Moving towards a two-tiered health system

The Federal Government’s stated concern about “6 minute medicine” is a sham. The real agenda is to reduce Medicare, which is why we should be glad that the Senate has indicated its opposition, writes Tim Woodruff.

The Federal Government’s budget proposed a Medicare co-payment of $7. It claimed that patients were seeing doctors too often and that a price signal was needed to reduce demand.

Because it couldn’t get this proposal through the Senate, it announced a new package, which Mr Abbott said “had significantly improved the Government’s co-payment measures, while at the same time maintaining the desired price signal”.

The intention was unchanged i.e. to reduce patient visits to doctors, and reduce the costs of Medicare.

The new proposal consists of three parts. The first is a direct cut of $5 to the Medicare rebate for everyone except pensioners and health care card holders. The ALP, Greens, and some crossbenchers have indicated they disagree with this so it may never happen as it must pass the Senate.

The second is to freeze the rebate until 2018 which means that because of inflation, this will amount to a $3 cut to the rebate for everyone by 2018. This can’t be stopped as it doesn’t require parliamentary approval.

The third part of the proposal, however, is to reduce by $20 rebates for visits less than 10 minutes in duration. The Government claims that this is intended to reduce “6 minute medicine”, the description given to the practice where patients are given inadequate time for the service they require, and rushed out of the consultation with a pat on the head and an unnecessary blood test, x-ray, or prescription, when doctors should instead be listening, questioning, and getting to the bottom of the problem.

Many doctors and patients have been concerned for years about this poor quality care.

Governments however have shown no concern until now. The issue wasn’t raised with the original budget proposal, or at any time during the years when Mr Abbott was health minister.

Indeed, if the concern regarding 6 minute medicine was genuine, it would include both a rebate increase for long consultations and a rebate cut for short consultations i.e. a carrot and a stick, with no net decrease in income for doctors. That could be good for patients. The problem for the Government is that it wouldn’t save any money and it wouldn’t send a price signal to reduce patient visits.

This Government’s stated concern about 6 minute medicine is a sham. The real agenda is to cut the Medicare income of doctors so that they will reduce bulk billing and increase co-payments in order to maintain their income.

That will achieve the Government’s stated aim of cutting patient visits to doctors. It won’t affect the rich. It will affect workers on low incomes and pensioners and health care card holders. This is where the ideology of the price signal ignores the reality that the effect of reducing visits will be that some people will delay going to their doctor until their mild symptoms have become severe and life threatening. It would appear that the Government has decided to let the health of those who are affected by these price signals finance its budget deficit.

This change to the rebate for short visits comes into effect on January 19. It can be reversed by the Senate when it next sits next month. The ALP has declared it will block the changes. The Greens and a number of crossbenchers have indicated they too will support a disallowance motion.

This change is a confidence trick by the Government to pursue an unchanged agenda. The total package must also be seen in combination with its approach to private health insurance. It is supporting trials by private health insurance companies which allow those with such insurance to avoid co-payments, to avoid the very price signals that the Government insists are necessary.

This is further evidence that the agenda is much more than just reducing bulk billing. The Federal Government wants a two-tiered health system where credit cards decide what level of care one receives. This is the American way. The next proposal may be to replace our flag with the Stars and Stripes.

Tim Woodruff is currently the vice-president of the Doctors Reform Society and a specialist physician working in private rheumatology practice in Melbourne. View his full profile here.