When you starve a person over a prolonged period, more damage is done than just an extreme loss of fat. Bones are thinned. The heart loses muscle and becomes dysfunctional. Kidneys are damaged. Cognitive function is slowed as the brain shrinks.
The Medicare rebate freeze, introduced by Labor and prolonged by the Liberals, has starved general practice for six years. At least a billion dollars has been drained from the frontline of healthcare. In the resulting vacuum, corporate super-clinics have established themselves and now inflate bulk billing rates with questionable billing strategies. Small, doctor-owned practices are on a financial knife edge. What other business would survive with prices frozen for six years while cost and complexity kept increasing? GP numbers are falling as the current workforce ages and junior doctors understandably choose other specialties. To crown it all, in the year prior to the freeze politicians served themselves a meaty wage increase of 29%. To undo the terrible damage the Labor/Liberal freeze has caused, primary care needs more than a bunch of flowers picked from its own garden.
Labor’s election promise to lift the remaining freeze a trifle earlier than the Liberals reveals how much they value primary care. Ceasing to assault general practice isn’t something for which GPs should be effusively grateful. The Liberals don’t appear to be any more capable of listening. They plan to spend $375m on new MRI licences, directly against the advice of the Australian Diagnostic Imaging Association.
Even when the parties agree they still can’t read the room, as evidenced by the bipartisan “heart health checks” announced in February. These checks don’t represent any extra funding for primary care, just a different way to categorise visits and more admin for GPs. The policy illustrates a politician’s reductionist view of healthcare. They sell piecemeal interventions that address single aspects of human health, which is like prescribing the latest superfood as a solution to obesity. It’s a good way to win votes, but it’s an expensive way of mopping up the overflowing bathwater, especially when GPs have the skill required to turn off the tap. When appropriately funded, GPs perform holistic assessments and provide patient-centred and drug free interventions. We also order fewer expensive MRIs.
This high value medicine that GPs offer represents a complete paradigm shift for both parties. If their goal is simply to save money, it’s been repeatedly proven that a government needs to put it into primary care. If their goals include improving population health, reducing untimely death and minimising the environmental impact of healthcare, they still need to put the money into primary care. But neither party has any use for healthcare founded on community and continuity. An experienced doctor embedded in a community who sends their kids to the local school and buys groceries from their own patients is of great value to that town, but no electoral benefit for anyone else. To state the obvious, these parties don’t want to save lives. They don’t even want to save money. They want to win votes, which requires an entirely different approach.
A memo produced by the Department of the Prime Minister and Cabinet details this strategy. The memo, “the value of statistical life,” contains instructions to guide the governing party in implementing the recommendations of expert groups, like doctors.
The memo states that the dollar value of a human life in a few years time is less than the dollar value of a human life today. The government has a formalised process for determining your fiscal value, and you are far less valuable on the other side of two elections than today. This how they decide where to put money. It’s hard to imagine anything more antithetical to preventive care.
As Richard Denniss, chief economist at the Australia Institute wrote, “It’s not that they [governments] don’t know it [preventive care] works. They just don’t think saving lots of lives in 40 years’ time is very valuable.”
Both parties did their part in starving our health system, and if either is serious about reviving it, they will start by re-injecting the billion dollars sucked out of general practice. They will increase rebates by 10% over two years, to offset the pause of 2% indexation multiplied by five years. Going forward, they will index the rebates at health CPI rather than wage index, to reflect the reality of medical inflation. They will, under the direction of practicing GPs, reform the funding model of mental health and chronic disease, the two most expensive and time-consuming areas.
Most of all, they will listen to those on the frontline. RACGP president Harry Nespolon has called on GPs around Australia to make clear to our patients how both parties are failing us all. GPs speak to two million Australians per week. If only we had a party to recommend who will give primary care the nourishment it needs.
• Elizabeth Oliver is a practicing GP and RACGP fellow
