Why has bulk-billing vanished?

04/11/2022

Martin A.

If you’ve seen a doctor recently, you will have noticed that you suddenly had to pay where you didn’t used to, needed to travel an extra 10-20 minutes to find a GP that still bulk-bills, or even booked a day or two in advance since earlier time slots were already snatched up.  Practices now use “mixed-billing”, where they charge you $20 minimum – an attack on the principle of a free, universal and accessible healthcare system. This now presents a very real barrier for many people, including working people who our economy relies on, who service your car, who make your lunch, and who will now be forced to delay their access to medical advice or reconsider it altogether. 

The costs for your GP have also risen accordingly, with many now struggling to stay afloat and the Medicare rebate falling offensively short of meeting the bare minimum needed to keep seeing patients. We are straying dangerously close to the US example, a path that will similarly be littered with suffering and injustice.

In October, the Royal Australian College of General Practitioners (RACGP) sounded the alarm on the Medicare rebate falling negligently short of meeting the costs of bulk-billing, estimated at 50% the amount required, and noted the absence of any rise to the MBS rebate in the recent budget. The number of GPs moving away from bulk-billing is accelerating, with more than one in five GPs surveyed in August stating they had changed their billing model, citing rising costs. This represents a jump from the one in ten GPs reporting so in July last year. With the system teetering dangerously on the edge of collapse, how has the government reacted? A measly 1.6% raise to the rebate, which is not even close to approaching inflation, let alone what Australians need right now. 

It is well within our government’s power to raise the Medicare rebate to a realistic amount. This would very quickly help both patients and GPs, particularly those suffering from burnout. Doctors have felt the need to try to cram as many patients in as short a time frame as possible to make the most out of the current rebate, and this, among other steps GPs take to stay afloat, does not do any favours for patients health outcomes. The writing has been on the wall since long before Albo took office, and the consequences for working people have already materialised.

Here we are now in the shadow of Labor’s shiny new “fiscally responsible” federal budget, and where do we find ourselves? The “workers party” has played their pipe, and working Australians have found themselves struggling, drowning, and gasping for air in an ocean of wage stagnation and rising cost of living. Meanwhile the pollies and their rich mates who will benefit from the stage 3 tax cuts, are clinking glasses as they sail away in their yachts. No increase to the Medicare rebate, no cost of living relief, but $243 billion in tax cuts for the richest Australians – exactly the ones who are not impacted by these issues. You could be forgiven for thinking Scomo never left office. This is the reality of the electoral system in a capitalist country. Our “choices” are between a party beholden to the wishes of the ruling class, and a party beholden to the wishes of the ruling class.

And while we are beholden to the wishes of those for whom the economy is run to profit, we will never experience truly free healthcare for all. The existence of a private healthcare sector presents a real threat to the function of a public one, as the billions looted in profit will be used as lobbying money to undermine the public system and force many to move over to private healthcare to meet their needs. Billions wielded as a hammer to smash against the public interest. Medicare was a concession from the ruling class to workers, and any concessions made by the owning class can and will be subject to grab backs, especially when the private sector begins to run out of room to expand into. Businesses must generate more and more private profit each year, lest they go the way of the competition they trampled over to get there. 

This runs in stark contrast to the need for healthcare to be free, and in a nation of such vast wealth there is no excuse, particularly when a comparatively impoverished country such as Cuba can provide world class healthcare for free to all Cubans. No one should have to pay for the right to good health, which is currently a privilege for those who can afford it, arbitrarily bordered off along class lines. A medical diagnosis can spell financial ruin.  A basic human necessity, health, cruelly withheld from whole sections of the population, and all for one reason. Corporate profit.

To hear our government lament  the state of Medicare, as if their hands were tied on the matter, while pushing full steam ahead to lock in the stage 3 tax cuts, is the most sick and twisted trick being played on real struggling working people as we speak. In times of capitalist crisis, it becomes painfully clear that those in positions of power in our government are only there because they serve the ruling class, not us.