A shadow minister told me a joke last week. “What do the Liberals stand for?”

“So Troy Buswell can sniff their seats.”

It’s not funny – it’s not even grammatical – but you have to get your jollies wherever you can when you’re in opposition. Particularly when you’re in as big a mess as the Liberal Party post-Budget.

http://blogs.theaustralian.news.com.au/christiankerr/index.php/theaustralian/comments/just_how_big_a_mess_are_the_liberals_in/

In that light. The truth about Abbott’s safety net, September 25, 2004 The Age.

The evidence shows it is the rich who are benefiting most from MedicarePlus, writes Charles Livingstone.

“This is a slightly surreal election campaign for many reasons, but one of the more diverting is the spectacle of the Howard Government trying to outspend the ALP on Medicare.

Enter the Government’s MedicarePlus Safety Net, whereby families or individuals who experience high out-of-pocket costs for doctors’ fees are reimbursed 80 per cent of the fee charged above the normal Medicare benefit.

Tony Abbott says the scheme protects ordinary Australians from high fees, and argues that it’s very popular. Certainly, someone out there likes it. Last week, Treasury advised that the original cost estimates of $440 million for this program over four years had increased by $142 million in the first year alone. And the evidence is that the lion’s share of this funding has gone to support the access of the most affluent members of our society to medical specialists, with likely serious inflationary consequences for the health-care system.

Abbott has told us that about 80 per cent of the safety net expenditure so far has been to reimburse people for specialist costs. Even though bulk-billing has declined among GPs to around two-thirds of consultations, this is way ahead of the bulk-billing rates for specialists, who on average bulk-billed only about 27 per cent of services in the June quarter this year.

If you see a specialist privately, you can expect a hefty up-front payment. This is because specialists are in a powerful position. Their skills are highly valued by people who need them. It’s fair that they be adequately remunerated, and by and large they earn far more than GPs. This is partly why GPs have felt left out in the income stakes and why bulk-billing has declined so markedly in recent years.

Abbott also provided data last week that sets out the level of funding the new safety net has provided on an electorate-by-electorate basis.

Has it been equitably distributed? Thanks to the Australian Bureau of Statistics, we have a reliable locality-based indicator of the relative socioeconomic status of Australians. The ABS uses a range of census data to prepare an index of comparative disadvantage, known as the Socio-Economic Index for Areas, or SEIFA. Governments use SEIFA for all sorts of things – indeed, the Federal Government uses it as the basis for its funding arrangements for private schools – so it’s a reliable measure of how well-off particular local areas are.

If we plot the SEIFA value for each federal electorate against the amount of money spent under the new safety net in each electorate, it becomes blindingly obvious that the most affluent parts of Australia have consumed most of the safety net payments.

The largest aggregate payment up to July 31 under the safety net was $911,828, in the nation’s most affluent electorate, Bradfield in Sydney. The smallest payment ($22,222) was in Australia’s third most disadvantaged electorate, Lingiari in the Northern Territory. Between these two poles, there is an unambiguous and statistically significant relationship between relative advantage and greater access to safety net dollars.

Further, the 25 electorates with the lowest SEIFA scores (the most disadvantaged) have averaged payments so far of about $148,000. The 25 electorates with the highest scores have averaged payments of about $448,000. Rural electorates have received an average of less than $150,000; inner metropolitan electorates, $326,000.

The reasons for this are straightforward. First, specialists are most accessible in urban areas. Second, it’s generally the more affluent who can afford to pay the fees that specialists charge. The less well-off have to queue to see specialist consultants and registrars at hospital clinics. Those with money enough to pay big up-front fees, however, can jump the queue.

The safety net thus provides a perverse incentive for specialists to increase their fees further, safe in the knowledge that the Government will pick up most of the tab. This is indeed inflationary (as exemplified by obstetric out-of-pocket costs, which rose by an average 17 per cent between March and June this year, the first full quarter of the new safety net) and makes it unlikely that the scheme will survive for long in its present form regardless of who wins on October 9.

Which is not to denigrate doctors. What, for example, would happen to the price of panel beating if the government agreed to pick up 80 per cent of the tab for any work the panel beater decided to do on your car?

On the evidence Abbott has so far provided, the safety net is unsustainable, inflationary, inequitable and directs money almost exactly where it is least needed. It may even reduce the supply of specialists working in public hospitals, since they can now expect to make vastly more income from private practice.

It would be pleasant indeed if the ad hoc “bidding war” over health care could be replaced by a serious commitment to much-needed reform of the system overall. But that would probably be too surreal”.

Charles Livingstone is a senior research fellow in the Faculty of Health Sciences at La Trobe University. http://www.theage.com.au/articles/2004/09/24/1095961853380.html

There is much available and more recent on the subject. For example.

http://www.news.com.au/dailytelegraph/story/0,22049,22255850-5001031,00.html

“A study by the Centre for Health economics, Research and Evaluation in 2006 found pregnant women using private obstetric services get back an average of $42 for every medical service from the safety net.

Chronically ill cancer patients get back just $18.65 from the scheme”.

And.

http://www.wsws.org/articles/2004/sep2004/medi-s28.shtml

http://www.treasurer.gov.au/DisplayDocs.aspx?doc=transcripts/2004/132.htm&pageID=004&min=phc&Year=2004&DocType=2

http://www.maternitycoalition.org.au/media/med140405.htm

My selection purposely excludes articles originating from politicians.

http://www.theaustralian.news.com.au/story/0,25197,23691650-5015662,00.html

This is perhaps the choicest quote…

“He is also the suavest presenter on the box, with a James Spader kind of insouciance. Many women of my acquaintance tell me they admire his polished assurance and dextrous articulateness. As a performer he certainly embodies a sense of the authentic mind, something we rarely see on local TV. ”

bbwwwaaahhhhhhahahahahha!

He co-ordinates my treatment with the Oncology Dept. at Nambour Hospital – they do what he says. I need regular tests (bone marrow biopsies etc.) these are done by QML because they bulk bill – if I had the same tests done at The Mater they would cost me $750.

Florescence in situ hybridisation genetic tests are also done by QML at no cost.

I have never experienced a problem with Nambour Hospital when I have required hospitalisation about every 3-4 months (this may be due to the fact that I have cancer of the immune system and always get a room by myself – because of infection problems).

Would I consider private health insurance? NO. Of course every case is different but in my case the system works well.