By Mungo MacCallum  Monday 15 December 2014

Photo: The GP co-payment changes will, if passed, be the most determined attack on the Medicare system ever contemplated. (AAP)

The original $7 GP co-payment plan may have been unpopular, but Tony Abbott's new proposal is something far more serious and sinister, writes Mungo MacCallum.

One of the more irritating aspects of our frequently exasperating Prime Minister is that even when he does a backflip, he doesn't do it properly.

There is never an apology, or a retraction: he was always right and now he's still right. It was a good policy, now it's a better policy. You should have been happy before, and now you ought to be delirious. But the punters are not convinced.

Of course, there are times when Tony Abbott won't admit there is even an issue in spite of overwhelming evidence.

Take, for instance, the ludicrous and hypocritical suggestion that the problems in his office stem not from the obsessive and dictatorial arrogance of his chief of staff, but from the sexism and misogyny of his colleagues. Those of them who have had a gutful of Abbott's enforcer, whether her name is Peta, Peter, Lucrezia Borgia or Genghis Khan, are not impressed.

And even when he moves to assuage or counter public criticism, he can't bring himself to offer more than a token. Julie Bishop's belated announcement of the $200 million to the Green Climate Fund - the despised Bob Brown Bank, masquerading as environmentalism under the guise of socialism - is better than nothing, but not much.

Even Abbott's fellow recalcitrant, Canadian Stephen Harper, has kicked in half as much again, while Japan's contribution was $1.5 billion and without strings attached. Australia will pay its instalments over four years, if it makes the payments. And it will not be new money anyway: Abbott will raid the already depleted foreign aid budget, something Bishop had vowed never to do. Another public slap down from the Prime Minister to his loyal deputy.

But by far the most important tergiversation of the past week is the apparent ditching of the $7 GP tax, and its replacement. This is not only serious, but downright sinister.

The headline good news is that pensioners, children and concession cards holders will be spared, which comes as a welcome relief to much of the neediest section of the population. But the far more ominous bad news is that the changes will, if passed, be the most determined and far-reaching attack on the Medicare system ever contemplated other than downright abolition.

To explain, we need to go back to the long and fraught history of our much loved universal health care scheme. When, nearly 50 years ago, Richard Scotton and John Deeble provide Gough Whitlam with what was then Medibank, their peculiar genius was the idea of bulk billing.

The determinedly independent body of Australian medicos would not submit to any concept of what they called socialised medicine, so they did not get it: they were allowed to continue to set their own fees at their own levels. But there was a sweetener; after consulting the profession, Medibank set up a schedule that would determine the commonwealth government funded rebates that would apply for the appointments and procedures.

The individual doctors could charge what they liked, but any gaps they demanded they would have to bill for themselves, involving their own bookkeeping. But if they chose to go stick with the rebates, there was virtually no paperwork: patients would sign a form assigning their payments to Medibank and Medibank would send the proceeds to the medicos' accounts - a big saving in time and money.

The specialists were not interested; they demanded real money, and much of their income came not from the commonwealth but from the states, through the public hospital networks. The Medibank rebate was a welcome bonus, but that was all. But a great many GPs, after some initial resistance, came round to the idea of a guaranteed minimum income without the need to burden a secretary or a receptionist to double up as an accountant. And so bulk billing became the core of Medibank, and, when it was reformed and rejigged by the government of Bob Hawke, of Medicare.

As time went on the Medicare levy of 1.5 per cent rose to 2 per cent (with a surcharge for high income earners without private health insurance) but it was not sufficient to secure the rising health budget. Hawke tinkered with the idea of a co-payment, but was rebuffed by his colleagues and by the GPs themselves, who had settled very comfortably into the long-standing regime. It took another generation for Abbott to revive the idea.

Obviously it was wildly unpopular with the public, and it was criticised by Labor and many others as an attack on the whole idea of universal Medicare. It was, but at least the co-payment was up front: the patients had to cough up their $7, which the medicos then handed over to consolidated revenue under the guise of a research fund. It would be expensive and time-consuming, but it was, in its own way, straightforward.

However the new version, even though the amount of the impost is to be reduced, is underhand, mean and sneaky. Instead of a co-payment from the patient, there is to be a deduction in the rebate from the doctor.

The Government is still to get the loot, but the doctor is faced with the choice of collecting it from the patient, or simply forgoing the income. Thus the GP will have to select whom and when to charge the $5 (or a part of it) and go through the unpleasant and task of getting it, processing it, and banking it him or herself.

The frustration and resentment will fester on both sides. And in the end, a lot of doctors will decide that it simply isn't worth it: they may as well forget bulk billing altogether and go back to a system of user pays, where they can charge their own fees, which will, because of the extra expense involved, inevitably go up.

The Liberals have never liked the idea of Medicare and public health; now they have devised, under the façade of a compromise, an insidious and possibly fatal attack on it. This is not barnacle removable - it is blitzkrieg. It is to be hoped that the Senate will have the perspicacity and determination to hold the line and protect what has been acknowledged as the Whitlam government's greatest and most enduring legacy.

Mungo Wentworth MacCallum is a political journalist and commentator. View his full profile here.

The GP backflip that became a blitzkrieg - The Drum (Australian Broadcasting Corporation)