In October last year someone sent me a brief proposal from a think tank suggesting people should pay for a bulk-billed visit to their doctor, by a man called Terry Barnes. I didn't think much of it - I am quite naive and didn't think it would go very far. As you will remember , over the Christmas break this same proposal hit the news and wasn't ignored as much as some people might have liked. The government ensured they weren't associated with the proposal, while running an ex-AMA president in a winnable byelection. As soon as the byelection was lost, the health minister, Peter Dutton, made a major speech and TV interview suggesting a co-payment for Medicare bulk-billing. Tony Abbott has since backed away again in a vague way, without ruling it out. Terry Barnes, the writer of the original proposal, has been appearing on the media and before the commission of audit. After Dutton's speech, he wrote this short article in Quadrant, which is where this encounter starts...
- I thought that this article did two things. I thought it suggested that anyone opposed to a Medicare co-payment was opposed to any Medicare reform; for example:
"Dutton took head-on the collective wisdom of the healthcare establishment – Medicare McCarthyites as I called them, a powerful lobby whose ostrich-like refusal to consider major structural reform was highlighted in a knee-jerk opinion piece in today’s Age by Labor’s novice health spokesman, Catherine King."
and I thought it ignored completely the evidence against the proposal that shows that it ends up costing more."Dutton’s ideological enemies want to strangle this essential debate at birth: they mustn’t be allowed to prevail."
The articles I had been reading didn't want to strangle this debate. They were taking part in the debate, using evidence that showed that co-payments result in a more expensive health system - precisely the opposite of what was intended.
(If you want to check this out, you need to be reading Croakey here and here and here and here and here. The Conversation discusses the issues here and here and here. The Consumer's Health Foundation have released a report written by Jennifer Doggett, who you will see participating below. The report and a summary infographic are here.)
So, I tweeted. Twice.
- I was pleased, though a little surprised to receive this reply
- And so we started a conversation about Medicare bulk-billing co-payments and Medicare reform. The wonderful jump-in jump-out nature of Twitter means a few others of joined us along the way.
I shall present the conversation as it happened, with some commentary about the points we make where I think clarification will be helpful. Clearly we disagree on this, and, though I try to be fair to both points of view, you will see where my views come from. Terry, I am sure, would present this conversation in a different way. You will see that I often took several tweets to make reply - I discovered it was an issue difficult to do justice to in under 140 characters! Here are the conversations...
- The main use of co-payments in our health system is currently on the PBS (if you don't include Medicare rebates for private billing GPs, I suppose)
- (This is a reference to the original Quadrant aticle)
- (PHI = Private Health Insurance)