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February 12, 2004
There is a political judgement buried in the daily media flows that a deal will be done over the Howard Government's Medicare Plus. What has been introduced into the Senate today is the safety net legislation that is part of the revised $2.4 billion Medicare Plus package.
The political background to this legislation is the Howard Government's slow strangling of Medicare and public hospitals over the last 7 years and Medicare’s continued popularity with Australian citizens. The Howard Government has continued to cry poor when funding Medicare, public hospitals and subsidised medications. It argues that the costs are becoming too great for any government to bear, hence the need for co-payment (out-of-pocket charges at point of service). Yet the Howard government happily pours ever increasing billions into the private health system. Medicare is worth defending despite the problems of uncapped fee-for-service medicine and inadequate rural medical services.
Abbott's MedicarePlus legislation is quite narrow. Most of the Package was implemented through regulation. It involves thresholds for all Medicare health expenses (safety net). The thresholds are $500 and $1000. Once reached an 80% rebate comes into play. The $500 threshold only applies to concession card holders and lower middle-income earners, whilst the $1000 threshold applies to everyone else.
Will the working poor be able to afford the $1000 of medical expenses? Is the effect of the rebate on specialist fees inflationary?
I was able to catch a bit of the Senate debate on Medicare Plus this morning. I'm trying to get a sense of how it all works. How are the deals done? What actually takes place in cutting a deal? How do the deals relate to the Senate debate?
There seems to be a ritualistic political debate between the Coalition and the ALP Senator's going on over safety net versus universal health system. I saw a bit of Senator Linda Kirk is more reasonable in presenting the ALP case. Of all the speakers Ursula Stevens was the most informed about the issues involved.
I saw nothing in the media about the negotiations. All I that I can see is the public debate in the Senate, which finished around lunchtime. The negotiations take place behind closed doors away from the public eye of the media. All we have is the odd news reports. One states that Tony Abbott is saying that he has ruled out making concessions on the Medicare safety net that were not in line with Government policy. Another states that the Independents are saying that they were keen to see Medicare returned to a universal health care system.
At the end the day nothing much had happened. Early reports said that negotiations were continuing and that progress was being made. That bland statement says nothing about whether the Independents have managed to pull Medicare Plus back to a universal health care system, let alone introduce some innovation into Medicare to break the doctor/drug style of medicine.
Update
Media reports on Friday morning represent Abbott as saying that he was frustrated but confident. He was going to the hard work to get his package through. Abbott is looking at the Independent Senators proposal to extend allied health (podiatry, physiotherapy and dietics) to more people under Medicare. And so he should. It is innovative.
The ACTU is reported as saying the legislation should be blocked in a last ditched stand to save bulk billing. They do make some good points about the discrimination towards singles and the working poor in the Medicare Plus package.
However, the "Custer's last stand" means that everyone should side with the ALP. The ACTU assumption is that only the ALP has the right policies on health. Anything that is not in accord with the health policies of the ALP represents a sell out.
Why not good criticism of the public subsidy for the private health insurance industry. A large percent of money passing through private health insurance failsv to make it to private hospitals - it goes onancillary services, excess "gap" payments to medical practitioners, and to bureaucrats in the private health insurance industry. A criticism of subsidizing private insurance that accepts supporting private hospitals.
Why not a few ideas on how to bust open the power of the doctor cartel as well? Many Australians go to allied health professions to seek help for their aching wounded bodies. Why cannot we open the door to a multidisciplinary course of treatment under Medicare? Why not a broader conception of primary health care, which is the most important sector of any health system.
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There is much more substance on the senate inquiry in the report which is available at http://www.aph.gov.au/Senate/committee/medicare_ctte/index.htm.
It seems that all participants took the inquiry seriously, but the Labor and Liberal members adopted their party lines, which leaves the minority parties to determine the ultimate recommendation.
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