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If you want to keep a blog that makes the arguments every day against the ravages of capitalism going and keeps alive the flame of democracy and community, make a donation to help cover my costs. And of course keep reading the blog. To donate click here. Keep socialist blog En Passant going. More... (4)

Sprouting sh*t for almost nothing
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My interview Razor Sharp 18 February
Me interviewed by Sharon Firebrace on Razor Sharp on Tuesday 18 February. http://sharonfirebrace.files.wordpress.com/2014/02/18-2-14-john-passant-aust-national-university-g20-meeting-age-of-enttilement-engineers-attack-of-austerity-hardship-on-civilians.mp3 (0)

My interview Razor Sharp 11 February 2014
Me interviewed by Sharon Firebrace on Razor Sharp this morning. The Royal Commission, car industry and age of entitlement get a lot of the coverage. http://sharonfirebrace.com/2014/02/11/john-passant-aust-national-university-canberra-2/ (0)

Razor Sharp 4 February 2014
Me on 4 February 2014 on Razor Sharp with Sharon Firebrace. http://sharonfirebrace.files.wordpress.com/2014/02/4-2-14-john-passant-aust-national-university-canberra-end-of-the-age-of-entitlement-for-the-needy-but-pandering-to-the-lusts-of-the-greedy.mp3 (0)

Time for a House Un-Australian Activities Committee?
Tony Abbott thinks the Australian Broadcasting Corporation is Un-Australian. I am looking forward to his government setting up the House Un-Australian Activities Committee. (1)

Make Gina Rinehart work for her dole
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Sick kids and paying upfront

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Save Medicare

Demonstrate in defence of Medicare at Sydney Town Hall 1 pm Saturday 4 January (0)

Me on Razor Sharp this morning
Me interviewed by Sharon Firebrace this morning for Razor Sharp. It happens every Tuesday. http://sharonfirebrace.com/2013/12/03/john-passant-australian-national-university-8/ (0)

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A great big new tax on going to the doctor?

The Daily Telegraph is reporting that the Abbott Government’s razor gang is set to introduce an upfront $5 fee for visits to the GP. The fee would apply to bulk billed consultations and exclude pensioners and concession card holders. Families may get 12 fee-free visits.

The  National Commission of Audit, dominated by the Business Council of Australia, will advise the Abbott government on ‘savings’ next year before the Budget. It has a co-payment as one of the issues to consider.

Such a co-payment would ‘save’ about $750 million over four years. By the way this is about the same amount the Labor government ‘saved’ by consigning 80,000 single parents, 90% of them women, and their kids to even greater poverty on Newstart.

Since the reports surfaced today about the proposed $5 tax on going to bulk-billing doctors, both the Prime Minister and the Minister for Health have refused to rule the idea in or out.

The proposal is not new. In fact the Hawke Labor Government introduced a co-payment of $2.50 in November 1991. It lasted only 3 months in the face of huge public opposition.  Paul Keating, the new PM, had the political sense to remove it, despite supporting it as Treasurer.

Abbott and co didn’t mention a great big new tax on going to the doctor before the election in September. They did mention cutting the cost pressures on families. Adding $5 to a visit to the doctor, and approving a 6.2% increase in health insurance premiums last week, the biggest in a decade, do the exact opposite.

The Abbott Opposition did also sprout 3 word slogans about axing the carbon tax and the mining tax, both of which fall in their legal incidence on big companies.

If they manage to abolish those two taxes then they’ll have a great big revenue black hole of billions. Making ‘savings’ by attacking poor people going to the doctor instead of taxing the rich and powerful is their idea of economic efficiency.

Even if they can’t abolish these two taxes someone has to pay for the Government transferring $8 billion to the Reserve Bank that it didn’t need.

Capitalism is such a sick system today that it cannot provide free or even adequate health care to all those who need it.

Under capitalism the human need for health care is rationed. One way of rationing is through price signals which just means poor and many poorly paid working class people receive less and less care as the price goes up.  Another way of rationing is through queues. Australia does both.

Introducing a co-payment won’t stop people getting sick. It will just see more of them presenting at hospitals. This of course is much more expensive than the $36 cost of bulk billed ten minute or so consultations. So my guess is the market ‘rationalists’ might extend the doctors’ tax to hospital visits.

Co-payment will see people staying at home rather than visiting the doctor or queueing in hospitals for hours if not days and so getting crooker and crooker. This is another cost on society that doesn’t necessarily show up in the profit and loss account of bean counters Abbott and Hockey.

It may also see some bulk-billing doctors move over to cost recovery billing and some patients move to such doctors for better access.

Nationalised or subsidised health systems were part of the European ruling class’s compromises with their working classes after the Depression and Second World War. As senior Tory, the future Lord Hailsham, warned in 1943: ‘If you don’t give the people social reform, they will give you social revolution.’

Such health systems can only be built on the back of a healthy, i.e. profitable, capitalist system. And that was the case after the Second World War. The destruction of capital during the war meant that the system had a new base from which to build. Second, the massive arms spending by US and Russian imperialism removed huge amounts from the accumulation process and so slowed down the tendency of the rate of profit to fall.

It was not till the late 1960s and early 70s that that tendency reasserted itself.  The ruling class response was neoliberalism, the use of the state and the market to shift wealth from the working class to capital as ways to address. This could be either though direct attack on the working class (think Pinochet, Thatcher and Reagan) or co-option of its trade union leadership (think Hawke and Keating and the Accord).

In Australia the tail of Keynesianism met the realities of falling global profit rates with the election of the Whitlam government and its implementation in 1974 of Medibank, a half way house of a national health care system.

The history of health care in Australia since then has been rationing through market mechanisms or queues or both. However when Fraser  began to attack it, workers in 1976 struck in defence of Medibank.

Taxes come out of surplus value, the unpaid labour workers provide to the bosses. The bosses regard this as theirs and so taxes (especially those falling directly initially on capital such as company taxes) are seen as an impediment to their profitability.

Of course a healthy and well educated workforce isn’t a threat to capitalism as such, but in times of declining profit rates the bosses see spending on such activity as a threat to their profits.

So cuts to social spending followed by company tax cuts are one short-term way for the ruling class to increase their share of surplus value and thus temporarily address declining profit rates.

When it comes to the $5 co-payment, my guess is that this is kite flying to see what the public reaction will be.  Let’s make it as loud and angry as in 1991. However even if we beat off this immediate challenge, clearly this Abbott government, like the Rudd and Gillard governments before it, is about long term shift in wealth distribution to the ruling class from the working class. That means that other cuts will be on their agenda.

It isn’t enough just to stop co-payments. We need to stop all attacks on social spending on the poor and working class. As Lord Hailsham so succinctly put it, if we want social reform, we have to threaten social revolution. In the years after the Second World War the system could give us progressive reforms. On a global scale it can no longer do so, although I note that sections of the Australian ruling class like the mining magnates and banking industry are very profitable.

Indeed, Australia is a low tax country and the top twenty percent own nearly 2/3rds of all the wealth in Australia. This is about $4 trillion. A modest one percent wealth tax on that top 20 percent would yield $40 billion a year, enough to provide free health care for all the working class.

Such a situation is not going to come about unless we are fighting, fighting for example for big wage increases at the point of production to redress the 3 decades of wealth shifting to capital and the rich and linking our economic demands to political ones.

Of course if workers did unleash their power then the question of free health care for all would be on the agenda and given capitalism’s inability to provide such benefits, the question of setting up a society to satisfy such a basic human need might arise.

That is for the future. Right now our side should be shouting ‘Abbott, get your hands off Medicare’ and organising the fightback. We struck in 1976 to defend Medibank. We can do so again today to defend Medicare.

As part of that we can demand Abbott tax the rich to improve, not destroy, Medicare. Free health care for all.

To comment on this or see what others are saying, hit the comments link under the heading. Like all posts on this blog comments close after 7 days.

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Comments

Pingback from A great big new tax on going to the doctor? | OzHouse
Time December 29, 2013 at 9:11 pm

[…] Dec 29 2013 by admin […]

Comment from Jolly
Time December 30, 2013 at 10:38 am

“Free medicare for all and tax the rich” … the rich is not part of the all??

Comment from Christopher Derrick
Time December 30, 2013 at 3:37 pm

I like your work and am currently putting together some hopefully, cutting Social Demcratic styled viewpoints on this newly registered website. I own the domain name.

Comment from Lorikeet
Time December 30, 2013 at 3:58 pm

In the late 1970s, the government decided to abolish Medibank, the predecessor of Medicare. This forced more people back into the public hospital system. At the time, I was working for a private Orthopaedic Specialist. With Medibank in place, we were flat out like lizards drinking. On abolition, we spent more time twiddling our thumbs.

If it were up to me, I think I would place a fairly generous means test on the Medicare Rebate. With so many large medical practices bulk billing nearly everyone, people are more inclined to seek medical treatment at the drop of a hat. This overloads the system and ramps up government costs.

Doctors in small medical practices would have their interests protected with a means test in place. Otherwise they will eventually be forced out of business by corporate clinics bulk billing everyone and using cheap foreign labour. The corporate model in aged care, medicine and dentistry will provide an “abattoir” type experience, with long queues and rapid inferior treatment.

Money could also be saved by retaining a generous cap on the Private Health Insurance Rebate. The recently announced premium increases are certainly unwelcome in an environment where our public hospital system is under threat.

The privatisation of public hospitals will force the poor to place reverse mortgages on their homes in order to access treatment. Here in Brisbane, the Royal Children’s Hospital is to be closed and replaced by a private hospital carrying out orthopaedic surgeries such as hip and knee replacements. This seems to have followed hard on the heels of the Princess Alexandra Hospital closing down its “elective” surgery orthopaedic list.

I believe that all of the government’s proposed negative changes are driven by the superannuation system, and will cause the very well heeled to gain a benefit from stripping the poor of their homes and life savings. Money hungry bankers are very keen to take over the housing market and reduce general standards of living.

Comment from Lorikeet
Time December 30, 2013 at 5:04 pm

Another problem that exists in the health system that makes it hard for us to get appointments with GPs in suburbia is the high level of overprescribing.

This not only keeps doctors’ surgeries full, but is also highly beneficial to corporates/capitalists running Big Pharma, along with creating high costs for the government.

When I spoke with social workers at the Brisbane North Medicare Local Conference, they said homeless people with mental health problems were not being properly assessed and treated, partly because they could not access Psychiatrists in either the public or private systems. They said GPs had to turn over one patient every 7 minutes to break even when running their practices. This would be partly caused by the high cost of shop rents (money hungry bankers again) and having to compete with corporate clinics which bulk bill everyone, including the rich.

I think the government should also place a cap on the fees that medical and surgical specialists can charge. Last night I saw a man on TV who said it cost him $4500 for a knee replacement, without including any hospital charges.

I think there should also be special rates available for pensioners and other disadvantaged groups.

Unfortunately my local GP thinks the answer to all of his problems is to charge top dollar to everyone, and to intimidate and abuse the disadvantaged. He clearly has no common sense, as this will simply drive more of his patients into the bulk billing corporate sector.

However, I consider it unfair for the GP to be forced into a position of accepting a Medicare Rebate for his services, or be run out of business by corporates. No one could argue that the GP is not the poor cousin of the medical profession, when nearly all medical and surgical specialists feel free to charge even the disadvantaged the maximum possible fee.