It is extremely unfortunate that changes to Medicare are being proposed in the climate of the election-campaign auction. Labor has offered cash rebates to people for various medical services not covered by Medicare, but they are restricted to services to children and are means tested. Labor will also build a medical school in north Queensland. The total cost is about $368 million a year. Miraculously, Prime Minister Paul Keating has promised no increase in the Medicare levy. But Labor has made and broken that promise twice before.
The Coalition is yet to present its health policy.
While it is important for the major parties to put forward policies at election time, the complexities of health delivery require more than a grubby auction. This week’s cash-in-hand promise is little more than a bribe. And public expenditure is not a magic pudding. Slices of spending cannot be continuously extracted and the pudding revert to a whole pudding again by magic.
Australia’s health system has significant problems. The most significant is that the Medicare levy nowhere near pays for the cost of Medicare. Secondly, there has been a huge fall in private health insurance in the past 10 years without any compensating inputs into the health system. Thirdly, government and private financing of health needs are full of anomalies. A visit to a bulk-billing GP is fully publicly funded. A pharmaceutical purchase is partially publicly funded whereas an adult’s visit to the dentist is completely publicly unfunded. There is no rational reason for these disparities. Fourthly, the financing arrangements between the states and the central government are erratic.
That said, Medicare is on the whole a significant achievement that puts Australia’s overall health system ahead of most countries in the world. In particular, it has the advantage of universality and administrative efficiency. Australia spends much less on health as a per centage of GDP that the US, for example, and delivers better service.
Medicare does not need an overhaul. Rather it needs some fine tuning. Unfortunately, that fine tuning would not be electorally popular, at least initially.
Experience with the Pharmaceutical Benefits Scheme has shown that making every user at least pay something helps curb overuse. Doctors could still bulk bill, but patients should be required to contribute as well. Unfortunately, bulk-billing has become to mean free visits to a GP and has become a political sacred cow.
At present the only advantage of private insurance is to jump the queues at public hospitals for elective surgery. There are disadvantages. Privately insured people undergoing major treatment at publiuc hospitals often get a bill that public patients do not get.
Further, community rating under which the fit pay the same premium as the infirm is driving the young people from private insurance. But it, too, has become a political sacred cow.
The system should be rationalised, so that everyone gets a Medicare payment of some sort for every treatment and insurance is only for the gap between that and the total bill. Patients should be able to use Medicare, insurance and cash or a combination to get treatment at private or public hospitals, and public hospitals should charge the same for everyone. Medicare could provide extra safety nets for pensioners and some capped annual bill for those caught with huge medical bills.
The different charging regimes at public hospitals and the inability of privately insured people to access Medicare benefits which they have arguably paid for through the levy have caused an imbalance in the system.
Handing out extra money to people who happen to have children for some treatments now not covered by Medicare will only partrially address the anomaly of having some medical treatments covered by the universal insurance scheme and others not. If your teeth are smashed or your eyes need glasses, there is no help; if your jaw is crushed or your legs need plaster, you are covered. Worse, physiotheraphy … often an essential element to getting people back toproductive work … is not covered.
Once again, if some of the sacred cows are moved, benefits could be spread more rationally.
A further intrusion of politics into sensible health delivery is the silly game of cost shifting between the central government and second-layer governments. For example, the ACT has done its best to clear cases from the ACT-funded Woden Valley out-patient ward to federally funded GPs. Similarly with the move from ACT-funded salaried doctors at health centres to federal Medicare-funded private practice.
Politics often causes inefficient allocation of resources. Witness the promise of a medical school in north Queensland in the face of an over-supply of doctors and the threat to existing schools in the ACT and Tasmania. But Labor needs votes in Queensland.
Election time is bad for Australia’s health.