Perth SP’s Joel Cooke looks at the Medicare debate from a socialist perspective
Medicare, alongside HECS, represents the final bastion of Social Democracy’s victories in Australia. Both of these reforms to the capitalist system are today mere shadows of those that the Australian working class struggled to win during and following the post-war capitalist boom (1945-73).

Now with world capitalism in turmoil, the Howard government (with barely a whisper of
dissent from the opposition parties) is attempting to utilise its post-Iraq support
to set in motion a process of economic rationalist reform Medicare that will
only serve to fuel the crisis of funding and quality of public health care in
Australia. Howard ‘A Fairer Medicare” package will force Medicare to the
point
where its quality would no longer be competitive with private health
insurance
moguls, allowing it to die away.

Not as Healthy as Howard Says.

The current crisis in Australia’s health system is a lot worse off than the
government is letting on. Howard’s Medicare plan simply misses (or ignores)
the
underlaying causes of the problems in the Medicare system. After years of
continual neglect by both Labor and Liberal since its conception in 1984,
Medicare has been allowed to degenerate to the brink of collapse. The
Liberal’s
economic rationalist “A fairer Medicare” reform has been formulated to help
push it over the edge.

The NSW state government has forced the closure of public hospitals, wards
and
slashed health staff numbers, resulting in over 58,317 people waiting for
surgery. In Perth, stress on hospitals has are forced hospital staff to turn
away ambulances with emergency patients due to the chronic shortage of
hospital
beds. The AMA (Australian Medical Association) says that the public hospital
system needs an injection of at least $600 million “just to keep their heads
above water”; to improve and extend services it would call for a lot more.
Without an immediate increase in funding the conditions hospitals will
continue
to collapse making healthcare not only unaffordable, but also unavailable.

The crisis in hospital funding has long been felt among patients and
doctors.
73% of GPs admit that they have patients who had been discharged from
hospitals “prematurely or inappropriately”, some without being cured of the
ailment that they were hospitalised for. Among Victorian heart attack
patients,
61% did not receive treatment within the within the 90 minute window
recommended by the British Heart Foundation. That the quality of health care
has continued to decline since the introduction of private health insurance
is
sufficient proof that a further privatised and deregulated healthcare will
not
be a benefit to Australians. The drastically under-funded public hospital
system has reached breaking point, if the health system gets much worse
hospitals will become a place where people come to catch disease not recover
from them.

The massive workload given to workers in the health industry is so
burdensome
that they are no longer able to comprehensively offer even the most basic of
services. Overworked nurses have been prevented from assisting patients
unable
to feed themselves, and one elderly female patient was inadvertently placed
in
a male ward. Many healthcare workers, who already have been unable to access
holidays and other benefits because of workloads and labour shortages, have
been forced into part-time and casual positions without any job security.
Poor
work conditions and employment prospects are keeping workers from entering
or
staying in the public health system. Without well payed and trained workers
in
fully equipped hospitals Australia’s healthcare will soon collapse. While
simultaneously withdrawing funds from public healthcare and attacking
militant
unions, Howard economic rationalism is forcing on the death decent
healthcare
in Australia.

This structural crisis in health care is reflective of the crisis in
capitalism. The thirst for bigger profits by private health concerns has
caused
a massive strain on the health system. A nationalised and democratically
planned health system could allocate funds to areas that are most needy not
those considered most profitable. Forming such a well-funded universal
medical
program is the only cure to the chaos of a deregulated profit driven health
system. It is the rich, who can afford overpriced private hospitals and
treatment and have no stake in the public health system, who are profiting
from
the destruction of Medicare. As long as poor health care continues to be
isolated among workers and the poor the rich will do nothing to fix
Australia’s
seriously flawed (read: profitable) health system.

A Rotten System Keeps the Doctor Away.

Once considered “the holly grail of medicine”, General Practice is no longer
an
appealing occupation to upcoming medical students. Due of a lack of increase
in
Bulk Billing rebates to doctors; the net income of GPs fell by $33,000
during
the 1995-2000 period. The stagnancy in the incomes of doctors, intensified
by
inflation slowly diminishing their ‘real wages’, has formed the pressure
behind
the 30% decrease in the number of GPs offering a Bulk Billing service. GPs
who
offer a Bulk Billing service receive $25 under the price per consultation
suggested by the Relative Value Study (RVS). The $3.25 increase in the size
of
rebate ($5.00 promised by Labour) will do little to improve the conditions
of
GPs, nor attract new doctors to the field.

These same economic pressures have lead to a mere 64% (and decreasing)
participation rate among trained GPs. This means that in order to fill the
shortage of 2000 GPs in Australia, the Howard government would need to
miraculously train 3200 new doctors overnight. The government’s proposed
Medicare package has given room for only 150 new recruitment places per
year,
which would take almost 32 years to meet the current crisis in the Health
Industry. With Howard’s proposed ‘New Higher Education Loans Program’ and
the
deregulation of HECS, it will be a wonder to see if he can find 150 students
who could afford to even attend university!

This drastic shortage in GP numbers has caused many doctors to find
themselves
seriously overworked. 40% of all doctors suffer from clinical depression,
which
is forcing many to practice part time and causing a further shortage in GPs
(a
drop in average GP patient time of just two hours per week is equivalent to
the
loss of about 1000 GPs in patient time). These work related problems are not
only keeping new GPs away but are also forcing many into early retirement,
bringing the rate of retirement among GPs to a level higher than
recruitment.
The overworking of doctors forms a vicious circle, which lowers not only the
quality but also general availability of medical care.

This pattern disintegration in the working conditions of doctors has pushed
them into the ranks of the working class. Doctors like all workers cannot
put
their faith in the capitalist parties, who have proven themselves
unconcerned
with the plight of GPs. Doctors need to join the struggle alongside other
workers. Their immediate task is to start building of a strong militant
doctors
union with a socialist programme, and close links to other fighting unions.
A
nascent doctors union will be able to lend support to, and find support in,
the
struggle already being lead by the Nurses. Medicine like all professions has
been stripped of its former prestige by capitalisms insatiable thirst for
profits, and doctor like all workers can only expect further cuts and
attacks
to their working and living conditions.

Not Able to Make a Diagnosis.

Labours “bid” on Medicare is no different form that of the Liberals in that
it
does not address the structural crisis in Medicare. According to current AMA
President Dr Bill Glasson, “They (Labor) have acknowledged the issues but
have
offered nothing to address the accelerating decline in bulk billing.” By
giving
no real incentives for doctors to Bulk Bill, Labor’s proposal will
eventually
force all GPs to drop Bulk Billing altogether, which like the Liberal’s
proposal, will effectively cause Medicare to waste away.

The Labor Party is now totally unable (or unwilling) to provide a real
alternative to the Liberals on the Medicare issue. “Both sides (Labor and
Liberal),” former AMA President Dr Kerryn Phelps explains, “have chosen to
play
the short term bidding game rather than try to fix Medicare for the longer
term.” This is because, Dr Phelps neglects to mention, Labor and Liberal
both
have the same long-term economic rationalist plan in mind; the only
difference
between them in policy is implementation not content.

That Labor has proven itself to be as pro-capitalist as the Liberals on the
Medicare issue comes as no real shock to many workers. Labour, never a truly
workers party, has now completely capitulated to the bourgeoisie. This near
absence of definition between Labor and the Liberals has been Labor’s
greatest
hindrance in the federal elections. As it becomes apparent to workers that
Labor no longer willing to represent their interests, ‘the old Labor
faithful’
are searching for alternatives among the minority parties – the Democrats
and
the Greens.

The mainstay of the Australian Democrats’ proposal is to address the
problems
in the Health system is to place a maximum price cap on consultation fees.
As
Dr Glasson aptly notes “capping doctors’ fees will not reduce out-of-pocket
expenses for patients… the Democrats proposal is worthy of only one cap – a
dunce’s cap.” The Democrats poor understanding of the Medicare issue coupled
with their pro-capitalist solution will seriously undermine the support that
the Democrats were able to gain among Australian workers for their
comparatively progressive stance on Iraq. Already suffering a collapse in
their
electoral base, the Democrats can ill afford to offer their members and
supporters policy as weak as this one.

The Medicare plan proposed by the Greens, while the most progressive of all
the
parties, refuses to go much further to the left than Labor. While
“scrapping”
the $2.3 billion private healthcare rebate would do much to temporarily
relieve
the problems in Medicare, it is ultimately as short sighted as the proposal
of
Labor or the Liberals. The allocation of these funds would extend Medicare
to
dental and mental health, but would do nothing to stop the flood of doctors
leaving General Practition. Workers would have a marginally better (at least
more secure) Medicare system under the Greens, but as doctors increasingly
refuse to Bulk Bill they will be forced back into a now unsubsidised –and
thus
more unaffordable - private health system. The Greens, while refusing to
look
outside of the capitalist system, will only be able to slow the demise of
Medicare and will never be able to fix it.

Ultimately, none of the major partied are honestly concerned with the state
of
Medicare; as Dr Glasson admits: “they have an eye on the next election and
not
the long-term sustainable future of Medicare and the Australian health
system.”
The Australian parliamentary parties have demonstrated themselves to be
politically bankrupt when it comes to issues of social welfare. If the Labor
party, considered to be (albeit barely) the only viable alternative to the
Liberals, was to win the next federal election, it can be assured that they
will renege on their flimsy promises to maintain Medicare. Instead, they can
be
expected to follow the privatisation path of Blair’s Labour Party, which
destroyed Britain’s National Health Service (NHS).

The Labor Party along with the Democrats and the Greens have been exposed
for
their inability to assess the Medicare issue, and pose a viable political
alternative to the Liberals. The fundamental problem of the opposition
parties
is that they want to reform Medicare along the same capitalist lines as the
Liberals, a process that show them to be against the interests of Australian
workers and in the pocket of the bosses. History has shown that social
reforms,
such as Medicare, will never be viable or lasting alongside capitalist greed
and profiteering. All the major parties have proven themselves to be
primarily
concerned with defending the bosses’ profits, and thus by definition,
antagonistic to the interests of the workers.

While the AMA and doctors are more than aware that all the major parties are
unwilling to fix Medicare, they are yet unable to see the way forward. “Now
that both sides have lowered the bar for health policy in this election,” Dr
Glasson pessimistically concedes, “we must now choose which party has
fiddled
around the edges of health policy the best.” This self-defeating solution
can
only speed up the demise of Medicare. Instead of simply giving in to the
bosses
the AMA should be looking for an alternative to Labor and the Liberals, and
to
capitalism itself.

Doctors, nurses and patients need to stand their own “Defend Medicare”
candidates in upcoming elections to provide an opposition force to the
capitalist agenda of the parliamentary parties. These candidates would be
able
to gain a massive layer of support among workers and Unions disenfranchised
form Labor and, by standing alongside other pro-worker candidates, would
form
the basis of a new mass workers party. Only such a party, armed with a clear
socialist program, can offer a viable long-term solution to the crisis in
Medicare. The defence of Medicare, intrinsically linked to the failure of
the
parliamentary parties, will eventually prove unviable without the formation
of
such a party.

Capitalism is a sick system.

The pharmaceutical multinationals have greedily watching the collapse of the
Australian Medicare system. Making up 8.5% of GDP ($50.3 billion) and 7% of
Australia’s work force in 1998-99 alone, privatisation of Medicare has the
potential to make massive profits for capitalist firms. Privatisation of
Medicare would occur alongside a rise in the price for health care, a
further
drop in its quality and retrenchments in the Health industry. Workers have
seen
the quality of services in Telstra and Qantas collapse following
privatisation
and deregulation, and must prepare themselves to defend the few remaining
benefits that Medicare holds.

In Britain, where Labour leader Tony Blair privatised the NHS in 1999, the
health system is in an advanced state of collapse. Domestics at England’s
Royal
Bolton hospital who are payed as little as £$4.47 per hour (£3.03 under the
EU
poverty standard) by the multinational medical firm ISS Mediclean. British
health workers have been forced to take strike action just to maintain their
pay at this poverty level! Conditions in the hospital system have gotten so
bad
over the last 4 years that the British government has been forced consider
the
re-nationalisation of its health system. Australian workers must look to the
struggle of their fellow workers in Britain and struggle to maintain
Medicare,
before it is allowed to collapse all together.

The USA, with only 54% privatisation of its health care system, spends 67%
more
than Australia as a proportion of GDP and 2.3 times as much per capita. Yet
despite this additional spending, the USA reports one of the worse
population
health statuses in the advanced world and has 82 million under- and
un-insured
people. Most of America’s highest spending simply goes in higher costs of
health services, placing Medical bills as the most common reason for
bankruptcy
in the US. Even with the experience of the failure of a deregulated health
care
system in the USA, American President George W. Bush is suggesting that
Australia must remove its PBS (Pharmaceutical Benefits Scheme) as part of
the
upcoming free-trade agreement between the US and Australia.

PBS gives the Australian government a near monopoly (90%) of all
prescription
drug purchases and sales. This forces the prices of all competing non-PBS
drugs
to fall as to compete. While this gives Australia one of the world’s most
equitable distributions of prescription drugs, it is also a hindrance to the
profits of the large Pharmaceutical multinationals. These are the same
Pharmaceutical companies that have prevented the distribution of affordable
AIDS treatment drugs the worse affected places in the world. Deregulation of
the Pharmaceutical industry in Australia would give a massive boost in the
profits of capitalist firms, but put even the most basic medicines (like
Ventolin and antibiotics) far out of the reach of average Australian
workers.
It is laughable that Bush and Howard, unable to fool workers about their
intentions in Iraq, think that Australians will support their deregulation
plans for the PBS.

The greatest burden to world healthcare is the massive greed of the massive
pharmaceutical multinationals. Pfizer, the company that holds the patents
for
both viagra and numerous AIDS treatment drugs, claims annual revenue of $86
billion (nearly three times Howard’s budget allocation to Healthcare) – and
this is only one of the many pharmaceutical giants in the world.
GlaxoSmithKline, one of the worlds largest Pharmaceutical companies employs
40,000 salesmen and only 10,000 scientists (drug advertising is the greatest
contributor to any rise in a drugs price). The boss of Pharmacia, another
pharmaceutical multinational, Fred Hassan, took home $US 3.6million last
year
alone. These are staggering figures for an industry plagued by
“under-funding”,
and facing the “need” for worldwide cuts in government spending.

The massive profits generated by the Health industry should be diverted back
into extending the mounting international health crisis. Only $10 billion is
needed to start to tackle the rapidly building HIV/AIDS epidemic, though
developed governments have given only $2.1 billon. Had the pharmaceutical
multinationals worked together, instead of competing for profits, the
detection, prevention and treatment of SARS could have taken place in an
incredibly shorter time. The capitalist Pharmaceutical companies have no
interest in solving any of the world health issues. As the well-known maxim
poetically puts it, “The money is in the treatment not the cure”.

The cure is in struggle.

Whether through cuts to Medicare in Australia, AIDS in Africa, SARS in Asia
or
silicone poisoning in the US (over 2 million American women suffer due to
botched silicone implant surgery) human health has become yet another
commodity
for capitalism, which almost paradoxically makes more profit when it is non-
existent. Poor health care is a worldwide problem and, as the Liberal’s
attack
on Medicare has shown, not contained to the neo-colonial world. Australian
workers have now been thrust into the international struggle to defend their
right to a decent standard of living, and ultimately a new society.

The health issue cannot be solved in Australia alone, or within the
framework
of capitalism as a whole. Medicare was, from the beginning, an attempt to
treat
the symptoms of inequality in the world while leaving the disease of
capitalism
intact. The only cure can be international socialism, the democratic
planning
of the world’s resources for the good of humanity. Only an equitable
socialist
health system, which sees people’s health as paramount not profit, will ever
be
able or willing to tackle the massive problems facing world health.

Australian workers and poor must become active in the campaign to “Defend
and
Extend Medicare”. Only by joint union and community action, armed with a
clear
socialist program, will there be any chance for workers to maintain
Medicare.
It is also important that the experience of Britain and the US is
remembered,
and workers form international working links with the health care struggle
in
all other nations. The latent power of the workers struggle is contained not
in our numbers alone, but also within our international solidarity. A victory
on the Saving Medicare will not be a lasting victory in itself, but must be
used as a catalyst to bring decent healthcare, living and working conditions and justice to the workers and poor around the world.

This entry was posted on Thursday, August 21st, 2003 at 3:58 am and is filed under Australian news and analysis. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.