7.37 The chapter considered the danger of 'boundary problems' - of people 'falling through the cracks' of the system. These problems are inherent in any differentiated system that steps away from the principles of universality and, in this respect, revisits many of the arguments made in relation to bulk-billing made in the preceding chapter. The Committee notes here the comments of Mr Goddard:
The role of safety nets is inextricably linked to copayments and a lack of access and a lack of equality of access. The more satisfactory access is, the less need there is for a safety net. However, safety nets become essential if there is going to be a significant level of copayment or out-of-pocket expenses.35
7.38 There is the danger a system focusing on safety nets implicitly serves to separate the wealthier part of society from the benefits of a system they continue to pay for. This was expressed by the Hon. Wendy Edmond:
We all pay taxes, and then people start objecting to paying for a safety net system at the same time as they are paying large amounts for private health insurance and, on top of that, copayments. So cuts happen in those areas that general taxes go towards. That is what happens in the United States. People object to increasing public health care and improving the quality of it for those who are left behind.36
7.39 On the evidence presented, the Committee does not consider inflationary pressures to be a significant concern arising out of the proposed safety nets. However the Committee does share the concerns of the many doctors who fear the potential for increased control over primary care by private health insurers. As Dr Gault, a GP in Port Fairy put it: 'It would be much worse than the HIC would ever be.'37
7.40 The Committee is also sceptical of the effectiveness over time of any reliance on private health insurance safety nets. Experience has shown that rapid rises in private health insurance premiums are likely to erode the affordability of the proposed net for many families, and again, it is those on the boundary � the working poor � who are likely to feel the greatest financial impact.
7.41 Overall, the Committee believes that any consideration of the issue of safety nets must be underpinned by a commitment to the principle of universality and the role of Medicare as a properly funded public insurer. Put into practice, this commitment removes much of the need for safety nets in the first place. However, to the extent that there is a need for safety nets, the Committee considers that any reform should focus on creating a single, simple, and automatic payment system. This would parallel the arrangement for safety nets under the Pharmaceutical Benefits Scheme, minimise the wastage of administrative costs, and ensure that those who need the assistance actually receive it.
The Committee recommends the Senate reject the proposal for an additional safety net that differentiates concessional and non-concessional patients.
The Committee recommends the expansion of the existing Medicare Safety Net to provide for all out-of-pocket costs in excess of a set amount.
The Committee recommends that this amount be indexed annually to ensure that the safety net reflects the real costs of health care.
7.42 Were this proposal implemented, it would render the second proposed private health insurance safety net unnecessary.
The Senate has now referred Medicare Plus to the same committee, but it's hard to see how these conclusions on the Fairer Medicare safety net can be any different for the Medicare Plus safety net. In fact, it's interesting to note that Medicare already incorporates a safety net, although somehow the Medicare Plus proposal fails to mention that medicare already includes two safety nets which cut in at $317.70 for out of pocket expenses and a tax rebate that cuts in at $1500.
All we're really seeing is an ideological push to shift costs from the Commonwealth MBS to State hospital emergency departments and from the public sector to private insurance.