27 November 2003

The people still support Medicare, even if the PM does not

The promise to maintain Medicare in its entirety was not the only lie. The even bigger lie was that the $2.2 billion-a-year private insurance rebate was designed to 'take the pressure off the public hospital system'. Like everyone else, doctors follow the money.

The Howard Government (and the Fraser government before it) has been undeviating in its central health policy objective: to undermine the universal character of Medicare (and Medibank before it) and turn it into a safety net for the poor - even if the privatised, American-style system the Government wants to create in its place is administratively far more inefficient and removes any semblance of control over doctors' incomes.

Continental European countries provide universal services bases, which means taxes are about 50 per cent of GDP. English-speaking countries tend to target services by means testing, which keeps taxes to about 30 per cent of GDP. Paradoxically, resistance to paying taxes is much higher in low-taxed English-speaking countries than in high-taxed continental European countries, because taxpayers in Anglo-Saxon countries resent paying taxes for services they can't or won't use.

Right-wing governments such as Howard's want the electoral pressure to remain relentlessly on the need for tax cuts, which reinforces social division and two-tier systems. Left-wing parties, defined as those with an ideological commitment to equity and social solidarity, favour universal systems based on the insurance principle that all put in and all are eligible to take out.

Where English-speaking countries have opted for universalist services - most notably the National Health Service in Britain and Medicare in Australia - their popularity has made it difficult for right-wing governments to reverse the policy.

The government is addressing this dilemma in two ways. They have taken actual policy decisions. Their free market theology has not stopped them heavily subsidising private insurance. The constant reduction in the bulk-billing payment to doctors has forced the bulk-billing rate.

The second tactic is to change the meaning of words. Universal and residual do not mean the same thing. To support their shift from universal to residual they have announced that they are providing a universal safety net. That is a little like providing a square circle.

They have also used historical revisionism. Howard, Abbot and Costello have all firmly declared that bulk-billing was never meant to be universal. That is contradicted by Medicare's own architect and by second reading speeches when the system was established. Howard vigorously opposed the creation of Medicare. that has not stopped him knowing better than Medicare's makers what they were doing.

The Senate Committee has the bestd efintion of Medicare's purposes:

At a philosophical level, the government package amounts to a decisive step away from the principle of universality that has underpinned Medicare since its inception. The Committee does not accept the government?s argument that, because everyone continues to be eligible to be bulk-billed and receives the same rebate, universality is preserved. This argument is disingenuous and ignores the reality of the incentive system the government seeks to put in place. In practice, a GP will receive more public money to treat a concession card holder than they will for treating a nonconcessional patient. The fact that the incentive payment has a different label to the rebate payment is of minimal practical significance, particularly given the direct rebate of funds to the practice. A Fairer Medicare is about a return to a welfare system.

Public Opinion has more.

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