Date: Tue, 25 Mar 97 23:37:44 CST
From: rich@pencil (Rich Winkel)
Subject: Australian Public Health Care Under Assault
/** headlines: 147.0 **/
** Topic: Australia Pubic Health Care Under Assault **
** Written 8:29 AM Mar 24, 1997 by newsdesk in cdp:headlines **
/* Written 3:46 PM Mar 22, 1997 by firstname.lastname@example.org in health.reform */
/* ---------- "Australia Pub Health Care Under Ass" ---------- */
From: Institute for Global Communications <email@example.com>
Subject: Australia Pub Health Care Under Assault
/* Written 2:59 PM Mar 16, 1997 by peg:greenleft in igc:greenleft.news */
Title: Stop the attacks on public health care!
Stop the attacks on public health care!
Jennifer Thompson, Green Left News
16 March 1997
"Ministers warn of health crisis", trumpeted the February 28
Australian. "Medicare emergency", warned the September 24
Bulletin cover, "what the health crisis means to you".
"Failing fast" said the Bulletin's January 14 story about the
hospital system, especially in NSW.
Since the Liberals came to federal government promising to retain
Medicare, bulk billing and community rating for private health
insurance, the ines have been strident. Promotion of the
"crisis" is being used by the government to sell health system
"reforms" that will violate those promises.
The crisis revolves, say these stories and many more, around the
increasing cost of our relatively accessible health care system.
Our ageing population and advanced medical technologies are
causing health care spending to spiral to out of control, they
claim. These problems are the reason the government must make a
further $1.3 billion in cuts, leaked in early March, to public
health spending in the next budget.
But what sort of crisis is it? The main crisis has been the
squeeze on the public health care system. The causes: increased
demand - inevitable with an ageing population and lower private
health fund membership - made worse by governments' refusal to
build more hospitals and community health infrastructure; and
inadequate funding, reflected in longer hospital waiting lists
and closures of beds, wards and hospitals.
Governments have reacted to the increased need for medical
services by attempting to use economic "rationalist" methods to
restrain costs. One of the key mechanisms is the introduction of
"price signals" to deter "overuse" of services. Another is to
run down public health services so that those who can afford to
will go to the private system - creating a two-tier health
Labor pioneered some of these changes, and the Liberals have
learned from those, like Brian Howe's 1991 co-payment proposal,
which were defeated by community pressure. The Liberals must find
a way to quietly dismantle the public health system, especially
Medicare, universal access to public hospitals and the
Pharmaceutical Benefits Scheme. Among the measures announced in
the last budget were:
efforts to shift higher and middle income earners from Medicare
to the private health system by charging single earners with
taxable income above $50,000 ($100,000 for couples and families)
a higher rate of Medicare levy - the stick - and giving single
earners with a taxable income of less than $35,000 ($70,000 for
couples and families) a reduced private insurance premium or tax
rebate - the carrot.
The Coalition now proposes, and Labor supports the move, to lower
the income threshold for the higher Medicare surcharge - to
$35,000 for singles and $70,000 for families.
reduction of hospital funding grants to the states by $300
million over four years. The leaked 1997 budget document detailed
a planned further cut in Commonwealth funding.
abolition of the Commonwealth dental program, which was
introduced in 1993-94 to provide dental services to Health Care
Card and Commonwealth Seniors Card holders.
capping of pathology expenditure and freezing of diagnostic
increased charges for drugs covered by the Pharmaceutical
Benefits Scheme. The proposals for the next budget include
removing some higher cost drugs from the PBS schedule;
removal of capital grants to nursing homes and allowing the
charging of an entry deposit, and means-testing of residential
care subsidies, moves that may force many older people to sell
their homes and leave others without nursing home care.
transfer of responsibility for the delivery of public health
programs to the states, which will make it easier to cut or
removal of some medical services, like IVF and tubal ligation
reversals, from the Medicare schedule and limitation of others,
such as visits to psychiatrists.
The main targets of "price-signal" mechanisms are pensioners,
who are the largest users of medical services. The Institute of
Public Affairs calculated in 1995 that a $5 co-payment would save
the government over $1 billion per year. Much of the savings
would occur because the system would discourage pensioners from
"unnecessary" visits to the doctor.
The Doctors' Reform Society points out the financial
"deterrent" for seeking medical services will particularly
affect early intervention, particularly where the patient is poor
and suffers from chronic illness, such as asthma. DRS national
president Con Costa points out that real health "dividends" lie
The government's efforts to stem the flow from the private health
system will create a two-tier health system. As the squeeze on
public hospitals worsens, two queues - a long one for Medicare
and a shorter, more expensive one for private patients - will
lead people who can afford it to the private health system. The
public system can then be degraded further as it becomes the
system for poorer, more politically marginalised people.
The myth that the private sector and market are more efficient
and important than the public sector justifies this approach. The
"efficiency" facts are otherwise. The tax office and Medicare
take only 5% of the health "premiums" they handle, while the
private funds take about 14%. Despite "competition" among
private health insurance funds - there are now 88, operated by 49
registered organisations - health insurance premiums have
increased at a much faster rate than inflation.
Unfortunately for the private health funds and providers of
private health services, given the choice of a comparatively
cheap, efficient and effective public health insurer - Medicare -
people, especially the young and healthy, have voted with their
feet. Despite the August budgetary subsidies for private health
insurance, membership of private health funds remains at a low
Ironically Labor health minister Carmen Lawrence's October 1995
measure to make private health insurance more attractive, by
allowing it to pay for 100% of the costs of a hospital stay, has
put them into the red. Private health funds recorded a collective
operating loss of $81 million in the year to June '96, chiefly
because the privately insured were now choosing to stay in
private hospitals, which are up to three times more expensive
than public hospitals.
The failure of "carrots" to lure people back into private
health insurance, the key to the private health system, means the
government will try more of the stick. That's what the government
cuts planned for the next budget are about.
The effects of the measures undertaken in the budget and since,
and the broad polemic against universal welfare payments -
"middle class welfare" to opponents of the social wage -
including Medicare, are short and long term.
In addition to delivering more business to the private health
system and cutting public spending, the longer term intention is
to induce what "rationalist" jargon calls "behaviour change".
That means that the poor should suffer ill health and shorter
lives without expecting decent care.
Rather than market-based "solutions" to the health care crisis,
we need a rational system of health care planning under community
control. Bringing that about will require a fight against the
irrational schemes of both major parties.<F41559s>n<F255D>
Comparing Australia's public health system with the US private
Figures from Australia's Health 1994, reprinted from Keith Joseph
in New Doctor Summer 1995.
| || United States|| Australia|
|Life expectancy (at birth)||Male 71.9 (1989)|| 73.9 (1990)|
|Female ||78.9 ||80.0|
|Maternal death rate (per 1000 live births, 1988) ||8.4 ||4.9|
(per 1000 live births) ||6.4 ||5.1|
|Health care expenditure
(% of GDP) ||13.4 ||8.2|
|Number of residents uninsured ||40 million ||Nil|