The Howard government wants a different Medicare: one where people who can, pay more to visit a doctor. The government is grappling with a complex economic issue, but should not dismiss the social benefits that Medicare delivers to the very sick and less well off. The degree to which the lower paid and the disadvantaged are protected will determine the success of the government’s plans.
In a bold step to restore bulk billing for pensioners and concession card holders, the government has shifted the escalating cost of general practitioner services from the public purse to private households. With seemingly little regard for public opinion, this embrace of a user-pays system heralds a major change in the culture of health services.
To encourage GPs to bulk-bill pensioners and concession card holders in more remote locations, the government will pay a maximum $6 per patient incentive to GPs. No incentive is paid to GPs who bulk bill patients without concession cards. This crude means test furthers the notion that only some people deserve the full value of Medicare cover. Moreover, charging all non-concession patients full fees will then become accepted practice. Bulk billing will largely disappear and become a slim prospect for a few.
In effect this new form of Medicare accepts that bulk-billing rates will fall from the present 70 per cent level to around 50 per cent of all GP consultations. It presumes that those entitled to the full benefit of Medicare are only the most needy.
Holding a concession card is no proof of impoverishment. Self-funded retirees can earn up to $80,000 a year and hold a health care card. Yet ‘working poor’ families on only $34,000 annually receive no benefits and will likely pay more to see the doctor. As research consistently indicates, the lower paid are also the most dependent on health services. This demonstrates the necessity of maintaining broad access to health care. Determining eligibility for full health cover based on income or working status is too simplistic given the diverse factors that give rise to bad health and chronic disability.
Of course the government is the last to admit that its ‘Fairer Medicare’ proposals will open the door to increased medical fees. But the major assumption underpinning the proposals is that bulk billing for concession card holders, at least, must be preserved. What happens for the rest of the community has been less clearly identified.
By releasing its Medicare changes before