Three decades after Medibank.(Politics)

NEARLY THIRTY YEARS ago, James McAuley and Peter Coleman gave me space in Quadrant to voice my concerns about Medibank. Over the ensuing decades, in Quadrant and elsewhere, I examined other issues in health care. As Medicare, nee Medibank, approaches its thirtieth birthday, I thought I might review my early public utterances in this journal. What was bothering me then? Was my angst justified? Or does the passage of time demand a new perspective?

I have an additional interest to declare. I did not know Quadrant's hospitable editors of the 1960s. But, at that time, both our current editor and the chairman of our Quadrant board were midwives of Medibank. I well remember a Yes, Minister-type meeting when I was President of the General Practitioners' Society in Australia. On Bill Hayden's right sat the departmental Sir Humphreys, headed by the late Dr Louis Weinholdt, inherited from the McMahon government. On his left were Medibank's architects, Richard Scotton and John Deeble, and his political advisers, including our current editor.

At the time, an arts degree saw me majoring in politics. My insights into public administration, so memorably parodied by Yes, Minister's Antony Jay and Jonathan Lynn, allowed me to sow dissent between those on the minister's left and those on his right. Of course, once Bill Hayden had bluffed the AMA into submission--to his surprise, as his autobiography tells us--the profession's opposition to Medibank was confined to guerrilla skirmishing.

Some seven or so years ago, I bumped into John Deeble at a conference. I took the opportunity to ask him why he had designed a system--Medibank--with an accelerator pedal, but with no brakes. He replied, candidly, that they had not thought that brakes would be necessary!

My role and credentials now clarified, what was in those early Quadrant articles?

The first article (May 1976), described two main concerns. The first was that the system encouraged the belief that "every patient and illness can be regarded as the 'domain' of one or other specialist, with a resulting professional frustration amongst GPs left the 'pickings'". The second was the threat of government direction of medical practice when, through bulk-billing, it gained control of the purse-strings of general practice.

The September 1976 article addressed "doctor-bashing" by the ACTU's Bob Hawke, who blamed "the doctors" for Malcolm Fraser's Medibank Mark III. The article concluded by quoting UK health economist Dennis Lees: "Medibank seems to rest on the same faulty logic and mistaken expectations that we in Britain have suffered from for over twenty-five years."