The battle for the health vote

The battle for the health vote

By James Vassilopoulos

As the next federal election looms, a Taverner poll published by the Sydney Sun-Herald on May 17 found that 70% said that health would be an important federal election issue for them, followed by education at 59% and employment at 55%.

 

The federal budget attempted to win support for the Coalition's health plans by including several small funding increases for Aboriginal health, veterans' hospital services and an extension of Seniors' Card eligibility.

These changes hardly dent the impact on health from the Coalition's savage first budget in 1996. That contained $4.4 billion in funding cuts, including cuts in hospital funding grants to the states and abolition of the commonwealth dental program. Altogether, 25 health items were slashed.

If the Coalition is re-elected — and as the recession in Asia impacts on Australia — it is likely to bring in another savage budget, including substantial cuts to health.

Dr Con Costa, national president of the Doctors Reform Society, calls the Coalition's health record “atrocious”. “They are giving money hand over fist to the private sector”, he told Green Left Weekly.

Costa said the federal government is “putting a squeeze on bulk-billing, to make it non-viable”. Bulk-billing is not readily available in many areas of Tasmania and Western Australia and in other rural areas.

The Coalition is also squeezing funding to public hospitals, Costa said. “The impact is felt in casualty departments, not just waiting lists. It can take up to eight hours to see a doctor in a life-threatening situation.”

Medicare and public hospitals are being undermined by funding cuts to the states so as to “shift the electoral damage onto the states”.

Costa said that Australia must choose what sort of health system it wants: a properly funded universal public system like Medicare, or a US-type “managed care” system in which insurance companies run the health system and poor people die because they do not have the cash to see a doctor. Costa believes the result of the Coalition's policy will be such a US-type “nightmare” health system.

Labor's record

When Labor was in power between 1983 and 1996, its policy was based on economic “rationalism” and the rule of the market. It privatised, deregulated, introduced user-pays and cut funding for services.

In 1991, Brian Howe, minister of health and a leader of Labor's left faction, attempted to introduce a Medicare co-payment. Visits to a doctor would have no longer been free, as they are now under bulk-billing. The proposal was defeated by a community campaign.

In 1995, health minister Carmen Lawrence introduced measures to make private health insurance more attractive to workers by allowing insurance funds to pay 100% of the cost of a hospital stay.

Labor cut public health spending by imposing “efficiency” standards on hospitals through case-mix funding. In this system, hospitals are allowed to keep any surplus generated by cutting costs. The most common savings result from reducing the length of hospital stays.

The ALP also “kowtowed to the treasury and did not allow bulk-billing rebates to increase in the last four years of their term”, Costa said.

Dr Kamala Emanuel, a member of the Democratic Socialist Party, told Green Left Weekly, “Both major parties' approaches are based on the view that health should be treated as something to be purchased on the market. This degrades public health services, preventive health care and action on the root causes of poor health — poverty, poor working conditions and a poisoned environment.”

Private funds decline

Figures released by the Private Health Insurance Administration Council show that a further 71,000 people left private funds in the first quarter of 1998. Only 31.1% of people are now covered by private health insurance.

This is despite $1.7 billion in subsidies being pumped into the private health insurance industry in the form of tax rebates. This money should have gone to the public hospital system rather than the private sector.

Costa believes that throwing money into the private system is not really meant to help it, but to “destroy the Medicare child, which is becoming too strong”.

The NSW Department of Health is expecting a big increase in the use of hospital services over the next 10 years. A report estimates there will be an 84% increase in cardiac surgery in the next eight years. Aged care assessments are expected to grow by 21% over the next three years. Aged care community nursing will grow by 84%, until 2021.

However, the claim of much of the establishment media, that a crisis in the health system requires major changes, is not true.

Australia spends 8.2% of gross domestic product on health, compared to 12.4% in the US, which has a highly privatised system. Figures recently published in the Australian and New Zealand Journal of Public Health show that health costs in Australia from 1973 to 1990 declined 1.6% in real terms, while those in the US rose 26%.

The expected increase in the use of health services can easily be met by increased funding. As Costa explained, “There is a crisis of the private health funds because they don't work. There is no crisis in the public system, except a crisis of funding.”

What solutions?

Kamala Emanuel told Green Left Weekly that the public health “crisis” can be solved by “defending and extending Medicare. Medicare should be expanded to cover the services of dentists, opticians, psychologists and physiotherapists.

“Bulk-billing must be extended, particularly to rural areas. Health should be paid for through a progressive taxation system. Funding to hospitals must be increased until waiting lists and casualty waiting times are eliminated.”

Emanuel said that these measure could be funded “as a first step, by making the wealthy and big corporations pay the tax that they should. This alone would find billions for services like health.”