The Abbott government was elected on a raft of lies and broken promises, all of which have the potential to have devastating consequences for many people,
predominantly pretty much exclusively those with least to begin with. Not that it’s always easy to tell precisely what the effects are going to be, as even Mr Abbott’s Cabinet seem to be unsure, as evidenced by yesterday’s quick about-face on pursuing HECS debt after death (and The Conversation‘s retraction of how long HECS will take to pay off now course costs and interest will rise, but the payment threshold will drop).
I’ll write about some of the other ‘reforms’ being introduced next week, particularly the targeting of people on Disability Support Pensions. Like my topic for today, that tactic’s come straight from the UK Tory playbook.
In the UK the Conservative government slowly starved the NHS of funds, then turned around and said “see? It doesn’t work!” as an insidious privatising began.
Australia leaped ahead a little there – we’ve started selling off aged care facilities already, with barely a whisper of consultation, let alone publicity (and that, too, I’ll address next week). But today I want to talk about co-payments for GP visits (and allied health consultations, and radiology, and other investigations).
This government has launched a concerted attack on universal health care. It started with a rubbery statistic – that annually, we make an average of eleven GP visits a year. That sounds like a lot to most people, and when uttered hand-in-hand with insinuations and outright claims that ‘some people’ (predominantly over-anxious mums, and the isolated elderly) are going ‘too often’ makes it seem reasonable for a tokenistic disincentive to ease the strain on our struggling public system.
Only none of it was actually true. On average, Australians see a health care practitioner who bulk-bills all or a portion of the visit eleven times a year, true – GP’s comprise about half of that, with the remaining visits going to physiotherapists, occupational therapists, dieticians, speech pathologists, diabetes educators, clinical nurse practitioners, and the like.
There are undoubtedly some GP visits that are unnecessary – after the fact, because often it’s not possible to tell if the issue’s significant or not; laypeople aren’t doctors. And even if you know that what you’ve got doesn’t require medical attention, many visits are for mandatory medical certificates for time off work or school.
But, says Mr Abbott, we don’t value what we get for free – a small impost, the cost of a cup of coffee, a sandwich, a couple of middies, is enough to make malingerers stop, think, appreciate what they’re getting.
Only here’s the thing – we already pay for Medicare. There’s a specific levy for it. And while it’s true that the levy’s 1.5% (plus an additional 1% if, like me, when you earn over the threshold you choose to support universal health care instead of private insurers), and Medicare costs 9% of GDP, that’s been the case since 1997.
Oh, but Medicare’s unsustainable, and so we have to pay more toward it.
Except that (despite cutting CSIRO funding to the bone, including the agencies that take research from the lab to the market, where we can make money – an area where Australia lags sadly behind most countries) we need the money to fund an enormous medical research centre. Not now, but in the future, when the funding comes in. Because that means we won’t need to spend so much on health care…
Our health care system is robust, cost-effective, and it delivers. It’s not perfect, but its imperfections are predominantly in under-servicing rural and remote areas, under-funding aged care and mental health, inadequate preventative interventions, and too much emphasis on sexy, expensive, acute care.
Here’s the reality – if you want to cut health care costs, general practitioners are not the place to look. They are one of the most cost-effective parts of our system. Good GP’s save money, and lives – prompt action means that many acute issues can be treated before they worsen, and chronic conditions are managed before they become life-threatening.
We don’t have figures on how much a hospital bed costs per day, before medications and interventions (though we do for aged care),so I can’t say how much an outpatient treatment of cellulitis through a course of oral antibiotics compares to inpatient admission for five to seven days, with intravenous antibiotics. I can tell you that it’s easily a hundred times more, based on the cost of the drugs and administration alone.
I can tell you with certainty that giving pneumovax or Fluvax to someone at risk costs a fraction of treating them for pneumonia or the ‘flu – and that, having had both, you’re looking at weeks of time off work as well as direct health care costs. That’s bad from a productivity perspective, disastrous if you’re one of the 40% of our work force on casual or contract work.
Poorly controlled diabetes causes multiple irreversible complications that mean anything from admissions for amputation, to dialysis – we know that the best, and least expensive, way to avoid that is regular education, supervision and support, including annual eye exams, bi-annual podiatry, lab bloods, and consultations with a specialist team of endocrinologists, dieticians and diabetes educators working with the client, family and GP.
That’s just three conditions, off the top of my head. As a nation, GPs are cost-effective. For those who are already struggling to make ends meet, Mr Abbott’s ‘small impost’, Ms Bishop’s sandwich, Mr Hockey’s middies or a third of a packet of smokes is the worst kind of disincentive.
These are people who’ve never had to decide between utilities and rent; between school shoes or dinner; who’ve never wept at a parking fine or rent increase. If you’ve never felt your heart leap at the discovery of $5, if a bought sandwich is an everyday occurrence and not a rare treat, you don’t get to decide that $7 isn’t much.
We know what will happen as a result of this move: those who most need early intervention will delay seeing a doctor, and present at emergency departments far sicker than they need to be, which means more cost for the system, and a lot more pain, suffering, risk, and potential economic consequences for them and their families.
Those who are on disability or aged pensions and have multiple medications will reduce their doses to eke out their drugs; fewer infants and children will be immunised; Pap smear and prostate exams will fall; annual wellness checks will be skipped.
And in the short term there won’t be an effect. But it won’t take long – and I mean months – before we start seeing the real damage, in human and fiscal costs.
We know this is a government that creates policies of myopia, that is incapable of long-term or big picture thinking. And we know that it’s a lot harder to reinstate a service or good than it is to retain it in the first place.
The time to act is now. Let your MP know that you don’t support co-payments. Write to the media, ring call back radio, tweet and post and shout it.
And if you’re in Melbourne, and you’re reading this today, join thousands of health care professionals and concerned citizens as we march for Medicare!