There is no need for a Chicken Little response - Medicare reform is needed

Nor will it automatically mean that non-healthcare-card holders will face an immediate hike in fees, for that would require a very significant change in GP business behaviour which I suspect is being overplayed.

At the moment there are four different ways in which GPs handle bulk billing. A doctor may:

1. Bulk bill all their patients.
2. Bulk bill their concession-card holders and charge everybody else a co-payment.
3. Bulk bill patients selectively, at times making concession-card holders pay a fee (especially if the GP thinks they don't need as many visits as the patient thinks) and at times bulk billing people on higher incomes, especially young families.
4. Not bulk bill anyone.

Nothing the government is proposing will stop the first group continuing to bulk bill everyone. In fact, if the practice has a large number of concession-card holders the GP will get a boost in income for them. The GP will have to make a business decision as to whether imposing a charge on the non-concession-card holders will drive them away from the practice.

The second group may get sufficient increase from higher bulk-billing rates to maintain their charges for other patients so no one is worse off. In the third case, the GP is given a real incentive to bulk bill all their concession-card holders rather than pick and choose. I would have thought this would really appeal to those concerned with social equity.

What will be different is that, for the first time, people on low incomes will be able to get a guarantee that a GP practice will bulk bill them every time they visit. And in rural areas the proposed increase in payments should encourage a return to bulk billing.

This, of course, is not recognised by the rather incompatible alliance of doctor's representatives and left-wing politicians and academics who are berating the moves. But I can't see the logic of their solution: increasing the Medicare rebate across the board.

If a doctor is so greedy as to abuse the government proposals, why wouldn't they abuse a higher rebate and simply maintain co-payments? (in addition to which, of course, payment of higher rebates because of an alleged decline in bulk-billing rates would simply encourage bad behaviour in the future).

And finally there's the offer of catastrophe insurance for those unfortunate people who become so ill that they rack up more than $1,000 in medical costs above the Medicare rebate that so antagonises the anti-health fund lobby.

At the moment those people don't have the option of covering those excessive bills: they have to pay them. What's wrong with giving them some protection if they wish to have it?

Unfortunately some people (the usual suspects) are so opposed to the concept of private health insurance that they blind themselves to the important part insurance plays in our health-care system.

Their real agenda is to transfer the 30 per cent rebate - which makes it possible for more than 2 million low-income earners to retain health insurance and therefore exercise some choice in their health-care arrangements - from health fund members using the private sector to health-care providers in the public sector.