BY CHRIS SLEE
Dr Joe Toscano has worked as a doctor in private practice for 21 years and is joint national coordinator of Defend and Extend Medicare (DEM), a group initiated in Victoria but aiming to extend nation-wide. Toscano spoke with Green Left Weekly at a rally outside Victoria's parliament house on August 28.
"Medicare was the most important social innovation since pensions", Toscano said. "Before 1973, many people had to choose whether to eat or go to a doctor. The individual was responsible for their own health costs. Under Medicare, health care became a collective responsibility."
Medicare has come under an "ideological attack" from the Coalition government, Toscano argued. He said that the government "believes that everything is an individual responsibility" and "has decided to extend the privatisation agenda to the health care sector".
But because Medicare is so popular, the government can't simply abolish it. Instead, Toscano claims, the Coalition has tried to destroy it by starving it of funding. "Because the Medicare rebate to doctors has not kept up with inflation, and because of the increasing cost of running a medical practice, doctors have abandoned bulk-billing". Whereas during the 1980s 84% of all medical visits were bulk-billed, this is now down to 67%.
But this approach created a problem for Liberal and National Party members of parliament. Their electorates have suffered the most, with bulk-billing rates down to 35-50%. Pensioners are sitting in regional hospitals for hours because they owe money to their local doctor, and so can't visit them.
This has led to increasing pressure on Coalition MPs from their constituents. The government's "reform" package, which Toscano describes as "Macchiavellian", is an attempt to address this.
Proposed attacks
Doctors who sign on to the government's package will get a slightly increased rebate for bulk-billing concession card holders. They will also be able to collect a Medicare rebate for non-concession card holders, in addition to charging a co-payment. The size of this co-payment will not be limited, so fees will go up. It may cost $100 for a family to visit a doctor.
People would be able to privately insure to cover costs in excess of $1000 per year. Federal health minister Kay Patterson says that such insurance would only cost $1 per week extra, but Toscano argues that it would be much more than this, since doctors' fees would not be limited.
Patterson claims the planned "reforms" would enable all concession card holders to be bulk-billed. But under this system, the doctor would get paid more for treating non-card holders. This would cause some doctors to offer a rapid but inferior service to card holders. Under the current system the doctor gets the same rebate for both types of patients, and hence a doctor who bulk-bills has no incentive to favour one over another.
Toscano argued that Medicare has held down health-care costs. Australia spends 10% of its gross domestic product on health, compared to more than 15% in the United States.
Soon after the Howard government came to power, it introduced the private health insurance rebate with the support of the ALP. The result was to transfer $3 billion, which could have gone to the public hospital system or to Medicare, into the hands of the private health insurance industry, which in turn pays for private hospital beds. The private health industry is subsidised by the taxpayer.
Extending Medicare
"We don't just want to save Medicare", said Toscano. "We want to extend the same collectivist principles to other areas", including dental, podiatry, physiotherapy and occupational therapy services, and the provision of spectacles to concession card holders.
He pointed out that such changes are not revolutionary. "These are changes that can be made through an act of parliament. They are achievable within a mixed economy."
However Medicare does introduce an element of "state payment and regulation" into the world of private medical practice. While many doctors opposed Medicare for this reason, Toscano sees advantages for the doctor: "Medicare improves the doctor/patient relationship. I don't have to worry about whether a patient can pay."
The ALP is making "saving Medicare" a key theme for the next election. It is promising to increase the bulk-billing rebate to doctors. However it has not suggested any extension of Medicare to dentistry or other services. It has not promised to abolish the private health insurance rebate. Toscano said he was keeping an open mind about whether the new shadow Health minister Julia Gillard would make any changes to Labor policy.
A political campaign
Toscano said that DEM is "highly political, but not party-political". Membership is open to all who believe that "Health care is a right not a charity or a luxury".
DEM is organised into groups on the basis of federal electorates. Currently there are 11 groups (ten in Victoria and one in Canberra). "I hope that through the September 5 rally other people will be enthused to form groups. I hope there will be 150 groups [one in every federal electorate] by the end of the year", Toscano said.
Local groups are autonomous, making their own decisions on activities within their electorates. Toscano said that activities could include "petitions, rallies, strikes and occupations".
DEM's first rally was held on September 5, under the slogan "Defend and Extend Medicare".
Those wishing to find out more should contact Defend and Extend Medicare by phoning (03) 5982 1170, emailing <defendmedicare@yahoo.com.au> or visiting the web site <http://www.defendmedicare.cjb.net>.
From Green Left Weekly, September 10, 2003.
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