By David Michell
For the vast majority of Australians, visiting the doctor is an unavoidable part of life. While it's not something to look forward to, its nice to know that the service is there and, under the Medicare system, essentially free.
Since Medicare was introduced by the Hawke Labor government in 1984, Australians have had direct access to GPs regardless of their ability to pay. Patients either receive the service at no charge through bulk-billing or reclaim most of the cost through a Medicare rebate which is financed by a uniform levy on taxation.
However, Prime Minister John Howards record on health policy does not inspire confidence. As Liberal leader in the second half of the 1980s, Howard made no secret of his hostility to Medicare. A Coalition policy statement in 1988 reads: "the real villain is Labor's doctrinaire commitment to a universal government health insurance system, Medicare, that has brought only declining standards and diminishing choice and rising costs".
Howards stated position during the election campaign was significantly different. Medicare would be retained in its present form, he said. Neither its universalism nor bulk-billing would be diluted. The party which had promised radical changes to Medicare at every election between 1983 and 1993 responded to public opinion on the issue of health care.
But we have heard the Liberals' promises on health care before. Some of us remember former Prime Minister Malcolm Fraser's similar commitment during the 1975 election campaign to "keep Medibank", an almost identical, and equally popular, health care system.
Soon after assuming office, however, the Fraser government began systematically to dismantle Medibank, and by 1981 the universality of the system had been discarded in favour of a voluntary scheme in which Australians had to be insured with a registered health fund. The original Medibank benefits were retained only for those deemed disadvantaged by the Department of Social Security.
Howard, who was federal treasurer while many of those changes were carried out, promised during the 1996 campaign that Medicare would not suffer a similar fate — regardless of the budget bottom-line that his government inherited from Labor. Since then, however, Treasurer Peter Costello has demanded $8 billion in savings over the next two years. The "savings" are to be delivered by all government departments (with the exception of Defence).
Many of Howard's pre-election promises are being abandoned. Large-scale redundancies have been forecast for the public service, funding to the ABC and universities is to be cut, and pension levels are set to be lowered. The Department of Health has not been spared, and there has been considerable media speculation as to what changes the new health minister, Michael Wooldridge, will make to the Medicare system.
Raising the Medicare levy is one option to increase funding to the system. But Howard has promised not to raise taxes to solve the budget problem. Another option proposed by the Finance Department is the revival of a policy which Labor decided against in 1991: the Medicare co-payment. Under this proposal, patients would be required to pay an up-front fee (the figure proposed earlier by Labor was $3.50, then $2.50, before the idea was eventually abandoned).
The introduction of a co-payment has not been specifically ruled out by either Wooldridge or Howard. When the issue arose in late April, both remained coy. Wooldridge said, "I'm not going to rule anything in or out", while Howard merely stated: "We are sticking to our election promises in relation to the retention of Medicare".
A co-payment remains an attractive option for the government despite the political dangers of tampering with Medicare. Its appeal for Wooldridge is increased by the fact that it would account for most of his required savings in one hit.
Furthermore, there is a feeling within the Liberal leadership that it might be possible to sell such a change to the public, or at least maintain any adverse reaction to a manageable level. Past surveys show a general preparedness among Australians to contribute more to the running of the health system. According to a 1991 survey by the Health Department, just over half the population did not look upon co-payments as unreasonable.
If the public is willing to sit back and allow a co-payment to be introduced, it will be sanctioning the first attack on the universal nature of Medicare. In all likelihood, such an attack would not be the last. While it is too early to announce the beginning of the end for Medicare, its survival under a Coalition government can not be taken for granted.