Twisted logic of budget GP fee policy

wanker

The Budget’s proposed $7 GP co-payment fee seems quite benign to many people. After all, if you are genuinely sick or concerned about your health, why would $7 make a difference?

But there simply is no logic behind it, and the more you think about it, the more twisted any possible logic becomes.

For example, to believe that the fee will deter time wasters but not genuine patients, you must invoke some idea that people know beforehand whether their ailment is time wasting or a sign of something more serious.

It’s like saying if people already knew the diagnosis they would get from the doctor, then they would be able to determine whether they actually need to visit the doctor.

This ignores the very purpose of general practitioners.

To be clear, medical services as usually classified in economics as credence goods. They are goods or services that we can’t properly judge will be beneficial to us or not.  All expert advice falls into this category.

For example, I could hear a strange engine noise and take the car to the mechanic. They could say that it is something minor and not to worry until the next service.

Would I be a mechanic time-waster? What if it turned out to be something serious that needed immediate attention?

Underlying the whole idea of a the $7 GP fee for bulk-billed patients is an irrational belief (see comments section) that medical services are being over-utilised.

If that were truly the case, we would see government advertising that told us to stay home when we thought we were getting sick, rather than what we in fact do see, which is a blanket message to better monitor our health with more regular check-ups and preventative health screening tests.

But that’s not the end of the failed logic.

If you still hold the irrational belief there are time wasters over-utilising GPs because the service is free, to believe that a price signal will remedy the problem requires a great deal of faith that the price will deter only the time-wasters and not those with genuine medical needs.

If the price does not discriminate in this way, there will be health costs accompanying the budget savings.

The best evidence we have for the price effect on medical care choice is the 8 year long RAND Health Insurance Experiment, run from 1974-1982. It found that greater cost-sharing “reduced “appropriate or needed” medical care as well as “inappropriate or unnecessary” medical care”.

In fact the experiment also found that the poorest in society are most likely to defer medical treatment when the price increases, meaning that the health costs of this policy will disproportionally fall on our poorest citizens, including the unemployed and the elderly.

If I can digress for a moment and tell a personal tale. When my youngest son was just a week old he had a few signs of illness including a rash, a fever, and lack of appetite. I was not overly concerned, but my wife took him to the GP in any case. Our GP had some concerns about meningitis and we were sent for various tests, including a rather traumatising (for Mum) lumber puncture, and ended up in hospital for two nights awaiting various other results, with baby being closely monitored. It turned out not to be meningitis but some other a mystery infection.

Had there been a GP fee for us at the time we may have delayed the visit another day or so. If we did, and it had been meningitis, we may received treatment too late avoid serious long term damage.

I’m sure there are thousands of similar stories about how an early visit to the GP, that may have seemed a little like time wasting, ended up preventing serious illness or even savings lives.

While $7 doesn’t seem like much of an issue to many, we should acknowledge that the economic logic for doing so is not sound. This policy is taking the exact opposite approach to what we know to be effective.

If it makes sense to charge patients for GP services to improve health outcomes, then by that logic we should charge parents to vaccinate their children. We don’t, because we know the benefits to having universal access to vaccinations provides massive health benefits to the individual and society as a whole.  The same applies to GP health services.

Maybe we should trust the experts themselves, the doctors, on this one.

Comments

  1. If it makes sense to charge patients for GP services to improve health outcomes….

    If it made sense, we would not charge $7.00/service, we would charge much more.

    This fee is not about health. It is about the sickness inside the minds of LNP ideologues who just hate the idea that mutual, socially-delivered insurance actually improves population health while also improving the lives of individuals.

    The LNP have embarked on a deeply radical, destructive and divisive scheme of social re-engineering to satisfy their own hatreds. They have revived an evil politics of envy and deserve nothing but contempt for doing so.

    The LNP claim a financial motive for their move. But this is also false. Undermining the sense of security and well-being of households – which is what their measure will induce if it is enacted – will certainly affect the economy. The LNP have this completely wrong in both ethical as well as economic terms.

    • migtronixMEMBER

      No you’re wrong briefly they are quite happy to use tax harvest to advance medicine, they just think you shouldn’t have access to it w/o coming across a door entry ticket clipper. Heads they win tails you die – but in the meantime thanks for working… Chump…

      Heard Andrews on RN brekkie how that fraud is still around beggars belief

    • >In fact the experiment also found that the poorest in society are most likely to defer medical treatment when the price increases, meaning that the health costs of this policy will disproportionally fall on our poorest citizens, including the unemployed and the elderly.

      And here’s the rub! I know the American Republicans don’t believe in Darwinism, unless it’s social Darwinism… and I’m positive Tony is cut from the same cloth.

      What’s better than killing off the poor? We’ve already got all their money, besides they wouldn’t be poor if they weren’t so stupid/weak/lazy/etc.! They brought it on themselves, dontyaknow!

  2. Is the argument that the charge is necessary to discourage overuse the main argument? My impression was the main one was simply to help cover the cost of the service.

    That is an interesting and persuasive argument re credence goods, especially if the amount raised is small in the overall scheme of health care costs.

    “….They are goods or services that we can’t properly judge will be beneficial to us or not. ..”

    While we may not be able to properly judge how beneficial they will be, we do know if we are not using the service to obtain the intended benefit (medical advice) at all.

    Whether there are people who are using medical services in volume for non-medical purposes (e,g loneliness or advice that GPs should not be the first port of call) and should get services for those purposes elsewhere is another question – Is there much evidence of this happening or is it just an urban myth about lonely people hangin’ with their Medico?

    In any event, very low income earners and social security recipients who might be discouraged from properly seeking medical advice by a co-payment should be protected.

    That should be easily achieved by marking their medicare card or number ‘no co-payment required’ or issuing them with a no copayment card that they produce with their medicare card.

    But I gather this is not how Joe’s plan is going to work.

    Good work again Rumples!

    • ” My impression was the main one was simply to help cover the cost of the service.”

      It can’t be this as the revenue isn’t going to the practitioner – but to a general fund.

      • Yes, that research fund concept sounds like the product of some half wit spin doctor (not the medical type).

        Why are only sick people forced to contribute to research into cancer?

        That is a bit of a sick joke. (groan sorry about that)

        Does anyone seriously believe that there will not be a dollar for dollar reduction in funding for medical research elsewhere in future budgets anyway.

        We are after all in the midst of a ‘budget emergency’ cue lightening bolts.

  3. Similar to the distortions created by free healthcare: people eating, drinking and smoking themselves into various (expensive) acute and chronic medical conditions without financial consequence.

    No system is perfect.

    The logic behind the $7 copayment is user pays ideology. Not particularly unreasonable

    It is easy for you to pick out thr emotive example of the blameless child, but most medical spending is on self inflicted disease

    Smoking related illness $16 billion
    Alcohol related $15 billion
    Obesity related $120 billion
    And others related to illicit drugs, trauma, non compliance: all avoidable

    Perhaps attaching a personal financial cost might reduce these as Australians seem to have a fairly blase attitude at the momenh

    • migtronixMEMBER

      Rubbish! The day politicians pay for their own meals, let alone health care FFS we can have that conversation

    • Coming,

      The appropriate and useful time to apply a tax or levy to deter people from smoking or some other behaviour we don’t approve of is as close to point when the behaviour occurs – for example when the product is purchased. In the case of smoking and to a lesser extent alcohol this is certainly done by government already, although by banning other recreational drugs they have lost the opportunity to send a price signal.

      It is pointless and kind of weird to apply a tax or impost when many years after the event some disease shows up – smoking and drinking related cancers can potentially arise decades after someone has stopped drinking and/or smoking, after all.

      Your comment about Australia’s blase attitude is also factually incorrect, given that amongst OECD countries Australia has one of the lowest rates of smoking, and those rates are in long term decline due in part to years of government campaigning, whilst similar government campaigns exist for drinking and healthy nutrition/exercise.

    • Those self inflicted illness you mention are also symptoms of poverty. The poor are much more likely to become dependant on alcohol or smoking to counter their bleak circumstance and they are less likely to be able to afford quality food and much less likely to be able to afford time or money for sufficient exercise.

      If we tackled poverty many of these self inflicted illnesses would be greatly reduced.

    • drsmithyMEMBER

      The logic behind the $7 copayment is user pays ideology. Not particularly unreasonable

      Indeed.

      In fact, it’s so reasonable we should apply the same logic to other publicly funded services like police, firefighting and education.

      Wouldn’t you agree ?

      • drsmithyMEMBER

        come on Doc, please, Coming’s a troll!

        True, but the rationale he presents is identical to that put forth by many other ostensibly more considered and balanced individuals.

        I would be less contemptuous if the people supporting this idea actually had the stones to be honest and present their real position – against publicly funded healthcare as a principle.

    • The fact that there are diseases and medical issues that are to a significant extent attributable to the behaviour of the individual is largely irrelevant, or in a budgetary sense might even be a positive.

      If you don’t die from a smoking, alcohol or obesity/diet related disease you will still eventually die.

      When you die, three things are relatively sure:
      1. You will have lived longer and so, if in receipt of benefits will have received those benefits for a longer period, thus costing more resources than if you died earlier
      2. You will most likely have cost a similar amount of money in your last 12 months for health care from the disease/condition from which you eventually die
      3. The longer you live the more likely you are to develop some form of dementia, or to become otherwise incapable of living at home, which means your cost of care could be high for a greater number of years than if you died younger without needing higher care except in the 12 mnths before you died.

      A modest proposal: All social security beneficiaries ought have a bottle of scotch and a carton of fags home delivered every day by the government so they die earlier to save pensions and dementia care!

      • migtronixMEMBER

        ought have a bottle of scotch and a carton of fags home delivered every day by the government

        Oh great! Another gift to the boomers 😉

  4. What you’ve missed Rumple is that the co-payment will be used to cure cancer. Are you saying you don’t want a cure for cancer?!?

    http://www.theaustralian.com.au/national-affairs/budget-2014/hockey-swaps-medicare-middy-for-coffee/story-fnmbxr2t-1226918453627

    JOE Hockey says people should be prepared to give up “a couple of cups of coffee or something else” to pay $7 to visit a doctor because the money could find a cure for cancer or Alzheimer’s.

    “The question comes down to priorities. And the fact is that the $7 that is being asked of people is going to go to a further investment in health care – a big investment in health care in the medical research future fund which means that we could find the cure for cancer or alzheimer’s or something that will inevitably inflict us or our family in the future.”

    • Indeed. I mean how many “ostentatious high roller” cigars can you get for $7 these days. It’s nothing.

    • I liked how Hockey said ‘A pack of cigarettes costs $22 – so that’s three visits to the doctor right there’. Presumably he thinks every low-income person in Australia is a smoker.

      • And it would be more useful if the money raised went towards research on new antibiotics, seeing as how the ones we have now are rapidly becoming ineffective.

      • migtronixMEMBER

        And did he mention how much of those 22 dollars already go to government? Nope, don’t want to give the spoiler away

      • drsmithyMEMBER

        It was astounding how much contempt for the poor he managed to squeeze into that twenty or so seconds of speaking.

    • I wish Lorax
      Any large research fund will be a barn door of a target for big pharma. In her book on drug companies, a senior Harvard lecturer pointed out:
      “The combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion) [in 2002]. Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.”
      And that was 2002! Can you seriously see the directors of big government projects (just look at their recent track records) being able to get any value for money when they’re in the hands of these people? Successive Australian governments have done nothing about the great pharmacy rorts which make the cost of a $7 fee to a low income earner a drop in the ocean compared to the giant rip-off they face when buying the medicine. Change that and you would have plenty of cash for cost effective research.
      Either change that, or spend the money on public transport.

    • Mining BoganMEMBER

      A big investment in the pharmaceutical companies that sponser Our Tony’s bike ride.

      Nothing more than criminal behavior.

    • I want a cure for cancer, but why fund it through a co-payment that hurts the poor.

      Just move the tax brackets to fund it, or change the service delivery model.

    • And here is a fallacy that really needs killing with fire. linking a particular expenditure to a particular tax is an illusion. It’s a useful trap politicians use to justify terrible behaviour.
      It’s like if I decided all my work before luch would pay my rent. If I miss half a day in the morning I’m not going to skip my rent I’m going to drop something else.

      If the co-payment was going to the GP’s or into medicare it would be a real link.
      But the your GP co-payment pays for cancer research is a lie. It pays for a tiny fraction of all govt spending just like every other tax dollar.

      I’m pretty sure economics has a term for this but it eludes me.

  5. I think if you actually talk to doctors (my family has a couple in it) you’ll find that in the suburbs something like 10% of their time is taken up by people who are essentially coming in for a chat a couple of times a month. This was one of the reasons why one doctor I know left GP practice to specialise.

    Of course, this doesn’t mean those people are “time-wasters”. To go into a doctor’s office for a chat, something is wrong. A better approach to this problem might be to find some way to deliver social services/counselling. Then the time of the more expensive (and less expert at counselling) doctors could be spent on people with immediate needs.

    • Indeed. I mean how many “ostentatious high roller” cigars can you get for $7 these days. It’s nothing.

    • migtronixMEMBER

      Charging $7 won’t make those lonely boomers any less boring and no single parent goes to the doctors for a chat so stick it!

    • My wife works for a medical centre, there are time wasters a plenty, anything from just wanting a chat and booking weekly catchups with the doctor ‘just in case they may have the sniffels’ in the week coming, or people regularly probing doctors for drugs but having nothing wrong with them. Meanwhile people who do need to see a doctor have to wait ages while the doctor deals with these time wasters.

      On the other side of the coin you have doctors and medical centre owners who care more about money then patients and try to see as many patients as they can to earn their $10k+ a week salary.

      Patients are just an annoyance in order for them to make their riches and milk the public purse. Hence why you’ll see doctors speaking up and saying it’s ‘an attack on the poor’, but really they are defending their income stream.

      As for the claim that a $7 fee is excess and punishes the poor, they still find money to buy cigarettes, alcohol and drugs. The funny thing is, when the consultation is free people get more demanding and the sense of entitlement is high.

      You try seeing a doctor in Asia or requiring any kind of medical attention there, it can send whole families into poverty. $7 is insignificant when you see what other people have to put up with.

      • migtronixMEMBER

        $7 is insignificant when you see what other people have to put up with

        Which other people? If you’re a single parent with 2 kids on circa $50K a year (something 3d1kbrain KAndrews [the disgusting fraud that should have been run out of parliament years ago] commented on this morning) clawing $7 – not to mention the frigging waiting behind BOOMERS!!! — is deeply cynical and achieves none of the things you mentioned. Boomers won’t give a shit about those $7 and young people are shafted YET EFFING AGAIN!!!

        How the heck you people can’t or won’t see this is bloody well beyond me it really is! And I’m the friggin libertarian no less!!!

      • Well this is the other side of the coin. It’s easy to be heart broken over the loss of free health, but that is based on the assumption people aren’t dodgy.

        Where I am it started to cost me $50 but then a bunch of Indian and and Asian immigrant doctors started up and now I go there. Seems to me bulk billers are a minority these days anyway.

      • @Mig

        Which other people?

        You know, people in poorer countries that get no government subsidised health care and would rather die then send their family into further poverty. I’ve witnesses this firsthand through my inlaws and their extended families.

        You’re rage about paying $7 to see a doctor is laughable.

      • migtronixMEMBER

        get no government subsidised health care and would rather die then send their family into further poverty.

        Oh I see! In that case lets make it $1000 f#ck it! If it’ll help all those dying people o/s? No? Doesn’t work that way?

        Who’s being risible now?

      • The other thing to think about is how little is invested in preventative health measures. If you really wanted to reduce expenditure you would invest in measures that helped people stay healthy.

        Such as, oh I don’t know, maybe a web site that advised people on how healthy food was? And a system of labelling which made it simpler to select healthy food?

        Wonder if anyone has thought of that?

      • “As for the claim that a $7 fee is excess and punishes the poor, they still find money to buy cigarettes, alcohol and drugs.

        Yes, all of them…except the ones that don’t.

      • drsmithyMEMBER

        It’s easy to be heart broken over the loss of free health, but that is based on the assumption people aren’t dodgy.

        Actually it’s based on the assumption – like welfare – that the dodgy people are an insignificant minority and the overall benefit far outweighs any loss.

        Which is what, you know, the evidence tends to show. Not that the right ever worries about anything as crazy as evidence, since it has a habit of conflicting with basically everything they think.

    • How much time is taken up getting referals for specialists? We have a disabled child and see multiply specialists and are constantly going back to the GP to get referals because the last one has expired. For example our child had surgery and when we have the regular six monthly check up with the surgeon, a new referal needed. Reform in this area would reduce unnecessary GP visits morethan the $7 co-payment.

  6. thomickersMEMBER

    One good thing is that the payment is going to be non-deductible/cant be offset to a negAtive gearers cashflow (unless they incur $2120+)

  7. Ronin8317MEMBER

    While this is just anecdotal evidence, I personally know one person who get a blood test every month, even though every single blood test returns a normal result.

    Every. Single. Month.

    When the GP tells her she doesn’t need it, she goes to another GP.

    I’m not sure if $7 is the solution though, since she can well afford it. This is the biggest problem with treating healthcare like a consumer product : the ‘consumer’ (i.e. patient) is not in a position to evaluate whether they need something or not.

    • migtronixMEMBER

      I give blood every few months, is that the same thing? I’m pretty sure they test it

      • Ronin8317MEMBER

        She is convinced she is sick, even though the GP tells her she isn’t. She also spends thousands on ‘alternative medicine’. So she is wasting medical services unnecessarily. Charging other people $7 for a GP visit however will do nothing to change her behaviour.

      • migtronixMEMBER

        I hear you dude my ex and my step mum are the same. Me on the other hand spent 3 months limping before I got an xray. But charging $7 to a single parent that spends more than half of what they earn on rent alone won’t do squat about it will it?

    • drsmithyMEMBER

      If someone had some evidence showing there were enough of these anecdotes to actually matter, we might be able to have an intelligent discussion about things.

      That no-one does, suggests to me there’s SFA of them in relative terms.

  8. Recently I fear that MB has gone “full retard” with it’s attachment to some of Hockeys more draconian measures.

    Good to see some sanity return to our regular program.
    Hope this writer contributes more often.

  9. Very good post Cameron – my quick take on this is that “benign” $7 fee will be $20 in about 7-10 years, going by long run inflation in healthcare costs.

    Given that the low/middle income earners in this country DO NOT get similar wage increases (and it seems LNP is hell bent on enshrining this, just as in the USA), this “benign” “small” “only costs same as a meat pie” fee will be out of reach within 10 years for most.

    I could be wrong – but I reckon this cartoon in the Canberra Times hits it on the head:

    boomers

    • probably Mig – the more I look at it (although I try not to) the more I think Australia is on path of US middle class destruction in next 20 years or so, well at least Gen X/Y/Millenium classes…

      Luckily, Australia can continue to rely on the endless resources boom, which is nice. (sic)

    • Ironically it comes from the Sydney Morning Domain stable.

      A know of a few boomers who’ve spent $100k on caravans. How many normal holidays could you get for that? But they’re not forced to make sensible decisions so it doesn’t matter. Costs something like $800 in petrol just to tow it up to QLD from Sydney.

      Boomers are god’s generation. Kneel down to their greatness for having been born at the right time.

      • migtronixMEMBER

        You’re ironic mask is slipping. Do something about it will you, or we won’t know what we’re looking at …

      • Just going with reality. The mob says they’re better than you, so for all intensive purposes they are. The mob is always correct.

      • migtronixMEMBER

        Like the mafia? Or the mob in parliament? Fascists are very good at exciting a mob – evidence Marius, Sulla, Caeser down to the goons in Kiev. Of course this time around the proscribed lists will appear on the net. Ever been dox’d?

      • No I have not been dox’d is that a threat?

        I was talking about the mob who keep on voting Lib/Lab.

      • migtronixMEMBER

        Its not a threat from me, nor was I necessarily suggesting you’d be the one to find yourself on the proscribed list – I’m just sayin’, the present is what it is and you either know how to harbour yourself (apparently you do) or you don’t….

  10. “The money saved from this and other cutbacks will be put into a $20 billion Medical Research Future Fund the government says will be the biggest in the world and it will be tasked with finding a cure for cancer and dementia.”

    Sounds pretty good to me. Of course, most voters are short term thinkers so this will not click well with them.

    When I was young, my dad would ask me to put 5c, 10c, 50c, $1 into a piggy box and he would tell me that one day when the box was full, we could break it and buy something big. I was skeptical but kept saving, rather than spend my money on lollies and toys I just put all my money into the piggy bank. After two years, the piggy bank eventually filled up and I was surprised I had so much money. We went to Tandy(i think) and I bought my first computer.

    I was able to learn computers at an age where most kids never had one and by the time the computer revolution started I had a huge advantage. I now make a very successful career/life from that little investment all those years ago.

    This is one of the best things the Liberals have done IMO. However, I would of preferred they exclude pensioners, DSP recipients, people on the dole and people who have severe illnesses from the co-payment fee.

    • migtronixMEMBER

      LOL did your Dad also tell you that the money “you were saving” was actually his? Did that ever enter you head? Did you ever ask “Dad if you can give me 10c today, why not 20c?”.

      The government sh1ts piggy banks from its prerogative…

  11. arctic explorer

    Hi Rumples. Your post is mostly right but I’ll make a few comments in respect to a few points.

    The Budget issue is how much of total health costs are borne by the Budget. Yes, both unnecessary and necessary visits to the GP will go down when co-payments are introduced. This means that Budget costs go down compared to where they would have been.

    Whether total health costs decline is not at all clear – in today’s Australia. Your example with your son is a good example of extremely high health costs being borne for close to zero health outcome achieved (not having a go at you at all – I’d do the same in your shoes). Using some out-of-date figures I used to have for hospital costs I’d estimate the total intervention cost was in the vicinity of $4,000 – $5,000.

    So it’s sort of like a “health elasticity” argument, whether the foregone costs of the majority will be outweighed by higher future health costs of the minority. You can see how it might happen but also how it might not happen.

    Even where individuals go on to incur very high hospital costs due to lack of early prevention/treatment – the total cost to the hospital system will remain unchanged (pretty much). This is because Australia rations on the basis of waiting lists (queue jumping introduces some twists). So in any one year only a certain number of individuals will be treated, on average. The hospital casemix will play a role in this as well, in addition to productivity/efficiency improvements in the health system.

    What it boils down to – which you pointed out – is that there is a shift of costs from the general taxpayer (via Budget funding) to the individual that gets sick. The poorest will be hit hardest due to their lower levels of health (on average) and lower ability to seek and obtain early intervention. This will be offset slightly because after 10 GP visits further visits are free of charge.

    Other costs will be borne by those people on hospital waiting lists that have to wait longer to get treatment. This presumes that there will be a new cohort of people who – not visiting their GP – develop more complex conditions than is currently the average casemix for the hospital system. Of course, this presumption may be incorrect and waiting times may not increase as a result.

    Just a few thoughts based on having worked in the health funding system (Commonwealth and State and Private) for the past 20 years.

    • Rumplestatskin

      Thanks for the informed comment.

      Sure, it may cost $5000 for the hospital stay. Money well spent in my book. And as I say, the money was spend not because my son had meningitis, but because we didn’t know if he had. Diagnosis and prevention etc are health services too, as you know.

      As a side note, it costs that amount whether we are privately insured or publicly insured. The fact that it comes from the national/State budget to which we all contribute premiums (in effect) than from the budget of a private insurer who does basically the same thing (collects premiums from a diverse group and pays out on a needs basis) is irrelevant from an economic perspective.

      A cost is a cost of resource that could not be directed elsewhere.

      You make a very good point that the total budge tis fixed and that amount is essentially rationed via waiting lists etc. And that they will bear costs as well. Definitely a point that only an informed insider could clearly see.

      I think you are right that we can’t tell the final result. As I say regularly, we are in the realm of moral arguments about whether we as a nation agree to provide a certain level of health care to all on the basis of need at no cost.

  12. One of the fastest growing areas of medical costs is pathology. But pathology tests occur because GPs order them, not because patients feel like wasting somebody’s time. The $7 fee is not going to incentivise anybody not to do a pathology test if their GP says “we better do a biopsy on that lump”. But paying the $7 might deter some people from going to the GP in the first place to get the lump checked out, especially if they are inclined to irrationally think that if they ignore a potential medical problem it might go away.

    • Not surprised. It’s in a doctors self-interest to order them for patients, they can get another fee from the patient just to give them results. Many pathology companies insert their own staff into medical centres to encourage more tests from doctors and increase business.

      • migtronixMEMBER

        To say nothing of those helpful and pretty pharma/path tech lobbyist (lets call them what they are, instead of reps) that will be ever so willing to fund a w/e in a 5 star FNQ resort to help you make up your mind as to whether you really need to ask for the tests/drugs…

  13. “If it makes sense to charge patients for GP services to improve health outcomes, then by that logic we should charge parents to vaccinate their children. We don’t, because we know the benefits to having universal access to vaccinations provides massive health benefits to the individual and society as a whole. The same applies to GP health services.”

    You know that a vaccination program is a public good, so should be publicly funded. Checking on your kid’s temperature is largely a private good, so should be partially, if not mostly, privately funded.

    • arctic explorer

      Thought I’d add that total health system costs are likely to rise due to rising GP fees – over and above the $7. In the past, inflation of GP fees were kept in check (well, at least they decreased from what they were before) through the bulk billing rate. With co-payments making a come back one can expect to see an increase in GP fee inflation rates. The total increase in health system costs will see a significant distribution from patients pockets to GP wallets.

    • Rumplestatskin

      “You know that a vaccination program is a public good”

      Not fully. The individual benefits from avoiding disease, right?

      “Checking on your kid’s temperature is largely a private good,”

      Not fully. Your kid’s school mates would be happy with early treatment/prevention of illness to avoid infection.

      Many companies encourage workers to stay home when they think they are sick to avoid the spread of infections around the office. It seems logical then that there are public good/ externality arguments for checking your kids temperature.

      • “there are public good/ externality arguments for checking your kids temperature”

        Yep. That’s why I said “largely a private good”. And that’s why it should be a partial co-payment, as is proposed, not fully user pays.

  14. The GP fee (with which I agree) is an ideological move. You can dress it up anyway you like, even make it look pretty via allocating proceeds to the Medical Research Fund. But in the end it is ideological – contribute toward your own benefit – a small element of user pays.

    I agree entirely. It’s capped at $70 a year, everyone can afford that. Over half the population contribute zero and are maintained by the State (whether welfare dependent or taxpayers that are ultimately net recipients).

    Suck it up.

    • migtronixMEMBER

      Well then why stop there 3d?!

      So you’re absolutely in favour of ending the fuel rebate yes? After all, shouldn’t you pay toward your own benefit?

      Talking out both sides of your hole as usual

    • It is an ideological move that could end up costing taxpayers more if people wait until their disease has progressed before seeing a doctor.

    • Ronin8317MEMBER

      The $70 cap is wrong. To discourage overuse, there should not be a cap.

      The ‘over half the population contribute zero’ is wrong. I believe the quote is from some right-wing thinktank saying ‘only half the population pays income tax’. However, almost everyone pays tax via the GST. The language distorts the situation by imply half the people don’t contribute to society.

      I believe the idea originated in the US, with some right-wing politician saying the poor should be taxed more because they currently don’t pay income tax. (While the rich should be taxed less). It’s not that far from the idea of a ‘head tax’ back in the old days when peasants unable to afford the ‘head tax’ ends up selling themselves to the nobles and land owners. I would like to believe that most Australian will not be willing to accept this.

      • Rumplestatskin

        /rant

        3d1k, remember that in this type of analysis there is an assumption that pre-tax income is morally, philosophically, ethically the correct one. Only if before tax income represents the ‘deserving’ income can you say that those paying tax are contributing from the wealth the deserve to others who do not deserve it.

        If you can’t say that, we are just left with this crazy notion that the before-tax distribution of income is merely an arbitrary construct; an historical legacy of imperfect laws, crony favours, criminal activity, wartime theft, political expediency, luck of birth, and so on.

        Could it really be that James Packer deserves his wealth? Is he really paying? Why did he deserve that wealth in the first place? Who agreed to that? I didn’t.

        In the end everyone pays – it’s just a choice of how we share our inherited wealth. Those who pay no net tax by your linked analysis certainly do pay to protect the wealth and property of others. They pay because they can’t show up at a mansion and camp in the back yard, even though they never agreed to be violently excluded from that piece of the earth.

        I recommend to read some of Bruenig’s writing on such matters http://mattbruenig.com/

      • migtronixMEMBER

        Thank you Rumples thank you!!

        You saved me another no doubt ignominious rant!

        That was perfect 🙂

      • “…we are just left with this crazy notion that the before-tax distribution of income is merely an arbitrary construct; an historical legacy of imperfect laws, crony favours, criminal activity, wartime theft, political expediency, luck of birth, and so on.”

        And I’d add genetic endowment, innovative prowess, preparedness to take risk, hard work, self sacrifice and so on.

        James Packer’s wealth is his business. He should be compelled to contribute no more a percentage of it to the national good than any other. He doesn’t need some sort of moral approval for his wealth. If he wishes to divest of some wealth to any cause or institution of his liking (assuming legal), his prerogative.

        An individual entirely supported by the State should be required to contribute a token fee capped at a very modest level for services rendered – should be expected as some recompense for a service not otherwise contributed to, rather than taken as an affront.

        Responsibility works both ways.

      • He doesn’t need some sort of moral approval for his wealth.

        He needs some sort of moral consensus to maintain it.

        He needs an agreed upon code of behaviour so machete wielding yoof don’t cut his head off.

        He needs people who believe in a societal construct that they put their bodies on the line to protect it and police it.

      • Fantastic explination of the point I was about to make Rumples.

        3diK’s contribution argument (and he’s far from alone in this attitude) relies on the assumption that our compensation for our efforts is fair.

        If (as Marx suggested) there is some rent element and what we get is less than full compensation for our contribution then without a tax/redistribution system we start from a state with the poor contributing to the rich.
        Life isn’t fair 3dik, the rentiers take a free lunch from the rest of us that is just as bad as how you feel when government takes from you. At least the govt spends more of my money on public goods than the rentiers do.

      • Glissom I certainly don’t start with that assumption. I am not bothered whether all are fairly compensated – however most are, some spectacularly so.

        I am not a proponent a blanket equality of income.

      • drsmithyMEMBER

        James Packer’s wealth is his business.

        Packer wouldn’t have his wealth without everyone else.

        Ergo, it’s everyone’s business.

    • It’s capped at $70 a year, everyone can afford that

      By that logic, the minig companies can afford the diesel excise.

      BHP, RIO…suck it up!

      Good to see you’re advocating much needed tax reform.

      • Silly Rusty. You’re confusing heroic job creators with wealth sucking plebs. Universal health care was a confused, adolescent aberration on our part. In hindsight it’s really quite embarrassing that we’ve held ourselves to such a mawkish social construct for so long. Never mind, we’re adults now and it’s time for us all to grow up and accept responsibility for our own failings, and yes, our own illness. I hear accounts of many poor people at the supermarket buying chocolates and imported strawberries for their children. Are we seriously suggesting such people can’t find an extra $70 a year ? That’s a small price for admission to adult responsibility.

      • migtronixMEMBER

        Spleen you do have a way a crystallising reason where there is none. I applaud you’re ironic restraint I really do.

    • drsmithyMEMBER

      I agree entirely. It’s capped at $70 a year, everyone can afford that. Over half the population contribute zero and are maintained by the State (whether welfare dependent or taxpayers that are ultimately net recipients).

      Suck it up.

      Good on you, minebot. You don’t let your inner psychopath shine through often enough.

      It can give irregular readers the wrong impression.

    • I did not know that it was capped at $70.

      Aw my god diddums.

      Seventy dollars aw my gawd I’m goign to march in May. Not.

      • migtronixMEMBER

        Because if you have to go the doctors >10/annum you’re perfectly healthy?

        What is wrong with you? These are people — the one’s I advocate for — who on any given day prioritise what to spend $7, it’ll be single parents with ill children with little other avenue on a particular Tuesday because the money just isn’t there yet.

        You’re being utterly irrational.

      • $70 out of a whole year’s pay is a lot? Even if it’s single mum welfare? It isn’t. We have too many single mums anyway, you have no business breeding a lot if you’re not doing well. You have to draw the line somewhere.

        AFAIK single mums get paid a lot anyway. This country is waaaayyyy too commie. It’s pretty concerning actually.

  15. Nicely put Rumples.
    Their goal is not acheived through their actions.
    Leaving us with two possibilities:
    1 Hockey is an idiot advised by idiots (always an option)
    Or
    2 Their real goal is something else. (but surely our beloved LNP could not be trying to undermine and eventually sell our universal health care to the insurance industry)

  16. BudreikaMEMBER

    I’m confused. I actually had no idea it was free to visit the doctor until this week. I just assumed I would need to pay.

    So, the point of the story is that only poor people go to the doctor… and because poor people make such good choices with their money, they’ll avoid going?

    And isn’t the co-payment capped at 10 visits per year ($70) anyway? How many times do people go to the doctor in a year? I don’t think I’ve even been to the doctor 10 times in my life, let alone 1 year.

    I’m not trying to be facetious, I just don’t understand given the relative worth of $7 in Australia that people would otherwise happily spend their money on.

    • So, the point of the story is that only poor people go to the doctor… and because poor people make such good choices with their money, they’ll avoid going?

      No the ideological story is that the cheaper things are, the more it is consumed. So when it’s free, demand approaches infinity and everyone develops hypochondria to consume the free product of health care.

      So with a price signal, demand drops.

      The real story is that the $7 is the tip of the wedge, it’ll blow out to $10, $20, $30 eventually. Torynuffs think they shouodn’t be paying for your health care. They don’t understand the value of a productive workforce when their health concerns are catered for.

  17. I will have to check with my pathology colleagues, but it is possible that a single blood test could end up cost more than anticipated: most “bloods” incorporates multiple tests and assays which could result in a significantly more expensive co payment than just $7.

    For instance someone who presents to their GP as being depressed, could end up being ordered over 10 different blood tests (all on the same form) in order to exclude other treatable organic conditions. If that ends up costing $70, it’s going to be a major disincentive for patients which could result in increased morbidity.