Health centres have provided good service to the people of Canberra since the first such centres in Australia were set up 20 years ago. There is great merit in having a range of health services under one roof: GP, counselling, nutrition, immunisations and so on. However, health centres cannot succeed without the presence of at least one GP. If the GPs disappear, the health centres will inevitably follow.
The question arises, though, who is to pay for the presence of a GP? The ACT Government made a decision earlier this year that it was not a good use of ACT taxpayers money to provide salaries for doctors at health centres when there were other ways of providing a similar service, principally by cost-shifting to the Commonwealth. The ACT decided that it would cease paying salaries and negotiate with doctors to take over the health-centre practices as private practitioners. All pensioners and other benefit recipients would still pay nothing because they would come under the Commonwealth’s Medicare bulk-billing arrangements. Some other disadvantaged patients would also pay nothing if the doctor saw fit. Others would pay at least something per visit, unless the doctors decided to totally bulk-bill, but that would be unlikely as the trend is against this in Canberra.
The upshot of the Government’s plan would have resulted in significant saving … largely at the expense of the Commonwealth and patients who could afford to pay. This could then be applied to other spending, such as education, or reduce rates … areas which have attracted large amount of community noise. In a polity with a finite fiscal cake, it seemed like a sensible wielding of the knife.
In a Quixotic gesture, he proposed in the Assembly that the Government only be allowed to end salaried doctors if their contractual replacements guaranteed to bulk-bill all patients, regardless of their ability to pay. A majority of the Assembly agreed. It was an easy, feel-good cop-out … but with consequences the reverse of what was intended. No doctors have been found who were willing to take over the practices on that basis.
Gone was an ideal opportunity for the ACT to engage in some constructive asset sales … some doctors’ practices … at the same time preserving the essential social elements of the original public arrangement. Those elements were that the disadvantaged get free treatment and that everyone in a community get access to a range of health services under one roof.
Those who can afford it should contribute something to health care. Payments, however small, reduce over-servicing as the changes to the Pharmaceutical Benefits Scheme have conclusively proved.
The Assembly should acknowledge the folly of its restriction on the sales and change its resolution to insisting only that social-security recipients and other disadvantaged people getting bulk-billing.
If any health centers close for lack of a GP, the blame lies with Mr Osborne. The Government can say that with unsustainable and conflicting demands from the community for lower rates and higher government help, it had devised a reasonable strategy which Mr Osborne and those who voted with him stymied.