December 09, 2014

Horse 1801 - Death Of Medicare By A Thousand Paper Efficiency Dividends (they're not cuts).
The $7 Medicare co-payment measure announced in the 2014-15 Budget will no longer proceed.
The Government will instead implement a package of measures that will strengthen Medicare and help make it sustainable, ensuring Australians will continue to have access to affordable, world-class health care.
The Government has listened to the views of the community.
Medicare rebates for common GP consultations will be reduced by $5 for non-concessional patients aged 16 and over from 1 July 2015.
Doctors may choose to recoup the $5 rebate reduction through an optional co-payment or continue to bulk bill non-concessional patients over the age of 16.
Doctors will be under no obligation to charge the co-payment and this decision will be entirely at their discretion.
- A strong and sustainable Medicare, Office of Prime Minister Tony Abbbott, 9th Dec 2014

In this brave new world where the words 'efficiency dividend' can now be used as a verb to replace the word 'cut', PM Tony Abbott has scrapped the proposed $7 co-payment to GPs by 'efficiency dividending' the amount that they'll be paid by the Federal Government per patient by $5.
This is a master stroke in barbarism. Instead of a straight cut to health, this is being used as a bludgeon to beat the Medicare system with. Instead of the government needing to wear the blame for this, this has been now been dressed up as something which is 'optional' for doctors to charge and since the general public will tend to blame their doctor, the Health Minister and Prime Minister can walk away from this in a white coat made of Teflon.
Ahah (I don't hear you ask because text is a silent medium), but where has the other $2 for the Medical Research Fund gone? That too has been 'efficiency dividended' away, like an ice cube in a frying pan.

There is nothing new about this sort of thing at all. This is a trick which Tony Abbott has pulled before. In the run up to the October election of 2004, he went on the ABC's program "Four Corners":
TICKY FULLERTON: Will this Government commit to keeping the Medicare-plus-safety-net as it is now in place after the election?
TICKY FULLERTON: That's a cast-iron commitment?
TONY ABBOTT: Cast-iron commitment. Absolutely.
TICKY FULLERTON: 80 per cent of out-of-pocket expenses rebatable over $300, over $700?
TONY ABBOTT: That is an absolutely rock solid, iron-clad commitment.
- Four Corners ABC 1, 6th Sep 2004

Just like the current policy, ten years later, an "absolutely rock solid, iron-clad commitment" disappeared to a wisp of smoke, the second after the election was over.

In the 2005 budget, Tony Abbott as Health Minister in the then Howard Government enacted policy which raised the Medicare Safety Net threshold amount from $300 to $500 for those on lower incomes and from $700 to $1000 for those on higher incomes; also in stark contrast to a promise made before an election.
This time around though, Mr Abbott doesn't have a strong character to hide behind like he did with John Howard. Maybe it's worth remembering that in the next election in 2007, the people of Mr Howard's electorate of Bennelong 'efficiency dividended' him at the ballot box and he became only second Prime Minister in Australian political history¹ to lose his own seat.

In the press conference this morning, Mr Abbott tried to defend the decision by saying that:
“For some time I’ve had backbenchers coming to me, I’ve had members of the community coming to me saying, ‘We support the idea of more price signals in the system, that’s an economic reform, but can’t it be better for children and for pensioners?’ That’s exactly what Peter Dutton and I are announcing today,
Who are these 'members of the community' who supposedly came to the Prime Minister? How is that possible? I work in Mosman which is in Mr Abbott's electorate and I can tell you that the last time that I saw him actually out in the community, was in the 2010 campaign.

Secondly, do members of the community actually use language like 'We support the idea of more price signals in the system'? Really? If so, who are these people? The only person who I know who might speak with such mefipulous³ verbosity like that is… well… me. Even then, apart from my terrace house on Pedant Corner, I also have a shopfront in Geektown²
No one in the world talks like that; so I seriously doubt that these people exist.

Look, this really isn't even about a co-payment and never was. Even if everyone in the country visited a doctor once a month, the whole scheme would have only collected $161m per year, which isn't really that much in the grand scheme of things.
It would be political suicide to dismantle Medicare but forcing it (and the public service generally) to suffer the death of a thousand paper 'efficiency dividends' will eventually weaken the system to the point of collapse.

The dismantling of Medicare, which I suspect is the intended end game here, will produce a more expensive health care system; the experience of the United States proves that most excellently. What it would do though, is shift expenditure from the public purse to private pockets and monetise profits. That's all good and fair provided you don't actually care about the health of the nation. If you are concerned with the pursuit of profits to the exclusion of all else, then this is an excellent aim; no doubt those entities which pay political parties (and who already pay minimal tax), would quite enjoy that.

Sir Winston Churchill once said that "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries" and yet he was the one who proposed Britain's NHS. He might be wrong though. In the twenty-first century which is very much beginning to resemble the later part of the nineteenth, we're seeing the beginning of both the unequal sharing of blessings and the unequal sharing of miseries.

¹The first being Stanley Bruce.
²Just up the A59 from Nerdsville.
³Mafipulation generally takes five minutes.

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