QED

Dutton On The Button

hospIn today’s Australian Financial Review I again made a policy case for extending price signals on Medicare-funded health services.  While this included the $6 co-payment on bulk-billed GP services, this also includes the possibility of imposing a means test on bulk-billing, so that only the most financially and clinically worse-off patients can obtain health care free at point of access.

The possibility of adopting such tough measures to rein in the growth in Medicare costs, and bust the myth of universality that has attached itself to Medicare, has been given a huge boost by the political guts of federal Health Minister Peter Dutton.

In his speech last week to the Committee for Economic Development Australia (transcript can be read here), and elaborated in a series of post-speech interviews, Dutton took head-on the collective wisdom of the healthcare establishment – Medicare McCarthyites as I called them, a powerful lobby whose ostrich-like refusal to consider major structural reform was highlighted in a knee-jerk opinion piece in today’s Age by Labor’s novice health spokesman, Catherine King.

In speaking out from the bully pulpit of office, Dutton did what no Coalition minister has done since Medicare’s foundation in 1984: he dared suggest there is no universal entitlement to free health care.  Particularly in his CEDA speech, he soberly, methodically and empirically made a policy and economic case for reining in the open-ended largesse of Medicare, and put firmly on the table what should become the new Medicare truism: that if Medicare is about paying according to means, those with means should pay.

It’s one thing for a former ministerial adviser and policy writer like me, or a think-tank like the Australian Centre for Health Research, to challenge the might of Australian healthcare establishment.  Snowballs and Hell come to mind.  But it’s another thing entirely for a Cabinet minister to expose himself to a vicious scare campaign simply because he dares to tell the truth about Medicare sustainability, and now he needs to keep his nerve against the enemy barrage.

Some on the economically purist Right will be disappointed that Dutton hasn’t gone further than he so far has.  But they should remember that even the greatest of empires eventually fall, if they didn’t reform from within – a message that resonates particularly in 2014 as we mark the centenary of the outbreak of the First World War. Indeed, Medicare is the Austria-Hungary of policy empires.

The Left, however, has grasped the significance of the threat.  That’s why we’ve seen so much disinformation, distortion and outright scaring of the electorate from those Medicare McCarthyites – including the Australian Medical Association – and opportunistic Labor and Green politicians wanting to attack the increasingly-confident Abbott government.  It’s therefore important that all those who care about sensible health policy, and maximising the rational use of scarce public and private health care resources, should get behind Dutton and his determination to have an effective policy conversation with the Australian people.

That means taking the vested interests head-on, and ensuring that Dutton’s messages aren’t drowned out by the banshees.  It means talking over the heads of the healthcare establishment directly to the Australian people, of whom the evidence indicates many are prepared to give Dutton’s case a fair hearing.

As with Iain Duncan Smith, Work and Pensions Secretary in the Cameron government, Dutton is showing a willingness to take on sacred cows of the welfare state, with the ultimate aim of preserving the best of what we have and better targeting stretched resources to where they’re most needed.  Dutton’s ideological enemies want to strangle this essential debate at birth: they mustn’t be allowed to prevail.

Change will come, but only against fierce opposition from these entrenched and powerful vested interests. Unless there is tolerant, informed and, above all, honest debate of health financing challenges and how best to address them, Australian healthcare will not move with the times, will become more expensive and less efficient, and its quality will be compromised.

By taking his ideology-obsessed opponents head-on, the quietly-spoken pragmatic managerialist who is Dutton is showing genuine political courage.  Indeed, is showing more political guts than many of his parliamentary colleagues.  Dutton’s measured stand therefore deserves respect, and community support.

Terry Barnes authored the October 2013 Australian Centre for Health Research paper on co-payments for bulk-billed GP services

1 comment
  • Geoffrey Luck

    This is the most important economic and social reform for a couple of generations – and long overdue. A bit of perspective…..When I was growing up the doctor was called only in cases of illness or accident. And I mean “called” because he actually came to the house and sat by the bed. There were all the childhood illnesses – measles, mumps, whooping cough, diphtheria and more rarely meningitis and poliomyelitis in the big epidemics of the ’40s. The rest of the time, people went to the chemist for quasi-medical advice and over-the-counter medicines for coughs and colds, scabies, boils and assorted ailments which didn’t really require a medical degree. After the war, the Attlee government introduced Britain’s National Health Service of free universal health care, and unplugged a dam of pent-up limitless demand on the state. By the time we went to live in Britain in the late ’60s, the local doctor’s panel limit of 3000 had been exceeded, and his waiting room held 20 or 30 people all day. My wife had an emergency operation and woke to find the surgeon was not the one she had consulted and who undertook to do the operation. One of the children developed quinzy and was told the waiting list was 18 months, but “I can do him immediately as a private patient.” Everyone knew what wreckage the NHS had caused, yet Australia went ahead and launched Medicare on the same lines – permissible infinite demand at a time of an increasing range of services and procedures. At the same time so many people who could well afford private medical insurance built swimming pools and took overseas holidays instead.

    Today Australia seems too politically timid to tell the truth to those people who can afford to look after themselves – in GP visits, hospital care, or (dare I say) child minding and kindergarten. Not everyone has a bulk-billing doctor. Many of us pay $75 for a GP visit, and receive a Medicare refund of $36.30. That’s pretty good value. The middle class people I know who use bulk-bill clinics have every right to do so, but morally they are rorting the system. Making such people contribute a modest co-payment is just, equitable and necessary in the preservation of free medical care for the needy, Carthago delenda est!

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