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Whither Medicare? The threat to Labor’s light on the hill

by Mark Sawyer | Jul 6, 2022 | Government, Latest Posts

Covid continues to pummel the health system. Interest rates are going up and the energy crisis rages. The new government has its work cut out. One of the most acute challenges is in healthcare, where Labor has always dreamed big, writes Mark Sawyer.

Australians pride themselves on their health system. The envy of the world, we like to think. And with the party that gave us Medicare back in power, things are likely to get even better. Alas, the reality looks different.

This year nurses in NSW went on strike, an action virtually unknown since the 1970s, claiming overwork and poor wages.

As the ABC reported on Tuesday:

  • Patient booking site Healthengine shows the length of time between going online to book an appointment and seeing a doctor has increased.
  • Doctors say they are facing a “perfect storm” caused by the Covid pandemic, flu and a shortage of GPs.
  • The Royal Australian College of GPs is calling for an increase in the Medicare rebate to attract new doctors.

Then there’s Cedric (not his real name). His local medical clinic is down to one bulk-billing doctor. His story is just one case of the grim reality as Australia deals with a serious doctor shortage, and the threat to the principles of universal, free, healthcare.

Healthcare for one and all

Labor has always defined itself as the party of expansion and optimism. ”The light on the hill,” as postwar prime minister Ben Chifley defined it. As part of its mission to improve and elevate the lives of ordinary working Australians and their dependents, Labor’s union wing set out to cut the working week, from 48 hours to 44 to 40 and eventually to 38 hours a week.

Even if this ideal has been tarnished by the rise of insecure work, the gig economy, it remains a keystone of Labor’s self-image.


Hunt attacks Labor’s Medicare policy as “slush fund”, forgets previous three years

The most important Labor initiative of the past 50 years has been universal free medical coverage, at least for GP services, emergency surgery and some elective treatment. Medibank was enacted by the Whitlam government in 1975 but filleted away by the Coalition government that overthrew Whitlam and ruled until 1983. Led by health minister Neal Blewett, Labor rebadged the scheme as Medicare and launched it with impressive efficiency on February 1, 1984.

It has long been an article of faith among Labor politicians that their party is the saviour of universal free healthcare, and the Coalition the destroyer.

The Coalition under John Howard did its best to neutralise the issue. In 2006, after 10 years in power, Howard upped the ante. Opening a medical practice in ”the wonderful electorate of Warringah”, he described the Coalition as ”the best friend that Medicare has ever had”.

But the scheme is threatened in the most fundamental way. Universal bulk-billing has been proclaimed dead.

The figures bear witness to the crisis. One in six consultations in Australia are likely to not be bulk billed. The national bulk-billing rate is now at 83%, with Tasmania faring the worst of the states (76.8%). Curiously, the two territories have the highest and the lowest rates: the Northern Territory has 89% and the ACT 76.5%.

That practice Howard opened is in the same electorate where Cedric switched doctors because his long time GP informed him that he would no longer be able to bulk bill him, blaming pressure from practice management.

”I had to switch,” Cedric says. ”I felt bad about the change because I see my old doctor sometimes when I go to the clinic. It feels weird. But I can’t stump up $80 every time I need a consultation. My old doctor was a great guy, but I couldn’t afford him. My new doctor is a great guy too, but more importantly he is the last one out of about 25 at his practice who bulk bills.”

Remember this is one of the most affluent electorates in Australia. Once Liberal, it is now held by a Teal independent, which is pretty well the definition of an affluent electorate after the 2022 election.

A threatening landscape

Royal Australian College of General Practitioners president Dr Karen Price has said GPs are taking action to ensure the sustainability of general practice by passing on costs to patients where suitable.

This is the landscape being navigated by the new Labor government and its health minister Mark Butler. Anthony Albanese campaigned in May on health as a strength for Labor. Even when he could not remember the six planks of Labor’s policy for the National Disability Insurance Scheme, he said Labor’s overall policy program was to  ”put people at the centre of the NDIS”.

Albanese pledged ”Improved patient access to General Practice, including after-hours”, ”improved patient access to GP led multidisciplinary team care, including nursing and allied health”, and ”decreased pressure on hospitals”.

Hey Scomo, here’s how to fund Medicare

Labor has gone further into the realm of healthcare than ever before, promising super clinics. These halfway houses between GP clinic and emergency rooms in hospitals loom as one of the most difficult promises to fulfill. During the 2022 election campaign, outgoing health minister Greg Hunt accused Labor of recycling failed policy.

”When last in government, Labor promised 65 of these super clinics, but only delivered 33, with a damning Auditor-General’s report criticising the then $650 million plan,” he said.

Then there is the 24-hour nurses Labor has promised for aged-care homes. The question remains: from where? Aged-care homes are staffed in many cases by migrants from poor nations. One is Nepal, which is ranked 142 out of 189 countries on the Human Development Index.

Borders are reopening around the world and the rush is on for migrants to fill the jobs that locals won’t do. But poaching health workers from poor countries looks a lot like the new colonialism. The World Health Organisation predicts a shortfall of 18 million health workers by 2030, mostly in low- and lower-middle income countries.

The cost of Medicare is tipped to reach $35.5 billion in 2025-26. The NDIS will overtake it. And yet the key plank of Medicare – the bulk-billing practice – is becoming harder to find.

The light on the hill has dimmed.





Mark Sawyer is a journalist with extensive experience in print and digital media in Sydney, Melbourne and rural Australia.

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