Thursday, March 20, 2014

MEDICARE WAS NEVER A SAFETY NET


Those who wish to dilute, extinguish, diminish or otherwise do damage to Medicare used to claim in the Howard era that Medicare was a safety net.  Many of us fought that battle then on the basis of the texts of history.  Now the diluters, extinguishers and diminishers are back and so is the myth that ‘Medicare was only a safety net, a means of covering the health costs of those who could not afford to pay’. Convenient untruth.

My colleague Andrew Wilson has drawn my attention freshly to the speech by Neal Blewett, the minister for health who introduced Medicare in September 1983.  Blewett described four foundations for Medicare:

Simplicity: “…the simpler we make a health scheme the more chance it has of delivering the services to those who need them most.”
Affordability: “…everyone will contribute towards the nation's health costs according to his or her ability to pay. Under Medicare people will not have to worry about falling behind in their payments and being caught with substantial bills.”
Universality: “…Medicare will provide the same entitlement to basic medical benefits, and treatment in a public hospital to every Australian resident regardless of income. In a society as wealthy as ours there should not be people putting off treatment because they cannot afford the bills. Basic health care should be the right of every Australian.”
`Efficiency: “…one of the Government's major objectives through the Medicare program is having the maximum number of health dollars spent on delivering health services rather than administering them.”
A fifth attribute, Access, was subsequently articulated with reference to public hospital care in the Medicare Agreements Act 1992, and was explicitly applied to primary health care services in the 2008 National Healthcare Agreement.

In discussion with Dr Blewett fifteen years ago, he made the point to me (along with affirming that Medicare was NOT a safety net) that, if there is to be a sustainable demand on the public purse to pay for a social security measure, such as Medicare, the commitment of all taxpayers to it should be rewarded with universal access. 

The point about one of the goals of Medicare being efficiency is important in the current context.  Medicare fee schedules have served as checks on medical fees.  If Medicare reimbursements for service are augmented with private insurance rebates, then  fees escalate.

It is thus surprising that the current minister for health, Mr Peter Dutton, who speaks wherever he goes about the need for efficiency and sustainability of the health system, is reported as having no problem with the idea that private  insurers would cover the gap between general practitioners’ fees and the Medicare rebate.  The circumventing of this limitation on private insurance by private insurers who pay participating practices an administrative fee for preferentially treating the private insurers’ clients (as in, ‘we won’t pay for your drinks but we will pay to keep the pub open’) steals from Mr Dutton’s hand an instrument for efficient control of general practitioners’ and community-based specialists’ fees.

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