The Liberal Party as the champion of Medicare? It sounds unlikely given decades of opposition to national health since Bill Hayden introduced Medibank, but it is not as unlikely as it looks if you understand the relationship between the medical profession and the Liberal Party.
Today Howard effectively trumped Mark Latham’s announcement of a $179 Million injection into Medicare to boost bulk-billing rates. Well, at least I think he did. Howard’s package is worth $1.8 Billion, but then that’s over 4 years, while I assume that Latham’s is for just one year, but then Latham claims he has a total package worth $3.4 Billion, but I have no idea how many years that runs for. It’s as complicated and mystifying as trying to compare rival telephone company charge schedules, and it’s meant to be – in the end you just have to put your trust with one or the other and go with them.
Where I think Howard wins is that his policy covers 100% of the cost of a doctor’s visit (in the unlikely event your doctor charges the scheduled fee that is), and this sounds like a better headline promise than Latham’s vaguer aspiration to take bulk-billing cover back to 85% (which it only briefly hit for only a short moment in its entire history, and that was under Hawke and Keating).
The Liberal Policy effectively marks a complete reversal in policy which has taken about 30 years.
This demonstrates a few things. First, there is a good reason why medicos are about the only professionals who as a group overwhelmingly and reflexively support the Coalition – their’s is the only union that is unconditionally supported by the Liberal Party.
Doctors have come to appreciate the steady cashflow of nationalised medicine and the lack of competitive pressure in how it is doled out. Original Liberal Party opposition to the then Medibank was driven as much by the doctors’ lobby as voters. Now the lobby has changed its mind, the party has been able to align its position with the majority of voters who have always liked Medicare.
Second it shows that in these post-ideological times, elections have become auctions where the prices bid for votes by both sets of bidders tend to converge. Elections are no longer about persuasion but purchase. Howard has analysts like his pollster Mark Textor who are better than Labor’s when it comes to negotiating the purchase price of votes. They analyse exactly who the key demographics are that they need and how much they have to pay them for their vote. That’s why Howard’s in with a good chance this election when after eight years he should be on the verge of being traded-in. As a measure of that skill, the second lot of $600 payments per child is going out to families at the moment.
Not that the country wins under either of the parties’ scenarios. Four Corners carried a story of variable quality on medical fraud. (Fullerton and her producers really need to take a short course on statistics because they obviously don’t understand the implications of medians and means). It suggested that perhaps 10% of Australia’s $20 B health budget disappears in “inappropriate practice” and fraud (not sure what the real difference is between the two but it seems to have something to do with dosage). This doesn’t include the large percentage who over-service because it is safer to do that than risked being sued when things go wrong for not having ordered every possible test. Or the doctors who, for example, prescribe anti-biotics to treat colds even though they will do no good, just because the patient pressures them.
Whether or not that is the correct figure, it certainly demonstrates that doctors are human and that some will exaggerate claims to increase their income.
The best curb on over-charging is through customers who have an interest in not being over-serviced because they are paying at least some of the bill. With their open-ended attitude to health, both Labor and the Coalition are encouraging higher health costs. Worse still, with an aging population it is likely they are institutionalising them. Sooner or later that will have an effect on the economy, including, yes, interest rates. But neither Howard nor Latham cares, as long as they get into the Lodge.
While governments and oppositions will take on some lobbies fairly easily doctors aren’t one. The doctor’s lobby may not always tell the exact truth, but when it comes to public opinion polls, they are one of the professions in which electors have a high degree of trust. What they are prescribing may not be in our collective interests, but as Howard would tell you, when it’s a question of the truth, who would you trust?