Health policy
What has happened to universal and affordable health care?
The Whitlam government, confronted with massive hostility, went to extraordinary lengths to establish Medibank, the precursor of Medicare, including running the risk of a double-dissolution election.
When the Coalition took office in 1975 Medibank was one of the few Whitlam programs they abolished, but there was enough corporate memory for the Hawke government to re-instate it as Medicare in 1983.
It is now common political wisdom that Medicare is an entrenched part of the Australian policy landscape.
But because of the influence of private health insurers, medical specialists and the pervasive “small government” philosophy, Medicare is becoming detached from its fundamental principles, particularly universalism. Just as our taxes pay for roads, which we’re entitled to use whether we drive a Corolla or a Maserati, Medicare was designed as a universal service.
The principle of universalism, however, is giving way to meaner ideas. Through funding constraints Medicare has increasingly taken on aspects of a program of distributive welfare, and like such schemes it is becoming more and more impoverished.
Martyn Goddard on his Policy Post has an article The cost-of-living crisis hits health care, revealing how for many, health care has become particularly unaffordable in the last couple of post-pandemic years. More people are avoiding seeing GPs because of cost; more people are deciding not to fill prescriptions; more people are avoiding dental treatment, and so on. At the same time bulk-billing rates are falling and out-of-pocket payments for medical services, particularly specialists, are becoming more burdensome.
Unsurprisingly his detailed figures reveal that this stress is not uniform: it’s younger people, particularly in the 25-34 age group, and poorer people, who face most difficulty in paying for health care.
To return to the history of Medicare, one reason we never had a Scandinavian-style system of universal public insurance was because of an interpretation of our Constitution. That interpretation was to limit the Commonwealth’s power to impose strong economic controls on health care practitioners. Goddard concludes that with the High Court’s changing interpretation of the Constitution such a scheme would not face such constraints if introduced now.
All we need is a social-democratic government with the courage of its convictions.
Why are qualified dentists packing shelves in supermarkets?
There is a shortage of dentists in Australia. There are possibly hundreds of refugees with dental qualifications who cannot practice as dentists.
Writing in The Saturday Paper – Refugees caught up in dentist accreditation – Martin McKenzie-Murray explains the reasons for this squandering of potential. Some has to with the cost of accreditation. Then there is the low pass rate (24 percent) in the written examination. Once those hurdles are dealt with there is the cost of setting up practice in regions where dentists are in short supply, particularly rural regions.
We expect that there should be strong qualification requirements for all health care practitioners. But do the barriers have to be so tough, and why is it that the Dental Board of Australia seems to have gone out of its way to ease the path for dentists from a handful of countries and not others?
Even if there are more dentists, however, can we afford to use their services? A Senate committee report into provision and access to dental services reports on affordability issues, and makes a number of recommendations about expanding existing programs to make dental care more accessible and affordable, particularly for people living in remote regions. Its final recommendation encompasses all other recommendations about affordability. It reads:
The committee recommends that the Australian Government works with the states and territories to achieve universal access to dental and oral health care, which expands coverage under Medicare or a similar scheme for essential oral health care, over time, in stages.
It is only because of the dead hand of Treasury, when Medibank and Medicare were developed last century, that dental care is not part of Medicare.
The Grattan Institute has a short article – Reform delay causes dental decay – summarising and commenting on the Senate report.
Covid-19 hasn’t gone away
Covid-19 hasn’t gone away, but good data on its infection rate hasn’t. Gone are the days when state health departments were able to collect data from people taking RAT tests. But we can still glean a fair bit of information from the Commonwealth webpage on Covid-19 reporting. Even though the absolute numbers are understated, and there are lags in reporting, the trends are clear: there is another wave of Covid-19.
Although there are fewer cases in each wave, the incidence of ICU admissions (a reasonably robust figure) is abating more slowly.
The Grattan Institute warns us we seem to have dropped the ball on vaccination, not only for Covid-19 but also for shingles and pneumococcal diseases. Peter Breadon and Ingrid Burfurd, authors of the report A fair shot: how to close the vaccination gap note that “in December 2021, more than 90 per cent of high-risk adults had been vaccinated for COVID in the previous six months. Today, it is just 27 per cent”.
They find big variation in vaccination rates: “Whether you get vaccinated depends a lot on things like where you live, where you were born, and what language you speak”.
They urge governments to mount assertive vaccination campaigns, with particular attention to those who live in poverty and those who mistrust the health system.