Medicare is broken and there is ‘no quick fix’

Credit:Illustration: Cathy Wilcox

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Medicare is broken and there is ‘no quick fix’

Daniel Andrews is to be commended for highlighting the inadequate funding by Medicare of GP services. But don’t hold your breath. The Medicare rebate for a standard consultation is $39.65. The fee most GPs charge non-concession patients is about $85. That figure is not plucked out of midair. It is the fee which would apply if a succession of governments had fairly indexed the Medicare schedule.

Indexation used to allow for increases in rental costs, practice consumables and salaries, and the net income adjustment was based on the move in average weekly earnings. But for many years there has been no increase, until July last year when 65 cents was added to the standard consultation fee rebate. That was someone’s little joke. In many cases, $39.65 does not even cover the practice’s costs.

Surprise, surprise: GPs are quitting and recruitment into general practice has nose dived. The number of GP consultations a year is in excess of 100 million. If the current system is to be maintained, bulk-billing rates will only go up again if the rebate for the standard consultation goes up by at least $30. That would cost Medicare about $3billion extra per year, with probably a minimal effect on productivity. Tell ’im he’s dreaming.

It has been estimated Australia will need 9000 more GPs by 2030. That also will not happen. In the meantime, more and more GPs will abandon bulk-billing. Premier, I think you will agree that Medicare is broken, at least for primary care. It will take a lot of money to “fix” it. And there is no quick fix.
Dr Paul Nisselle, Middle Park

The strategists are not on the side of the GPs

I am a bulk-billing GP. This week over a drink, I told friends I did not think there would be anything for me in any changes to Medicare; that it would provide all assistance short of actual help, and that any spending would be a win for academics and administrators.

I was reassured when I read healthcare economist Stephen Duckett’s comment that “there is academic evidence that when you increase doctors’ fees, the rebates, often the doctors decide to take the increase not as increased income, but as increased leisure and they reduce their hours” (The Age, 9/1). Does he think I will lie around eating cookies if I get a pay rise, and that our common objective of better health outcomes will not be served by a rebate increase?

The great Australian Harry Bridges, who ran the Longshoreman’s Union in the US, said: “I get on OK with the bosses as long as they don’t tell me they’re on my side”. Well, I can get on OK with strategists who will fix general practice – as long as they don’t tell me they’re on my side or that of the patients.
Dr Peter Dillane, Northcote

The overlooked asset: the community health sector

Good on the Victorian and NSW premiers for pushing the federal government for a fix on the GP bulk-billing crisis and the wider prevention and primary care system crisis. In 1973, the Whitlam government launched the community health program, which aimed to improve equity and access to prevention and primary care services for those most in need.

It begs the question: Why hasn’t the Andrews government been more proactive in providing the advice sought following the completion of the 2019 community health taskforce report it commissioned? Time and again, the community health sector has proven to be an asset for needy and marginalised Victorians. This well-engaged, community-centric option might just be a national solution (in a modernised version) to the crisis in prevention and primary care which all communities are facing.
John Hedditch, former prevention, primary care and public health manager, Department of Health and Human Services

Axe the tax cuts and increase bulk-billing rebate

No doubt there is more to improving healthcare services than just increasing the bulk-billing rebate. However, this long overdue adjustment would surely have a significant effect on GP availability. As for paying for it, money budgeted for the tax cuts for high-income earners could be well utilised for this reform.
Bill Pimm, Mentone


Cuts destroyed the system

We can sympathise with Daniel Andrews and Dominic Perrottet in their battle against cuts to health funding. For many years, federal governments have promised more services at less cost by imposing “efficiency dividends”. This implies the government’s excellent financial managers have identified waste in bloated bureaucracies.

However, any waste originally present will have long gone, and further “efficiencies” now represent more cuts to the delivery of essential services. Our health services are underfunded and reportedly close to collapse. The Albanese government must provide an effective, financially sustainable health system for all.
Chris Young, Surrey Hills

Diddums, poor little Harry

Britons who lived through World War II were children scurrying into air-raid shelters in a London under bombardment – a city where King George VI and his family chose to remain as an example of leadership, whilst many European royals sought safety in the US. This commanded our respect for the House of Windsor.

Many of us lost fathers who were fighting in far away war zones. Many were evacuated far from what was left of loving families and experienced a full range of less than ideal conditions, from rationed food to being billeted in a range of homes, some unsuitable.

We were taught to strive for what we hoped for, make the best of what educational facilities were available in the absence of so many teachers being mobilised for the armed forces, appreciate what we had and to be tough and resilient. I suggest Prince Harry reads some history and reconsiders his assessment of how poorly life has treated him.
Eileen Montague, Croydon

Another typical family

Who would have thought it? A privileged, pompous, powerful English family is subject to the same trials we ordinary folk endure – squabbles, jealousy and name calling. Can we please all move on and leave them to, hopefully, some form of resolution.
Dorothy Galloway, Mentone

The bottom line is racism

In his attempt to force a comparison between Harry and Meghan and Edward VIII and his wife, Rob Harris (The Age, 9/1) seems to have forgotten that Wallis Simpson was a white woman.

Meghan is a woman of colour who was subjected to a well-documented, highly co-ordinated campaign of trolling by a small but effective group of people who did not want a black woman incorporated into the royal family nor have mixed-race children in the line of succession to the crown.

Most of the media seem complicit in this racism by repeating and amplifying the attacks, rather than tackling the serious issues involved. It does not matter if you like Meghan and Harry or what they are now doing to make a living. She should have been defended by the royal family, not excluded.
Laurie Bebbington, South Yarra

You call this ‘suffering’?

It sickens me to view the plethora of material about Harry, Meghan and the royal family. Have we, and the media, no moral conscience? There are so many tragic stories of families struggling to survive famine, war, poverty and violence. What must they think about this privileged couple who have it all, not least a $15million home, selling their souls for money, regardless of who it hurts?
Kathy Diviny, Coburg

A tragic family break-up

Prince Harry and Meghan took themselves to the US. Perhaps they should settle there quietly and cease the carping criticism of the family they left behind. Currently they are doing themselves damage and burning more bridges which they will find increasingly difficult to rebuild. It is very sad to watch.
Allan Thomas, Nunawading

Justifying tax breaks

Why should buying a car – electric or not – be cheaper for someone because they are on a salary, when it is not needed for their work – “Tax breaks but long waits for EV buyers” (The Age, 9/1)?

How is that good for society, or the environment? It would appear that what was once a tax dodge has been decided to be good for all of society, just like negative gearing is somehow justified because owning a nice car and a second home is the middle-class dream.
Rob Skelton, Creswick

What to do with preps …

Children starting prep this year do not attend classes for full days or full-time for the first four weeks while assessments of their levels are conducted. OK, that’s great but what arrangements are schools making for working families to cover the supervision necessities this presents? Families are under enough pressure as it is without throwing this at them as well.
Tim Waley, Armadale

… and over the holidays?

Roshena Campbell asks “is it time for baby bonus round two” (Comment, 9/1). She misses the real cause of the phenomenon of families choosing to have fewer or no children. With working parents only entitled to four weeks of annual leave a year, but children requiring 12 weeks break from schooling (which they need), there is no chance a couple can put in the quality time needed to raise a child to the age of 18. No doubt it is even harder for single parents.

Until overworked Australians are given back time to spend with their families, why would they choose to have children? In our modern economy with extensive automation and efficiencies, workers should be given eight weeks’ annual leave.
Paul Kennedy, Eaglemont

Population and climate

In an over-populated world, the idea of increasing our birth rate to boost the economy seems very shortsighted, like a Ponzi scheme that just kicks the can down the road. Overpopulation is contributing to climate change which is playing havoc with food production. In Victoria our infrastructure is not serving its existing people. However, as Roshena Campbell also suggests, major tax reform is a solution.
Helen Pereira, Heidelberg Heights

Gains from immigration

Correspondents variously express concern about the growth of our population due to migration and also world population growth (Letters, 9/1). However immigration to Australia does not result in net world population growth, it is simply a shift of people from one country to another.

Considering the substantial export from Australia of food and other essential commodities, it is obvious we could support a much larger population. If immigration means more of those exports are consumed here, our economy benefits and so does the environment due to the reduction in carbon emissions from international transportation.
Daniel Cole, Essendon

A plea for uniformity

At a beachside space recently, four otherwise intelligent people stood for 10minutes trying to work the parking machine. Then the printing took so long that we all ended up with a ticket for the wrong car’s rego, which led to farcically chasing one another through the car park.

Machines in some places offer apps, but depending where you are, it is probably a different app from the last machine you used. Instructions are generally as clear as mud and different from the last machine. Some need rego numbers entered, others require “hard to work out” bay numbers, and yet others require neither of these.

It is a source of aggravation and cause of delays for many. So, if the Victorian government is listening – please consider phasing in one simple, statewide system.
Gail Greatorex, Ormond

The right to be heard

I am dismayed by Peter Dutton’s attempt to thwart the Voice referendum, but not surprised. The National Party has already said it would not support it.

The red herring tactic by the conservatives, espoused by their elder statesman, John Howard, is to cause concern among the wider population that there is insufficient information relating to how the Voice will operate. This is in spite of their own former minister for Indigenous Australians, Ken Wyatt, debunking this claim.

Who would not support the proposition that Indigenous Australians deserve to have their voice heard by parliament in matters affecting them?
Barry Clarke, Kensington

Unnecessary and harmful

Professor Patrick McGorry says the removal of the extra 10 Medicare-subsidised psychology sessions “is not a cut” and that psychologists can “fill those places with new patients” (Comment, 9/1). Tell that to the many people who rely on these sessions. The people whom I and many others see are not replaceable nor are their needs a sideshow.

This is not primarily about psychologists’ incomes, rather the many people not quite in McGorry’s “middle” whose needs are not adequately met by 10 sessions and who have complex issues, though not complex enough to require a dedicated multidisciplinary approach as rightly advocated by him.

Many such people do well with a skilled psychologist of their choice, otherwise they are struggling to cope with the demands of their day to day lives. There are a wide range of needs and they do not need to compete. Cutting the number of psychology sessions that can be claimed under Medicare is a backward step, saving little and one that harms many. When we are still in a pandemic, this is even more difficult to understand.
Marie Weiss, Ivanhoe

Please, take my call

All empathy with Jon Faine (Sunday Age, 8/1) for his efforts with government user-friendly online services.

More frustration at Centrelink’s phone service, where getting the robot to interpret your query is near impossible. Eventually an option of speaking to a consultant is possible.
The robot cautions about aggressive tones, informs you that there are no available operators and the line goes dead without a word of apology or suggestion to call back. Perhaps the boffins could provide a call-back option as many businesses do.
George Reed, Wheelers Hill


Credit:Illustration: Matt Golding


Right-wingers opposed to the Voice are unable to join the dots.
Kevan Richards, Mount Helen

A Liberal Party fundraising levy to give women a chance (8/1)? Any moment now, Tony Abbott will shout “big new tax”.
Tim Durbridge, Brunswick

If the Liberal Party is facing an “existential crisis”, the low number of women in its ranks is the least of its problems.
Annie Wilson, Inverloch

Re the US Speaker. Oh dear. Is this the return of McCarthyism?
Jason Apostolou, St Kilda

Better a PM who ″⁣treats us like mugs″⁣ (8/1) than one who deceives his ministers, parliament and the people.
Matthew Hamilton, Kew

When a man of no character incites anarchy, every wannabe and sad sack will replicate these “look at me” moments.
Sharyn Bhalla, Ferntree Gully


After H and M filled our papers and TV over the slow holiday period, I’m looking forward to real news – like the tennis.
Heather Barker, Albert Park

Spare me the dirty laundry, Harry.
Rob Upson, Kennington

I do hope they can find a very good therapist for Harry.
Brian Morley, Donvale

During the colonial era, aristocratic English families sent jealous, angry or useless younger sons to the colonies. Perfect for Harry.
Benedict Clark, Ryanston


So South Australians appreciate unvaccinated tennis players. Hopefully Victorians won’t be so gracious.
Margaret Sullivan, Caulfield North

l’m sick of union members doing the hard yards for non-union parasites (8/1). Let non-unionists negotiate their own benefits.
James Lane, Hampton East

What a joke: supermarket chains claim to have frozen their price rises (9/1).
Michael McKenna, Warragul

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