A Labor- Coalition clash over bulk-billing is not only foolish, but masks the fact that much more must be done to keep our healthcare system fit for purpose.
Since the demise of the Abbott government’s $7 mandatory GP co-payment, a 2014 budget measure, Medicare bulk-billing for general practitioner services has become more of an untouchable sacred cow than ever. It has become as preserved in political aspic as the sclerotic, chaotic and inefficient National Health Service has long been in Britain, and it will be no surprise if, in 2032, the Brisbane Olympics opening ceremony features a homage to bulk-billed Medicare, just as London 2012 starred the dancing beds of the NHS.
This hasn’t stopped the Albanese government resorting to another “mediscare” to denounce its Coalition opponents. After Bill Shorten’s highly successful mediscare 1.0 in 2016 – conjured from a modest administrative proposal to reorganise the Medicare back office – almost defeated then-prime minister Malcolm Turnbull and set the clock ticking on Turnbull’s leadership, Labor has returned to the well again and again to frame itself as the defender of Medicare against conservative Visigoths seeking to destroy it.
It’s therefore unsurprising, with Anthony Albanese’s government languishing in the polls, and exploiting the fact Opposition Leader Peter Dutton was health minister in 2014, that mediscare is again being trotted out by Labor, and lavish public spending on Medicare is being foreshadowed as the centrepiece of Albanese’s re-election pitch.
Before Christmas, Treasurer Jim Chalmers started the mediscare ball rolling. Addressing Coalition criticism of spending blowouts in the mid-year economic and fiscal outlook, Chalmers said: “When Peter Dutton was the health minister he came after Medicare. He tried to introduce a GP tax, he tried to attack the universality of Medicare, and we know he’s a risk to Medicare because we know his record as health minister.”
Federal health minister Mark Butler joined the fray, saying Labor had rescued bulk billing after its “free fall” under the Coalition. He cites the success of Labor’s increased incentives to GPs to bulk-bill under-16s and concession cardholders while remaining silent on Australian Institute of Health and Welfare data showing that bulk-billing rates for Australians aged between 16 and 64 are falling, and patient out-of-pocket costs for GP services have increased. Butler hints at yet more public money being thrown at Medicare to increase bulk-billing and expand Labor’s taxpayer-funded urgent care centre network that cuts the lunch of private general practices.
After Chalmers’ first mediscare lunge, the Liberal Party parried with a video of opposition health spokeswoman Anne Ruston decrying Labor’s hyperbole. Ruston highlighted billions of dollars in year-on-year Medicare funding increases under the previous Coalition government. “This led to record high bulk-billing rates,” she boasted, stating that, under the Coalition, headline bulk billing reached 86 per cent, while under Labor it has fallen to 78 per cent. Ruston also made sure to mention that, under Labor, “Australians are paying more out-of-pocket costs than ever before”.
As for policy proposals to improve Medicare, make primary and acute service more affordable to consumers, and keep an increasingly rickety healthcare system on the road as the Boomer generation threatens to swamp it, ideas from Ruston come there none.
Indeed, for almost three years, the Coalition has sharply criticised Labor, but months out from a federal election has as yet offered no comprehensive policy solutions other than restoring former minister Greg Hunt’s 20-per-patient Medicare-funded psychologist consultations. No wonder Chalmers, Butler and Labor think yet another mediscare will work: the Coalition has given a blank sheet to work on.
From a policy perspective, what’s most disappointing about this “he said, she said” Medicare politicking is its confirmation that both major parties are lazily reducing the debate on healthcare priorities and reform to the lowest common denominator of bulk-billing. Universal bulk-billing is no Nirvana: it’s middle-class welfare. Working people in normally good health, who can afford to pay $50 or so on top of their Medicare rebates a few times a year – at most – to see a GP, are brainwashed to think any out-of-pocket cost is immoral. Moderate out-of-pocket costs for those who can afford them are unpopular but are necessary and instrumental to keeping Australian general practices the accessible and affordable world-class healthcare services that they are.
A Labor-Coalition electoral clash over which party is better for bulk-billing is not only foolish but masks the fact that so much more needs to be done to keep our sprawling healthcare system fit for purpose. From improving the viability of primary care to prioritising prevention and early intervention, getting more value for massive public hospital funding investments, and renovating private health insurance and the private health choice, there are so many more pressing needs for reform than entrenching the “free stuff” political mentality behind bulk-billed Medicare.
As this election year starts, the bulk-billing obsession of both sides insults the intelligence of Australian voters.
Terry Barnes is a Liberal Party member and policy consultant who formerly advised federal and Victorian Liberal ministers.
