Last week a proposed decrease in the Medicare rebate went down, not so much in a blaze of glory as with a whimper of “confusion”. The minister responsible for the changes, Peter Dutton has also moved on, leaving behind the accolade of “worst health minister in 35 years.” The immigration portfolio may yet provide a chance for Mr Dutton to shine, though recent critiques of his short time in his new post don’t bode well .
In this article, re-published with thanks to Australian Doctor, Paul Smith, the magazine’s deputy editor, reminds us that, as the GP co-payment is still on the table, the worst of Peter Dutton’s legacy as Health Minister may be yet to come.
So Peter Dutton has gone.
The week before Christmas came the media release announcing Tony Abbott’s cabinet reboot and with it, a new office for Mr Dutton in the immigration department.
Mr Dutton leaves behind many questions, among them whether he was Australia’s worst federal health minister.
There may be candidates whose efforts in pursuit of the dishonour go too far back in time, or whose tenure was too short to cast judgement. But Mr Dutton was around long enough — just over a year — to stake a claim.
For many, he seemed someone intent on loyally serving nothing but the narrowest of party interests, a politician who rather than taking on the laborious task of fixing the dysfunctions of the health system became a type of anti-health minister.
The clues were there during his time as Opposition health spokesperson. He rarely troubled the democratic process by putting parliamentary questions to the health minister of the day — whether that was Nicola Roxon or Tanya Plibersek.
This was meant to be the period of great reform.
Such dormancy on the floor of the house eventually became a running joke around the corridors of Canberra. How was he filling his days?
It is true that he did turn up on the health conference circuit. His appearances at the AMA’s annual meetings were frequent. He would talk about the sanctity of the doctor—patient relationship and the need to reduce red tape — soothing words unlikely to wake delegates from their slumbers.
But his flirtations with the national debate extended little further than an attack on GP super clinics as a $650 million waste of money (which must have felt like shooting fish in a barrel) and a newsworthy declaration (later muddied to the point of complete obfuscation) to sink Medicare Locals.
I still remember watching the TV during the Federal Election when he went head-to-head with Tanya Plibersek during the National Press Club debate on health. He started accusing the government of denying access to life-saving drugs by undermining the PBAC listing process.
He had a point. But asked to give an example of the drugs he was talking about he started to flounder, mumbling something about not having the exact list with him. To the 150 odd health industry big-wigs in the audience, it wasn’t a good look.
These were the CV highlights of a position he held for six years.
Wasn’t Mr Dutton meant to be offering an alternative vision for Australia’s future health system? Cynicism can provide reasons for his reticence, if not a justification. In opposition the strategy is to deal in non core promises.
The one ‘half’ argument you can muster in his favour was that he (and his leader) simply wanted to avoid the verbal over-reach that constituted the primary achievement of Kevin Rudd’s grand ambitions in health, particularly when the government coffers were empty.
So even though Mr Dutton’s initial co-payment plan should have been a manifesto commitment, it seems almost certain that it didn’t exist (even in the demented dreams of his factional colleagues) until after Mr Abbott was sworn in as Prime Minister and the Treasury started hunting for some cost cutters.
This can be the only reason for the co-payment contraption the government eventually came up with in the budget last year, a bastardised, socially regressive, bureaucratic, ill-conceived, anti-health policy meant to fund the apparently imminent discovery of cures for dementia and cancer.
Given Mr Dutton’s years as opposition health spokesman, he should have learnt enough to see what it really was and warn his colleagues against it. Maybe that happened. But the evidence is absent.
He was also foolish enough to declare two weeks before the billion-dollar cuts were unveiled that his government was “completely committed to rebuilding general practice”.
His credibility then took a further battering when he spent the subsequent months defending the policy with claims the reform would result in a “$2 windfall” for GPs.
But fundamentally the root of so many of his limitations was that he never seemed to work out the link between hospitals and the Medicare budget he was so keen to make sustainable. It could have transformed his intellectual and political world view.
All this is now a footnote of course.
Last month’s launch of Co-pay Mark II is probably the policy that the government’s backbenchers believe should have been announced first time around.
It still contains all sorts of horrors — not least a massive de-funding of primary care and a failure to deal with the real cost drivers in health.
I guess the Coalition could argue that it simply takes back much of the Medicare funding — increasing rebates to 100% of the schedule fee, introducing the bulk-billing incentives — used by Mr Abbott to prop up bulk-billing rates when he was health minister under John Howard.
But maybe that would be to admit Mr Abbott did more than most to foster the public expectation for the bulk-billed GP care that he now decries.
We remain in a state of flux. What happens next will determine whether Mr Dutton’s struggles over the last 12 months have permanent effects.
If the co-payment reforms are swept away by the bigger political tide — by the Senate, by public backlash, by a new government — perhaps his legacy will be as just another ineffective cabinet chair filler.
If the co-payment reforms remain, his legacy would be darker: the politician who managed to show that governments can sacrifice the funding of general practice at a whim.
As a definition of an anti-health minister, that is probably the most accurate.
You can read the original article in Australian Doctor here.