THE Australian Medical Association has declared war on the Abbott government.
In an aggressively strident article in Fairfax newspapers yesterday, AMA president and neurosurgeon Brian Owler savaged the Coalition’s plan for a $7 co-payment on general practitioner, pathology and radiology services.
In doing so, Owler followed his GP predecessor, Steve Hambleton, who opposed a co-payment from the moment the Australian Centre for Health Research think tank’s proposal to revive and update the Hawke government’s 1991 GP co-payment became hot news last December.
But compared to Hambleton’s dignified persistence, Owler aimed a political blunderbuss firmly at Tony Abbott and Health Minister Peter Dutton.
“The AMA is supportive of some co-payments, but not the one proposed by the government,” Owler wrote tersely.
“The co-payment is unfair and unnecessary. Ideology has pushed this proposal too far. The Prime Minister should step in and scrap this policy. If not, it deserves to fail in the Senate.”
The doctors union is throwing down a surgical glove to the government. The message from the AMA couldn’t be clearer, and it is this: “We, the AMA, will decide who comes to Medicare and the circumstances in which they come.”
Instead of engaging constructively with Abbott and Dutton, the AMA has chosen to go on the offensive, effectively saying that it will use the mystical power of its white clinical coats to tell the Australian people how to think about not just the government’s co-payment plan but any government policy they disagree with.
To be sure, the government’s bulk-billing plan is in need of policy and political surgery to survive the Senate’s incoming kennel of Clive Palmer’s neophyte PUPs, and it certainly doesn’t lack critics.
It could have been better designed by the bureaucrats, more time could have been taken over it, and ministers and their advisers could have considered more thoroughly the tricky politics of selling it to a dubious Australian public. I, for one, have written that it puts finding budget savings ahead of long-term structural reform of Medicare sustainability.
But, unlike the AMA, at least I have offered some constructive suggestions to make the co-payment plan more palatable, including dumping the $5 Medicare rebate cut accompanying the co-payments, and ensuring that families as well as pensioners and concession cardholders are protected adequately against unexpected cost hits. The AMA simply rails against the measure, claims it to be unnecessary and offers no alternatives.
The medical profession may believe, with good reason, that it is the most trusted occupation in Australia; the latest annual Readers Digest trust poll reaffirms that.
But such public trust in doctors doesn’t give the unelected and unaccountable AMA the right to claim a de facto veto of the policies of the elected government of the day, and shut down any attempted health reforms it doesn’t like.
Nor does it have any right to claim the political moral high ground on GP co-payments when it has rather dubious form of its own. Indeed, it’s no surprise that Owler said that the AMA supported some co-payments: that’s because his surgeon and specialist members love them to bits.
When it comes to patient out-of-pockets, and bulk-billing rates, the Department of Health’s quarterly Medicare statistics are damning. These look at Medicare volumes and expenses by speciality, and for Owler’s AMA they make embarrassing reading.
For the nine months from last July to March, surgeons and their assistants bulk-billed just more than 40 per cent of services, and average out-of-pockets for non-bulk-billed surgical services was $69. Obstetricians had a bulk-billing rate of 47 per cent and average OOPs of $214. Other specialists had a bulk-billing rate of 29 per cent and racked up average OOPs of $60.
But these specialties are model billers compared to anaesthetists. For them, the bulk-billing rate was a measly 9.8 per cent, with average out-of-pockets almost $110. No wonder they deliver the anaesthetic before they deliver the bill.
Doctors living in glass houses shouldn’t throw stones at the government. The hypocrisy of the AMA’s belligerent stand against the proposed GP co-payments, and for GP bulk-billing, while its specialist members merrily plunder patients’ pockets — as well as Medicare and private health insurance — is breathtaking. Instead of bagging Abbott, Dutton and the government, who have shown great political courage in grasping the co-payment nettle, the AMA should be working positively with them to tackle serious underlying problems in our healthcare culture.
There is one way for the government to confront the AMA’s criticism. As part of any modification of the co-payment plan, it could cap the out-of-pockets charged on any Medicare-rebated service. Then, perhaps, the white-coated leaders of the nation’s most powerful trade union really would have something to think about.
Terry Barnes advised Tony Abbott as health minister and wrote the Australian Centre for Health Research’s co-payment proposal