Do our leaders believe in a fair go? The Prime Minister has stated that he and Lucy have been lucky and observed that “there are taxi drivers that work harder than I ever have and they don’t have much money”. One might expect that such recognition of the place of luck (genes, family support, education, freedom from illness or exposure to trauma) in achieving wealth and the security that goes with that would lead to the development of policies which minimise the place of luck in our lives. But timely access to affordable health care, first class education and justice before the law remain a struggle for many. It appears that both major political parties are quite happy to pursue policies which entrench the importance of that luck. An examination of our health system highlights this.

My patients who earn $36,000 a year pay $36 for most prescriptions. My patients who earn $360,000 pay the same, and those on $3 billion pay the same. Usually, these prescriptions are for conditions which can’t be avoided, it’s just bad luck. This government imposed co-payment is a tax on illness. It is not noticed by those on $360,000 but for those struggling on $36,000 or pensioners who pay a reduced tax on illness of $6 per prescription, this does affect their small disposable incomes. It is a regressive tax.

The effect on patient behaviour of this regressive tax on illness is well documented. The Australian newspaper commissioned a Newspoll Survey in 2011 and reported that 18% of those earning $40-79K delayed or did not fill a prescription due to cost. Slightly lower figures for the whole population from the Australian Bureau of Statistics Patient Experience survey (10%) and the Commonwealth Fund survey (14%) indicate that underuse is a major consequence of such co-payments. The Commonwealth Fund survey has also looked at sicker Australians and found not surprisingly, that the figure rises to 20% for them.

So much for the Government imposed tax on illness, the prescription co-payment. There was also the general practice (GP)  co-payment in its many forms. The ALP’s Senator Wong labelled it quite correctly a tax on illness. That label has fallen from the ALP lexicon, presumably because they realise that the prescription co-payment they support is also a tax on illness.

But we are left with doctor determined co-payments.  This is the so called co-payment by stealth, whereby the Government has frozen the indexation of the Medicare rebate resulting in a gradual decline in GP and specialist Medicare income, forcing doctors to either accept a salary decrease or charge co-payments. Both major parties have applied this freeze, claiming it needed to be done as a savings measure. The Coalition however has been clear about its other intention which is to force doctors to charge new or higher co-payments and discourage use. This intention is based on the flawed Commission of Audit report suggesting patients were seeing doctors too often. To date the bulk billing rate hasn’t fallen but over time doctors are unlikely to accept the $18000 decline in their income from Medicare. New or higher co-payments will be charged. Some doctors will have standard co-payments whether the patient’s income is $36,000 or $360,000 and the Coalition knows this will be the result. Is such a regressive tax on illness fair?

The claim by our leaders is that such taxes on illness are necessary to ensure that people value the service and don’t overuse it. The hypocrisy of this claim is demonstrated by the facts. Both major political parties support the laws which have been passed to encourage  ‘no gap’ private health insurance (PHI)  for hospital care which, when it works properly, ensures that there is no price signal, no co-payment for repeated admissions to a private hospital in any one year. In addition, the Coalition supported a 2014 trial in general practice (GP) which eliminated co-payments for GP visits for those covered by PHI. It would appear that our leaders believe that some taxes on illness are necessary only for those who can’t afford PHI. Is that fair?

We have a progressive tax system which exists as a recognition that the market delivers income to people very unevenly and if we are to have a civil society which respects and supports people irrespective of luck, we need to redistribute that income. Taxing illness does the opposite. It redistributes advantage to those on higher incomes.

It would seem that our leaders, attitude is “I have made it, I plan to stay comfortable. You are unlucky. I might help you a little, but I’m not changing the system to minimise the place of luck in getting to my position of security and wealth.” Elitism and entitlement rather than a fair go would appear to be the principles driving most of our leaders.