When a wake is finally held for the GP co-payment (whose condition surely must now be judged as terminal), those writing the eulogies will have no trouble finding remarkable stories to tell.

Who could possibly forget the Prime Minister complaining to G20 leaders about his pesky personal health problem?

Perhaps the newly deposed Victorian Premier Denis Napthine will also have a few choice words to say about the political flip flopping around the co-payment, just days out from an election – yielding so many helpful headlines of chaos and confusion.

Meanwhile, here are a few notes for potential eulogy writers, courtesy of two prominent Croakey contributors, Emeritus Professor of Public Health and Community Medicine, Stephen Leeder, and Wonky Health columnist and GP Dr Tim Senior.

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Stephen Leeder, Emeritus Professor of Public Health and Community Medicine, University of Sydney, Editor-in-chief, Medical Journal of Australia

“Here is a puzzling existential question:  where do thought bubbles come from?

The $7 dollar co-payment proposal was a thought bubble.  It had no parentage in policy.  It was first announced to ensure that the health system remained sustainable.  The system is not rendered sustainable or unsustainable b y finance, only by political decisions. Never mind.

This proposition lacked credibility.  When the budge announcement was made the health system had returned to sustainability and the $7 co-payment was to be used to pay for more medical research, largely directed as Hockey put it to cancer, dementia and heart disease, all of which were likely to be more common in the future because he had abolished the National Preventive Health Agency.

When interviewed by Fran Kelly on August 14, Dutton had changed his tune again.  The $7 was to send a price signal.  People were using GPs too much.  His modelling however said that GP consults would fall only by 1%. This would allow doctors to spend more time with their patients. But, said Fran, if a GP is seeing 50 patients a day the copay will reduce this only to 49.5.  I can’t remember the rest of the conversation.

The co-pay was sufficiently critical to Australia’s economy apparently for Abbott to use it to explain his inability to balance Australia’s budget to his brothers and sisters in the G20 knitting circle.  Whether any of them understood what he was talking about is debatable.  Nevertheless he was clearly  ‘speaking from the heart’.

The co-pay is pure ideology.  You can bet that Abbott will flagellate the poor over their use of GPs in some way if not through the copay then by reducing the amount paid for bulk billed consults.

Pox on all their houses.”

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Q&A with Dr Tim Senior

1. What is your understanding of the current situation?
The Government went into the general election promising no cuts to health, and with a health policy that made no mention of  co-payments to see a GP or for pathology or radiology. They campaigned strongly on the fact that the previous government introduced a carbon tax after ruling it out before the election. After winning the federal election, a co-payment was proposed by a think tank and by the government’s own Commission of Audit. The Government backed away from the policy at a by-election and a senate election, before announcing it without warning in the May Federal Budget (set at half the level recommended by the Commission of Audit). The Government have the numbers to pass this in the lower house, but not in the Senate, then upper house, and have not introduced legislation.

In the last week, the party room has been briefing that the policy would be dropped, subsequently contradicted by the treasurer, Joe Hockey, and the Health Minister, among others. One of the Government’s own senators has said they will vote against the co-payment, and the policy is opposed by the Labor Party, the Greens and most of the cross bench senators, leaving it very unlikely that it can be passed.

The Government has been counselling the idea of introducing part of the reform – reducing the fee paid for medical services – through regulation. This would have the effect of cutting doctor reimbursement, if the patient was charged by the doctor, or reducing the rebate the patient receives. However, if implemented this way, the Senate can, and most likely will, disallow the regulations, preventing its full implementation. Most observers believe that there is no way the co-payment can pass.

2. What do you expect will be the outcome? Will we get a copayment or not and with what impact?
The most likely income is that the co-payment will not be implemented. The Senate will block changes to legislation or regulation. The public and health professionals do not support a mandatory co-payment and the Government is losing support because of this policy, among others.

It remains to be seen whether the Government will continue to support a co-payment on principle, or whether the policy will be dropped to shore up support as the next election approaches. For a co-payment to be implemented, the support of a number of cross bench senators will be needed. One of these is opposing all Government legislation in protest at another policy. She has split from the Palmer United Party, leaving the challenge of negotiating with the cross bench much more difficult. Add to this, one of the Government’s own senators saying he will vote against the changes, and there does not seem to be any way that the Senate will approve a co-payment.

The impact will be that Medicare continues as it is. It is unlikely that either side of politics would attempt significant reform of the health system, following this debate. There are some calls from health organisations for health reform to manage increasing chronic disease and multi-morbidity, but it is not clear that these are being taken up more broadly.

3. What are the lessons out of this story?
The arguments proposed by the Government were based mainly on an assumption that Medicare was unsustainable, but the facts that this argument was based on were quite easily and quickly debunked. The Commission of Audit said that people were making an average of 11 visits to the doctor per year, when this was not close to the official stats of 5-6. The Government’s own figures showed the cost of Medicare decreasing.

Against this, patient groups, medical colleges, public health professionals and political opponents all were saying the same thing – that these changes would disproportionately affect the most vulnerable. This wasn’t a co-ordinated campaign, but the message clearly fitted with the wider narrative about the budget as a whole being unfair. The Government have not managed to shift the terms of the debate away from a discussion about fairness.

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PostScript from Croakey

Another discussion point for the eulogies (from medical journalist Michael Woodhead)…

 

 

 

 

 

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