17 May 2003

Riverbank and Medicare
The Crean speech was well-delivered. The policies were less well-thought out.

The conventional wisdom is that saving the Murray-Darling basin will cost $600 million. Launching a $150 million initiative on the basis that it's a start will not save the rivers. Opposing land clearing is going to be rough when we clear more land than any other nation and it's being done under the aegis of ALP premiers like Beattie. Land clearing in Queensland effects the basin all the way downstream to the Coorong. Irrigation systems upstream effect what happens when you turn on a tap in Adelaide.

We need those rivers. So really, while we have lots of enthusiasm merely because a federal politician has noticed the state of the basin we actually need a lot more done very soon. A lot of money needs to be thrown at this problem and it will be a brave federal leader who takes on the destructive neglect of the states.

Medicare is a universal health system based on access to the Medicare rebate. Crean should have bitten the bullet on universalism and defended the principle instead of (as with the Riverbank plan) promoting incremental change that will ultimately fail. The most infuriating aspect of the Medicare situation is that the crisis is entirely artificial.

The Parliamentary Library Research Note, Is medicare universal? says:

While bulk billing may not be universally available, it is a key plank of the Medicare system. Certainly it could be argued that one of the primary aims of Medicare was to promote bulk billing by doctors and thus promote the de-commodification of health services. That is, the take up of bulk billing by GPs was seen as a way of breaking the nexus between access to health services and capacity to pay. The steady increase in the percentage of Medicare services bulk billed from the introduction of Medicare in 1984 until 1996 provides some evidence that bulk billing was seen as a central and important component of the Medicare system. Other evidence of bulk billing's importance for the national health insurance system, Medicare, is provided in various statements and speeches made by the Labor government during the 1980s.

Gee whiz, what happened in 1996? And what was the Medicare rebate when Howard took the reins and what is it now? I suspect that spending a lot less money on ideologically-driven subsidies to the well-off such as the health insurance rebate and redirecting that money into raising the Medicare rebate might achieve a lot more than a scheme of special payments to doctors. More later.

And just a quiet word. Medicare is and always has been a Labor project. When suddenly the likes of John Howard and Peter Costello are allowed to lecture the ALP on the 'original intent' of Labor's own program it might be best to start arguing rather than wait for the axe. An energetic opposition might even have kept the falling Medicare rebate before the parliament and the people from the time it started - when Howard and Costello came to power.

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