Medicare under threat

Health has certainly been in the news in recent times - and generally for all the wrong reasons. Crisis management and “blame shifting” have become the norm rather than the exception. Rational and well thought out responses to our current predicament are rare. Community confidence in our health system has been shaken and this is not likely to improve if we cannot move out of crisis mode. A subtle shift in health policy, from public health provision to public health payments, has been occurring nationally.

It is difficult to achieve a sustained focus on the source of our problems in health and the reforms needed to address them. The issues are complex and inter-related and there will be no quick fix or simple solutions. A co-ordinated and concerted effort is required from state and federal governments, “consumers” of health services, private health service providers, and a myriad of other key stakeholders, if we are to implement sustainable solutions.

Since 1998 the Public Hospitals Health and Medicare Alliance of Queensland (PHHAMAQ) has been actively lobbying all levels of government for a co-ordinated response to health reform. PHHAMAQ is a community based coalition that shares common concerns about the future of the Australian health system, with membership drawn form health consumer organisations, health provider organisations, community organisations and trade unions.

The purpose of PHHAMAQ is to:

• share information about issues of concern to PHHAMAQ members; and
• raise awareness within the community and with all political parties about health matters.

Members of PHHAMAQ subscribe to a basic set of principles in their lobbying and community engagement activities:

• health care is a right that should be based on need and not on ability to pay;
• healthy citizens are the most valuable resource of any society;
• the best and fairest way of achieving health care is through Medicare, Australia’s universal tax-funded health insurance system;
• Medicare is the fairest way of meeting people’s needs while containing costs and compares favourably with health systems in other OECD countries; and
• Medicare provides a common good for the benefit of all Australians.

The provision of private health services is and should only ever be complementary to the maintenance of a viable and effective public health system. PHHAMAQ is a member of the Australian Health Care Reform Alliance (AHCRA). The Queensland Nurses’ Union (QNU) provides secretariat support for PHHAMAQ and PHHAMAQ resources can be accessed from the QNU website.

By 1998 it became apparent that at federal government level a significant shift in health policy was quietly taking place, that is, a shift in emphasis from a universal model of health care (as exemplified by Medicare) towards a US-style user pays model.

Foundation members of PHHAMAQ were concerned that history may be repeating itself - just as Medibank (Medicare’s predecessor) had been undermined by stealth under the Fraser Government the same fate appeared to be in store for Medicare. Although the rhetoric of the Howard Government is that they are “Medicare’s best friend” actions speak louder than words.

Under the Howard Government out of pocket health expenses have skyrocketed and universal rates of bulk billing by GPs have declined. Medicare is increasingly becoming a “safety net” arrangement. Specifically targeted, rather than universal, initiatives are favoured. Those who can “afford to” are encouraged to take responsibility for their own health. On the surface the rhetoric sounds logical and fair, but the outcomes from adopting such an approach are neither.

Unfortunately, state governments appear to be increasingly falling for this “user pays” ideology as the pressure of increased healthcare costs is felt.