Category: Health

  • JOHN MENADUE. Preferential treatment for private patients in public hospitals in NSW.

    See below a poster from NSW Health which is being displayed in public hospitals in NSW.

    Readers may be interested to comment.

    Two things interest me. The first is that the advertisement infers that if you have private health insurance you will get superior service in a public hospital. That surely attacks the principle that in public hospitals patients are to be treated according to their therapeutic needs and not on the basis of income or private insurance. The former CEO of Medibank Pte proposed that PHI members should have priority in Emergency Departments.

    The second is that there is an inefficient churning of public money. The Australian taxpayer provides $11 billion p.a. in a subsidy to private health insurance. This subsidy is apparently to be used in part to pay bills for private patients in public hospitals. How much more efficient it would be for the Federal government to abolish the subsidy and adequately fund public hospitals. This churning of money is a symptom of the division of responsibilities in health in Australia and in the inefficiency of private health insurance.. The administrative costs of PHI are three times higher than those of Medicare. PHI premium increases over the last decade have been double the rate of CPI.

     

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  • JOHN MENADUE. Dental Care – Medicare – Private Health Insurance.

     

    Funding a Medicare dental scheme instead of the subsidy to PHI. 

    The PHI subsidy of over $10 billion p.a. would be much better spent on a Medicare dental scheme.

    In the following article Jennifer Doggett in Croakey, reports that about one third of Australians put off going to a dentist because of costs. (more…)

  • DAVID CHARLES. Venture Capital and Start Ups – Is Berlin an example for Australian capital cities?

     

    During a visit to Berlin in mid September this year I was struck by the way the venture capital and start up scene in Berlin had shifted from being something of an exotic hothouse flower to one of the leading places for new business creation in Germany and indeed Europe. Ernst and Young in its 2015 study Liquidity meets Perspective: Venture Capital and Start Ups in Germany argues that Berlin is the new kid on the block and has already got some impressive milestones behind it. Between 2011 and 2015 17,000 jobs were created.

    According to Ernst&Young, in terms of start ups and the mobilization of venture capital Berlin may have already caught up with London as the leading European location for tech based businesses. In 2015 Euro 2.9 billion of tech start up business took place in Germany. Of this over two-thirds was in Berlin with the lion’s share of deals being in IT and communications and E-Commerce. This placed Berlin ahead of London in that year.

    The question is how did this come about given the special nature of Berlin and its complex post World War 2 history as an island economy which had lost much of its industrial base? Are there pointers that Australia (and indeed the major Australian capital cities) can learn from in developing our own start up eco-systems? (more…)

  • IAN McAULEY. The Mounting Case For A Royal Commission Into Banks And Insurance Companies

    An overwhelming majority of Australians support a Royal Commission into the finance sector. Ian McAuley explains why.

    We’re paying too much for a bloated financial service sector.A prominent example is Australia’s largest health insurer, Medibank Private, which in the last financial year absorbed just over a billion dollars of contributors’ premiums in management overheads and profits – $511 million as profit and $516 million as management expenses. Spread over its 1.9 million policies that’s $540 per policy holder.

    Using a combination of subsidies and penalties (most notably the Medicare Levy Surcharge) successive governments have bludgeoned Australians into holding private health insurance, even though it has proven to be a woefully ineffective and high-cost mechanism of doing what Medicare can do so much better.

    Out of every dollar that contributors spend on private health insurers, only 83 cents comes back as claims paid. By comparison, of every dollar that passes through Medicare and the Australian Tax Office, 95 cents is spent on health services.

    It’s no wonder people are annoyed with private health insurers: in a recent survey 78 per cent of respondents agreed with the proposition that “private health insurers put profits before patients”. And it’s no wonder that the government’s stealthy moves to displace Medicare with private insurance met with so much resistance in the recent election.

    When it comes to general insurance – the insurance that covers cars, houses and business assets – the industry’s performance is even worse. Health insurers, it turns out, are the leanest among a well-fattened lot. (more…)

  • PETER WHITEFORD. The $4.8 trillion dollar question: will an ‘investment approach’ to welfare help the most disadvantaged?

     

    Social Services Minister Christian Porter on Tuesday released a report on the lifetime costs of the social security system for the Australian population, putting it at close to A$4.8 trillion.

    The report was an initiative of the 2015-16 budget, when the government allocated A$33.7 million to establish an Australian Priority Investment Approach to Welfare based on actuarial analysis of social security data. (more…)

  • The creeping Americanisation of Australian healthcare.

    In this blog, I have repeatedly posted articles about the threat to Medicare in the $11 billion pa. subsidy which the Australian government provides to support private health insurance companies in Australia. We are sleep walking into the destruction of Medicare unless we reverse this trend. The US health system dependent upon private health insurance is the most expensive and inequitable in the world.  (more…)

  • JOHN MENADUE. ‘Aunty, with our prospects in life – what is the point of being healthy?’

     

    The ABC Boyer Lecture series this year is being delivered by Sir Michael Marmot, the World Medical Association President and Professor of Epidemiology and Public Health at University College London .The main thrust of his lecture series has been about inequalities, poverty and social conditions – the social determinants – that have a major impact on health in the community.  (more…)

  • PATRICK McGORRY. We must settle the refugees before it is too late.

    In this article in the SMH, Patrick McGorry, the President of the Society for Mental Health Research, says;

    The time has come, before it is too late, to re-settle these fellow human beings and not just the children, but all of those who qualify as genuine refugees and who deserve a second chance for life.

    See link to article below:

    http://www.smh.com.au/comment/we-must-resettle-the-refugees-before-it-is-too-late-20160907-grav05.html

     

     

  • JOHN MENADUE. Medicare, Private Health Insurance and the ALP

    In my article, ‘Down a different path in Melbourne: how Medibank was conceived’ written in 2000 for the Medical Journal of Australia (see link below), I described the history from 1967 to 1975 which led to Medibank/Medicare.  In that article, I highlighted one issue that drove Gough Whitlam’s determination to establish Medibank/Medicare. His concern was that “The Liberal and Country party Coalition’s voluntary health insurance scheme, supported by taxpayer deductions was wasteful and inequitable.”

    The package of measures that introduced Medibank/Medicare abolished the taxpayer subsidy for private health insurance. When the Hawke government introduced a revised Medicare in 1983 it removed the private health insurance subsidies that the Fraser government had introduced.

    The ALP today doesn’t understand the threat to Medicare of the $11 billion per annum  government subsidy to private health insurance. I drew attention to this in an earlier blog, ‘The Labor Party does not understand its own creation‘.

     

    ‘Down a different path in Melbourne:  how Medibank was conceived’.   Menadue article (1)

  • WALTER HAMILTON. Minamata Remembered

     

    This year is the sixtieth anniversary of the methyl mercury poisoning in Japan that caused ‘Minamata Disease’. Shocking images of victims captured by the American photographer W. Eugene Smith (his Tomoko Uemura in Her Bath perhaps the best known) have served ever since as a warning to the world of the threat from industrial pollution.

    Documents recently obtained by NHK television’s Close-Up Gendai current affairs program have revealed how politicians and bureaucrats colluded with the firm responsible for the pollution scandal, Chisso Corporation, to keep it afloat using public money while restricting compensation payments to victims. (more…)

  • JOHN MENADUE. Medicare – the Labor Party does not understand its own creation.

     

    It is claimed that at the last Federal election, the Coalition lost support because it was going to undermine Medicare. In fact, at the last election, the ALP was proposing to do more to undermine Medicare than the Coalition.

    Let me explain. (more…)

  • Why a Single-Payer Healthcare System is Inevitable

    Private markets for health insurance pose a structural problem, and Obamacare can’t fix it. (more…)

  • IAN WEBSTER. Malcolm Turnbull and homelessness – reaching mentally ill people

     

    This week our PM, Malcolm Turnbull, was admonished when he gave $5 to a homeless man in Melbourne. He was sorry if people thought he should not have done this. He said, “I felt sorry for the guy”….”there but for the grace of God go I.”

    George Orwell wrote after being ‘down and out’ in Paris and London, “Still I can point to one or two things. I have definitely learned by being hard up. I shall never again think that all tramps are drunken scoundrels, nor expect a beggar to be grateful when I give him a penny, nor be surprised if men out of work lack energy, nor subscribe to the Salvation Army, nor pawn my clothes, nor refuse a handbill, nor enjoy a meal at a smart restaurant. That is a beginning.” (more…)

  • PETER GIBILISCO. Some key ideas for the next generation of disability activists.

     

    1.  Meritocracy

    Meritocracy is a belief that seems to me to still be alive and well in the senior management of disability support. It also seems to drive many aspects of public policy, particularly when appeals are made to “equal opportunity”.

    Advocates of a meritocratic approach to disability policy are still assuming that the base-line principle should be that people get out of the system what they put into it. That is why they seek to remove any barriers to people with disabilities’ “putting in”. It is a political vision – often articulated in terms of free market principles – that wants a future based on merit. Hence “meritocracy” (rule by those who gain merit) and is an alternative to aristocracy (the rule by those who inherit land), or more recently to a class-based “luck” of being born in the right place at the right time. But in 1998, Michael Young argued in an article titled Meritocracy Revisited, “meritocracy is even worse than aristocracy because it attempts to acquire plus points because it connotes power and privilege as merited rather than born with”. (more…)

  • JOHN DWYER. A shared vision for restructuring primary care in Australia.

     

    At last the clouds are dispersing, the sun is shining through and one can see a splendid vision of a restructured primary health system that meets the needs of contemporary Australia. For the first time that I can remember, there is a consensus among informed consumers and health professionals that enthusiastically supports the introduction of “Patient-Centred Healthcare Homes” as the primary care model we need to deliver cost effective and equitable integrated primary care. The model has been or is being implemented in eleven OECD countries and the results are most encouraging. Just published is a position paper from a “roundtable” exercise involving The Consumers Health Forum, the George Institute, the Royal Australian College of General Practice, the Menzies Centre for Health Policy, Sydney University and the Australian National University. Their support for the model echoes that of the AMA and the Royal Australasian College of Physicians. I am providing this impressive list of supporters, as consensus on healthcare reform in Australia has been held captive by vested interests for so long. (more…)

  • IAN McAULEY. Health care and Labor.

     

    In the recent election Labor had fine words on health care – “Labor will ensure that access to health care is determined by your Medicare card, and not your credit card” – but in reality its policy proposals, if implemented, would have been even more destructive of Medicare than the Coalition’s.

    The Coalition, true to form, proposed to entice more people into holding private health insurance, but Labor’s enticements to hold PHI were even stronger.   (more…)

  • IAN McAULEY. Problems of Private Health Insurance.

    The PHI industry continues to make two invalid assumptions about private health care. 

    The first is that governments are intrinsically high cost and bureaucratic and that the private sector is unquestionably more efficient. This is patently not true. The least efficient health service in the world, the US, is based on private health insurance and the private sector. The most efficient health service in the world is the National Health Service in Britain which is based on a single public funder. In 2014 ,Ramsey Health,the principle beneficiary of subsidised PHI paid its CEO $31 m ,the highest remuneration in the country and much higher  even than the CEOs of the banks..Further ,Gap Insurance offered by PHI companies has underwritten record increases in specialist remuneration. PHI drives high health care costs.

    The second assumption is that the PHI industry assumes that public health services are for the poor. This is an implicit rejection of the principle that we need a quality and universal health system which is available for all. The PHI sector wants to push us into a two-tiered health system – one for the rich and the other for the poor. 

    Ian McAuley addressed many of these issues in a paper that he recently delivered to a health insurance summit.  The summary of his paper follows with a link to the full article at the end.  John Menadue. 

     

    Summary of paper to accompany presentation to the 2016 Health Insurance Summit, Sydney, 28 July 2016

    Private health insurance has generally been quarantined from the economic scrutiny that successive governments have applied to other sectors of the economy. Rather than being based on any firm economic model, financial support for private health insurance has been based on partisan preferences, with Coalition governments notably more enthusiastic than Labor governments to support it.

    So it stands as part of the complex mix that characterises our health care funding. There is no integrated health care “system” in Australia: rather we have a set of programs with different legacies, different loci of responsibility and different funding principles.

    Within that mix private health insurance has taken its place, and there is an assumption that the funding of private hospitals is inexorably linked to private insurance.

    Because governments have been becoming increasingly concerned about the budgetary costs of the private health insurance rebate, they are shifting towards the incentives in the Medicare Levy Surcharge as a way to support private insurance.

    This makes assistance to private insurance more opaque, particularly in a political environment where there is undue emphasis on fiscal outcomes (rather than economic management). Use of such hidden assistance is a retreat to the policies of the 1960s, before the cost of tariff and quota assistance for manufacturing was brought to account.

    In the absence of economic analysis of the costs and benefits of private insurance, governments, particularly Coalition governments, have argued to defend its privileged position – relieving pressure on public hospitals, providing choice, protecting the “private system” – and have suggested that publicly-funded health should be re-defined as distributive welfare for the needy rather than as a shared universal service.

    But as a means of sharing health care costs, private insurance is a high-cost and inequitable mechanism to achieve what the tax system and a single insurer can do far better. Its administrative overheads are high, and it lacks the incentives or capacity to control moral hazard and to contain health care costs.

    There is mounting evidence, revealed in the recent election campaign, that public opinion is coming to align with economists’ view that a single insurer such as Medicare is the most appropriate way to share health care costs. There is little point in saving the public $1.00 in taxes paid to the ATO if instead they are cajoled into paying $1.10 or $1.50 to private insurers – essentially privatised tax collectors.

    Australia needs exposure of the cost of support for PHI, and, an open debate about health care funding – not the emotive “private” vs “public” rhetoric that often takes place, but rather the basic question about how much we should take personal responsibility for paying for our own health care, without insurance, and how much we should share through Medicare. If the options are explained clearly Australians may accept a reasonable regime of co-payments, so long as they are not seen as a wedge to allow private insurance to destroy Medicare.

    Ian McAuley, Fellow, Centre for Policy Development

    For a link to Ian McAuley’s full paper, see http://www.ianmcauley.com/academic/confs/phijul2016.pdf

    (more…)

  • PETER YOUNG. Speaking of Freedom: Human rights and mental health in detention.

    Peter Young is a member of Doctors for Refugees who have launched a High Court challenge against the Secrecy Provisions in the Border Force Act which states that an ‘entrusted person’ who discloses protected information can face up to two years in prison. I am reposting below an earlier article that Peter Young contributed to this blog. This article was based on a speech he gave at a public meeting organised by the Asylum Seekers Centre.  John Menadue

    In 2011, after many years working in public hospitals and community mental health services I came to work for the Commonwealth Government’s privately contracted immigration detention health provider.

    This was a time when there had been much public and professional criticism of immigration detention. The harms to mental health of prolonged arbitrary detention were already being documented through the Palmer Inquiry; in reviews by the Australian Human Rights Commission; the Commonwealth Ombudsman and; in Coronial Inquiries relating to a number of deaths in detention. (more…)

  • LESLEY BARCLAY. Diagnosing rural health gaps in the election.

    The Coalition represents most rural electorates in Australia. But we seldom hear of much concern about their constituents who have poor health and poor health services. this is a repost of an earlier article by Lesley Barclay about the problems of rural health. John Menadue.

    It is timely as the federal election approaches to consider whether all Australians are getting the healthcare they need. Approximately 30 per cent of Australians live in rural and remote areas.

    Arguably they do not get a ‘fair go’ in relation to their healthcare compared to the rest of us.

    Rural and remote Australians are disadvantaged by social circumstances that influence their health status and ripen them for avoidable chronic disease when compared to counterparts in Australia’s major cities. (more…)

  • JOHN DWYER. Medicare and the 45th Parliament.

     

    Clearly the future of Medicare was the election issue of greatest importance for most Australians. Community concern was focussed on the possibility that the primary care they receive from their general practitioner might be privatised such that a superior service would be available to those who paid more, either directly or though the extension of private hospital insurance to allow for coverage of GP services. This was never going to happen but its important to understand what it was that had stimulated discussion of the possibility. Private health insurers, who are not permitted to cover services provided with Medicare dollars, are frustrated as community health services are not reducing the number of their insured who need hospital care. Many insurers see 60-70% of their costs generated by 5-10% of their insured who need frequent stays in hospital. As there is much evidence that primary care systems elsewhere are better than us at reducing the incidence of hospital care, they would like to provide these superior services to those they insure. To do so would cost a fraction of the expense needed for hospital care. (more…)

  • CHRISTINE DUFFIELD & MARY CHIARELLA. The predicted nursing shortage: strategies and solutions

     

    The nursing workforce

    • The nursing workforce comprises 3 regulated groups: Nurse Practitioners (NPs), Registered Nurses (RNs) and Enrolled Nurses (ENs). Nurses recognise that other unregulated groups of healthcare workers (for example Assistants in Nursing (AINs)) perform nursing care, and the research is clear that they require support from registered nurses (Duffield et al, 2014). Other regulated health professions, including general practitioners (GPs) have also regularly performed various aspects of nursing care. In General Practice over the past twenty years, practice nurses have been increasingly employed to perform those nursing aspects of care (Merrick et al, 2011).
    • The scope of practice for nurses is not defined by the tasks nurses perform, but by the acuity of the people they are caring for and the concomitant range of skills that they will require for their practice. For example, assisting a person who is acutely ill and haemodynamically unstable with their personal hygiene may well require the assessment and clinical management skills of an RN, but the same personal hygiene skills may be performed by an AIN if the person is convalescent.
    • Nurses will perform their skills across a continuum from novice to expert (Benner, 1984) at different stages of their career development and according to the different levels of registration: NPs perform all of their skill-sets at a highly complex level (NMBA, 2014), whereas ENs may perform only some of their skill sets and to a less complex level (NMBA, 2016).

    (more…)

  • IAN WEBSTER. Health care for aged people is increasingly complex.

     

    From his experience in intensive care in one of Australia’s busiest intensive care units at Liverpool Hospital in Southwest Sydney, Professor Ken Hillman describes the failure of specialised, super-specialised, medicine to deal appropriately and humanely with seriously ill aged persons and those whose life has run its course. (Ageing and end-of-life issues, posted 9/7/2016 in Pearls and Irritations)

    Ockham’s Razor (1) is wielded inappropriately when there is not a single biological breakdown but many breakdowns. Ageing causes progressive erosion of the reserve capacity in all body systems; and chronic disease impairs the function of many organs. The aims in preventive medicine and successful ageing are to protect and preserve the function of body systems with advancing age and to prevent the onset and progression of chronic disease. (more…)

  • PETER GIBILISCO. Five years in retrospect: Life without control

     

    I look back on the last five years and come to a sad conclusion. For some considerable time, I have been losing control of my movements. But from July 2011 there has occurred a progressive loss of control that is potentially more fundamental than the biological loss of muscular power. It has not been physiological so much as social and personal. What am I referring to? July 2011, five years ago, was when I move into a group-home for people with high support needs. (more…)

  • KATHY CHAPMAN & BRIDGET KELLY. Unhealthy sport sponsorship continues to target kids.

    In the final month of the countdown to the Olympic Games, our sports stars are probably not eating and drinking the Games sponsors’ foods. Again, as in previous Olympics, the Olympic Games sponsors are Coca-Cola, McDonald’s and Cadburys, whose foods and drinks are not good choices for athletes due to their lack of nutrition and high levels of salt, sugar and saturated fats.Unhealthy sponsorship of sport filters all the way down through sport from the elite level to Saturday morning kids’ clubs. (more…)

  • KEN HILLMAN. Ageing and end of life issues.

    It is well known that our population is living longer. But has our health system adapted to this ageing population? Do the elderly fit into the construct of a single diagnosis? Can we identify those who are coming to the end of their life? Do we ask them if they would prefer to spend the last few months of life in hospitals? What is the impact of the increasing number of medications that they are taking? What is the impact of modern medicine on age related deterioration? (more…)

  • JOHN MENADUE. What the major parties ignored in the election?

     

    The election seemed more about avoiding some key issues than a contest of values and ideas.

    Because so many key issues such as refugees were avoided, it is not surprising that so many voters, about one third, turned their backs on the major parties. Some issues like the NBN were widely canvassed in social media but largely ignored in the public campaign. (more…)

  • JOHN MENADUE. Privatisation of Medicare has been underway for years.

    In this blog before the election, I highlighted the risks to Medicare in many posts.  See links below:

    John Menadue. Privatisation and the hollowing out of Medicare.
    David Pope. Medicare – Eaten out from within.
    Ian McAuley. Bill Shorten is right: Malcolm Turnbull is a major threat to Medicare.
    Lesley Russell. It is disingenuous of the Coalition to claim it has no intention of privatising Medicare.
    John Menadue. Facts on the $11 b p.a. private health insurance industry subsidy.

    In addition to the case set out in the above posts, we should consider some important and related background. The Coalition has a record of privatisation in many fields.

    • In technical education the Coalition has been undermining TAFE by subsidising private providers, including many shonky providers.
    • The Coalition privatised Medibank.
    • An adviser to Tony Abbott proposed to the Abbott government the introduction of the $6 co-payment for Medicare general practice services. That adviser suggested that anyone that didn’t like the co-payment should take out private health insurance. Tony Abbott has told us many times that ‘PHI is in the coalitions DNA’
    • The friends of the Coalition appointed to the Commission of Audit recommended a co-payment of $15 per visit and suggested that public hospitals should charge public patients.
    • The Abbott government announced changes to the Medicare rebate. That didn’t work politically so the government embarked on a five year freeze on the rebate.
    • Then the Coalition backed a $57 billion saving over ten years on public hospitals.

    It is clear to me that whilst the ‘shell’ of Medicare will remain it is being steadily eaten away from within, particularly by PHI. Further, the Coalition was taking every opportunity to cut  Medicare spending in ways which would not upset its principal backers, PHI funds and private hospitals.

    Bill Shorten was right to warn of the threat to Medicare.

  • It is disingenuous of the Coalition to claim it has no intention of privatising Medicare.

    The election campaign battle over Medicare should come as no surprise. It echoes disputes during previous campaigns and have their origins in ideological divides that date back to well before Medicare was founded and have persisted through the subsequent political disputes. Labor sees the health of Australians as a matter of sufficient national importance that it requires government intervention; the Coalition sees it more as a matter of personal responsibility and individual choice.

     

    The compromises struck in order to enact Medicare have meant that Australia’s healthcare has been a blend of public and private systems, with precise relationships, both competitive and cooperative, never fully delineated. The pendulum has swung in favour of one or the other aspect – public or private – depending on who is in government and the financial pressures of the times.

    Political and voter reactions to these swings are compounded by the efforts of key stakeholders to protect their own interests. Organised medicine, most obviously the Australian Medical Association, has been a powerful and disruptive player in healthcare politics, driven primarily by the fear that governments of both political persuasions will interfere in their conditions of work and pricing power.

    The AMA has a love–hate relationship with Medicare and a tradition of opposing key health reforms, good and bad, from both political parties. Their price for agreeing to the introduction of the Pharmaceutical Benefits Scheme in the 1940s, extracted from then opposition leader Robert Menzies, was a referendum to change the constitution to prohibit any form of “civil conscription,” thus effectively making a socialised system like Britain’s National Health Service impossible and shaping the role of private providers in the delivery of Medicare services.

    Together these issues highlight why Medicare is so vulnerable to claims of privatisation and why these claims have validity. It is disingenuous of the Coalition to claim it has no intention of privatising Medicare when this option has clearly been considered; and it’s important to remember that the Coalition has said nothing that would preclude private initiatives from competing alongside Medicare. History shows that while ideologies may be temporarily cast aside for political gain, they are never abandoned.

    The fight to introduce Medicare was bitter and protracted. During 1973 the Coalition twice blocked the enabling legislation for Labor’s first version, Medibank, in the Senate, and it did so again after the election in 1974. This forced a joint sitting of the parliament in August 1974, which finally passed the bill by ninety-five to ninety-two votes. Notwithstanding its election commitment to keep Medibank, Malcolm Fraser’s Coalition government, which came to power in November 1975, dismantled the program in all but name.

    Labor returned to office in 1983, having pledged to reinstate “the basic principle of the right of all Australians to health services according to their needs.” The following year, under prime minister Bob Hawke, the government reintroduced the original model, now called Medicare. For all of the following twelve years in opposition, the Coalition remained strongly opposed to Medicare. As opposition leader, John Howard spoke out often and vehemently. He declared Medicare a “disaster” and a “nightmare” and promised that under his government “bulk billing under Medicare would go, except for those classified as disadvantaged and there would be the option of belonging either to Medicare or to a private health fund.”

    It was only in his push to win the 1996 election that Howard realised he needed to reassure the electorate about the future of Medicare and bulk-billing. He conceded that his commitment to retain Medicare was based on a pragmatic view of voters’ priorities rather than on his party’s political convictions or a change in the system itself: “It’s not a question of whether it’s become better. It is a question of us believing that Medicare is seen by the overwhelming majority of the Australian community as an important part of the social security infrastructure.”

    This commitment was undermined by his government’s push, using a series of financial carrots and sticks, to bolster the uptake of private health insurance, and by its erosion of bulk-billing rates. An effective Labor campaign around bulk-billing and rising out-of-pocket costs saw an interesting set of responses from the Howard government. In 2003, it introduced a $900 million policy package, A Fairer Medicare, which was highly criticised by all stakeholders. A parliamentary inquiryreportdescribed the package as “a decisive step away from the principle of universality that has underpinned Medicare since its inception.” Its enabling legislation was blocked in the Senate.

    With the 2004 election looming, the government, with Tony Abbott as health minister, announced a compromise policy package called Medicare Plus (soon to become Medicare Plus Plus, after Abbott negotiated a deal with Senate independents to ensure its passage). The new arrangements included higher reimbursements for doctors who bulk-billed and an Extended Medicare Safety Net aimed at addressing out-of-pocket costs. As bulk-billing rates climbed and safety-net payments burgeoned, Abbott declared the government “Medicare’s greatest friend.”

    These Howard–Abbott policies were enacted in support of political ideology (in the case of the private health insurance rebate) and out of a pragmatic need to address voters’ demands (in the case of Medicare changes). There was little evidence to support the changes, and their financial imposts and impact on equity remain as serious problems for the healthcare system.

    The Extended Medicare Safety Net tied the amount of Medicare benefit to the doctor’s fee rather than the Medicare reimbursement; with no government control over specialists’ fees, the safety net was predictably arecipe for fee inflation. Not surprisingly, that means the vast bulk of the benefits find their way to high-income electorates. Costs have burgeoned despite parameter adjustments by both Coalition and Labor governments.

    In the 2014–15 Budget, the Abbott government revealed plans to “simplify” Medicare safety net arrangements. The enacting legislation was rejected by the Senate in 2015, though, over concernsabout the impact on chronically ill Australians and the reductions in outlays ($267 million over the forward estimates). Health minister Sussan Leypromisedfurther consultation but there is no evidence these have occurred.

    The private health insurance rebate is one of the most contentious issues in health policy. The 2016–17 budget papers show that it currently costs $6.5 billion annually, and both the rebate and the cost of health insurance premiums are allowed to grow at rates well beyond those deemed acceptable for Medicare and the Pharmaceutical Benefits Scheme.

    It’s an anomaly – some would say an outrageous one – that “private” health cover is so heavily subsidised by the public purse. Despite this, less than half (47 per cent) of Australians have private hospital cover. There is no evidencethat the private health insurance rebate is achieving its policy intent, and it has been a significant factor in driving up costs.

    Economist Saul Eslake says the rebate should be scrapped. “Subsidising people to do something they would do anyway is a waste of taxpayers’ money,” he wrote earlier this year. “The rebate reduces the discipline on health insurance funds to keep their premiums under control. And it’s a form of middle-class welfare that the country can no longer afford.” Figures from the Parliamentary Budget Office show that ditching the rebate could save the federal government as much as $10 billion over the next four years.

    Yet, despite all the evidence and the criticisms from a wide range of health experts, Tony Abbott was right when he said that “private health insurance is in our DNA.” This is certainly true for the Coalition, but successive governments of both persuasions have failed to convincingly articulate why Australians need what is increasingly a duplicate health care system – with duplicate costs for many – and why the federal financial contribution to private health insurance should be so substantial.

    Since coming to office in 2013, the Coalition has undermined public confidence in a public, universal healthcare system with talk about budget unsustainability and the overuse of Medicare services. A surreptitious shiftfrom public to private is occurring via increased co-payments, the abolition of bulk-billing incentives, the freezing of Medicare fees to doctors, and other measures. Out-of-pocket costs are the fastest rising part of the healthcare budget.

    Expert advice requested by the government has more overtly supported privatising Medicare. The 2014 National Commission of Audit raised the possibility of requiring higher-income earners to take out private health insurance for basic health services in place of Medicare. Like the Harper Competition Policy Review, it also advocated an expanded role and less regulation for the private health insurance sector. Responding to the Harper review in November 2015, the government committed to commissioning aProductivity Commission review of how competition principles can be applied to the human services sector.

    The government has also signalled its agenda to allow private health insurance to play an expanded role in primary care. Some of the larger funds are already expanding their activities in this sector, but with little regulatory oversight.

    Despite the prime minister’s protestations that moves to outsource the payment systems for Medicare and the PBS do not constitute the privatisation of Medicare, the public is rightly sceptical. It’s surprising that the AMA is not similarly concerned. Semantic games have gone on about what constitutes privatisation and about the differences between Medicare payment systems and Medicare services, as have disputes about whether the findings of advisory groups and calls for expressions of interest can be said to indicate certain actions, and what the new buzz words of “competition” and “contestability” really mean for health care. More forthright statements from the prime minister might actually help his case here.

    The risk is that Australia is headed stealthily but inexorably towards a two-tiered health care system in which those with resources and access can purchase the services they want, regardless of need, and Medicare becomes a ragged safety net for the less well-off. Labor’s scare campaign is biting because enough voters remember where we have been with Medicare policies and can see where we are headed. The Coalition would do well to read the results of a 2008 poll that showed a striking preference for public over private healthcare, with those surveyed clearly favouring an improved public health care system supported by the public purse.

    Lesley Russell is the Adjunct Associate Professor at the Menzies School of Health Policy at the University of Sydney. She has been a senior policy adviser to the Federal Parliamentary Labor Party.

  • JOHN MENADUE. Saving Medicare.

     

    In an earlier article in this blog, I outlined how Medicare is under threat but not for the reasons outlined by Bill Shorten. The threat is the erosion of Medicare from within by the power of vested interests and in this case, private health insurance. This vested interests wants to bend Medicare to its own ends and take us down the disastrous US private health insurance path. That would destroy Medicare. (more…)

  • GREIG CRAFT. Drinking and Driving: a global problem.

    Global Problem

    Alcohol, drugs and driving simply do not go together. Driving requires a person’s attentiveness and the ability to make quick decisions on the road, to react to changes in the environment and execute specific, often difficult maneuvers behind the wheel. When drinking alcohol, using drugs, or being distracted for any reason, driving becomes dangerous – and potentially lethal![1] (more…)