Monday, March 31, 2003

Bulk billing

The Australian institution is far stronger than the government that runs it would have you believe. I did this talk on Life Matters just ahead of a Health Report special on the same subject. Anyone would think that the percentage of services bulk billed was now low. It is still not that far short of 70 per cent. Not that low at all.

In fact it is higher than it has been at any time in the years leading up to 1992.

The percentage of services bulk billed climbed from 45 per cent in 1984 to a peak of 72 per cent in 2001 and has been coming off a touch since then. It was 67.9 per cent in March 2003.

The real story is one of how popular bulk billing has been with patients and doctors. Popular with patients because it costs nothing out of pocket, and popular with the doctors that bulk bill because that is a unique selling proposition for them.

But the unique selling proposition is only available if the doctor agrees to charge not a dollar above the scheduled fee. An extra dollar and that sales proposition vanishes, patients have to hand over $26 dollars or so of real money and engage in paperwork. That doctor becomes much less attractive.

That's how bulk billing has kept down doctor's charges...

The Howard government has undermined it - first by not allowing the bulk billing payment to doctors to keep pace with rising costs, forcing many doctors to either abandon bulk billing or try to fit in as many as (a reported) eighty bulk billing patients a day in order to make it work.

And now it plans to remove that unique selling proposition for bulk billing - convenience.

Under its proposals doctors will be able to charge an extra dollar or two and offer just as much convenience - a simple swipe of the card and the handover of only the extra dollar or two. Most most-probably will.

It’s an idea that seems almost calculated to kill bulk billing.

Introduced on the largely spurious ground that bulk billing is bleeding.

It is only bleeding because the government began knifing it when it came into office in 1996.

Mmm… Removing a break on what doctors can charge… whose interest would that serve?

Thank heavens the ‘reform’ is held up in the Senate.

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Monday, March 24, 2003

The US is surprisingly vulnerable. 24/3/2003

It is throwing its weight around militarily and in questions of trade, but its economic underbelly is very soft.

And, I told Geraldine, not just when it comes to being a very big debtor to the rest of the world.

Most of the US's exports are intangible, entertainment and drugs among them. I mention drugs because most of the value in them is the intellectual property.

The countries the US sells to don't actually need to buy US music, drugs, films, TV programs etc.

They could copy them.

Think about it. The bulk of exports from the US are only worth something if the rest of the world agrees to pay something.

Or the rest of the world could pay less, or less than the US wants. Against Australia's financial interest we agreed to extend the patent life on drugs a few years back. The US would like us, and the rest of the world, to extend the term on copyright.

We could refuse. And the more the US throws its weight around worldwide the more likely it is that that someone will.

The US has a very soft underbelly.

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