When $6 is more than you think

The government is trying to balance the budget, and since fighter planes are super cool they absolutely have to stay, but Medicare and pensions?  Not so much.

(Honestly, it’s really hard for me at the moment to work out which of the government’s policies upsets me most.  I suspect that this is a deliberate strategy on their part, in fact – if you create enough policies that rile up the entire left-leaning section of the population, but do them all simultaneously, everyone has to pick their favourite or succumb to exhaustion.  It’s divide-and-conquer stuff.  And I think it’s pretty disgusting.  But I’m sure you had figured that out already.)

Anyway, today I’d like to talk a bit about the idea of getting rid of bulk billing and having a minimum $6 payment to visit the doctor.  The reason I’d like to talk about it is that it sounds like such a minor thing – such a fair way to allow everyone to contribute to fixing the alleged budget blowout – but in fact it’s going to affect some of our most vulnerable Australians in a very negative way.

Right now, I’m one of the lucky ones.  I am employed full time, and my job pays quite well, I have pretty generous sick leave benefits, and I even get several days a year when I can take a sick day without producing a doctor’s certificate.  I even get the flu vaccination for free through work.  Since I’m in reasonably good health (and, admittedly, rather avoidant about doctors generally), I go to the doctor three or four times a year – when I need a doctor’s certificate, or when I have a cough that Will Not Die and it’s reaching the point where I’m getting a bit worried about breathing and such.  $6 per visit isn’t such an onerous requirement for me, right now.

This has not always been the case.

Before I worked in this job, I did temp work for several years.  By the end of it, I’d got really good at temping and was doing very nearly as well as a full-time worker.  But at the start, things weren’t so good.  I had chronic back problems which caused me to miss a lot of work – and in the temping world, missing work means that you don’t get paid.  Also, I was working in a call centre, which meant that my base rate of pay was pretty low in the first place.   There were certainly weeks when keeping the lights on meant taking a minimalist approach to eating.  (My maths skills got some serious use whenever I went grocery shopping – if tomatoes are $3 per kilo, and I have 150g of tomatoes, that’s going to be about 50 cents, and pasta is $1.50, so that’s two dollars, and I can probably get an onion for 20 cents, and I have $4 to last me until tomorrow, so if capsicums are $6 per kilo, can I find a capsicum that will cost less than $1.80…?)   I budgeted my week down to the last cent, and if my pay was unexpectedly delayed by a public holiday, then I was in trouble.  (Serious trouble, in fact.  At one point, my agency didn’t tell us they were delaying our pay by three days, and I wound up with the choice of taking the tram to work without a ticket or skipping work and losing my job.  I couldn’t risk being fired, so I fare evaded, and got caught. Which meant that in the next pay, I had to find $100 to pay the fine… I think I wound up selling a lot of my books.)

There is no way I could have afforded a $6 doctor visit in an emergency.  I would probably have stayed home until payday, and hoped the problem went away.

And I was still one of the lucky ones.  Through no virtue of my own, I had a roof over my head.  I had no dependents.  I had a washing machine, which meant I didn’t have to pay for the laundromat!  As a result, I actually did manage to eat every day, and never quite lost any of my utilities.  My back problems, while painful, eventually sorted themselves out without much intervention (health insurance and physio visits being among the things I couldn’t budget for).  I also had a good education, which meant that once my back problems improved, I was able to get pretty constant work.   And this situation only lasted about a year, which meant that I didn’t have to start doing expensive things like buying new clothes or replacing broken appliances.

I was lucky.  And that was still an absolutely terrifying and stressful year and I hope I never have to be that close to absolute poverty again.Here’s the thing.  $6 isn’t much if you are working full time, if you have no dependents, if you only go to the doctor occasionally.  But what if you are unemployed?  What if you are just employed enough that you don’t get the healthcare card, but are still not earning much more than the minimum wage?  What if you have dependent children?  And for heaven’s sake – what if you are disabled or chronically ill?  What if you need to go to the doctor regularly?  What if you are disabled *and* have children who need to go to the doctor? What about follow-up tests and diagnostics?  Those are going to add up. How much is that $6 visit really going to cost you?

There are two things to consider here.  First, the $6 doctor visit is essentially a flat tax, and flat taxes always affect people on low incomes more than people on high incomes.  $6 for a doctor’s visit is 0.4% of weekly earnings for someone earning an average income ($1,483.5 per week, as at last November).  For someone on the disability pension, earning $828 per fortnight, or $414 per week (per the DHS website), it’s 1.4%.  If you are on Newstart, and earning the princely sum of $255 per week, it’s 2.3% of your income.

(this is where I had to stop for a few minutes and be depressed at how incredibly little we are expecting people to live on. Ouch.)

None of these percentages are very big in and of themselves, but it should, I think, be obvious that someone on a lower income is going to feel that $6 more than someone on a high income.  Flat taxes are inherently inequitable for exactly this reason, and a just society should look to other taxation models to create income.

The second thing to consider is the fact that someone on a disability benefit is, in all probability, going to need to go to the doctor more often than someone who is in full time work.  Add in the fact that this person is probably paying for medications and equipment that a healthy person wouldn’t need (and did I mention that that Hockey is also making mutterings about cuts to the Pharmaceutical Benefits Scheme?), and we have what amounts to a tax on people with chronic illnesses and disabilities – right at the same time that the Government is re-structuring the disability pension with the apparent intent of getting more people back onto the lower-paying Newstart (For a comprehensive essay on this subject, I highly recommend The Conscience Vote).

This, to me, sounds a lot like discrimination.There is, of course, another way of looking at this.  You could argue that, if a particular group of people visits the doctor more often, it is only fair to ask this group to pay more into the system for medical care.  You could argue that it is unfair for the rest of society to have to support them.

Well, yes, you could make these arguments, but you would be wrong, for the following reasons.

1. Healthcare is not a luxury item, it’s a necessity. People do not go to the doctor just for fun, because it’s free and they are bored today.  People go to the doctor because they are sick.  Being unlucky should not attract an extra tax.  (And I’m well aware that various forms of ill-luck do attract effective taxes and penalties in life – ask me about having to pay more GST than my husband does because I am a woman and therefore need to buy sanitary supplies periodically! – but why create new taxes on misfortune?)

2. Ill health will come to all of us eventually.  Most people do not go through their entire lives as fit as a fiddle, and then drop dead without a fuss in their 90s.  Instead, most people have a period of decline towards the end of their lives – and their medical costs rise dramatically in their last few years of life.  This is why we have insurance and taxes – because logically, most people’s need for healthcare occurs at the point in their lives when their earning power is at its lowest.

3. It is in the best interests of society to have roads and bridges that are structurally sound, schools that teach children the basics of how to be functioning adults, trained ambulance workers and firefighters, good hospitals, and any number of other things.  We may not use each of these things – I’ve never personally needed the services of the fire brigade, and I’m very grateful for that – but we agree that they need to exist, that the burden of these things should not fall on individuals, and we pay taxes accordingly.  I would argue that it is also in the best interests of society that people can afford preventative care (which costs the health system less in the long run), and that people with special needs are enabled to participate in society – and this starts with taking care of the basics of food, shelter, and health.

Oh, and speaking of the public good, here’s a third reason why charging a fee for doctor’s visits is a bad idea: from  a public health perspective, you really, really do not want to discourage people from going to the doctor when they are sick in an infectious disease scenario.  If there is an epidemic in the offing, we want people to get treatment without worrying about being able to afford going to the doctor.  (We also want people to stay home from work if they are sick, but there are a much wider range of issues at play here, and they are beyond the scope of this article)

Getting rid of bulk billing is a bad idea.  It harms people who are financially vulnerable, and creates an extra tax on people who are in poor health.  And it is potentially dangerous to our society. 

It is also, in my opinion, simply wrong.

I’ll finish with a final story – a cautionary tale, if you will – from when I studied genetic counselling.  We were learning about Huntington’s Disease, which is an inherited neurodegenerative disease that is invariably fatal, and generally manifests late enough in life in the first generation that carriers have already have children or even grandchildren.  It’s horrible.  Our textbooks all told us about the enormously high suicide rate among carriers and sufferers… except that in Australia, the suicide rate is actually pretty low.  We’re pretty good at looking after our Huntington’s Disease patients in this country.

But our textbooks were written in the USA, where a slow-moving neurodegenerative disease is not just a personal health disaster, it’s also a financial disaster which can bankrupt not just the affected individual, but his or her entire family.  And so people were killing themselves to avoid leaving their family in unspeakable debt.

Charging people $6 to see a doctor is a long way from bankrupting people with chronic illnesses, but it is certainly a step in the wrong direction.  Let’s not take that step.  Medicare is one of the most precious things we have in this country – it’s a fundamental service that promotes equality and participation in society.  For people who are really struggling financially, it’s one less thing to worry about.

Don’t let them take it away from us.


Do Something!

There are numerous petitions that you can sign – Save Medicare, The Greens, and GetUp all have online petitions going.

If you have a bit more time, you could write to Treasurer Joe Hockey, to PM Tony Abbott, to the Minister for Health, Peter Dutton, or to the Shadow Minister for Health, Catherine King.  The Minister for Social Services, Kevin Andrews, might also be worth considering.  You could also try writing to your local member, or to one of your local Senators.  Or all of the above!  Emails are good, mailed letters are better, if you have the means, motive and opportunity for this.  Phone calls are particularly good.

By good, incidentally, I mean both ‘harder to ignore’ and ‘demonstrative of your commitment to the issue’.  Knowing that a thousand people care enough to click a button on Facebook is a very different thing to knowing that a thousand people care enough to take the time to write, or to do something as scary as ringing the office to express their concerns about the policy.

You can keep the email or letter short – just a few sentences registering that you are against co-pays for medicare, and giving a reason why, or you can write something a bit more detailed.  I tend to do the latter, because, as you might have gathered, I never shut up. I suspect a medium-length letter is more effective than an oh-shut-up-already-Catherine length letter.

Some talking points might be…

    • the increased burden on emergency departments if people are unable to afford to visit their GPs
    • the potential public health risks
    • the excessive burden this co-pay would put on people with chronic health conditions
    • how this co-pay would affect you

Actually, I don’t really know how to do talking points, so feel free to suggest more in the comments.

If you are a Greens or Labor sort of person and have the time, it might also be worth contacting either an MP or the party generally to find out whether they are doing anything specific to fight this legislation that they might want community support or help with.  Myself, I’m going the letter-writing route, since I’m relatively time-poor at present.

It’s also not a bad thing, if you know of an MP who has spoken out against this legislation in a way you particularly agree with, to write and thank them.  It’s good for the people who are on your side to know that there are people who appreciate them and are paying attention – and it’s also kind of nice for your own mental health to write letters of support occasionally as well as letters of the ‘please don’t do this!’ variety.

Good luck!

Edited to add: a friend sent me a link to the Protecting Our Tomorrow campaign about Meningococcal Disease, photographed by Anne Geddes.  Meningococcal Disease is all on its own an excellent argument in favour of going to the doctor when you are sick – because it starts off looking pretty much like any old flu, but it progresses incredible fast and can cause appalling damage, or even death within hours.  So again, let’s not make finances a barrier that stops people who are sick from going to the doctor.  This should not be how things work in a civilised society.

Also, apologies for the multiple edits.  WordPress is playing merry hell with my formatting today, and I’d like my paragraphs to stay as I left them!

8 thoughts on “When $6 is more than you think

  1. What really worries me about this is that they’re also thinking of charging people to go to the emergency department of hospitals, if it’s “not an emergency”. The husband of a friend of mine came off his bike up at Kinglake. He was fine – knocked out and badly grazed, but got a lift home, stayed up long enough to make sure he wasn’t concussed, put mercurochrome on the grazes, left it at that. Three days later the grazes on his foot were not only not healing, but getting bad looking. So, it being late at night and his wife nagging him about not leaving it until morning, they went to the local hospital to get it looked at. Long story short – staph infection, skin graft didn’t take, ended up spending two weeksn in hospital while they IVed quite strong antibiotics into him and stopped the infection. I was talking to him afterwards, and asking how his foot was, when he casually mentioned that if he’d still been in the US he’d have lost the foot. He had no health insurance, and wouldn’t have gone to the emergency department until it was much, much too late to do anything other than amputate – he couldn’t afford the costs.
    Looking at my friend’s story, you could argue that he should have been charged because a grazed foot wasn’t an emergency. Except… it kind of ended up being so. It really does worry me that people on low incomes won’t present at hospitals because they can’t afford the charges until the costs are significantly higher than if they’d seen a doctor or come in earlier.
    (It also annoys the crap out of me that there seems to be this idea that people present at emergency departments for fun – because seriously, sitting around for hours on end is everyone’s idea of entertainment, honestly. Mostly people present because the doctor’s aren’t open and they’re worried, quite often they’ve rung Nurse on Call (who seem to invariably tell people to see a doctor, anecdotally speaking), and they haven’t heard of the doctor on call service. Now if they’d expand that it’d help enormously – hell, even just triaging so the GP patients are shuffled through more quickly would help. That would mean having a GP in the emergency dept instead of using the already rostered staff, granted.)

    • I love your idea of having a GP on duty in the Emergency Department. Though I suspect you might have trouble filling the role – I’ve always had the sense that many people go into GP work because they don’t want to work ridiculous shifts…

      As for your friend, ouch. That sounds scary. And I agree – there are definitely things where you just don’t know if it’s bad or not until you get there and someone checks it out (says she who wandered around with a broken ankle for three days before going to a hospital to get it X-rayed).

      As for the US health system, I find it terrifying. A woman I used to know online died of it – her doctors and hospitals all recommended one course of treatment for her cancer (with a very high probability of success), but the insurance company would only cover a different course of treatment – which wasn’t indicated for that cancer at all – and so she died, in all probability far sooner than she should have. It’s a terrible way to run a health service – and even in the US, they are trying to move away form it. I can’t understand why anyone would try to move back towards it.

  2. Also I’d like to point out that I don’t know where Hockey et al are going to see their doctors, but almost nowhere bulk bills exclusively. Our co-payment is around $20 if it’s not bulk billed, which is why I don’t go and see the doctor for myself – my son has a health care card, so his co-payment is cheaper, and he’s more often bulk billed. Trying to find somewhere you can be sure will bulk bill you is a pain in the arse – and doesn’t lead to good care as people turn up randomly at clinics, so no available history.

    • Me too – I’m out in the country and it’s around $25 a visit, $14 for people on disability, Newstart or single parents’ pension, no charge for aged pensioners on the full pension. But this is also because these same doctors have to run the hospital, go in the ambulance, work weekends, and travel huge distances…and if the clinic bulk billed we’d have no doctors at all.

  3. Dear Cate,

    Thank you for your continuing blogs, and in particular last week’s one about the $6 co-payment. It was very impressive, and I put a link up on my Facebook page – it’s been ‘liked’ by 5 people and shared by 2. In addition I sent an e-mail just a short time ago to my local Liberal MP, Christopher Pyne, which follows. Keep up the good work.


Leave a Reply to Catherine Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.