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11 December 2014
by John Passant

It isn’t the co-payment they are killing; it is Medicare

Tony Abbott hasn’t backed down on his scheme to make us pay for going to the doctor. He has merely changed the focus of who imposes the co-payment and hopes that we will blame doctors rather than the government for any increase in our health bills.

Under the Budget attack on the poor and workers it was going to be that we’d have to pay $7 to go to the doctor. Now it is a bit more sneaky.

The government will reduce the Medicare rebate for going to your local doctor by $5, ie down from $37.05 to $32.05. For pensioners, under 16s and those on concession cards there will be no change to the rebate. Yet despite these changes the Government estimates it will still receive over $3 billion from the ‘reforms’ over the next 4 years, much the same amount as for the $7 co-payment. In other words the government is confident that we will end up paying just as much under these changes as we would have under the old proposals. So nothing has really changed.

On top of that, the idea that we need to salvage Medicare is given the lie by the fact none of this $750 million a year is going into primary health care. The money will go to a Medical Research Fund, the interest on which will fund medical research. A good initiative perhaps on its own, but why are we paying for it? Why aren’t the people who benefit most in money terms from a fit workforce, the bosses, paying for it? And if public health spending is out of control, unmanageable or whatever other lies the Government tells us, why isn’t this $5 co-payment going to fund primary care, hospitals and nurses?

Doctors who bulk bill will face a choice – continue to bulk bill, but now at the lower rate, and thus reduce their income by up to almost 14% ($5/$37) or recoup all or some of that loss by charging their clients up to $5. They could also of course speed up consultations even more so they make up the loss in income by seeing patients in say 6 minute blocks rather than ten. For lawyers and accountants 6 minutes might sound familiar as the standard billing time. This government wants to reduce medical care to time billing and price signals.

The government will also freeze the rebate at $32.05 for the next four years. So bulk billing doctors will be under even more pressure over time to abandon bulk billing or speed up consultations.

Many doctors don’t always bulk bill. The rebate is woefully inadequate to address the real costs of the medical services and allow good, hard working and decent GPs to earn an adequate living. So many charge above the bulk bill amount (often as much as twice the rebated amount.) Lets take an example.

Say a doctor charges $75 for a visit from an employed person and say that person earns $40,000, not that much above the minimum wage. That person receives $37.05 back. So they pay, under the present arrangements $37.95 out of their own pocket. Under the government’s proposed scheme they’d get $32.05 back in rebate and if $75 remained the fee, they would pay $42.95 out of their own pocket.

The government hopes its new arrangements will see a person in those circumstances say to their doctor, you should reduce you charges by $5 a consultation so I am not wore off. Some doctors may do that anyway. However most will want to keep their current living standards for their long hours and good advice. And we patients aren’t idiots. We know it is government which is taking the extra $5 from us, not the doctor. We aren’t fools, although Abbott and his health Minister Dutton seem to think we are. I hope that all across Australia doctors put up signs to the effect that it is the government, not the doctor, increasing the costs of visiting them by $5.

The second issue here is the undemocratic nature of the changes. Instead of getting the Senate to pass amendments to current laws (which they know the Senate will reject) the Abbott government will implement these changes through legislative instrument (a regulation). The Senate then has 6 sitting months to overturn the regulation. So the change will be in place before the Senate next sits in February and it is not clear all the Senators who opposed the $7 co-payment will oppose the disguised $5 co-payment. We need to be out on the streets against these changes to give those wavering senators a spine to stand up to this latest ploy by the government to destroy Medicare.

Make no mistake. The co-payment isn’t dead; it has just changed its spots. This government’s long term plan is to destroy Medicare and to move to a fully privatised health system. This $5 co-payment is the first step down that long path. We have to organise a serious fight to defend Medicare. Our trade unions and unionists, especially in the health sector and Department of Health have the power to stop this government in its tracks. Let’s urge them to do so.