What happens if "your" company goes broke? You would
be in the same boat as 40 million US citizens quoted previously that
have no health cover at all.
Health care would become one more entitlement that could be lost.
For Australian unions to be even contemplating adding another tier to
what is already being proposed for the health system - this time with a
divide between those in well organised jobs and those who are not - is
not on!
In general, the efforts of the unions within the movement to save
Medicare are to be applauded, but the floating of more ideas from US
labour relations books introduces a defeatist tone and an unacceptable
"fallback position" for the Australian labour movement.
Medicare must be saved and properly funded as a universal, bulk-billing
national health insurance system. The money is there. The rebate and
other subsidies to the private health system - which are a criminal
appropriation of public monies - must be ended.
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