The following article was published in "The Guardian", newspaper of the
Communist Party of Australia in its issue of Wednesday, July 16th, 2003.
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Howard's way on health - Destroying Medicare -- Feeding Insurance Companies
The following is the text of a talk given by Dr Con Costa to the Sydney
District Conference of the Communist Party held on July 6.
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Cutbacks to health and Medicare are just one of the many attacks on the
people by the Howard Government. But it is a very sensitive area and, in
my experience, people feel very strongly about the attacks on Medicare
and the public health system.
Before Howard was elected he promised that "Medicare stays". It was an
unequivocal statement implying to the voters that Medicare and
bulk-billing would stay. He promised this to the Australian people. In
fact, the Liberal Party could not have won a Federal election unless
they supported Medicare.
Well, Howard lied. He totally deceived the public. Since he has been in
government the whole emphasis on health funding has switched to the
private health system and we are talking about almost $4 billion
annually of taxpayer's money.
(I know people talk about the private health insurance rebate (PHI
Rebate) as being $2.3 billion but Leonie Segal from the Health Economics
Unit at Monash University has recently analysed the cost of the PHI
Rebate and, adding up all the on costs and the losses from the Medicare
levy from people being in private health insurance, it comes to $3.6
billion!! Every year!!)
So Howard and Costello are diverting almost $4 billion of taxpayer's
money annually from Medicare and from public hospitals and bulk-billing
and it is going into the pockets of the private health insurance
industry . and sixty percent of this large amount of money goes on
ancillaries - not hospital care.
Private affluence and public squalor
Their aim is to introduce a US-style health system to this country -
creating what G K Gailbraith, a well known US economist, described as a
system of private affluence and public squalor. It is a health system
where, if you have money you get the best and if you are poor or without
insurance, you go without and you die.
I think this is an important point we need to be making to the
Australian people. It's not just Medicare that is being got rid of. It
is the Australian form of health care that Howard and Costello are
putting to the sword by cutting off funding.
Australia's system is built on the British model with universal public
hospitals accessible to all via casualty and emergency services and GP's
as the providers of primary care. They are also the gate-keepers to
specialist care and hospital admission.
Tried, tested and cost effective model
This is a tried and tested model and has always worked as a cost
effective model. People do not go directly to expensive specialist care.
They go first to their GP who, hopefully keeps them healthy and keeps
them away from expensive care unless it is necessary. Or they go to the
casualty or emergency room if they need to.
This whole system is under threat because if Medicare goes we won't
continue with that British model. It will be the US-model and will be
run by insurance companies. It will be managed care and we will lose a
lot of the freedoms that we now take for granted.
At the moment you are free to walk into any public casualty centre if
you feel sick - you are free to do it.
If you see your doctor he or she is free to treat you in any way they
feel professionally is the right way for you without asking for approval
from the government or an insurance company. There is no third party in
the consultation room being a part of the decisions.
These basic freedoms do not exist in the expensive US model, even if you
can afford top cover private health insurance. You still need to ring
your insurer if you feel sick in the middle of the night and request
permission to go to casualty.
Some bureaucrat at the end of the line may say, "Do you really need to?
What about waiting until Monday and seeing your GP as it will be a lot
cheaper for us." They might OK you to go to an Emergency Room but direct
you to one of the hospitals they own in the next town.
So we are going to lose a lot of freedoms that we have taken for granted
in the Australian system even if you are one of the lucky 60 per cent
that can afford the private health insurance.
If you cannot afford private health insurance you just won't get health
care or you will go to a relative to beg for the money or you will sell
your house. You may not recall that prior to Medibank being introduced
[by the Whitlam Government], the commonest cause for going to jail for
non-criminal causes in South Australia was because of failure to pay
your medical bills.
So what is under threat here is not just Medicare. What is under threat
is the Australian way of life and Australia's form of health care.
Howard's policies are all about shoe-horning in a US-style of health -
because we know that Howard is a pro-US model person. The war on Iraq
was just one example of his strong pro-US position.
He has an extreme position on these issues and a strong belief in the
free market and that people should individually pay for what they need,
including their health care.
But Howard's position does not make economic or public health sense.
Imagine trying to stop a SARS epidemic where more than 30 percent of the
people do not have private health insurance and cannot access hospital
or other health care, in a fully privatised system.
Imagine trying to stop the outbreak of a communicable disease in a
society where 30 per cent or more do not have access to proper health
services. There will be a permanent reservoir of infection in society
which will be a risk to all.
How can Australia afford a health system which will increase from just
over 8 per cent GDP to around 14 per cent GDP as is the case in the US?
Consider that under Medicare three per cent of the dollar is spent on
administration and 97 per cent on health care. In a private system, 14
per cent goes on administrative costs - to check all those claims - and
another 25 per cent goes to the shareholders - leaving only around 60
per cent for health care!
Medicare and bulk billing on the rack
As a result of the transfer of almost $4 billion to the private health
insurance every year, we are seeing the effects on the public health
system and bulk billing.
People are getting turnstile medicine when they go to the GP - if they
can find one that still bulk bills!
I have told the story before of a young woman who turned up at our
medical practice on a Monday feeling nauseous. She said she had been to
a Medical Centre the day before and had waited two hours before getting
in to see a doctor. He gave her some anti-nausea pills but she didn't
get better. She came to me and of course the first question I asked was,
"Did he do a pregnancy test?" The answer, "No". The pregnancy test was
positive and we took a different approach to her nausea symptoms.
Doctors are maintaining their incomes by pushing patients through
quicker and sicker and it is the patient that loses.
At nursing homes patients may not get visited and elderly people on
multiple drugs who are really sick and have not been visited regularly
either die quicker or they yo-yo back and forward to the public hospital
at $1000 a bed. The GP won't do a $30 nursing home visit because the
government won't increase the rebate by 10 per cent. So the Federal
Government is saving $3 on a nursing home visit and it is costing $2000
to $3000 for three days in a public hospital to the State Government -
or it is costing the elderly nursing patient their life!
This is what Howard is doing. He is bleeding the system dry and the
States are now starting to scream because all the cost is ending up on
the State public hospitals - which are, incidentally, about $1 billion
under-funded by the Feds to begin with. So patients are sent out of
hospital quicker and sicker and the whole process goes around and around.
The public system is being squeezed financially while the Government
gives $3.6 billion annually to the private health insurance industry.
It is the people who are paying with their health and with their lives
and this is what Howard has done for the last four years and we should
be really screaming about it because it is inhumane.
We are now almost down to the sort of health system one would expect in
Africa were 200 people line up in the morning just to get a few seconds
of the doctor's time.
Most doctors who still bulk-bill have a professional and conscientious
attitude and are trying hard. But they are going to the wall. They are
just getting fed up and are putting up a sign "we now charge $45". They
will see half the number of patients and earn the same money.
Howard has achieved all of this through his private health insurance
rebate. At the last budget Costello proudly said that the Liberals are
spending more on health than any other previous government. He justified
this claim by including the $4 billion insurance rebate in his total of
health spending.
And Costello after budget night said on national TV that the next thing
that has to go is the Pharmaceutical Benefit Scheme (PBS), "if not this
year or next year, it is going". If the PBS goes it will result in the
immediate doubling in the price of a prescription - from $23 to $47 and
eventually to $70, $80 or even $120 a script per month. And a lot of my
patients are on five or six scripts a month!
In the United States where there is no PBS it costs $1000 a month for
your tablets if you are a diabetic or chronic heart disease patient.
Patients have to ask the doctor for tablets that are four times the
normal strength. They break their tablets into halves and quarters to be
able to afford their medicines - or they take their tablets in bursts -
only when they can afford them!
At this very moment the free trade agreement between Australia and the
US is in an advanced stage. The Pharmaceutical Benefit Scheme is one of
the items that is being negotiated away and this is all happening in secret.
How are people going to afford their drugs? This is major issue we are
talking about. What Howard and Costello are saying is that we can afford
private health insurance but not an affordable drug scheme. No wonder
Howard is having trouble selling it because he knows that Medicare is
popular even with Liberal voters!
An alternative way
The Doctors' Reform Society (DRS) and the National Medicare Alliance has
come up with an alternative way to spend Howard's annual $4 billion GIFT
to the private health insurance companies.
We have to get rid of the PHI rip-off because if we don't, Medicare
cannot be properly funded. We cannot keep giving $4 billion every year
of taxpayer's money to the private health insurance funds and have
enough money for Medicare.
1) If we put $280 million to increase the rebate to GP's by say $5 some
will be happier to bulk-bill. (However many will only return to
bulk-billing when it is properly indexed to inflation, given the bad
experiences of the past).
2) And then, rather than give all the money directly to the doctors
let's help them and their patients by putting another $180 million to
pay for nurses in general practice.
The girl who waited two hours in a medical centre because of nausea
could have been seen by the nurse while she was waiting and could have
had the pregnancy test done and been better prepared to see a busy
doctor. Also mothers with asthmatic kids waiting for hours could be
shown how to use the nebulisers or advice on asthma or diabetics and be
given diet and advice on home management, or the elderly explained their
medications, etc.
GPs working with practice nurses are commonplace in country areas which
are declared "areas of need" and receive government subsidies.
We are saying, "Let's make bulk-billing GPs an "area of need", because
they are bulk billing."
(Howard has also cut down on the number of doctors and reduced the
number of provider numbers. You need a provider number to access
Medicare payments. As a result, there are no locums, there are no
assistants. These doctors are overworked and they can't get any help
because the private charging doctors and the entrepreneurial medical
centres quickly soak up any of the limited spare doctors.
3) Increase public hospital spending by $710 million - because we know
they are hugely under-funded.
4) We also call for $750 million for a proper National Dental Scheme.
One of the first and meanest acts of the Howard Government was to get
rid of the $100 million (and very minimal) dental scheme where very poor
and elderly people could get their teeth fixed so they could eat.
We're saying don't just bring back the mini-$100 million scheme but
build a FULL $750 million scheme to give a proper national dental scheme
for people who really need it.
5) Also the PBS needs fixing as costs are going up - new prescriptions
now hit the market at around $120 per month. The pharmaceutical
companies are spending $750 million dollars every year to directly
market their products to GPs. They spend $30,000 per year on each and
every doctor in Australia.
In contrast the Government spends only $5 million dollars on a
government education scheme - and even this small intervention saves $15
million dollars for the PBS. We are calling for the Government to spend
$150 million to fund independent drug detailers to advise GPs on
appropriate use of medications and to combat the drug company
propaganda. Even then we would be outspent five to one by the drug
companies.
6) $120 million dollars would give a 10 per cent increase for Aboriginal
health which would be money well spent.
7) A 10 per cent increase for aged care at $300 million.
This all adds up to around $2.6 billion - thus we still have $1 billion
of the $3.6 billion PHI rebate left over. So obviously we can afford
Medicare and we can afford the PBS.
Medicare fight-back needed
Medicare cannot survive without the support of the Labor Party. But
their position was hardly clear until more recently. And it was not so
long ago when Labor health spokesperson Steven Smith was talking about
the future of Medicare as "a safety net".
Unfortunately the Labor Party is trying to have it both ways when they
say they will defend Medicare but they will also keep financing the
private health insurance industry. It is an illusion to think we can
fund two systems. The Government's priority is for the public system on
which we all depend, and which they promised to maintain, should go.
Other than the CPA the only party that has a clear position on getting
rid of the PHI rebate is the Greens. The Democrats are talking about
supporting Howard's budget changes to bulk-billing if they can get
guarantees on the capping of doctors' costs. Pigs might fly. They also
have a position of support for a means-tested PHI rebate.
The ACTU through Sharan Burrow and the National Committee has taken a
good position on Medicare and bulk billing - although some individual
unions may still be under the delusion that they will be OK through
bargaining for PHI cover for their members.
Women often understand the importance of good health care - women are
usually the main carers for children. Before Medicare it was often only
the rich women who had reproductive checks. Before Medicare there were
no doctors in the western suburbs of Sydney - (few could afford to pay
them). So the ACTU felt keenly that Howard's policies would impact very
strongly on workers, particularly on fixed wages, and they took a great
position.
There is the National Medicare Alliance which has been working well for
several years. It includes ACOSS, the Pensioners, the ACA, and the
National Nurses Federation and, since the ACTU came on board, state Save
Medicare Committees were formed. Now we are seeing them spring up in
locality areas and I spoke at Parramatta Save Medicare recently.
We need to support this nationwide and local grass-roots activity and
clarify the issues. I think we have to attack principally the PHI rebate
and it is important that we know where political parties stand on this.
Let's be quite clear. If the PHI rebate stays, Howard does not need to
make any further attacks on Medicare. The whole system is imploding
through lack of proper funding and we are going to get a user-pays and
US-style health system.
We also need to get into the specifics, because many are saying they
support Medicare because it is popular. We need to promote the objective
of getting rid of the PHI rebate through slogans such as "a national
dental scheme or private health insurance", "bulk-billing or private
health insurance" etc, so people understand what their choices are and
don't feel that "something is being taken away from them" if they lose
their PHI rebate.
(People are being tricked by the offer of discounted private health
insurance because they can "get their sunglasses for free". But when
they go to the GP with their kids they all have to pay and they will
soon be paying double for their prescriptions as well as co-payments for
all medical services such as x-rays and mammograms.
Soon they will find that the local public hospital is means-tested and
that they will no longer have a choice about whether they choose to use
their PHI or not. Very quickly that free pair of sunglasses will come to
be very expensive.)
Work together on Medicare
Above all the anti-Howard political forces need to start working closer
together on Medicare if we are going to save Australia's health system -
and not spend time on attacking each other.
This will be a challenge in itself given the Labor Party's hostility and
competitiveness with the Greens and other progressive parties, the deep
divisions among left parties and the divided and opportunistic policies
of the Democrats, not to mention the numerous key independents in the
Senate. (Remember it was Senator Harradine's single vote that gave
Howard his victory on the PHI rebate in return for a "no gaps and known
gaps" guarantee.)
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