Contrary to our national mythos, Australia does not have universal healthcare. Sure, if you have a life-threatening emergency, critical heart disease or cancer then you can reasonably expect timely, quality treatment at your local public hospital. Excepting those situations, however, our health system is riddled with inequality and compromise where the underpinning principle is not universality, but that you get what you pay for.
Gaps
Medicare rebates to patients no longer cover the cost of health services (parts and labour) in 2022. As a result, more GP clinics are introducing gap payments — a paradigm that will disproportionately limit access to healthcare for low income Australians.
Socioeconomic disadvantage is already a risk factor for poorer health outcomes. If increasing gap payments mean Australians are put in the position of forgoing luxury purchases like check-ups, their risk of developing chronic disease is amplified. Left unaddressed, this leads to more chronic disease at greater cost to the future health budget, a fiscal example of prevention as better than cure.
Going beyond medical consultations, it is also time to rethink access to physiotherapy, psychology and allied health. The highly restrictive Enhanced Primary Care (EPC) scheme confers a literal handful of rebates for allied health, otherwise Medicare does not fund visits to the physio or dentist.
Access to psychology services is better resourced; however, the key step of acquiring a mental health plan to do so is a pointless charade — it adds no value to the patient and exists solely to gate-keep the mental health budget. Everything is terrible and you shouldn’t need a GP blessing to confirm that and get counselling about it.
Fair’s fare
We can look to other countries to compare and tweak our current model. The United Kingdom’s NHS is more equitable than Medicare but it is bloated and inflexible. A USA-style corporate hellscape is no more palatable, but that is exactly what our current health system more closely resembles. Fine if you can pay, otherwise you’ll take what you get and say thank you.
The US Affordable Healthcare Act expanded healthcare access on a means-tested basis. It is a useful example on how Australia could provide fairer healthcare but first it requires us to ditch the fantasy that Medicare is the gold standard of equitable healthcare. It is a point of Australian pride that Medicare is an egalitarian system funded by a fixed levy but, nearly 40 years on from its introduction, Australia is a society of absurd wealth inequality where egalitarian is not a synonym for fair.
If some Australians own 50 iceberg lettuces and others have none, you don’t fix that problem by giving everyone a taxpayer-funded lettuce. Even if fairness isn’t the guiding principle, cold utilitarian economics tells us to make future health budget savings by providing more primary and preventative care dollars to those with the least capital.
The reformation
Medicare’s current fee-for-service (FFS) schedule is constantly under review but remains open to mercenary rorting. One alternative to FFS is paying health practitioners a base salary, as they are in public hospitals. The fizzer idea of Health Care Homes has demonstrated that any move to introduce fixed payments alongside the FFS honeypot is fraught and such an act would necessitate a complete knock-down-rebuild of Medicare.
Assuming Health Minister Mark Butler’s appetite for reform extends only to light renovation, rebates could be expanded to include dental, mental and allied health and selectively increased to reduce the gap payments for low-income Australians. Similar to the NDIS this would distribute health funding according to need, with need being determined by income and assets.
The task of Medicare reform and reshaping the Medicare levy is well above my pay grade but the current situation of increasing gap payments for all is neither healthy nor fair. Despite the parochial bad aftertaste of leaning into a tiered model of healthcare, it may be the fairest choice. since under our current system everyone gets the same federal health assistance whether they live in a harbourside mansion or no fixed address.
Have you felt the pinch of gap payments? Does our healthcare system need to be overhauled? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.
