Political Corrections

with Mungo MacCallum

A trail of broken promises

The spin from the government is that breaking the promise on its Medicare safety net is a sad but wise decision; it may not be popular, but it is responsible.

Thus it should really be a matter for relief, if not rejoicing; our masters, firm but fair, have once again done the right thing. As always, you can rely on Honest John.

This line is in fact just another lie, albeit not quite as blatant and cynical as the rock solid, iron clad pre-election commitment to set the net's thresholds in stone for all eternity. Attacking the blow out simply by making it a little harder to access was neither wise nor responsible. The responsible thing to do would have been to have abolished it altogether and a truly wise government would never have introduced it in the first place.

It was always bad policy; a heath service that works properly does not need a safety net. If it's not working properly, common sense suggests that you fix it rather than merely try to cushion the fall for those who miss out. Deep down, Health Minister Tony Abbott knows this, but neither he nor the government, and particularly Howard, has ever been serious about a universal health system.

However, the public likes it, so Abbott came up with the safety net to provide a justification for a further lie: the Howard Government, we were told at enormous public expense for much of last year, really loved Medicare - indeed, it loved it even more than Labor, which was why it was spending so much public money on a safety net. While Labor was trying to cajole doctors back to bulk-billing, thereby keeping Medicare as a relatively cheap system available to all, the government was in fact giving you extra money to pay the ever-increasing cost of seeing a doctor.

Well, actually that wasn't quite the way it worked; actually the government was giving the doctors extra money to cover the ever-increasing cost of golf clubs, BMWs and skiing holidays in Colorado. But this meant that, as the doctors gleefully raised their fees yet again, the public didn't have to pay quite as much.

The only catch was that you had to go to the doctor quite a few times before the government started paying him on your behalf. In the past Abbott and his predecessors have inveighed against the way bulk billing encouraged over-servicing; if patients didn't have to pay, they took more consultations than they needed. The safety net gave this a new twist; the more consultations you had, the less you paid. And if the consultations were really expensive, as with a specialist, the safety net subsidy kicked in more quickly.

The punters went for it; and, as always, the rich were fastest off the mark. It appears that those living in the ritzier suburbs have more diseases than their counterparts in the slums, or at least that their diseases are more expensive; in its first year, the vast bulk of the money which was supposed to protect those who really couldn't afford medical fees went to those who quite clearly could afford them. Like that other insane piece of health policy, the Private Health Insurance Rebate, the safety net represented a massive and open-ended redistribution of resources from the poor to the rich.

And among the rich the greatest beneficiaries were the doctors themselves. In the past they had at least been forced to pay some attention to real patient costs - the gap between what they charged and what Medicare refunded to their patients. Bulk billing had, of course, decreased over the Howard years through lack of any incentive from the government to maintain it, but it was still seen as the ideal - at least the most public-spirited course for doctors to take.

Hardened to criticism as they had become, some sections of the profession were still sensitive to the accusation that the operation they most enjoyed performing on their patients was a total walletectomy. Fees had, of course, gone up, but there was at least some moral force for restraint. But the safety net ended all that; if the government is paying, why hold back? The signal from Howard and Abbott was that from now on it was open slather.

The critics pointed this out before the scheme was even introduced: it was an invitation to both doctors and patients to help themselves from the Treasury. And so of course, it proved; well before the election it was clear that the scheme in its original form was unsustainable. This did not stop the government swearing to preserve it.

Abbott now uses the same excuse as Howard used after the children overboard myth collapsed: he thought it was true at the time. Apart from the fact that he must have been both deaf and blind if this is so, Abbott of all people should know that the excuse doesn't wash: Bob Ellis thought it was true that Tanya Coleman bonked him to convert him to Liberalism, but that didn't stop Abbott successfully suing Ellis for a motza.

But he still won't admit the whole idea was wrong; the solution is just to make people spend more money before the taxpayer tap starts flowing. Of course it won't work, but it just might stem the flood for another year or so. Then it will be time to break another promise - responsibly, of course.