'Capitalistic': It's time to re-design Medicare

Rather than enable capitalist business structures for GPs, Medicare should provide real government-led health care, writes Alex Lipa.

*This article was highly commended in the IA Writing Competition Most Compelling Article category.

*Also listen to the audio version of this article on Spotify HERE.

AUSTRALIANS HAVE, for the most part, had a harmonious relationship with Medicare since it was moulded into its current form by the Hawke Government in 1984.

Up until the latest pandemic, we would wander into the local GP clinic, announcing our arrival to the 19-year-old gatekeeper behind the reception desk. We’d wait for the compulsory 35 minutes past the time we booked, shooting daggers at everyone and anyone we feel has made our wait longer than it needs to be. The appointment would conclude and we would wander out of the clinic, not giving a second thought to the financial mechanisms behind this service.

Let’s deconstruct a typical interaction with a GP in 2023. The first thing that must be strenuously pointed out is that you aren’t seeing a doctor. You are first and foremost seeing a small business owner. A small business owner who is being savagely pulled end from end by increasing costs, decreasing real dollar revenue and a customer base with ever more complicated needs.

Deteriorating health, housing and education upshot of inequality

A broken promise is of no consequence when $254 billion for tax relief could be used for deteriorating health, social, aged and disability services, and for education.

Once your medical interaction is complete, the time has come to compensate this highly educated small business owner for their time. You hand over $85 to the poor kid you badgered seven times regarding your late appointment, and in an instant, a multi-billion-dollar computer system designed to rival NSA complexity calculates the sum that the patient needs to be compensated and deposits $39.75 instantly into your bank account.

How is this highly complex, glorified "Beem It" funded? By taxing the very doctors, nurses, admin staff and patients who use Medicare day in, day out. Nobody is proposing that the funding of the healthcare system itself should be abolished. It is the leaky bucket we use to fund doctors and reimburse patients that is a bureaucratic nightmare.

Why have we accepted that every social interaction must have a corporate entity inserted in the middle? Why is it normal to expect that doctors are smart enough to diagnose and treat our illnesses, but cannot be trusted to be productive without a convoluted billing system?

It would be nice to frame this article as a lightbulb moment occurring in a doctor’s waiting room. Unfortunately, like a lot of Australians, going to the doctor is not something that happens very often nowadays. We’ve reached the point under capitalism where even the most well-intentioned systems like Medicare and the NDIS are collapsing under the artificial pressure of treating every human interaction as a financial transaction.

Mental health reforms dying at the altar of politics

An announcement by the Victorian Government of a new mental health commission is worthless when mental health laws are being routinely broken.

The Government wants people to see doctors. We as a species know that despite healthcare being a right, it is also a considerable cost on society. Preventative healthcare is cheaper than reactive healthcare. It is as true of your oven or washing machine as it is of your body.

Would anything fundamentally change for patients or doctors if we removed this obsession with market-driven solutions to every problem? Do patients care if the room in which they see a doctor is owned by the doctor or the Government?

Let’s propose an alternative solution. A patient walks into a government-owned GP clinic. The doctor is paid an average salary of $275,000 per year and has all the equipment and consumables supplied by the Government. No need for the patient to compensate the doctor. No need for the government to compensate the patient. No need for the taxpayer to fund a financial reimbursement system that seems like the product of a Pythagorean fever dream.

And for those of you who are nostalgic, you can still wait 35 minutes past your appointment time.

*This article is also available on audio here: