Australia still has a good health system on world standards, but we are squandering it fast.
Last week three or four things added to the evidence that we are heading that way.
A judgment brought down by the Federal Court in Western Australia slammed the Australian Medical Association for engaging in anti-competitive conduct. A paper by Julie Smith issued by the Australia Institute put the damning dots and crosses on the I’s and T’s on what we have known to be the inequity of the Government’s health-insurance rebate scheme. An institute paper by Fran White and Kevin Collyer put the cement work on what has worried many about the corporatisation of health care. And long-running disputes by nurses in NSW and ACT have continued without governments recognising the fundamental folly of continuing to exploit (mainly) women in a profession so necessary to society’s well-being.
It adds up to a conclusion that unless trends change in Australian health care, we are headed away from a system that has by-and-large treated everyone who is seriously ill for about 8 per cent of GDP to an American-style system which treats less that 70 per cent of the population for about 12 per cent of GDP — all on the altar of the manic economic rationalist belief that the private sector can deliver everything better than the public sector.
When will the Coalition realise that the private sector does widgets very well, but education and health quite poorly. When will the Labor Party realise that the private sector does widgets and telecommunications much better than the public sector. Spare us from ideologues.
Smith’s paper reveals the inequity of the health-insurance rebate.
It reveals that the Government has jumped into a very expensive policy trap of its own making. It sought to increase private health insurance. Early attempts failed. Then two more things were introduced quite quickly: the life-time health-cover rules which threatened ever-increasing penalties if you were not in private cover by the age of 30 and then the 30 per cent tax rebate on premiums.
The carrot of the latter did little to increase the number of people covered, but it came at a cost of $1.6 billion in 1999-00 rising to as much as $3 billion in 2002-03. But the money does not go to health. It goes into the pockets of those who can afford insurance to spend on what they like. Also half of it goes to the top 20 per cent of taxpayers. The rebate is not means tested and it is open-ended. You can get the rebate for health insurance for everything – gyms, dentists, glasses, fads etc.
In fact, a smart insurance company would offer a high-cost no-gap policy which covered a huge amount of lifestyle “”health” items – buying a bicycle or indoor gym, for example. These costs would effectively become tax deductions.
When the stick is added to this policy folly, it becomes a fiasco. The life-time health cover rules and the Medicare surcharge for the uninsured are brow-beating significant numbers into insurance. And everyone who joins costs the Government and extra few hundred dollars in rebate. And every few hundred dollars taken out of the health budget in rebates for people to spend how they like are a few hundred dollars fewer to be spent on public health.
The policy is a health fizzer even if it has bought some votes.
Collyer and White’s paper documents alarming trends in the privatisation of medicine, with corporations tapping into Medicare and the Pharmaceutical benefits Scheme as well as private insurance to gain their profits.
Private hospital chains, corporate private practice (where doctors do not own the practice but work for a corporation), private chains of radiology and pathology are all on the rise. Pharmacies and research are following. They are also often linked. So patients can find themselves referred from doctor, to tests, to hospital to drugs, to rehabilitation obtaining services from one company.
These corporations’ primary aim is profit. Over-servicing (with the public footing much of the bill) is not controlled. Indeed, it is encouraged. Private provision is usually more expensive.
Public-policy makers who are paying for a lot of this lose control. And in the research area, information is not shared for the public benefit.
And in Western Australia a week ago the Federal Court found in favour of the Australian Competition and Consumer Commission against the Australian Medical Association (WA). The ACCC alleged the AMA and a group of doctors came to an arrangement to keep up the fees for treating public patients in a partially privatised hospital owned by Mayne Nickless (trading as Health Care of Australia) in a way that would “”prevent, restrict or limit the supply by some or all of those doctors present of medical services to public patients at the Joondalup Health Campus”.
Some of the contentions are still disputed by Mayne Nickless and will be litigated, but you could conclude from the ACCC’s allegations that it was a way of shutting public patients out of the newly partially privatised hospital by charging them at a high rate.
If this is a sample of what is happening with increasing privatisation of hitherto fully public hospitals, it means public patients – who get treated under Medicare for minimal personal costs – will get shut out. They will have fewer hospitals to go to and longer waiting queues. Meanwhile those with money and (government-subsidised) insurance will get top-flight (government-subsidised) treatment.
Meanwhile as money flows from the public sector to the private sector, the nurses in the public sector continue to struggle for a decent wage.
Yes, let’s have private-sector involvement in the health sector – but not profits subsidised by taxpayers money. This is not a health policy – it is looking after the affluent.