11 March 2004

No magic pill, but it's a clever political fix

The package does not merely address the narrow issue of the decline in bulk-billing rates by GPs, it revolutionises the scope of Medicare by making it more relevant to Australians beset by a range of lifestyle health problems not easily solved by traditional general practice.

It will now cover services provided by dieticians, mental health workers, occupational therapists, podiatrists, osteopaths, chiropractors, nurses and psychologists. Meg Lees says this will keep Australians healthier and save money because preventive strategies will be used rather than costlier medical intervention.

On the other hand, it may bump up health costs because many of these services are already in demand.

Health policy has now become a big point of difference between the Coalition and Labor as both sides prepare for the election.

The Coalition is offering a two-tier Medicare system with generous subsidies and a far greater range of services offered to those in need costing $1 billion more than Labor's, which offers a universally available Medicare system with incentives to improve bulk-billing as well as a government-funded dental scheme.

Labor enjoyed a 24-point advantage over the Coalition as the party best able to handle health policy, a Herald poll conducted by ACNielsen found two weeks ago. Tony Abbott has his work cut out for him as he tries to shrink this lead, but he has made a spirited start.

This package is not all bad. Ultimately, the lasting element will be the expansion of Medicare to allied services. The top-up payment is neither here nor there and will have little impact on bulk billing. The Senate committee reported last October that the bulk billing initiative was trying to solve a problem (concession card holder access to bulk billing) that does not exist while avoiding a problem (universal access to bulk billing) that does. The new Abbot package continues that approach.

The bulk billing problem will be resolved only by raising the common fee to 1996 levels. I believe that will happen, and if the government's slide in the polls is not arrested, it will happen under a Labor government. The Coalition really does not want to explain to its middle class voters why they do not get the new benefits available to concession card holders.

Meanwhile, shifting the health focus from traditional medicine to preventive strategies like enabling some access to allied health care is a significant reform. I suspect the cost will be fairly dramatic once, for example, dental fees start kicking the safety net along.

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