• The Abbott government's attitude to healthcare is that those who can pay, should - and those who can’t should just work harder, writes Richard Di Natale. (AAP)
The idea behind Medicare is that everyone gets access to high quality health care, no matter what the size of their wallet. We should be building it up, not tearing it down.
By
Richard Di Natale

12 May 2014 - 5:25 PM  UPDATED 12 May 2014 - 5:25 PM

The Abbott Government is on the warpath and Medicare is the target.

The Coalition has never liked Medicare because it prefers a user-pays model and now it sees an opportunity to tear it down under the guise of a budget emergency. The Health Minister claims that Medicare is unsustainable and the rigged Commission of Audit process has predictably recommended co-payments for GP visits and increasing the cost of medicines.

The narrative being pushed by The Abbott Government and the commission is that health costs are spiraling out of control but in reality spending has increased only slightly as a proportion of GDP over the last decade. This small increase has nothing to do with unnecessary GP visits and is primarily a result of improving medical technology leading to better investigations and treatments.  Would anyone actually prefer that Australians miss out on new and better therapies for diseases like cancer?

This preference for a private, user-pays model of health care would take Australia towards a two-tiered American style system where many people simply can’t afford basic treatment.

But this attack on Medicare is not based on evidence. The Abbott government and its handpicked Commissioners from the big end of town just don’t believe that government should be in the business of providing these sorts of services. They believe that those who can pay, should; and those who can’t should just work harder.

Consider the issue of GP co-payments. This recommendation is based on the perception that people are going to the doctor too often when they don't have to, even though the commission has no evidence of this. What the evidence does show is that co-payments might reduce some unnecessary medical care, but it would also prevent necessary medical care. Many of these people will end up in hospitals requiring far more serious and expensive treatment. Besides, the whole point of going to a doctor is to get advice and reassurance that your symptoms don’t require treatment. If someone is suffering chest pain, they shouldn't have to think twice about cost before consulting a doctor.

The same is true for PBS co-payments. The Commission of Audit argues that increasing the PBS co-payment for medicines would “be an important step in providing a signal to users about the cost of their care and place greater value on these medicines potentially reducing the incentive that users face to not take their medicines”. In fact we know that the reverse is true. People are currently not filling prescriptions because they cannot afford the existing co-payment so the logic that increasing the co-payment further would somehow improve compliance is baffling. Increasing the cost of something may increase its value when you’re talking about Chanel No 5 or a bottle of Grange, but in the real world of life saving medicines things are a little different.  The real life consequence is that people won’t take their blood pressure or diabetes medication and that’s bad for the patient and bad for the taxpayer.

But the most dangerous health recommendations from the commission is to let private health insurance cover GP visits and then to force people on incomes of more than $80,000 to drop Medicare. If the Abbott Government implemented these recommendations then, to borrow a phrase from the Prime Minister, Medicare would be dead, buried and cremated.

This preference for a private, user-pays model of health care would take Australia towards a two-tiered American style system where many people simply can’t afford basic treatment. It’s also much more expensive overall, which is why the US spends twice what Australia does as a proportion of GDP but has much worse health outcomes. A single universal insurer like Medicare drives down costs because it sets the price for health services.

Medicare is one of the great Australian success stories. It may not be perfect but for 30 years it has delivered healthcare fairly and efficiently. Everyone gets access to high quality health care, no matter what the size of their wallet or whether they are unlucky enough to be born with a chronic disease.

We should be looking at ways of building up Medicare, not tearing it down. We should be bringing dental care into Medicare and looking for other ways to reduce people's out-of-pocket costs, not increase them.

This is a battle over what kind of country we want to be. The Greens believe that your health should never be determined by your bank balance and that’s why we are standing up for Medicare and will fight to protect it.

Senator Richard Di Natale is the chair of the Senate Inquiry into the Commission of Audit and a former GP.