Medicine is pressured by a radical socialist transformation. Some of this is top down. Much of it is bottom up, writes Dr Grant N Ross
For 2 years I was the Melbourne University Liberal Club’s token doctor. Turning up late, or never, I would always be out of kilter with JSM, political theories and fights of the day and somewhat under the impression that Kroger was a kind of cheese. Luckily, being a stereotype got me over the line.I would like to redeem my standing by attempting to write about the direction of health under Labor and the alternative policy direction the Liberal Party should choose when in Government.
I feel that there is a need for a Liberal establishment to take note of the direction of health under Roxon and Plibersek and to hear the story I am about to tell about the pressures within medicine that will come to change the way doctors do politics for the next 20 years. All is not well, and I want to tell you why.
As we speak, Medicine is pressured by a radical socialist transformation. Some of this is top down. Much of it is bottom up.
The Top Down
From the top down, there have been a series of reforms that:
Create a greater role for government in health
Are mostly anti-doctor
Occurred without significant consultation with the medical profession
Involved the creation of enormous layers of bureaucracy to centrally manage an existing private industry
Prioritised special interests and unions rather than the front line service deliveries
Such reforms include the creation of many different councils to micromanage various health care aims instead of directly funding practitioners; and by doing so orchestrate a transfer of power away from practitioners and patients towards bureaucrats and their interests.
A quick list of the agencies and bureaucracies created by federal Labor include the following:
Australian commission on safety and quality of healthcare
National Health performance authority
Independent Hospital Pricing Authority
The Administrator and funding body
Australian Medical Locals Network
Australian national preventative health agency
Local Hospital Networks
Health Workforce Australia
Aged Care Reform Implementation Council
Mental Health Commission
Aged Care Financing Authority
There are three cardinal reforms by Labor that have made things worse in health; national registration, Prescribing and Medicare Locals.
Since 2010 we have had the imposition of a massive tax on doctors by way of a National Registration reform by Nicola Roxon. Previously, doctors were registered to a state body but are now registered to the Australian Health Practitioners Registration Agency; a centralised national authority.
AHPRA, formed by Labor to ‘facilitate’ national registration, imposes a $680 ‘Doctor Tax’ on doctors every year; much higher than previously imposed. The agency’s role, it seems, is to run a police check once a year, keep names on a register and then deal with a doctor if they do something wrong by threatening or taking away the legal right to practice Medicine.
Whilst most doctors agree on the need for professional regulation, nobody accepted the AHPRA model being imposed in the face of a functioning previous system.
There is an overwhelming sentiment among the medical community that the AHPRA reforms are decidedly anti-doctor. Firstly, they removed semi-autonomy from the previous state based QUANGOs. Secondly, the AHPRA came about against the wishes of the AMA and the medical profession at large. Thirdly, doctors have to pay extraordinarily higher registration fees. Fourthly, AHPRA lumps doctors together with other health professionals in an overt breach of professional autonomy:
What is most worrying is that the registration reforms are a direct step towards the complete Federal take over of health; via monopolising the licensing of ALL health professionals in the country to one federally controlled agency. This should be interpreted as a step towards government socialisation of the entire health workforce.
Nobody is quite sure what will happen in the future with AHPRA. I would look at it as a dysfunctional way of registering doctors and a target for reform under a Liberal government.
Prescribing under Labor
The Labor reforms have particularly offended the medical profession by allowing nurses and other non-doctors to prescribe medications. Prescribing has long been the privilege of the physician, a deeply difficult and precise business and the Government have legislated for non doctors to prescribe dangerous medications.
Doctors still do not agree with this. Below is an example of a lethal medication that should not be given to people in a range of circumstances ranging from addiction to intra cranial conditions that is available from a nurse with no medical training.
General Practice and the Medicare Locals
Medicare Locals are essentially the creation of large bureaucracies all across Australia to control the delivery of General Practice services. Marking the greatest shift of power away from the functioning private sector to yet more bureaucrats, these organizations claim to ‘coordinate resources’, ‘identify gaps in access’ and other nebulous imperatives.
They are really about creating a centralized bureaucracy, more removed from front line services, to control the allocation of General Practice visits. Most of these agencies will be run by non-doctors with political agendas. This WILL redirect front line funding.
Whilst most left leaning elitists and pundits would label a move against Medicare Locals as ‘protectionism’ for doctors, it should be a Liberal priority for several reasons.
Fee for service, rather than centralized allocation, is the most efficient form of funding for primary care. Doctors alone deliver the vast majority of primary care via their minute to minute labor. Direct funding is clearly superior.
Secondly, reinforcing private practice builds trust within the medical profession and empowers doctors to deliver good care for their patients.
Thirdly, it builds on the only model that can safely deliver cost effective health care in a flexible and dynamic way. There is pragmatism within the medical profession that is unrivaled in history. Pragmatism requires individual liberty. It is the antithesis of bureaucracy.
Doctors should be allowed to govern how they arrange their practice and the market is the best way to ensure that each patient finds the doctor they prefer. We all know that we would prefer to choose our doctor when we need them; not when the government tells us.
I have written about three big players in the health reform agenda of the last 5 years. National Registration and the step towards socialist health system, widening of prescribing rights and finally the complete government takeover of General Practice. These are just a few example of the top down socialist pressures on health that I have noticed. Alas, they are not the most worrying change ahead of us.
Luckily for us, Peter Dutton, Shadow Minister for Health, has already demonstrated his capacity for reform by pledging to scrap the Medicare Locals and GP super clinics.
Dutton is an ex policemen, successful businessman, ex-Minister in the Howard Government and assistant treasurer to the great Peter Costello. He is clearly a man who understands health and has a distinct policy vision to restore the health system to a position of strength, rather than interference and bureaucratization. I believe he will be warmly welcomed by the medical community and be one of the best advocates for the restoration of a sensible health system.
The Bottom Up
If the fantasia reforms of the Roxon/Plibersek era are anything to lose sleep over, they are nothing on the bottom up forces plaguing medicine at a much more sinister level.
Since my entry into medicine as a first year student in 2006, the values underpinning medicine have been rampantly veering towards the left. The pressures mounting from the bottom, aka medical school environments, are horrendously aligned with ALP and Greens stigmata. For those who thought that foaming at the mouth socialism and bureaucratic elitism were limited to the confines of the Arts departments, you are wrong.
The Medical schools themselves have pursued a long march style reform into the medical degree; especially in the selection of candidates. Traditionally, school leavers were selected based on ENTER/ATAR score and the Undergraduate Medical Admissions Tests. No test is perfect, but the principle was that admission was based on objective academic capacity; with a view to selecting bright school leavers (whether advantaged or otherwise).
This principle cemented medicine as being about academic capacity, something worth its salt in any market, rather than ‘social equity’. This is the right way for things to be.
Nowadays, courses almost universally select via interview. You can dress up how ‘official’ and ‘standardized’ your interviews are, but they remain the quintessence of subjective selection. That is the purpose of interviews. They are effectively a mechanism to allow people to form a personal opinion on a candidate. And exercise bias.
On a background of the inherent socialist tendencies of education at both secondary and tertiary level, the reforms to selection have outright enabled the medical schools to pursue a political agenda that aims to expand the role of government in healthcare, involve medicine into a nexus of government social equality agendas and further the promotion of minority special interests to any particular degree. This is the definition of long-marching.
The results of these efforts are now coming to fruition. Medicine is becoming overtaken by special interest group after special interest group, all vying to dictate the rules of medical practice and employment, values and principles in an ever growing mountain of elitist control. The effects of this can be seen via organizations such as the Australian Medical Students Association, the Post Graduate Medical Council of Victoria and even the Medical Journal of Australia and the Australian Medical Association; a nexus of bureaucratic woe:
These organizations are replete with bureaucratic choke holds and indecisive post modern ‘collaboration tactics. The result, obviously, is what we have seen under Kevin Rudd: Power from the people to their overlords in an ever growing unholy alliance of bureaucrats, red tape and pathetic backyard politicians who would rather do anything to promote themselves rather than a good idea. It promotes ‘sellout politics’ and betrays the individuals who together make medicine what it is and what gives individuals the right to be free in this country. So long as this framework persists, doctors will be worse off and patients will be worse off.
At the moment, the AMA can be proud of the leadership it has had. Brendan Nelson went on to become Liberal Party Leader. Rosanna Capolingua was clearly Liberal, Michael Wooldridge kept General Practice sustainable and independent. Steve Hambleton, current AMA leader, stands for sensible restraint and genuinely aims to protect autonomy for doctors. We have been lucky. But I am not so sure about our future. Just look at what the ever growing Australian Medical Association calls for on Climate Change:
Australian Medical Student Association
- The Australian Medical Association’s is little better than the student body in this regard:
I think I have made my case. If anybody in the Coalition did have a silver bullet to stop the long march, they’d immediately be preselected for a golden safe seat. I am not that man.
However, if we were to theoretically look at reversing the political bias pressuring medicine in Australia, I would start with reforms that target medical selection, medical training, the de-bureaucratisation of medical registration at the junior level and aim to move the governance of medical training away from University bureaucrats and elitist back to grassroots doctor groups.
This would help. There is an argument for such change on the basis that it restores efficiency and principles of autonomy to the medical profession and by extension of that, to patients. It would be one hell of an effort, but I honestly do not believe it to be beyond an Abbott government to achieve in some capacity.
The other issues are perennial for Liberals; especially for those of us who have campaigned on campus. The fight against bureaucrats, against elitists and to genuinely reform education in this country in the way that David Cameron is trying in England. Perhaps some of the above changes could be caught up in a commission of audit. I would like to see that. But I don’t know. I am not a politician.
As a doctor, I naturally bring more of a background of social sciences and welfare to the Liberal table than I do tax reform and economics.
However, there is a need for a Liberal establishment to take note of the direction of health reform that the Roxon and Plibersek ministry has imposed on health and a need to identify them as inefficient, retrograde, centralist and to be removed as needed. Equally important is the message I would like to impart about the need to think about what is needed to prevent the medical establishment being long marched into foot soldiers for the ALP.
Just remember, health accounts for 12-17% of spending and employs 11% of all Australians. That is one hell of a voter base to lose to the left.
Peter Dutton has a lot to contribute to health in the next Liberal Government. Autonomy, efficiency and restraint will serve our country well. Similarly, I encourage young Liberals in rising positions of leadership to consider the principles of a sound health system as they develop their policy directions.
The electorate expect a good health system and we have no excuse for leaving ourselves weak on this front from a simple lack of knowledge.
Dr Grant N Ross MBBS B.Med Sci is a medical practitioner and graduate of Melbourne University.
Footnote I - The Health Practitioner Regulation National Law came into effect in 2010. Whilst it was a COAG agreement, AHPRA was a cornerstone commitment of Labor and driven largely by their political agenda and under mostly government influence.
Footnote II - http://www.ahpra.gov.au/ accessed 6/11/2012
Footnote III - http://www.amsa.org.au/ see About AMSA accessed 6/11/2012
Footnote V - Australian Medical Students 2010 Policy Document Climate Change and Health see website www.amsa.org.au
Footnote VI - http://ama.com.au/node/4442