Whoever put the care in Australia's "Medicare" was kidding

Australia has a system of universal "free" healthcare that was introduced by the socialists (the Labor Party) and which is called "Medicare". Subsequent conservative governments have been afraid to tinker too much with it except that they give you a partial refund if you opt out of the system and take private insurance instead. So about a third of Australians do opt out and use our excellent network of private health facilities. The Queensland private health system is fabulous in my opinion -- and I use it often. What the Australian public health system generally is like is alluded to below by Dr John Graham, an emeritus consultant physician at Sydney Hospital where he is also chairman of the Department of Medicine.

Australia truly is the lucky country, especially when considering the available health care for its citizens. But none of this can be attributed to Medicare and its "medical benefits". In 1966, when I began my clinical years at Sydney Hospital, Australia could rightly boast the world's best in medical and nursing care. Moreover, the doctors and nurses loved their work, and most patients showed a commensurate respect and gratitude in return.

Most doctors still enjoy good relationships with their patients, but very few love their work any more. Doctoring has been progressively driven off the rails by political and economic expediency. Workplace morale, especially in public hospitals, has plummeted. The artificial barriers to both excellence and expedition in hospital care are endless. Optimal outcomes are frustrated beyond all reason. Patients must sometimes wonder whether or not they are pawns, rather than people. How often must they leave a hospital ward or a doctor's rooms and ask themselves: "Does anyone really care?" When the truth is known, Medicare certainly doesn't, and for any medical practice reliant on Medicare it's almost impossible to.

What is hard to fathom is that Labor, which historically stood up for the least well-off in our society, was the party that brought about the situation where the least well-off are finding it more difficult than ever to get the top level of hospital care for any problems other than emergencies. It was Labor that forsook the honorary (unpaid) specialist system in public hospitals to tighten government control on the doctors. It was Labor in NSW that got rid of the means test that had protected the needy by giving them access to plenty of beds in public hospitals. No wonder waiting lists for the less well-off have blown out. It was Labor, under Gough Whitlam, that introduced Medibank and then entrenched it as the rebadged Medicare under Bob Hawke. It was Labor that embedded the concept of bulk-billing by GPs, which forced them to downscale the quality of their services to fit the remuneration on offer.

The Coalition can't be let off the hook, either. The Federal Government has had more than enough years to rectify the problems and yet has done nothing to change a system that is all about economics and politics and has nothing to do with health care.

Let's look at an example of Medicare in the doctor's office. Why on earth would a bulk-billing GP be enticed to devote 39 minutes to a level-C consultation if he or she could trim it to 20 minutes and get the identical reimbursement from Medicare? With similar farces in Medicare rebates for specialist consultations, it's little wonder Medicare has, through its economics, caused many specialist doctors to stop listening, examining and thinking, and to simply become proceduralists. There is a significant shortage of real doctors doing real doctoring.

In looking at our supply of new doctors, which is patently inadequate, why is the Federal Government limiting the intake of students wanting to study medicine at universities? The answer is Medicare. For every new medical graduate, there is an application to be given a provider number. Without this, a doctor's patients would be ineligible for a Medicare rebate. The Government is worried that more doctors would mean more provider numbers, and hence a bigger government outlay on health. The rationale for limiting entry to medical schools is thus based purely on Medicare doctrine and not on any desire to improve health care.

Whatever the economists' views on Medicare, it has been an experiment without historical foundation, and without any humanitarian intent or scientific validity. And so what should be done?

First, rescind Medicare, and in its place introduce a safety-net rebate scheme for approved welfare-card holders to receive medical and surgical care in GP's surgeries and public hospitals (both as inpatients and outpatients).

Second, return to private arrangements for all other services. Doctors will then have to value those services fairly, while letting patients demand value for their dollar.

Third, let all health insurance funds offer whatever insurance covers they choose, for whatever range of health services their clients may choose.

Fourth, provide 100 per cent tax deductibility for all private health insurance and for all out-of-pocket expenses for medical, dental and pharmaceutical services.

Fifth, amalgamate the state and federal health responsibilities under a federal banner.

Sixth, give back an honorary board of governors to every public hospital so that better trust and meaningful communication can lead to greater efficiency and better staff morale. Greater productivity and generally improved health outcomes will ensue automatically.

And finally, with no Medicare, abolish the ridiculous Medicare levy. Hopefully, the Prime Minister, John Howard, and the Health Minister, Tony Abbott, will show the courage for, and commitment to, genuine reform that will greatly benefit all Australians.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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