Reform Medicare to sustain system

Australia’s hybrid public/private healthcare system, including the principle of universal coverage through Medicare, has served the nation well, in general, since the Whitlam government created Medibank in 1975. Few people familiar with the US system, which alienates those unable to afford insurance, or its polar opposite, Britain’s sclerotic National Health Service, which is crumbling by the week, would want to emulate either alternative here. Medibank became Medicare under the Hawke-Keating government and has had a few changes and tweaks along the way. It is ripe for reform, however, after the ravages of Covid, the pressures created by an ageing population, serious doctor shortages, and rising costs, driven not only by inflation but by ever more sophisticated treatments and medications. These come at a high price.

Few would argue when Health Minister Mark Butler says the established system of subsidising individual consultations through general practitioners alone is no longer fit for purpose. Bulk-billing rates plummeted by 7 per cent in the past year and continue to fall as general practices move to charge patients, including pensioners and children, extra to supplement Medicare rebates, which have not kept up with cost-of-living increases. Millions of patients struggle to get timely appointments with GPs amid growing demand and a diminishing workforce as increasing numbers of medical graduates prefer to specialise and eschew the poor income of many GPs.

Labor is the major party best positioned to deliver reform. Voters know it is deeply wedded to the system. Coming from a Coalition government, such efforts would inevitably attract claims, however false, of a conspiracy to abandon Medicare. The Albanese government has a long way to go to deliver reform. But what has been said to date has much to recommend it. Mr Butler, as health editor Natasha Robinson has reported, envisages a new funding model that would allocate money to practices to employ nurses, paramedics and other allied health practitioners such as physiotherapists and diabetes educators, working in teams delivering complex care. Patients familiar with GP practices employing nurses know the advantages. Well-qualified nurses carry out work such as dressings, giving injections, conducting allergy tests, and assessing the needs of elderly patients, freeing up doctors.

It is not the entire answer, but health insurance funds have a worthwhile point in pushing for the opportunity to be able to cover doctors’ gap fees under a reformed system. That impost would need to be paid for, mainly through members’ policies, which could be problematic for lower-income fund members. It is a fact, however, that many with private coverage opt for operations in the public system because their insurance cannot cover the gaps in doctors’ fees. In doing so, these patients add to the problem of public hospital waiting lists. Recent experience shows Australians in most income brackets are not averse to paying a reasonable amount for health insurance. On Tuesday, we reported that one million people – many from battler outer-suburban and regional electorates – took out private cover during the pandemic amid fears of a disintegrating public system.

Reforming Medicare to ensure it is sustainable is one of the most important services the Albanese government can perform. In doing so, it must be careful to avoid unintended consequences such as creating a situation that leads to an unviable drain on spending, similar to what has happened with the trajectory of the NDIS. The options will be clearer when its Strengthening Medicare Taskforce produces its recommendations before national cabinet meets on February 1.