After surviving the Liberal Party backbench revolt, Tony Abbott was reported as saying that when offered the option of believing a politician or a doctor, the public will back the doctor.
But when it comes to health and Medicare, what about backing the truth?
The Abbott government’s mission is essentially twofold: an ideological determination to destroy Medicare, and its desire to drag money out of health to solve its trumpeted budget crisis.
In just five weeks over a hot summer, Abbott backed down twice on Medicare changes: first, dumping his May 2014 budget proposal to tax every patient an additional $7 dollars a visit; then, after a howl of protest, dumping his changes to time-based Medicare consultations, the $20 GP tax.
However, still on the table is the $5 optional co-payment scheduled for July 1 this year, and the four-year freeze on Medicare rebates. Confused government policy has gone from $7 to $20 to optional $5 and freezes.
But why?
The basis for all these changes are predicated on a variety of falsehoods used by the government regarding the economic viability of Medicare, cheered on in particular by Terry Barnes, a former adviser to Abbott as health minister; Michael Wooldridge, who as health minister in the 1990s set off the doctor shortage seen in Australia today; and Tony Shepherd, the chairman of Abbott’s Commission of Audit who claimed the average Australian went to the doctor 11 times a year, confusing a service provided to a patient with a visit.
The Abbott government’s mission is essentially twofold: an ideological determination to destroy Medicare, and its desire to drag money out of health to solve its trumpeted budget crisis. On the first part it should be upfront and honest and say it does not believe in a universal health insurance system and be judged accordingly. Instead, it extends a freeze first implemented by Labor so the freeze will extend to six years.
Much like a slow bleed that cannot be cauterised leads to a haemorrhage, Medicare rates of bulk billing will decline slowly at first and then rapidly as doctors increasingly move away from bulk billing and patients pile back into public hospital emergency departments for non-emergency management.
However, on the issue of Medicare financial sustainability and general practice, the facts tell a completely different story that neither justifies a rebate freeze – for which patients will ultimately pay – nor a specified co-payment as trumpeted by the government.
Medicare outlays are described as either growing dramatically or as unsustainable.
But what is remarkable is that publicly available evidence unambiguously shows that Medicare outlays as a proportion of GDP over the past 30 years at the general practice level have remained remarkably stable.
In 1984-5, at the start of Medicare, the figure for general practice was 0.35 per cent of GDP. In 2013-14 that figure was 0.40 per cent of GDP, a 0.05 per cent increase over 30 years.
Indeed, when the figures for radiology and pathology specialist visits and in-hospital Medicare benefits for operations are included, they also show very stable Medicare outlays as a proportion of GDP. And as for the Medicare levy itself (excluding the specifically legislated increases in the levy) as a proportion of GDP, it too has remained stable. This over the years of deficit and surplus and deficit through Hawke, Keating, Howard, Rudd and Gillard to now.
They are remarkable statistics because our population is ageing; remarkable because more and expensive tests are being ordered; remarkable because GPs and their teams are providing a greater range of services, which is exactly what the government wants the sector to do.
So you would think that a government would praise, encourage and look to the sector to continue to strive and improve health-service delivery in an environment in which general practice economic impact has been static over the 30-year life of Medicare while doing more and more. But instead GPs as a group are slammed on the basis of the so called “six-minute medicine epidemic” that no one seems to be able to substantiate other than with mindless rhetoric and sloganeering. Or we get absurd propositions from Treasurer Joe Hockey, that it is somehow wrong that in this society that values health service access as a right, that his own child is treated in a public facility at minimal out-of-pocket cost simply because Hockey earns a lot, when the truth is that the Medicare levy he pays continues to make the same stable contribution.
Neither the Medicare system nor any other government program should remain static. New technologies and new programs that improve the system of primary care delivery should be trialled, tested, and, if found to be of benefit to the quality and delivery of health services, implemented. The government could start by talking to groups such as the Royal Australian College of General Practitioners and others about opportunities in improving health service delivery; programs such as the medical home, making the eHealth record a reality, voluntary patient registration, and enhancing multi-disciplinary team care, to name a few.
Whether a doctor chooses to bulk bill or charge the patient a fee is a matter for the doctor and the patient in a free marketplace. And so it should remain.
But a government that fabricates a crisis in primary healthcare funding on a 30-year history of stable Medicare expenditures to solve its other economic problems is not the best friend health and Medicare ever had.
Henry Pinskier is a Melbourne doctor and businessman, a former director of the Alfred Hospital, and a former vice-president of the Victorian ALP.