“Abbott dumps co-payment” the headlines ran yesterday afternoon, rather misleadingly. A more accurate description is that the Medicare co-payment has been dumped onto doctors, who’ll now have the responsibility of charging it to make up for the $5 per consultation cut in the Medicare rebate, a freeze in rebates and a redefinition of consultations to cut the rebate for shorter consultations. If doctors don’t charge patients a co-payment, they’ll be significantly out of pocket. A bit like cutting university funding by 20% and then telling higher education institutions to go make up the difference by charging higher fees.
The only actual dumping relates to rebates for children and concession card holders, for whom the rebate will remain as is, and the removal of pathology tests. Otherwise, it’s pretty much the same co-payment proposal, but now rendered “optional”. The sort of option whereby you implement the government’s agenda or cop a major pay cut. As the Prime Minister put it yesterday:
“… what we’re saying to doctors is that with adults who don’t have concession cards, we don’t mind you charging a co-payment of up to $5. That’s what we’re saying, obviously we’re saying that … that’s an entirely reasonable position, an absolutely reasonable position.”
You bet you are — you bet I am.
The way Health Minister Peter “the invisible man” Dutton now tells it, the original proposal was just an opening gambit, a basis for negotiation. That’s somewhat in contradiction to his insistence, and especially that of Treasurer Joe Hockey, before 3pm yesterday that the original proposal was outstanding policy and the government wouldn’t be deviating from it, no way. As you may recall, it was only last Monday that the Prime Minister, in his “reset” media conference, insisted he was sticking with the original proposal, contrary to what someone he implicitly rebuked as a junior staffer from his office had told multiple media outlets.
Still unresolved is the downright bizarre contradiction at the heart of the co-payment: it’s not about unsustainable health spending (which isn’t unsustainable anyway, as repeatedly demonstrated) or about fixing the budget deficit. All of the savings will still go to a medical research fund, not to the budget bottom line. [update below] In an extraordinary moment at yesterday’s announcement, Abbott appeared to get annoyed at being asked why he was persevering with the fund and demanded “is there anyone in this country who doesn’t support the principle of a greater spend on medical research?” Coming from the man whose government has slashed funding for the CSIRO, sacked researchers and denies basic science as a matter of policy, it was a question laden with hypocrisy. Regardless of that, there’s still no clear, single explanation from the government as to why it wants a co-payment for GP services.
In the government’s view, doctors will welcome the opportunity to act, in effect, as tax collectors for Peter Dutton. Whether it’s successful in convincing GPs and patients that all is well, however, may depend on the information campaign that the government will almost certainly roll out to try to sell the new policy. This is an area in which misinformation can spread rapidly — after the budget, many doctors’ surgeries had to explain to worried patients that the co-payment didn’t instantly apply and that they continued to bulk-bill. But having excluded children and pensioners from the reduced rebate, and knowing that middle- and higher-income people probably already pay to see their GPs anyway, the government can be confident that even if GPs aren’t happy about being tax collectors, the main demographic affected by the co-payment is low-income earners. And they don’t tend to vote Liberal anyway.
Update: Fairfax’s Peter Martin corrects me on the deficit — the savings will both reduce the deficit and fund the medical research fund. He notes: “Under the accounting rules for such funds, (Future Fund, higher education fund etc) the contributions are accounted toward the bottom line as additions to the surplus (or subtractions from the deficit). It is only when the proceeds of the funds are spent that they detract from the budget bottom line.”
How long exactly would it take to accumulate the $20 billion for the medical research fund? Assuming that when the total is reached, that it’s actually used for medical research and that circumstances haven’t changed and it’s needed for other purposes.
If anyone believes this, please send me their details. I have this magnificent bridge for sale, just one previous owner, with views of the Sydney Opera House
If the GPs absorb the $5 per consultation, then it won’t do anything with the demand for medical services (although, yesterday I went for a vitally important blood test, which I have to have yearly, determining immediate treatment, not just a screening test, and I had to wait an hour for the phlebotomist to get around to me; if I could have got immediate attention for the added payment of $5 I would have grabbed it). I’d bet that they don’t.
Jacquie Lambie and staff please note this is just another rAbbott con. Vote down the dis-allowable instrument.
I’ll be interested in the media’s response to this.
I can’t see the general public seeing this as anything other than a ‘mean and sneaky’ Prime Minister ignoring the clear message the public and the Parliament were sending him.
Meand and sneaky, now where did I hear that phrase before?
Maybe if Abbott and co actually had a plan, upon getting elected, apart from three word slogans and relentless negativity, they might not be in this mess.
Labor don’t need Xmas presents this year, Abbott is the gift that just keeps on giving.
I have read Peter Martin’s article in The Age and the changes are even less straighforward than they are trying to make out they are.
The rebate for the 10 minute consultation which is now $37.05 from Medicare will drop to $11.95.
Now I am a pretty healthy senior and see my excellent, non-sausage-machine GP between about 4 and 8 times a year. I pay $80 for the vast bulk of my visits and I get the $37.05 rebate. This means in future that instead of being $42.95 out of pocket for each visit, I will be $68.95 out of pocket and will be paying pretty well all my own GP bill.
I can afford to do this at the moment. We don’t have a mortgage, or children at school or university and all those expenses of younger adults. But how many families not on concession cards are going to be able to pay this for each adult visit at a time of their lives when they are catching all the illnesses their kids pick up at school etc.
And will the doctors be required to add on another $5? And what is the rebate for longer visits? Where in fact does the $5 come in when the rebate for the most common visit has been cut to less than a third?
It strikes me that it is another attempt at privatisation by clumsy, tricky, contemptible stealth.
And the next step? Allow private health insurance companies to run the primary healthcare centres that are supposed to replace the efficient and effective Medicare Locals? Then allow the private health insurance companies to cover the much higher cost of GP visits . . . . ?
Voila, we have the US model of healthcare which everyone knows does such a good job.
It gets me down, really, just how ideological and incompetent this lot are. This attempt is not a back down, it is proposing an even worse alternative. It is not about the most effective healthcare system. It’s not about health at all. It is about blinkered, barren Teaparty economics.