Behind the Government's Medicare plan:
killing bulk-billing

Anna Pha

Last week the Howard Government managed to buy off four 
independent Senators and get its highly regressive Medicare 
legislation passed. The dishonestly named "Medicare Plus" is 
another step on the path to wiping out the universal nature of 
Medicare, including the scrapping of bulk billing: effectively 
the end of Medicare.

The public health system is in crisis, at the point of collapse 
after years of under-funding and undermining by government. Many 
doctors and nurses have already left and many more are seriously 
thinking about it. The Howard Government has taken measures to 
prop it up until after the elections.

It is doing this by throwing millions of dollars to doctors, in 
particular to specialists and rural doctors with negligible 
benefit to the health services.

For patients, the only certainties are that the cost of medical 
services will rise, public hospitals will remain under-funded and 
Medicare will move another step towards becoming a second class 
health system or "safety net" for those who cannot afford the 
expensive private sector.

"Medicare Plus is designed to kill off bulk billing", said Dr Tim 
Woodruff, President, Doctors' Reform Society. "It means that most 
of our patients will not be bulk billed because they are not 
pensioners and card holders. It means that many pensioners and 
health care card holders will not be bulk billed."

The original package that had been knocked back by the Senate 
remains virtually in tact. There are some relatively minor short-
term gains for a few patients, but overall the package undermines 
the integrity of Medicare and its future.

Tasmanian Senators Brian Harradine and Shayne Murphy, former 
Democrat leader Meg Lees and One Nation's Len Harris — all up 
for re-election soon — were bribed with some additional services 
in Tasmania and rural concessions regarding doctors' rebates and 
some semblance of dental and other benefits.

"Even though the incentive to bulk bill concession card holders 
and children under 16 will increase from $5 to $7.50 in rural 
areas [and in Tasmania], there is no guarantee that general 
practitioners in these areas actually will bulk bill", Australian 
Nursing Federation Federal Secretary Jill Illife pointed out.

The proposals for enhancing primary health care by extending 
Medicare rebates to dental and other areas are a positive move, 
but fall far short of what is required.

Dental treatment under Medicare is limited to a total of $220 for 
three dental consultations! That in itself is a joke! How many 
dentists offer treatment at that price?

"This is a health care measure not a dental care scheme and will 
only be available where dental treatment is required to treat a 
chronic medical condition", said Health Minister Tony Abbott 
whose government cut a national dental program that targeted 
pensioners and the poor when it came to office in 1996.

Likewise coverage for other health professionals such as 
psychologists, physiotherapists, podiatrists, dieticians and 
chiropractors will also leave patients out of pocket and with 
very limited access to Medicare benefits.

The Minister is lying when he claims that "All Australians will 
now be protected against major medical bills resulting from out-
of-hospital health costs including GP visits, specialist 
consultations, X-rays, blood tests, MRI scans, CT scans and 
radiation oncology".

Safety net illusions

The "safety net" will come into play when out of pocket costs 
(co-payments) for Medicare services provided out of hospital, 
reach $300 for a family or individual with a concession card or 
receiving Family Tax Benefit (A). For all others the safety net 
kicks in when expenses reach $700.

When patients hit the safety net, Medicare will cover 80 percent 
of the co-payment . (The co-payment is the difference between 
what the doctor charges and the rebate that Medicare normally 
pays when a patient is not bulk billed.)

"This so-called 'safety net' is more a safety net for 
specialists' incomes; a blank cheque for them to increase co-
payment from $50 to $1500 without feeling bad, knowing that there 
is a limit to how much the patient will pay", said Dr Woodruff.

The amounts might not sound much to the likes of Abbott, but to 
struggling families, the unemployed, pensioners and workers on 
low incomes, it is a lot. 

When the $300 or $700 is added to the cost of prescription 
medicines (safety net kicks in at over $600), medications that 
are not on the PBS list, hospital expenses, dentist visits, 
opticians, glasses, hearing aids, prosthetics and all the other 
medical expenses many people will simply be locked out of the 
system

And if you are paying for private health insurance as well — as 
the government wants — then you could be looking at being out of 
pocket by thousands of dollars in the case of a serious accident 
or a chronic medical condition or even just from the normal wear 
and tear of getting old.

And that is now. What happens when the government increases the 
$300 and $700 thresholds and reduces the rebate or fails to 
increase it in line with rising prices. This is how it drove 
doctors out of bulk billing — making bulk billing economically 
unsustainable for GPs. This is what it did with the PBS system — 
the safety net threshold has risen by hundreds of dollars and the 
payment for scripts by hundreds of percent.

Dr Woodruff sums it up: "We will  have a two tiered system, a 
charity system for some elderly and kids, receiving second class 
care and turnstile medicine as befits charity cases, and a pay-
as-you-go system for the rest, with a saggy inadequate safety net 
which will fail to catch the many who will struggle to afford the 
bills."

"for those who are bulk billed it means they will be seen as 
second class citizens, not able to pay their way to decent health 
care, relying on doctors' charity", Dr Woodruff said.

Bulk billing for all

Medicare means everyone has access to bulk billing: it is not a 
charity but an essential service that Australians from every walk 
of life support.

If everyone is fully covered then there is no need for any safety 
net. Safety nets are for catching people who fall out, who miss 
out, who are not covered.

The four Senators have traded off the essential elements of 
Medicare for a few dollars and some services that will diminish 
over time. They have voted for the destruction of Medicare and 
its replacement by a safety net system.

The government is spending an extra $2.85 billion over the next 
four years (average of $700,000 each year) for little long-term 
gain. In addition it will be throwing hundreds of thousands more 
dollars to the private health insurance industry and private 
hospitals through its 30 percent rebate on private health 
insurance. This is already costing $2.4 billion a year, not one 
cent of which improves health care.

There is plenty of money to fund Medicare and the public hospital 
system as it should be funded. Apart from the $2.4 billion 
handout to private health insurance there is the additional $50 
billion plus being spent on military equipment as well as a 
budget surplus.

With the $2.4 billion alone, the government could restore 
Medicare to offer universal bulk billing for medical services. In 
addition it could improve and extend Medicare to cover dental 
health and reduce the price of prescriptions. It could provide 
adequate funding for public hospitals and begin to address the 
crisis in aged care.