Medicare doesn’t need a check-up, it needs a full-body examination

  • Published October 24, 2022

Sydney Morning Herald,  23 October 2022

One of corruption’s more insidious aspects is the way it gets explained away and diminished. The medico lobbies squealing about Adele Ferguson’s expose on Medicare rorts no doubt believe there is no problem because the practice is widespread and normalised.

This collective mentality is the gateway to rationalisation – fabricating a moral excuse or disengaging from the consequences because the behaviour has become normalised. But no matter how loud the lobbies shout or how powerful they are in the halls of power, Ferguson’s evidence is impossible to ignore.

Dead people are being billed and patient records falsified. A cottage industry has emerged to help practitioners milk the system. No one even denies Medicare is being rorted. Indeed, the debate is now about the scale of fraud.

My own organisation went through a well-publicised episode of fraud and corruption a decade ago. The pain of that exposure was felt beyond those guilty of rorting. Members, delegates and staff were humiliated and shamed.
But ultimately the exposure was entirely healthy. The rorters were expunged, and the HSU is perpetually alert to how it uses resources. Every time we spend a dollar we genuinely ask ourselves if members will benefit. As a result, our union membership has almost doubled, our staff has tripled and our finances have transformed from a $23 million deficit to a $55 million surplus.

The broader health system would benefit from the same discipline and rigour. Instead of brittleness it needs honest self-appraisal.

That’s the problem with Health Minister Mark Butler signalling a departmental probe into Medicare – he’s not going far enough. What we really need is a full royal commission with powers to discover documents and compel witnesses. The scope should extend beyond GPs and Medicare to consider how and where the health budget is being spent.

Our union successfully moved a motion at the NSW ALP party conference to make a state royal commission into health spending NSW Labor policy. But it would be more powerful if it was adopted at a commonwealth level.

In NSW, the annual health spend is $38 billion – more than one-third of the state’s budget. The truth is, no one knows where it’s all going or how it’s being spent. Health workers who keep the system moving – such as paramedics, therapists, radiologists, cleaners and nurses – know it’s not going to salaries. They have been operating under a pay cap for the last decade. Indeed, research by Professor David Peetz shows the average health worker will be several thousand dollars out of pocket due to the wages policy. In 2022-23, for example, a second-year paramedic will see their annual income shrink by $2402.61.

This underinvestment in staff has fostered an attraction-and-retention crisis. In the 10 years to March 2020 the number of vacancies in the NSW health sector doubled from around 3000 to 6000, but by July 2022 they nearly doubled again to almost 12,000 vacancies.

Every day health and hospital workers are going backwards, and we are on the precipice of a mass resignation. Yet, there is little transparency about the income of non-salaried doctors and specialists. What we do know is concerning. Locum doctors, for example, now charge up to $5000 per day, or $35,000 per week before expenses and accommodation. NSW spent $997 million on visiting medical officer costs in 2020-21, which was four times more than Victoria and 10 times more than Queensland.

There is also ample evidence of cost shifting in the system. A recent freedom of information request revealed about one-in-10 hospital beds in the Illawarra is occupied by an aged care resident. Anecdotally, we know there are similar challenges with disability care.
The unedifying squabbles between private health insurers and device manufacturers over who gets a bigger slice of the pie is another prime example of a complete lack of focus on how the public benefits.

There is no question Australia and NSW enjoy a world-class health system. But to stay healthy we need more than a cursory check-up. We need a full-body examination of where and how our health dollar is being spent.