So much much for all that nonsense last year about scraping off the barnacles for a fresh political start in 2015. The government has now backed down on last year’s co-payment backdown before it has even begun.
The new health minister, Sussan Ley – quite sensibly – says she wants to consult with doctors and the parliament to try to find a fair way to implement what she says are the government’s core aims: a price signal for patients who can afford to pay and continued bulk-billing for those who cannot.
It’s just a shame the government didn’t think of that in the first place, either when it announced the original across-the-board $7 co-payment, or when Tony Abbott and his then health minister, Peter Dutton, waited until after parliament had risen for 2014 to announce a complex series of changes to replace the original budget policy that had stalled in the Senate.
They insisted their December plan – which would miraculously save almost exactly the same $3.5bn over four years as the old one – was in fact “better” because they had listened to the community. But they hadn’t listened to doctors or the parliament – neither had been consulted. And one of the three new measures was set to take effect from 19 January – next Monday – before parliament met again and had a chance to disallow it.
Initially the government got some of the headlines it was hoping for: that the co-payment had been “dumped” and that bulk-billing would stay for children, pensioners and people in nursing homes. Neither Labor nor the Greens rejected all the changes out of hand.
But in fact the government was reducing or freezing Medicare payments to GPs in different ways, and leaving it up to the doctors to decide how, and to which patients, they would pass on the costs. Children and pensioners were exempted from a cut to GP rebates for general patients by $5 to be introduced in July. But they were not exempted from the big reduction in the rebate for consultations lasting less than 10 minutes from $37 to $16.95, which was supposed to start on Monday, and which Ley now says will not proceed.
The December plan meant a “co-payment” of much more than $7 was almost inevitable because doctors could not possibly absorb such a reduction in their incomes. It was just less immediately clear that government policy was to blame.
The January backdown on the December backdown happened just hours after another minister had insisted no backdown would occur. It also came as the Queensland premier was trying to run an unusual January state election campaign, partly to try to avoid unpopular federal policies. Meanwhile, doctors were filling the airwaves with their objections and Labor, the Greens and the crossbench in the Senate were firming in their resolve to overturn the plan as soon as they were able. The government was again left looking both hard-hearted and chaotic.
Now that the process is different, the result may be different too.
Doctors are not opposed to co-payments in principle, and I suspect voters could be persuaded to put up with them if they were properly debated and introduced in a transparent, coherent and fair way. Even countries such as Norway and Sweden, with generous public services, ask patients who can afford it to make a contribution.
Co-payment 2.0 looked like a dodgy makeover of co-payment 1.0, driven by the primary aim of achieving the same savings.
Now Ley, who wasn’t even at the cabinet table when the first two co-payment plans were decided, has to come up with co-payment 3.0 against a backdrop of mistrust and confusion. But she at least has a chance to deliver sensible policy.