Wednesday, 6 July 2016

Mediscare, shmediscare

Essential Report, 5 June 2016

The baying and bleating coming from the designated Liberal-Nationals corner of the schoolyard over the so-called Mediscare is odd to say the least.

Take this text message that allegedly turned up on an unknown number of mobile phones:

That particular Queensland Labor text has been referred to the Australian Federal Police by someone within Coalition ranks.

This mob point the finger at one example of a text message sent on the last day of the federal election campaign while bellowing We wuz robbed!

Never mind that est. 69% of people who voted Labor had made their minds up about their first preference vote from two weeks to over a month ago and, est. 75% of Liberal-Nationals voters had done the same.

Ignore the fact that almost 3 million voters had pre-polled by 30 June 2016 and it was impossible for the last day of the election campaign to affect them.

Pretend that it is beyond a reasonable person's understanding to realize this means that over 8.11 million voters would probably not have been influenced by that tweet even if they had received it.

No,no. There was a !!Mediscare!! which lied about the best friends that Medicare ever had and lost the Coalition votes and seats.

All those attempts to whittle away at universal heath care that the Liberals and Nationals have  tried over the years and of which the general public were well aware? Phfft! Means nothing says Turnbull & Co.


The Age, 15 April 2005:

Prime Minister John Howard has refused to rule out further cuts to the Medicare safety net, following yesterday's announcement that  low-income earners face a 75 per cent rise in out-of-pocket medical expenses.

Subsidies for 400,000 Australians with big medical bills will be axed under the clawback of the Medicare safety net, announced yesterday.

In his second broken election promise in six months, Prime Minister John Howard yesterday announced that the poor will now have to spend $500 - up from $306 - before the Government picks up most of their health costs.

Others will have to pay $1000, compared with $716 under the existing system.
"This is not a popular decision, I understand that," Mr Howard told ABC radio this morning. ``People will be disappointed, people will be critical, I accept that.

"I don't like having to make this announcement, but I had a choice between maintaining something, the cost of which was ratcheting up, or alternatively taking some unpopular decisions now so that in the long term we can keep the safety net."

He said while a safety net would remain under the Coalition, he refused to promise that there would be no more changes.

"We don't have any (changes) in mind, but I am not going to give an iron-clad guarantee in relation to that," he said. 

Under the changes, foreshadowed in The Age last month, the number of families and individuals qualifying for help is projected to drop from 1.9 million last year to about 1.5 million in 2006, according to Government figures.

The backflip is a public humiliation for Health Minister Tony Abbott, who last year gave an "absolutely rock-solid, ironclad commitment" that the safety net would remain unchanged.

ABC Radio The World Today, 27 April 2005:

ELEANOR HALL: Federal Health Minister Tony Abbott's comments on the possible budget cutback to Medicare-funded IVF treatments have prompted a leading IVF specialist to speak out.
Dr David Molloy says he's stunned by the minister's assertion there has to be "some limit" on the funds the Government is prepared to spend on elective and non-essential procedures like IVF.
And he warns that Mr Abbott has just opened up a whole new argument on the future of Medicare and the procedures it will fund. 

The Sydney Morning Herald, 21 February 2014:

Health Minister Peter Dutton has also signalled that Medicare could be means-tested with access to bulk-billing and medical tests such as X-rays, blood tests limited to those on lower incomes, in a News Corp report.
Mr Dutton questioned why those on higher incomes should be able to go to the doctor ''for free'' and said it was ''one of the discussions . . . we have to have''.

Australian Parliamentary LibraryBudget Review 2014–15 Index:

Patient co-payment

A $7 patient co-payment on bulk-billed general practice (GP) visits, and out-of-hospital pathology and diagnostic imaging services, will apply from 1 July 2015. In addition, the MBS rebate for these services will be cut by $5, regardless of whether they are bulk billed.[1] For concession card holders and children under 16, the rebate reduction will only apply for the first 10 visits a year, after which the full MBS rebate will apply.[2] Certain MBS services, such as Health Assessments and Chronic Disease Management items will be quarantined from the co-payment. Savings of $3.5 billion over five years will be used to fund a new Medical Research Future Fund.
The imposition of the co-payment is to ensure all patients contribute to the cost of their health care.

Under current Medicare arrangements doctors are free set their own fees, but those who choose to bulk bill accept the MBS rebate as full payment for the service and cannot charge a co-payment. The rebate for out-of-hospital services is 85 per cent of the Medicare Schedule Fee, but GP services attract a 100 per cent rebate.[3] Under this measure, doctors will have the discretion to charge a co-payment of $7 for bulk billed and other services, but their Medicare rebate will also be reduced by $5. This means they will be worse off each time they bulk bill unless they impose the co-payment…..

Other savings

Savings of $99.2 million over the forward estimates will also be achieved by lowering the MBS rebate for optometry services (from 85 to 80 per cent of the Schedule fee), and removing a charging cap. The time period for Medicare rebatable eye examinations will also be extended from two to three years for asymptomatic people under 65, and reduced from two to one year for those over 65.

National Rural Health Alliance Briefing Paper, The future of Medicare, February 2015:


Under the original version of the Abbott Government's proposed co-payment, patients would have been charged a co-payment of $7 per visit to the GP, and for each episode of pathology testing and diagnostic imaging. The co-payment was to be waived for concession card holders after 10 visits, offering them some protection against high out of pocket costs.

In the next iteration of the proposal, the Government made the co-payment optional (the decision being left to the GP) but also proposed to reduce the Medicare rebate by $5 for short consultations. It expected some GPs to 'choose to recoup the $5 rebate reduction through an optional co-payment'. In order to protect vulnerable people, the Government proposed to keep in place incentives that encourage GPs to bulk-bill concession card holders and children under 16.

Subsequently, the Government proposed changes to the funding rules for GP consultations along with substantial rebate reductions for short (Level A) consultations; the changes were meant to discourage 'six-minute medicine'. The Australian Medical Association (AMA) complained that the changes would disadvantage experienced and efficient GPs, and would exacerbate problems with timely access to care. It also pointed out that the costs (of the rebate reduction) would likely be passed on to patients. Because of the outcry from health, community service and rights-based interest groups (including the medical profession) over these proposed changes, the Government is now consulting with the sector. However it appears to be committed to bulk-billing only for 'vulnerable' and concessional patients.

The Government's intention to move away from pursuing high bulk-billing rates is an important change in policy direction and its implications for Medicare, and the principles it was founded on, need to be closely examined. In our view, restricting bulk-billing only to vulnerable patients would be a retrograde step. It is vital that the cost of care does not prevent people from using primary care services. However there is evidence that this is already happening….

The importance of keeping Medicare universal

Medicare was designed to provide Australians with universal access to high-quality health care regardless of where they live, or their ability to pay. It was not designed to be a safetynet scheme for those without the means to pay for private insurance, nor was it meant to compete in the market alongside private health insurers. When past governments have experimented with reforms to health insurance along these lines, they found that the results were disappointing. Rather than helping to constrain expenditure on health, opt-out versions of Medicare made it more difficult to contain health care costs because the anticipated benefits of competition - lower prices - did not materialise in the insurance or medical markets.

Because it is financed through taxation, Medicare provides an equitable means of paying for health care. Those with greater means contribute more through our progressive taxation system and help cover the health care costs of those with less. The facility to leverage larger contributions towards the cost of health care from those on higher incomes already exists under Medicare. As a result, less equitable policies, such as compulsory co-payments, are unnecessary in the Australian context.

We believe that the universal nature of Medicare embodies the Australian spirit of 'a fair go for all'. Not only does the principle of universality reflect our past and our values, it also provides an efficient and equitable means of funding access to health care. For these reasons, we oppose any reforms that undermine the universal nature of Medicare and seek to transform it into a safety net scheme for the poor. Instead, we urge the Government to look for alternative means of protecting the sustainability of Medicare: changes that will preserve both equity and efficiency.

SBS News, 28 December 2015:

Australian Medical Association president Brian Owler says the removal of items from the Medicare Benefits Schedule could lead to higher out-of-pocket costs for patients.
Federal Health Minister Sussan Ley announced on Monday 23 tests and procedures, including ear, nose and throat surgeries and diagnostic imaging, have been recommended for removal as part of a major shake up of Medicare.
Ms Ley said in a statement the 23 items, which also include gastroenterology, obstetrics and thoratic medicine services, cost $6.8 million in the past year and were used 52,500 times….
He said some patients would be left out-of-pocket as some of the items recommended for removal were part of other procedures or were used for very specific circumstances.

The West Australian, 9 February 2016:

Medicare, pharmaceutical and aged-care benefits would be delivered by the private sector under an extraordinary transformation of health services being secretly considered by the Federal Government.

The West Australian has learnt that planning for the ambitious but politically risky outsourcing of government payments is well-advanced, with a view to making it a key feature of Treasurer Scott Morrison’s first Budget in May.

To be put to the market a few weeks later, the $50 billion-plus outsourcing would be the first time the private sector has delivered a national service subsidised by the government.

It would replace back-office operations done by bureaucrats.

They would administer claims and payments while overseeing eligibility criteria, meaning they would require access to people’s sensitive private information.

Doctors would also have to open their books to the provider, , which would be subject to regulatory oversight.

The payment system task force run by bureaucrat John Cahill is believed to have proposed a “proof of concept” trial next year. It would require companies being selected this year.

Australia Post, eftpos providers, Telstra and the big banks are showing interest given they have online payment and supply structures.

Foreign multinationals may also bid including Serco, Fuji-Xerox and Accenture. When former treasurer Joe Hockey flagged outsourcing Medicare payments in 2014, the Community and Public Sector Union warned of thousands of job losses. The Australian Medical Association has also spoken against the privatisation of Medicare and the Pharmaceutical Benefits Scheme.

Within a fortnight, accountants Ernst & Young, KPMG, PricewaterhouseCoopers, McKinsey, Deloitte and Boston Consulting and will lodge bids to design the business case for the potential privatisation.

Though it would come with a short-term cost — possibly billions of dollars — to rebuild data and payment systems, the Government believes it would recoup much more later….

Labor Herald, 29 April 2016:

More than half a million Australians have signed a petition opposing the Turnbull government’s $650m cuts to Medicare, sending a clear warning to Malcolm Turnbull: hands off our Medicare.

ABC News, 3 May 2016:

Health experts say many of the budget measures will mean patients are worse-off.
Consumers Health Forum chief executive Leanne Wells said the Government's move to freeze Medicare rebates over the next three years could potentially increase the pressure on GPs to drop bulk billing and charge additional fees.
"The vote of a future Senate could also mean a range of fresh out-of-pocket costs, including a $5 rise in the co-payment for prescribed medicines and cutting of the $630 million in bulk-billing incentives to pathologists and radiologists," Ms Wells said.
"These measures will discourage the sort of reform we need to support a primary health care system that would improve care for those with chronic and complex illness."

Within weeks of its election in 2013 the Coalition entertained a proposal from a former advisor to Tony Abbott as health minister to end free visits to the doctor by requiring a mandatory co-payment of $6. Anyone who didn't like it would be invited to take out private health gap insurance.

Its Commission of Audit recommended a co-payment of $15 per visit and $5 per concession card holder, and then its first budget announced that "previously bulk-billed patients can expect to contribute $7 towards to cost of standard consultations." Medicare Rebates would be cut by $5 and bulk billing incentives would "only be paid to providers when they collect the $7 patient contribution". It encouraged public hospitals to charge public patients who walked in off the street in order to stem the leakage from doctors.

Seven months later Abbott dumped the $7 co-payment and replaced it with a $5 co-payment, all of which was to come from doctors, also abandoning that a few months later. Then he announced plans to slash the Medicare Rebate for short visits from $37.05 to $16.95, also abandoning that a few weeks later.

In his second budget he extended an existing one-year freeze on the Medicare Rebates by a further five years to 2020. By then doctors incomes would have fallen 15 per cent relative to other incomes unless they abandoned bulk billing.

And he booked a budget saving of $57 billion over 10 years by lifting grants to states for running hospitals by much less than the cost of running them, a good deal of which is still baked in to the Turnbull government's budget numbers.

Within a year of taking office he called for expressions of interest from the private sector in running the $29 billion Medicare and Pharmaceutical Benefits Scheme claims system. Among the Australian firms that are believed to have responded are Eftpos, Australia Post and Telstra offshoot Stellar. Among the foreign companies are British services giant Serco, which provides immigration detention centre services, Japanese-US technology giant Fuji-Xerox, German software house SAP and US professional services firm Accenture.

Malcolm Turnbull went into the election campaign continuing to defend the outsourcing option, only to abandon it on Q&A after it came to be conflated with privatisation.

The scare campaign worked because Medicare's supporters were already scared.

@otiose94, 5 July 2016


A little more history on the subject……

The Conversation, 5 July 2016

The Whitlam government’s Medibank program, the predecessor of Medicare, faced furious opposition from the Liberals and (then) Country Party. Allied with the Australian Medical Association, the conservative opposition fought the introduction of universal health insurance, blocking it in the Senate.

The Medibank legislation was forced through parliament in 1974 after a double dissolution election and the only joint sitting of both houses of Parliament. Even then, a rearguard High Court action invalidated crucial funding legislation. As a result of this resistance, Medibank was introduced in July 1975, only four months before the dismissal of the Whitlam government.

The Fraser Coalition government initially kept its promise to preserve Medibank. But through a series of complicated “reforms”, Fraser kept the name, but gradually turned the remnants into a means tested “welfare” system. In 1981 Medibank was abolished completely and Australia returned to the patchy and chaotic coverage of subsidised private health insurance.

This pattern of hostility was replicated against the Hawke government’s Medicare, which was introduced in 1984. For the next decade, Coalition politicians promised to set Australians free from the shackles of compulsory national health insurance.

The electorate was unimpressed. The low point of these attempts to replace universal coverage came with Peter Shack, the Liberal shadow health minister, admitting he had no workable policy going into the 1990 election:

“I want to say with all the frankness I can muster, the Liberal and National Parties do not have a particularly good track record in health, and you don’t need me to remind you of our last period in government.”

Coalition hostility to Medicare played a big part in Labor’s very successful scare campaign in the 1993 “GST” election. The John Hewson-led opposition promised to end bulk billing and restore the supremacy of private insurance. Analysts have determined the Medicare issue as more important than the GST in Keating’s triumph.

This sorry tale appeared to end in 1996. John Howard, heading for a Coalition landslide, reassured voters that not only would his government be “relaxed and comfortable”, but he recognised the error of attacking Medicare. He declared Australians “want Medicare kept” and pledged that “Medicare will remain totally in place under a Coalition government”…..

Howard froze the level of GP rebates (fees) in the 1996 budget. This slowly squeezed GP incomes, forcing many to abandon bulk billing and charge upfront fees. Whether intentional or not, the decline of bulk billing revived old fears of Coalition intentions towards Medicare.

By 2003 the issue was hurting the government so badly, a new health minister, Tony Abbott, came in with an open cheque book to end the crisis. Even then, new bulk billing incentives were aimed selectively at children and pensioners. Howard argued:

“it was never the design [of Medicare] … to guarantee bulk billing for every citizen.”

An extension of this “safety net” argument was a commitment to private health insurance. Both the Fraser and Howard governments tried to force higher-income earners into private insurance. The Howard government subsidised private insurance – but kept it largely to coverage of hospital and specialist services, maintaining Medicare’s monopoly over GP services.

The Abbott government’s Commission of Audit ended this truce. It argued that:

“Expanded private health insurance coverage should be introduced for basic health services currently covered by Medicare. Higher-income earners should be required to insure for basic health services in place of Medicare.”

Political commentator Nikki Savva has argued the Commission’s position shocked Abbott and he ignored most of its recommendations. However, it is not surprising that when his government attempted to bring in new GP co-payments (a Commission recommendation), these were read as part of a fundamental assault on Medicare principles of bulk billing and universality.

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