Bulk Billing Under Threat — Fight for Free, Fully-Funded Healthcare!

The cost of living crisis is hitting from every angle, public hospitals are at breaking point, and Covid numbers are rising yet again. On top of all of this, years of cuts to public spending mean that bulk billing (a system where healthcare services are provided to patients at no or low cost) and Australia’s universal health care system, are effectively coming to an end for working class people.

It’s particularly dire for young people, women, LGBTIQA+ people, Indigenous people, migrants and people living in rural areas. Bulk billing makes it possible for working people to visit a doctor without paying anything out-of-pocket. But people are finding it harder to locate a doctor that bulk bills, and marginalised communities continue to struggle to access appropriate healthcare. Many young people are avoiding doctors visits and prescription medication due to increasing out-of-pocket costs.

The Labor Party paints itself as a champion of universal healthcare, but the election propaganda of Labor Party politicians is difficult to take seriously. Labor is directly responsible for the failure of bulk-billing rebates to rise with inflation. The Albanese government is currently presiding over the historic collapse of free doctor visits in Australia.

We can’t afford for the public health system to continue to be strangled by capitalist politicians. Profit should not be allowed to rule our health and wellbeing.

Medicare has been under attack for its entire existence

Universal healthcare was a victory won by the organised working class. It has been under attack from big business politicians, in both Labor and the Liberal Party, ever since it was won.

Free public hospital care and subsidized private care were implemented in 1974 by the Whitlam government. This government came to power on a wave of working-class activism. The women’s and Aboriginal rights movements of the 70s fought for improved healthcare, establishing community-controlled services and shelters. Militant unions demanded quality public services for workers. Many in the movement for healthcare reform fought within their unions and the Labor Party. They stood against powerful lobby groups, including doctors associations and private health insurance companies, who often wanted to keep healthcare privatised.

Universal healthcare was not a gift handed down on a silver platter. It was under attack from the beginning. The year after it was introduced, the Fraser government abolished universal healthcare, limiting it to retirees.

Working people fought back through a mass movement, holding Australia’s largest general strike in 1976 to defend it. This, along with tireless activism by working class people within the Labor Party, led to the next Labor government bringing Medicare into effect in 1984. Labor claims this working-class victory for itself, calling themselves the party of Medicare at every election, but they are largely responsible for its slow demise.

Medicare has seen a number of attacks through the years. Governments have been obsessed with pushing people into private health insurance. They have provided chronically inadequate funding, creating a situation where free healthcare became harder to access at times, leading to notoriously long waits to see many bulk-billing doctors. In the 2000s, there was a spike in doctors introducing gap fees — extra out-of-pocket fees paid by patients. Subsidies for specialist services have declined steadily since Medicare began.

In 1997 the Howard government raised taxes on working class people supposedly to pay for Medicare, bringing in the 2% Medicare levy surcharge. In 2014, the government of Tony Abbott attempted to introduce a co-pay system, to eliminate free healthcare with one stroke. This was defeated by mass outrage. His government was already plagued by regular protests of thousands of people, and they ditched the co-pay idea in early 2015, before activists could organise a repeat of the nation-wide anti-Abbott “March in March” protests of early 2014. The Liberal-National Coalition often faces immediate public backlash when it attempts to cut back Medicare. In contrast, Labor manages to introduce lasting cuts.

Labor claims credit for a system that it undermines

The Labor Party loves to claim credit for Medicare, when in reality they have spearheaded the slow destruction of free healthcare. In 2013, the Gillard Labor government imposed a “temporary” freeze on bulk billing rebates. The following Liberal-National government retained the freeze until 2019, when rebates were increased by just 1.6 percent.

An AMA (Australian Medical Association) report found that for three decades, governments have removed $8.6 billion from the funding of the most common GP consultation fees. The Albanese government’s promise of $3.5 billion “extra” funding over five years is less than half of this loss.

Just last year, Labor made large cuts to already-underfunded mental health support. And Albanese’s most recent budget includes further cuts to Medicare, hidden behind the guise of ‘saving’.

In response to alarm over the drop in bulk billing, Labor’s budget set aside funds for bulk-billing incentives — but only for concession card holders, pensioners and under 16s. These are cohorts that many GPs would already provide concessions for.

Labor’s approach completely ignores the very real struggle of low — and so-called middle-income earners. Many people are struggling to make ends meet, but are not eligible for concessions. Labor’s policy seems designed to break people away from the idea of free healthcare, treating it as a concession in extreme situations, a charity mindset, rather than a fundamental human right.

Many working people struggle to access healthcare

Labor and Liberal governments have effectively been cutting Medicare rebates by refusing to raise them with inflation. This has led to many clinics introducing co-pay fees and limiting their free services purely to concession-holders. There has been a fall in the number of people accessing bulk billing, and doctors have warned for some time that the situation is only getting worse.

Public hospital funding also needs to be drastically increased. Patients often find themselves on years-long waiting lists for essential surgeries, and there are constant delays to ambulance services, with ambulances still ramping outside hospitals. Labor is cutting health spending on Covid safety measures, even though the pandemic is still going and many vulnerable people are effectively still living in lockdown.

A report early this year found that there was a 50% increase in the number of people who reported not accessing a doctor compared to the previous year. Dental waiting lists blow out to years in some cases; for example, half of Tasmanian patients wait more than 3 years for treatment.

The Australian Healthcare Index June 2023 report, a survey of more than 10,000 respondents, found that 51% of people aged 18–34 report going to the doctor less often due to the cost. 43% of this age group reported skipping prescribed medication because they couldn’t afford it, and 35% of all respondents reported skipping medical diagnostic tests due to the out-of-pocket expenses associated with them.

There can be dire health consequences to people avoiding doctors, medication and medical imaging, and experiencing delayed treatment. Failing to deal with medical issues early can mean encountering worse problems later on. People who aren’t able to see a doctor early may find themselves in the hospital system later, which itself is already strained.

Healthcare is undermined by profit

This is the disastrous situation seen in systems dominated by private healthcare. Because health services run as businesses, healthcare providers have a business plan to work to, rather than a health plan. There are many areas of the industry that under-train and under-pay healthcare workers in the interests of business.

This impacts the care healthcare workers are able to provide. Many don’t have access to adequate training to provide safe and meaningful care to LGBTIQA people, or to people with disabilities, to migrants, refugees, Indigenous people, and people experiencing mental health issues or trauma.

Public hospitals are not run for profit, but the government diverts hundreds of millions of dollars in funds to private hospitals. Many of these private hospitals claim the right to discriminate in not providing services such as abortion. And public hospitals face incentives to prioritise privately insured patients.

While our public hospitals aren’t themselves run for a profit, and many publicly funded services exist (though not enough), the whole healthcare industry is dominated by the interests of big business, particularly big drug companies. The private pharmaceutical industry in Australia is a billion-dollar industry.

And the private health insurance industry is always waiting in the wings, lobbying for the eradication of public healthcare so they can make more money. In 2019 Mark Fitzgibbon, the managing director of NIB, openly called for Medicare to be abolished and private health insurance to be made mandatory. This would lead to the kind of nightmare scenario seen in places like the US. There, activists have been fighting for a universal healthcare system to bring an end to the horror stories created by the private health insurance industry.

Most Australian GPs operate privately. Bulk billing rebates — when they are adequate — mean that people can access private GPs without paying anything up-front. In the past, activists have fought for free, public, community-controlled health services.

Healthy policy analyst Charles Maskell-Knight told Guardian Australia: “The problem is we are obsessed with fee-for-service medicine, and we need to try and get away from that idea.”

ANU Associate Professor Louise Stone told The Lancet recently that the fee-for-service approach incentivises ‘quick and easy consultations rather than complex care, such as for people with chronic disease or mental health problems’. She said, “I do not understand why I get paid more for administering a flu shot versus a mental health examination. It’s not about the money, it never has been, I just want to do my job. Health is not a market.”

We need guaranteed health services that do not depend on a capitalist market, instead of the insecurity of a system in which most doctors are sole traders and small business owners.

Misogyny in the healthcare system

Women, trans men and non-binary people assigned female at birth are particularly affected by shortcomings in the healthcare system, often facing poor treatment rooted in misogyny. For years, key health issues such as endometriosis, menopause and abortion have been neglected because of the way capitalist society denigrates women.

In the 1970s, the women’s movement pushed for extensive changes in healthcare, establishing refuges and women’s health services. Aboriginal women were involved in fighting for changes to Aboriginal healthcare. These movements all pushed for a new way of organising healthcare, away from the private market model.

The winding back of Roe vs wade last year showed that even when improvements have been won, they can be taken away from us. It triggered a global discussion among abortion rights activists about how to ensure the ongoing protection of abortion rights in places like Australia.

While abortion is now decriminalised in all states and territories across the country, it is by no means safe, free or accessible to all those who need it. This is something that we need to fight for.

Access to reproductive healthcare is particularly difficult for people in rural areas. People accessing abortions face barriers of distance and expense, as well as facing doctors who refuse to provide access to the procedure. People face a ‘postcode lottery’ as to whether they have access to their own reproductive rights and bodily autonomy.

Barriers to LGBTIQ healthcare

Because the government is failing to address the bulk billing crisis, some of the medical centres adopting a co-pay system will include the small number of LGBTIQ-inclusive bulk billing services. This reduces the options for people who are already at-risk.

A 2019 survey found that healthcare was where LGBTIQ people in Australia feel the least accepted. They are also less likely to have a regular doctor than non-LGBTIQ people. Continuity of care is important for everyone, but particularly important when people are undergoing medical transition. Ongoing monitoring of health is key to many forms of gender-affirming care, especially hormone therapy. People need to feel secure that if they undergo medical transition there is a reliable healthcare system that can provide ongoing support.

Many aspects of gender-affirming care are extremely expensive, even when they are covered by medicare rebates. Many trans people already face especially high medical bills, including the expenses of having to miss work for some procedures. The crisis in bulk billing only makes this situation worse.

Everyone should have full access to healthcare, including gender-affirming care — something that many working people find themselves needing. Everyone deserves the control over their own body that is made possible by modern medicine, to live their lives to their fullest.

There is no reason healthcare cannot be fully funded for everyone at every stage of their lives — we have just watched the government pledge to spend $368 billion over ten years to build nuclear submarines. They claim they need to keep a tight rein on Medicare spending, but plenty of money can be found for a sabre-rattling campaign aimed at shoring up relationships with the US government.

Aboriginal healthcare continues to be in a dire situation

There is an enormous gap in life expectancy, rates of suicide, rates of incarceration, poverty and overall health between Indigenous and non-Indigenous people in Australia. “Closing the Gap” has supposedly been a goal of successive governments, but their policies have fallen behind targets for years.

Aboriginal communities suffer higher rates of heart disease, kidney disease and communicable diseases. There are higher rates of dietary problems and issues with alcoholism. These are diseases of poverty all over the world.

The cause of Aboriginal poverty is not a mystery. Massive amounts of wealth are stolen from Aboriginal communities, through the exploitation of labour, land and resources, but also in the form of inadequate funding and social marginalisation.

Capitalism is a system based on private ownership for the purpose of profit, and profits taken out of society lead directly to poverty. To actually close the gap in Aboriginal healthcare, we need to fight to take this wealth back, to place resources in the hands of Aboriginal communities, and for genuine self-determination — for Aboriginal people to have control over those resources.

Indigenous healthcare needs to be under Indigenous community control

A recent New South Wales state enquiry into remote and rural healthcare reported numerous cases of Aboriginal people facing racism at the hands of the NSW health service. Inadequate hospital care has led to the deaths of Aboriginal people, and is one of the factors in the high rates of Aboriginal deaths in custody.

Rural communities where many Aboriginal people live suffer from a lack of doctors, and face long travel times to get care. Many Indigenous people face the additional burden of not being able to trust the care that they receive. One of the demands of the Aboriginal rights movement is for Indigenous control of Indigenous services.

When the Aboriginal Medical Service was established by activists in Sydney in 1971, it sought to provide culturally appropriate care under the control of the community. They found that Aboriginal people who had avoided doctors because of bad experiences with the healthcare system were able to trust a service that they knew was in the hands of their community.

We have to fight for democratic, community control of health services, and for these services to be provided with adequate resources. All of this is connected to a need for self-determination and Indigenous sovereignty, and to the need to take the wealth out of the hands of capitalists and return it to the community.

We need a to demand a new system

The fight for Aboriginal rights needs to be joined by a fight for better healthcare for everyone. The reason that healthcare is underfunded is that the wealth of society is hoarded in the form of profits. Governments continually cut taxes on profit, and refuse to really touch the super-profits of the mining and banking industries.

Instead of adequate funding to address the widely-known issues, we have endless inquiries, such as the recent report into “Ending the postcode lottery”. Often these inquiries will make some good recommendations, but even as mild as these recommendations are, the political will to implement them is missing. Capitalist politicians, who work to ensure big business continue to make profits, do not want to make the changes necessary.

Real universal healthcare can be won by a mass struggle of the working class. Every layer affected needs to be at the forefront of the struggle. Healthcare workers, marginalised communities affected by bad healthcare policy, and workers in all industries and sectors have an interest in a genuinely universal healthcare system.

To truly end the postcode lottery, to make reproductive healthcare safe, free and accessible for all, to solve the problems in women’s, LGBTIQ and Indigenous healthcare, we need a complete shift in the way that Medicare is funded and the way that we approach healthcare.

Instead of wasting billions of dollars on nuclear submarines, and fanning the flames of war, we need to build hospitals and community/worker controlled services, providing culturally appropriate, informed care and education.

Instead of relying on a complex system of rebates, healthcare needs to be fully public and democratically controlled. It needs to be provided free at the point of service. This needs to extend to dental and mental health.

Democratic control would mean services can be extended to all areas that need them. If the communities affected have direct power over the services they receive, Indigenous people can ensure culturally appropriate healthcare, and LGBTIQ people can ensure healthcare that respects and understands them.

A working-class movement can win

When Labor introduced Medicare in the 1980s, it was because they were under the influence of militant working class activists. In the 1970s, the Whitlam government was elected on a wave of working class activism. When the Fraser government later dismantled their healthcare policy, working-class people held one of the largest general strikes in Australia’s history — the Medibank Strike of 1976. Conservative trade union leaders, like Bob Hawke, made attempts to demobilise the strike. But when Hawke was elected Prime Minister a few years later, his government was under pressure to introduce Medicare. He came to power when there was a historic public mood for universal healthcare.

Because of the work of thousands of working class activists, for decades Australia had a situation where most working class people could walk into a doctors office and receive free care without paying.

Now this historic victory is under threat. We need to respond to the threat by demanding more than just the saving of bulk billing, but a properly funded healthcare system that genuinely serves everybody.

Today, the Labor Party has been emptied out of the ordinary people who used to make up most of its membership. We need to build a new movement, and fight for a new party of the working class. This party must be based on social movements and trade unions. It should unite the fights for Aboriginal rights, LGBTIQ rights, women’s rights and services for working people, like fully-funded healthcare. Capitalism will never deliver this for us willingly — we need to fight for a socialist society.