Medicare skullduggery

By  Don Edgar  and  Patricia Edgar

Mar 5, 2025

Prime Minister Albanese has announced an $8.5 billion boost for Medicare to make bulk-billing available to all adults, not just concession card holders. Within hours, the Leader of the Opposition matched Labor's bid. Both leaders are acutely aware that health care affordability is a critical issue for the electorate. In his commentary on P&I March 1  Ross Gittins  states "Medicare has more problems than just out of pocket payments'.

Indeed, it has. Medibank came into effect in July 1975 but faced opposition from peak medical bodies from the start. Following the election of Prime Minister Malcolm Fraser in November 1975, his government made changes; a 2.5% income levy was imposed to fund Medibank and there were changes to hospital funding, benefits and bulk billing, and private insurance rebates. The Australian Medical Association encouraged doctors not to bulk bill patients, and there were calls for a national strike in public hospitals.

In 1983, the Hawke Government re-established a cheaper, simpler universal health insurance scheme called Medicare, which began on 1 February 1984. By then more than 14 million Australians - 92% of the population - had signed up for Medicare, and the Australian Government had issued 6.5 million Medicare cards. Medicare restored bulk billing. People could see a doctor free of charge. Public hospital treatment was free so people no longer had to miss out on health care because they couldn't afford it. But the AMA was never onside.

A move towards privatisation of medical clinics followed. By 2017, some 45% of all GPs were associated with a private company, and by 2020 there were more than 400 Medical Centres run as private businesses. These Centres are focused on making a profit; providing care, the commodity they sell, is secondary. Therein is an insidious problem for the health service as an industry.

Despite various government attempts to encourage more bulk billing by GPs, about 1.5 million people say they do not go to a doctor because they can't afford it. All taxpayers (above a certain income limit) are now charged a levy of 2% of their taxable income to fund the overall health system. But medical costs have risen because of the trend towards specialisation and technological advances in treatment. Other critical factors affecting GP services include our larger population, poorly serviced outer suburban areas and a contrived shortage of doctors. Some relief has come from the (Coalition-opposed) provision for 60-day prescriptions to reduce the need for more visits.

But an inexorable pattern has taken hold in privately managed corporate clinics. There is pressure on doctors to increase the number of patients they see, charge "at their discretion" full fees for a referral, or a script renewal. There is no concession for those with chronic disease, the unemployed, the poverty-stricken mother who comes in with a child and asks for advice - no double bookings allowed. Albanese and Dutton are seeking to redress these bulk billing barriers by raising the government rebate to doctors.

When researching this article, a specialist advised us so much pressure is being placed on GPs that in 10 minutes after "Hello how are you?" and "Take a seat", there is only enough time for a doctor to make a specialist referral, write a script or order a test, certainly not time to present and discuss complex personal and medical problems.

This may be good business for the specialists but not for the patient or the system. And we know this is not the way an effective healthcare system should operate.

We have recently experienced an egregious example of corporatisation. For more than 17 years we have had the same very competent doctor, working within a local clinic, who knows our medical history intimately, gives us the time needed for every consultation, and he bulk bills many of his patients whom he judges to be in need. This accords with AMA rules which say the GP can determine their own fees based on the cost of running the medical practice and the circumstances of the individual. Yet this GP was summarily sacked, his patients not advised, and their records held by the practice.

We had noticed signs of new managerialism - a lock on the door to restrict entry until buzzed in by someone at the desk; an insistence on showing our Medicare card on every visit to be admitted; refusing either one of us making a joint appointment without signed permission of the other; the disappearance of friendly receptionists familiar with regular patients, and a new, colder culture about the place.

On investigation, we have found that GP salaries vary - between $230,000 to $350,000 p.a in metropolitan areas, slightly higher in regional areas because of incentives to work outside cities. The average gross profit for a GP practice is 35.9%, net profit around 11.3%. The circumstances with individual practitioners vary. We often hear of cries of doctor poverty as small GP practices compete with large corporations with deep pockets.

The research shows the current system needs investigating urgently. Raising the bulk billing rate will not solve the issues stemming from a culture which is primarily profit-driven. The cost of medical access remains variable, the continuity and quality of GP care is unpredictable and over-servicing - where clinics are co-located with pathology, radiation and other specialist services - is common.

In the words of the management of the clinic, when asked to justify their processes they wrote, "as a private clinic patients should come with an expectation that there will be a charge for their appointment unless they hold an aged or Disability Pension Card". What of a doctor's discretion? (Which is also stated on their website as policy). It's a mess.

Even with the new subsidies, Minister Butler will need to watch for deviance and exploitation.