Just over a year ago John Howard and his government were swept to power with a promise to govern for everyone and make us feel more comfortable and relaxed.  What has happened in the health arena since then and how comfortable and relaxed should consumers of health services feel?

The Government promised to maintain Medicare and improve access to appropriate health care, including various strategies aimed at reducing public hospital waiting lists.  The poor and disadvantaged were, of course, supposed to be quarantined from any ill effects of changes in policy.

It is in the area of Medicare that the most damage has been done and the undermining and diminishing of universal entitlements that occurred under the Fraser government in the 1970s and early 80s appears certain to continue.  They have no coherent plan, or even an apparent interest, in looking at the central issues of adequate funding for health care or mechanisms to ensure the equitable delivery of health services to all Australians.  The bean counting mentality which has been the centrepiece of most governments in recent times is reaching new heights and as medical practitioners we should all be very concerned for our patients.

Despite the promises, cuts to Medicare began within months of this government taking office.  Health Care Card holders had their pharmaceutical costs increased by over 20 per cent, Medicare rebates have remained frozen, people with psychiatric illnesses had their access to benefits cut.  The poor and disadvantaged have certainly not been spared.  Despite all these changes in the name of saving money, Federal funding for public hospitals has continued to be cut while more and more people are trying to utilise them.  The promises to reduce waiting lists for surgery sound very hollow in this context.

The Howard government’s only solution to the significant structural problems faced by our health system has been to pay large sums of money to prop up inefficient and unpopular private insurance. The government is in effect forking out about $600 million as a subsidy to health insurance funds to recoup what they claim will be $300 million and what in practice will probably be a lot less. Before these promised rebates for private health insurance even occur, the cost of health insurance has increased by a greater amount than the rebate and restrictions on benefits such as limits on access to private palliative care have been flagged.   At best the rebates may somewhat reduce the flood of people leaving the private system.  The government has done nothing to address the obvious inefficiencies of the private health insurance system or to improve equity and access, the underlying philosophical pillars of Medicare. At the same time they have savagely cut services in a range of community services which will only add to the burden of ill health in our community.

An important example of poorly thought through Government policy is in Aboriginal health.  The government promised that, in view of the seriousness of Aboriginal health problems, Aboriginal health would be quarantined from their cuts. It is true that funds specifically for Aboriginal health services have not been cut, and a relatively small amount of extra funding has been found for some new services; however, programs designed to address the underlying issues and make a long term difference to Aboriginal health were the most savagely cut in the budget last year.

Funding for Aboriginal health services is important given the substantial under spending by the Health Insurance Commission on Aboriginal people and the great need many ill Aboriginal people have for care.  It is a matter of universal entitlement for people who are ill to be able to access appropriate health services but this is not a solution to the underlying problems.  All the many reports on Aboriginal health over the past 20 to 30 years have pointed out that programs to improve things such as Aboriginal control of their own affairs, economic security (including land and employment), housing, a safe environment and education are necessary to improve Aboriginal health in the long term.  These areas have all been savagely cut by the Howard Government and remain under constant attack.

Even in more traditionally conservative areas such as medical research, the new Government has taken some alarming steps.  Political interference in medical research has become very prominent under the Howard government.  This has included Federal Parliament passing legislation to interfere with the processes for assessing and approving one specific drug (RU 486) and the overturning of the Health Minister’s preferred candidate to become the new chairperson of the National Health and Medical Research Council over this same issue.  This was almost certainly the low point in political interference in research by any government in recent memory and demonstrates that while politically correct speech may be out under Howard, research that follows the political agenda of the Government is mandatory.   Chasing votes in the Senate comes not only at the expense of  increased salaries and allegations of  impropriety but also at the expense of scientific freedom.  The price of pursuing the sale of Telstra has already been very large and the actual sale has not even been completed yet.

John Howard is relaxed and comfortable in the best tradition of Roman emperors, while one of the best public health systems in the world crumbles away due to insufficient funding and lack of attention.  Unfortunately consumers and providers of health care are anything but relaxed.  Even the Government’s most ardent supporters have been surprised by its lack of vision.  The big lie that simply privatising health care is cheaper has been exposed in several States.  The Port Macquarie privatisation in NSW cost $6 million more than the public system it replaced  and the initial substantial reduction in services and eventual increased cost of Modbury Hospital in South Australia are only the most public examples.  The need to have a strong and adequately funded public health system is recognised by almost everyone except John Howard and Peter Costello.   Our patients deserve a more intelligent response from their government.  There is still time for the Federal Government to address the fundamental issues, but time is running out if we do not want an expensive, divisive and inefficient system such as they have in the US.

Dr David Atkinson, DRS Western Australian Branch
16 April 1997
published Australian Doctor