Committed to doctors and patients

THE RECENT Federal Budget was hugely disappointing for health in Australia. The Government reluctantly came to the conclusion that it had no choice but to lift the freeze on Medicare rebates. To not do so would have made it extremely vulnerable to Opposition claims that the Coalition is trying to undermine Medicare. However, the Government has only committed to reinstating rebates over a period of three years, with only $9 million allocated in the 12 months from July 2017 to July 2018. This means that some Medicare items, including items covering chronic care in general practice, will have not increased for 6 years by 2020.

Federal AMA decided to agree to a compact with the Federal Government for this 2017 budget. This essentially meant that AMA would accept the staged lifting of the Medicare rebate freeze, and in return, be in a position to negotiate with the Government for a number of other health priority areas. It has been AMA policy for three years now to lift the freeze on Medicare rebates, so on the surface this seemed to be a victory for us.

So why is AMA (NSW) opposed to the compact, and critical of the budget? Why have I, as President, spoken out in contrast to Federal and other State AMA branches?

AMA exists to fight for the best deal possible for our members, and for our patients. By any assessment, the freeze on Medicare rebates has been grossly unfair to both. Practitioners either accept a drop in income from Medicare despite the ongoing increase in costs of running their practices, see more patients by extending the hours they work or by seeing patients more quickly, or increase the out of pocket expenses for patients. Furthermore, the people most dependent upon Medicare coverage are, as always, those with the least ability to pay extra for their healthcare – the elderly, the unemployed, the chronically ill, Indigenous Australians – so our colleagues working with these patients are the ones most severely affected by the Medicare rebate freeze. The very people looking after the most vulnerable in our society are the ones most adversely affected by the Government’s policy, and the quality of care provided to our patients is threatened by inadequate funding.

Mainstream media has generally been disinterested in the health components of the Federal Budget. They have been fooled into believing that the Turnbull Government has seen the light on health and on Medicare. Having a ‘compact’ with the AMA has been a political master stroke for Health Minister Greg Hunt, because it has allowed him to validate any queries about the funding of health by claiming he has the support of both the AMA and the RACGP and is working productively with us. This remains to be seen.

What vision for health has the Government articulated? What public health issues has the Turnbull Government developed comprehensive policies for? I recently heard an expert speaker at the Obesity forum at our AMA National Conference use an analogy that if 60% of the adult Australian population was suddenly infected with a life-threatening virus, the government would probably declare a state of emergency, and yet it sits on its hands and watches the obesity crisis roll along. In fact, the Deputy Prime Minister states he thinks the idea of a sugar tax is ‘bonkers mad’! What is the plan for public hospital funding? How can practitioners be appropriately rewarded for quality practice? How does the Federal Government plan to better care for the elderly population? What funding is being increased to help Close the Gap? None of these critically important issues have been adequately addressed in either policy, or budgetary, measures by the Turnbull Government.

AMA (NSW) will continue to pressure the Federal Government to improve the funding of health, including better supporting Medicare. The Coalition is unlikely to be re-elected if it cannot convince the voting public that it can manage the health of the nation, and that requires investment. This places the AMA in a very strong negotiating position, which we should use in the interests of our patients and our members, in a responsible way. This is not a partisan issue. AMA (NSW) will also continue to demand that the Labor Party commit to health, and stick to its promises.

Continuing on the theme of doing the right thing, the general response to the release of the AMA policy on marriage equality has been extremely positive. There has been some dissent from a few members. However, I remain very proud that the AMA has moved to this position, and shown our support of LGBTIQ patients and colleagues. If people feel their doctor will be supportive of their choices, and less likely to discriminate against them, then we have achieved something important.