This is a current question with Shorten claiming that the Liberals are trying to privatise it and Turnbull calling this a Labor lie. What is the truth? The answer is in the history of Medicare funding. Medibank was set up by the Whitlam government and the bulk billing frees were set at 85% of the AMA ‘Most Common Fee’. The 15% was a discount but saved doctors a lot of costs and all their bad debts. They got slightly less, but the clerical and hassles saved by simply sending the paperwork, and later the computer message to the Medicare computer was felt to be a good deal.
But ever since then both major parties have not raised the Medicare same rate as inflation, in fact at about half the inflation rate. This has resulted in the Medicare rebate being about half the AMA fees. Specialists often will not see patients on Medicare unless they have a Health Care card, and GP practices simply cannot survive if all their patients are bulk billed. GP practices have survived by having pathology companies rent a room where they collect bloods for a relatively high price. This has allowed the government to keep the GP Medicate rebates low. Recently the government tried to change the pathology rebates, and the companies resisted, but the treat was that the pathology companies would stop subsidising GP rental and a whole fuss would have erupted re the uneconomic nature of General Practice. The government did not want this just before an election, so the pathology system was left as is. But can we trust the Turnbull government? I don’t think so. A couple of other pointers:
The Emergency Departments (EDs) have recently been in the news as having a hugely increased workload and there was a request for funds, also recently seen as a question to Turnbull on Q&A. EDs get busier if people do not go to GPs, who are far cheaper, and generally pick up problems earlier than EDs. So the rise in ED use is likely to be a reflection of the lack of funding of GPs by Medicare.
There have been a lot of rather convoluted plans to deal with chronic illness. As the population ages, and as it gets problems with obesity and diabetes, there are more visits, more prevention is needed. GPs are the cheapest medical intervention, so one might have expected that they would be the key element in the strategy to deal with it, perhaps supplemented by practice nurses or other slightly cheaper options based around GP-type community health centres. But instead of this there was a bemoaning of the difficulties and lot of convoluted nonsense trying to avoid raising GP payments to a viable level. It looked very like the object was not to find a solution to the problem, so that Private Heath insurers and the profit sector could get a look in at the problem and start to make some money.
Now we hear that there has been $5 million to look at outsourcing, just the payments part of Medicare. Well Medicare is Just a payments system, so that is the guts of it.
So it is very likely that the Libs want to privatise Medicare and take us to a US model of the health care. The public do not want this, but big business does, a powerful lobby in Canberra does, party political donors do, and the government can lessen the amount it pays for health, even though the total cost will rise dramatically.
Labor also has historically a very bad record. They have allowed the Medicare rebate to fall with inflation, had a rebate ‘freeze’ of their own, and their only promise is to stop the freeze, which still leaves most doctors either unwilling in the case of specialists or unable in the case of GPs, to survive.
Dr Arthur Chesterfield-Evans is a medical practitioner with degrees in Surgery, Occupational Health and Political Economy. He spent some years in tobacco control, and was a NSW State member of Parliament for the Australian Democrats. He is currently treating Workers Compensation and Third party injuries, and standing for the Greens in North Sydney.