Co-payment to see doctors

The outrage that has greeted proposals of a $6 co-payment for a visit to the GP is a sight to behold. The ALP’s health spokesman, Catherine King, was mortified

Mr Glasson is today stating what the Prime Minister and Mr Dutton are too scared to admit.

The Coalition want to sneak in a new tax that will hit families every time they take their sick child to the doctor.

Families shouldn’t have to keep footing the bill for the Prime Minister’s broken promises.

Labor will fight the Coalition’s new GP tax in 2014, in Griffith, and right across the country.

The proposal is hardly a tax – it is a fee for service that covers a small fraction of the taxpayer-funded medicare contribution for each visit to a doctor.

I have long supported a modest co-payment for visiting a GP, and, for that matter, visiting a hospital. Price signals are important, and even if set well below the actual cost of the service at least weed out the worst cases of overservicing.

I agree with Andrew Podger that the co-payment should be around $30. If we want to get the Federal Budget into surplus, and offer the prospect of future tax cuts, the Government has to be serious about significant cuts to spending and applying sensible co-payments for accessing government-funded services such as Medicare.

The same people who would think nothing about spending $100 on a night out, or throwing $50 at the poker machines, or spending $5 on a cup of coffee, seem to think it outrageous to spend $6 going to see a GP. It seems that their priorities are wrong.

About J

J has an economics background and is a part-time consultant
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224 Responses to Co-payment to see doctors

  1. Tel

    It’s a reduction in spending, not an increase in tax. The $6 goes to the doctor, not to the government.

  2. john malpas

    you co pay for the pills do you not.
    Will the doctors dare to try to collect the $5 or just have to wear it for business’s sake.

  3. Barry

    In pre socialised medicine days, doctors covered “charity cases” costs pro bono. I imagine if there is a family who truly cannot afford $6, then any doctor would consider doing the same.

    Best, of course would be a return to the old ways.

  4. Empire Strikes Back

    I agree with Andrew Podger that the co-payment should be around $30.

    There is a false perception that the Medicare levy funds the health budget. First demolish this myth, then go for co-payment. $30 isn’t politically feasible. It’s principle thing, go for $5 first up and then see what impact the price signal achieves.

  5. deiseal

    This proposed co-payment is a waste of time, at least in the country, GP’s already charge co-payments and the people who use healthcare cards will be excluded. Far better to reduce the number of people on Healthcare cards.

  6. entropy

    One thing that needs to happen is for income tax to be reduced and the Medicare levy increased to truly reflect outlays on Medicare.

    On the matter of the co-payment, not a criticism of the concept, but the political reality of any implementation of the proposal would reduce the efficacy of its purpose to reduce over servicing. You can just imagine it:
    1. We are going to introduce a copayment to reduce over servicing
    2. Oh, we are copping heat from little old ladies, so we have decided to exclude pensioners
    3. Oh, babies. OK, let’s exclude young families.
    4. Oh, womyns’ problems. Can’t talk about that, better exclude those too.

    Now, what was the point again?

  7. Jazza

    I can’t see any government hitting people first up with a $30 copayment for each visit–what would that make the cost of a visit to Specialists, who already charge you something akin to $120 each visit even when you are a pensioner?
    I expect the government will announce it is going to pay between $5 and %10 less per claim to GPs, and let their ofices face the clients and ask for the co payment.
    In no way will this be a new tax, but it will surely be spun so on “our” ABC and through Fairfax papers, that will find a real government action to diss and not have to forecast the PM’s likely future missteps as real facts, to fill their nasty anti- everything- Liberal- Government front pages

  8. Sid Vicious

    Parramatta Leagues Club information for members and guests:

    Bingo

    Play Bingo at Vikings every Friday from 12pm. Just $1.00 a book for a chance to win great prizes.

    It’s a fun, social event with some good old fashioned ribbing!

    I wonder how many people spend their days with a bar stool stuck to their arse and then amble off to the local doctor complaining of mobility problems.

  9. Ant

    Speaking of illnesses, you can see how sick the Left’s welfare obsession is right there.

  10. Fred

    The Latham Definition –

    a tax … is a compulsory exaction of money by a public
    authority for public purposes, enforceable by law, and is
    not a payment for services rendered.

    Paying to go to the doctor is hardly a tax. Some ALP members are retards.

  11. grumpy

    Those whinging about it should move to a large regional city where the co-payment is around $35 coz no doctors bulk bill at all.

  12. Leigh Lowe

    The senior doctor at a large clinic in our town constantly bemoans the long line of time-wasters clogging his clinic. Many are there for nothing more than a chat and possibly a moment in the day where they are the centre of someone’s attention.
    That may be an indicator of other societal problems, but these are not problems which require the scarce resources of our GPs.
    I’ll bet a $5 co-payment would cut down the number of clinic cloggers.

  13. CatAttack

    My doctor doesn’t bulk bill. I already pay a $40 “co-payment” called a gap. The hysteria over what is a modest co-payment that excludes pensioners is ridiculous. Of course the campaigns on social media have already kicked into high gear with “hands off our Medicare” and Bill Shorten (remember him) describing it as a tax. I prefer to take advice on this matter from that respected economist Andrew Leigh http://andrewleigh.org/pdf/Medicare%20oped.pdf

  14. cuckoo

    The news services did the usual roundup of vox-pops, and the women who thought $6 to see a GP was a ‘hardship’, were not exactly wearing potato sacks and sporting self-administered pudding-bowl haircuts.

  15. Bruce

    Good idea or not,no one can deny it was a political master stroke to have Bill Glasson being allowed to carry the smelly can. I’m sure the Labor candidate for Griffith,Terri Butler,would agree. Bye bye Bill.

  16. vlad

    Politically $5 is better than $6 as it’s a single banknote.

  17. Flyingduk

    Whereas the benefit of a co-payment as a price signal is self evident, where is the discussion about the inefficiency and stupidity of an ‘insurance’ system that covers minor, predictable and ongoing costs? Insurance is intended to cover you against major and rare losses, not minor, weekly or predictable ones. Medicare is analagous to an ‘insurance’ system to pay for your cars petrol. Medicare should cover only large, unpredictable and potentially ruinous expenses, eg the cost of admission to hospital for surgery. It should not cover minor expenses like a $50 doctors bill. Doing so incurs heavy administrative costs whilst simultaneously implying to people that the service is cost free.

  18. Walter Plinge

    For the co-payment to be effective you would need to simultaneously introduce a reasonably substantial co-payment (say, $60) for attendance at public hospital emergency departments. These are clogged up enough already with minor cases of the sniffles.

  19. .

    Grumpy is right.

    Bulk billing is a dead sacred cow in some parts.

    I don’t get how the ALP call this a tax – but a tax cut is a “saving”. Interesting…but wrong.

    I’ve heard King talk when she was a very junior Minister. At first I questioned her intelligence. I was wrong. She is simply playing the part the machine tells her to do. She is on automatic – here is the script.

    I consider a power hungry and dangerous individual.

    Her CV reads like an abomination to those who are regulars here. A director at KPMG, of social services?

    With no apsertions about her work ethic, I’m not entirely sure she’s ever made an honest buck.

  20. CatAttack

    Bruce Yes I can see the ALP campaign posters already featuring Bill Glasson, an over-wrought hysterical mother and a sick kiddie with a snot running down his nose, rheumy eyes and 40 degree fever who is forced to stay at home because of Tony’s tax on battlers.

  21. Mr Rusty

    Wow. Leftard outrage over a minor impost for a service where there is a verifiable, measurable return to the consumer and often of great personal benefit (the diagnosis and cure of a disease or illness.)

    My power bills have almost doubled in 3 years thanks to the Carbon Tax for absolutely no measurable return or benefit whatsoever to me or any consumer and certainly no producers (except Greentard produced trash.) In fact the impact on job losses and business closures has been a double whammy as even more tax dollars need to go to support the increase in unemployment.

    Leftard reaction – not a peep.

    Coalition strategy from now when faced with howls of outrage should be to explain that people will be able to afford to see the Doctor every week once Labor’s Carbon Tax is repealed.

  22. Arjayh

    I don’t see what the fuss is. I pay $76 for a consultation with the doc and get $35 back from Medicare. And the waiting room is always full of patients.
    The minimum fee should be starting at $10 to reduce the over servicing.

  23. Gab

    Rather hypocritical of anyone from Labor to criticize the government over this given it was something they themselves were willing to do a few yeas ago. But it’s different when they do it, naturally.

  24. Rabz

    People are whining about a $6 fee to access a scarce service?

    Idiots.

  25. sabrina

    Few queries and comments
    1. What proportion of GP visits are unnecessary visits or time wasters?
    2. Where does the $6/visit come from? My GP charges us $10 and we visit only if we want. We preferred to visit him over the bulk-billers (have plenty in our area) because we are comfortable with his diagnosis methods and reluctance to prescribe medicine unless required or any procedures willy-nilly.
    3. From what I have read, it does not seem that GP visits are the main reason for ever-increasing cost of health care. Is there enough competition among the health funds?

  26. boy on a bike

    My current co-payment is $35 to see our GP. The total fee is $70 for a consultation, and Medicare rebates half of that. The place I go to used to bulk bill, but they were overwhelmed with patients, so they started charging. Some of the doctors at the clinic still bulk bill, but you need to book a day ahead to get in to see them and there is every chance you’ll be sitting in the waiting room for an hour past your appointed time. With the private GPs, you can book same day and the wait is almost non-existent. From what I gather, most of the GP clinics in our area are now doing the same.

  27. Johno

    I have long supported a modest co-payment for visiting a GP, and, for that matter, visiting a hospital. Price signals are important, and even if set well below the actual cost of the service at least weed out the worst cases of overservicing.

    A government mandated co-payment isn’t a ‘price signal’! It maybe a good way to help fund a taxpayer funded service and it maybe a good way of reducing over use of the system, but it most defiantly isn’t a price signal.

    Price signals only arise in free markets where the users are confronted with the true cost of providing a service from providers who have to risk their own money in offering those services. These prices provide information and incentives to the users and providers to make the best possible use of resources to satisfy the users most urgent wants.

    A government administered ‘price’ achieves none of this!

  28. candy

    $5 co-payment is a good idea. Co-payments at Emergency is a really terrible idea.

    Tony Abbott and Peter Dutton have got to get out there and sell the positives immediately before the ABC and leftwing media take it over and ruin it for them, but the government is missing in action (as usual).

  29. GerardB

    What is the problem – I spent $20-30 per week pursuing lotto and pay my GP $65 for a standard visit; of which I receive an immediate rebate of about $36.20 from Medicare, a nett or co-payment of $28.80. Bewdy – good value.

    Surely, if you want good medical treatment, some form of co-payment is essential.

  30. Obio

    Leigh Lowe #1132635, posted on January 3, 2014 at 8:43 am
    The senior doctor at a large clinic in our town constantly bemoans the long line of time-wasters clogging his clinic. Many are there for nothing more than a chat and possibly a moment in the day where they are the centre of someone’s attention.

    My father was a country doctor and repeatedly made the same comment, often these people were on the pension or some other form of government assistance. Excluding pensioners and social security card holders will defeat the purpose to a great extent.

  31. Price signals are important,

    In the case of medical services, people typically under consume preliminary services resulting in higher costs further down the track. If the goal is to minimise expenditure using price signals the smart thing to do would be to pay people to have regular check ups to ensure medical issues are dealt with before they become serious and expensive to remedy.

    But then, that wouldn’t be screwing over poor people, so we can’t do that.

  32. .

    Considering those on welfare don’t pay, I can only udnerstand you endorse the plan Desipis and want the copayment charged at hosptials.

  33. pete m

    Old debate – medicare!! It de-valued doctors. It made their service into a consumable rather than a necessity.

    New debate – hey let’s put a value on it. Naturally the freeloaders say even $5 is too much. It is beyond parody.

    I’m lucky I guess to have stuck by my GP and when he went above the rebate he kept his old patients with no co-payment – I guess that is reward for keeping me alive!

  34. pete m

    Despisis – my personal experience is those on welfare over utilise medical sevices like GP and hospitals. I see their claims history regularly and it runs to pages. I cannot see why anyone needs a payment to visit the GP. that is bizarre. There is nothing stopping them having regualar health checks, but now apparently mother Earth (i.e. taxpayer) needs to PAY THEM to use a free service?

    PUHLEASE!!!!!!!!!!

  35. Token

    I’ll bet a $5 co-payment would cut down the number of clinic cloggers.

    There seems to be a danger of a program ruined by unclear & therefore mixed objectives.

    No one could realistically think that the $5 was to fund the program, rather Leigh identies the cost being offset.

    By putting the value of $30 into the public sphere, Podger is fuelling the lefty scare campaign.

    Have you guys learned nothing from Hewson’s ’93 election loss?

  36. MuddyPuppy

    My job – I’m one of those dastardly public servants many on here despise – brings me into contact with a broad range of people who access the public service my organisation provides. A great percentage are aged, some own their own very palatial homes, and others live in public housing. My point is this: While I am not privy to any of their financial details, observation over a period of time informs me that if you can afford cigarettes, alcohol, pay television, visits to the pokies, and fresh ‘gossip’ magazines each week, then you can afford a small co-payment for a health service. Certainly there may be some who privately rent and have overwhelming medical bills for chronic conditions, but the vast majority of pensioners I work for (who pay nothing for the service I provide) are by no means destitute.

  37. Token

    My father was a country doctor and repeatedly made the same comment…

    My brother in law refuses to bulk bill & imposes an extra payment to ensure he can retain other doctors in his practice.

  38. A rare injection of reality by desipis into a stream of Cat stupidity.

  39. dot, no. I think introducing price signals/market mechanisms into the medical services field will corrupt the decision making processes and result in worse outcomes overall. The last thing we want to do is head towards the screwed up heath system the US has.

  40. .

    monty

    Can you tell me how many “poor people” go to the doctor to get regular check ups and how many will be stopped by the co-payment?

    Don’t you think people are going to take preventative care more seriously – i.e safer sex, less binge drinking, more likely to get innoculations because of this?

    Basically anyone who is tight with money, rich or poor, would want to minimise visits to the doctor.

    You are saying this makes them completely unaffordable. I think this is untrue.

  41. Foggyfig

    I would gladly pay a co-payment if it meant I could see my doctor on the day I need to not 3 weeks hence which is the waiting time in our local town. If I wake up sick and need to see a doctor today, I ring the surgery they say sorry no available appointments, I then take myself to the local small hospital and they call the surgery for advice which is usually please come back at 6pm and the doctor will see you then.

  42. .

    Desipis the US does not have price signals as they are idealised.

    The Government demands the employer buys coverage. What obligation does the employee then have to look after their care?

    What price signal was involved there? Large fines and a higher cost of employing staff.

    I think introducing price signals/market mechanisms into the medical services field will corrupt the decision making processes and result in worse outcomes overall.

    Why not for buying a home, or buying food?

  43. boy on a bike

    From the UK - wonder if the same is happening here? This wouldn’t help.

    Indeed, in this age group, 61 per cent of doctors are now women and 39 per cent men.
    In the age group 30 to 50 years, over the same period, the number of female doctors increased by 24 per cent compared with 2 per cent for males. In this age group, men still outnumber women by 54 per cent to 46 per cent — but that ratio will soon reverse.
    I fear this gender imbalance is already having a negative effect on the NHS.
    The reason is that most female doctors end up working part-time — usually in general practice — and then retire early.
    As a result, it is necessary to train two female doctors so they can cover the same amount of work as one full-time colleague.
    Given that the cost of training a doctor is at least £500,000, are taxpayers getting the best return on their investment?
    There is another important issue. Women in hospital medicine tend to avoid the more demanding specialities which require greater commitment, have more antisocial working hours and include responsibility for management.

  44. .

    Foggyfig
    #1132776, posted on January 3, 2014 at 11:13 am

    I would gladly pay a co-payment if it meant I could see my doctor on the day I need to not 3 weeks hence which is the waiting time in our local town. If I wake up sick and need to see a doctor today, I ring the surgery they say sorry no available appointments, I then take myself to the local small hospital and they call the surgery for advice which is usually please come back at 6pm and the doctor will see you then.

    Bingo.

    If you have a respiratory infection, waiting three weeks might kill you. Or you might have to go to hospital. Or you could just pay $5 and get in and treat society to some preventative care, take pressure off the hosptials and get weeks of your life back.

  45. my personal experience is those on welfare over utilise medical sevices (sic) like GP and hospitals.

    There will be those that over utilise, and there will be those that under utilise. The question is which costs the system more. As far as I’m aware the evidence shows its the later that cost more. This is why you see health funds try to subsidize all sorts of preventative health care related products and services. So do we want government to go with a policy that follows the economically rational actions of the market based health funds, or go with a policy that satiates the conservative hate for poor people even though it costs more in the long run?

  46. Mat

    ‘Another injection of stupidity by monty into a stream of Cat reality’

    Fixed it for you.

  47. Tel

    Old debate – medicare!! It de-valued doctors. It made their service into a consumable rather than a necessity.

    There was an even older debate about whether the medical industry should be run by one big union, but I guess finally modern air transport has resolved that debate.

  48. .

    What evidence?

    You are just speculating that $5 will deter people to go at all rather than let people get care when it is needed.

  49. Grumbles

    Desipis, yes, you may pay people to have check ups. I don’t want to but you can spend your money on that, because God Forbid, they cared about their own health.

    I hate it that socialist medicine is used as an excuse for all the other Big Brother programs.

  50. Brett_McS

    Doctors used to be typically the most respected people in the local community, and politicians hated that. A doctor friend related to me how he was next to Neville Wran at a dinner and Wran said to him – perhaps after a few wines, and paraphrasing – Doctors are the last independent authority figures in society and we aim to control you. The politicians have certainly fulfilled that promise.

  51. candy

    If you paid “poor people” $5 to go to the doctor for a check-up, they wouldn’t go. The transport to get there would nullify it, or $5 would just not be enough to nudge someone out of the house when they’re got something better to do.

    You’d have to pay around $20 or more to make it worthwhile, maybe even more. It would have to be compulsory too. What a silly idea!

  52. Why not for buying a home, or buying food?

    Because they are different types of decisions, both in terms of the capacity of regular people to understand their medical needs (and hence judge whether the cost is worth it) and also the way human psychology impacts medical related choices.

  53. Infidel Tiger

    Doctors are the last independent authority figures in society and we aim to control you. The politicians have certainly fulfilled that promise.

    They certainly have. The AMA is a left wing terrorist organisation.

  54. Tel

    If the goal is to minimise expenditure using price signals the smart thing to do would be to pay people to have regular check ups to ensure medical issues are dealt with before they become serious and expensive to remedy.

    My experience with GP visits is they hardly check anything. Generally if I come down sick and need a medical certificate I come in and say, “Hey I caught something, I feel sick” and the GP says, “Yeah, you look sick, have a medical certificate.”

    Once upon a time they would also prescribe antibiotics, but now they just tell you to go home again. I’ve never quite understood the purpose of the whole procedure, nor why employers take it so seriously that you have to show a medical certificate. Is this going to magically save money? I can’t imagine how.

  55. .

    desipis
    #1132794, posted on January 3, 2014 at 11:26 am

    Why not for buying a home, or buying food?

    Because they are different types of decisions, both in terms of the capacity of regular people to understand their medical needs (and hence judge whether the cost is worth it) and also the way human psychology impacts medical related choices.

    A lack of adequete or appropriate food and shelterare inimical to health. How many people are building surveyors or nutritionists?

    Surely they are the same sort of decision?

  56. .

    ‘shelter are’

    Sorry, I hate typos

  57. Surely they are the same sort of decision?

    Your argument is that knowing you’re hungry and hence need to eat a sandwich is the same as knowing you have cancer and need chemotherapy?

  58. stackja

    Barry
    #1132587, posted on January 3, 2014 at 8:07 am
    In pre socialised medicine days, doctors covered “charity cases” costs pro bono. I imagine if there is a family who truly cannot afford $6, then any doctor would consider doing the same.
    Best, of course would be a return to the old ways.

    Public hospitals before ALP had VMOs

  59. .

    Your argument is that knowing you’re hungry and hence need to eat a sandwich is the same as knowing you have cancer and need chemotherapy?

    I never said that, but please explain why they are not the same.

    It would be good if you can explain why charging a co-payment doesn’t create lifestyle changes that can prevent most cancers.

  60. Andrew

    I’d like these grubs to explain if a small co-payment is indicative of conservative666′s wanting to destroy Medicare, why it was a Hawke govt initiative?

    I’ve heard ideas like “first 12 free” to stop this kind of rubbish.

    @Entropy, you’re right – it’s there to stop the chronic overservicers who are overwhelmingly the same old people who will be exempted.

    What are we actually trying to stop, overservicing? There’s probably better ways.

    Anyhow, I went to the doc while on business in Perth. Have a $36 copayment because we don’t bulk bill. And a surcharge for being here for the first time. And we can’t sort you out today coz the nurse is busy, so come back tomorrow. And that will be another couple of hundred (including $45 for the fucking SUTURE KIT to sew you back up after we’ve finished!). Strangely enough, I paid it.

  61. Lem

    IT, it is true that we doctors are generally gutless bastards, mainly because we actually have to face our patients and don’t generally have the stomach for withdrawing services over fee issues, however if you cast your mind back ten years to the medical defence crisis, government soon jumped to on legal reforms when doctors threatened to walk away from high risk specialities. And some significant reforms they were.

    I think the co payment will and should go ahead, it is modest at $5 and should be $10 probably. Anyway, a single note, no need to handle coins. Most people are already paying, and doctors already select the needy to bulk themselves.

  62. Andrew

    pay people to have regular check ups

    sounded pretty moronic at first reading but we now have proof that there is no leftist thought bubble so stupid that m0nty doesn’t approve it.

  63. Bruce

    It’s the thin edge of the wedge thing. $5 this year,how much next year ? $20 ? $30 or more ? We all know Government charges or taxes never really go down,at best they sometimes just get repackaged.Unless the Government walks away from this bright idea very smartly it’s sure to be a major issue for the Griffith by-election and for Glasson and Abbott it’s a loser all the way.

  64. .

    pay people to have regular check ups

    Given how useless the health hotline was – this is a real dud.

  65. Lem

    Andrew I guess the $45 was the difference between healing by primary and secondary intention, so probably a worthwhile investment :)

    BTW there is a lot of government surveillance now for over servicing, which is easy to identify by item number searches and comparing a docs profile against the average. The department regularly comes for suspect practitioners and does audits, with demands for payback if over servicing is proven. And we all get sent annual reports pour encourager les autres…

  66. Brett_McS

    Only when services are provided bureaucratically (and hence funded by the taxpayer) do we hear talk about the need to reduce the cost to the system. Do we talk about reducing costs to the food supply system, or the lawn mower supply system? No, because these systems expand and contract according to need. With bureaucracies, as von Mises showed (in the aptly titled “Bureaucracy”) the system doesn’t exist to serve the customers, it exists to serve the employees. However it starts out it eventually reaches the point where all the taxpayer dollars are spent on “friction” – internal costs. Nothing comes out the other end.

  67. rebel with cause

    satiates the conservative hate for poor people even though it costs more in the long run?

    Yes that’s conservatism in a nutshell isn’t it – just sheer hate for the poor. I won’t be sated until the streets of Sydney represent a Dickensian London, with shoe shine boys and chimney sweeps doffing their caps as I pass down the street, silently hating their poor beady eyes.

  68. dot,

    It would be good if you can explain why charging a co-payment doesn’t create lifestyle changes that can prevent most cancers.

    It would be good if the people supporting the co-payment would explain why they think it would.

    The issue seems to be a small fraction of the population are irrationally over consuming health services wasting the doctor’s and their own time. So the “solution” is to impose a price signal which would cause rational people to consume less services. At what point does the price signal make people who were behaving irrationally magically start behaving rationally?

  69. Also, since doctors are already free to charge more than the Medicare rebate, why not leave the market to determine whether an extra fee is charged rather than have the government come in and dictate doctors’ fee structures?

  70. Lem

    Rebel, you need to see someone about those thought processes. Take your concession card and your GP will bulk bill you :)

  71. Dot, your argument at 11:11 is pure nudge conservatism. Surprising, coming from you.

    The co-payment idea couldn’t get up under Hawke, I don’t see how a much inferior politician like Abbott thinks he could swing it.

    The myth that the Libs are better economic managers is shown to be a lie with thought balloons like this one.

  72. Gab

    The myth that the Libs are better economic managers

    LOL what a moron you are.

  73. JC

    Fatboy

    In this case you think that the sign of being a better economic manager is if doctors visits had absolutely no co-payments, right?

  74. Notafan

    In the late 1980s I had no bulk billers in my area and paid between $30 and $75 for doctor visits, it wasn’t an option not to take sick infants to the doctors so we paid. That was a lot of money on a very tight budget.
    Now we have bulk bill and a GP who comments about the full waiting room because there is nothing good on TV. The trouble is I think the biggest overusers are likely to be the people with too much time on their hands.
    I have suspicions about emergency room visitors as well, the same people who can’t be bothered taking their kids who have a virus to the doctors during the day and then going up after tea to the hospital.
    Of course this is all about city dwellers as I don’t know anyone living in rural areas who can access bulk billers.

  75. .

    Because Desipis, an even smaller proportion would actually be discouraged by the $5 fee.

    The disincentive is a one off payment for those who get checkups. The disincentive is many payments for those who are reckless and expect the doc to patch them up.

    At what point does the price signal make people who were behaving irrationally magically start behaving rationally?

    Funny you ask that given you think that $5 per year is going to make people irrational. Maybe they will just cut out a luxury (like one coffee or beer per year). Maybe if they are rational now they will alter their budget accordingly?

    now monty – do you think doctors charging what they like and operating pro bono for the poor out of their own freewill is “nudge conservatism”?

    Yet you support high excise taxes for ‘road congestion’ and ‘health reasons’.

    Ergo you did not make a credible criticism, monty.

  76. Lem

    Nota fan, I think the Labor argument that people who have to pay a modest copayment to bulk billing doctors are going to spend several hours sitting in a hospital A&E department for flu symptoms rather than pay is ridiculous and shows they haven’t walked through a public hospital lately. We are talking the cost of a cup of coffee.

  77. Infidel Tiger

    Once upon a time they would also prescribe antibiotics, but now they just tell you to go home again. I’ve never quite understood the purpose of the whole procedure, nor why employers take it so seriously that you have to show a medical certificate. Is this going to magically save money? I can’t imagine how.

    GP’s are just a referral service for specialists and someone friendly to drop your stride in front of.

  78. tomix

    The ALP needs all the help it can get in the Griffith by-election.

    The Courier Mail will struggle to present ol’ ambulance chaser T.B. as a worthy candidate.

  79. Obio

    desipis #1132769, posted on January 3, 2014 at 11:09 am
    dot, no. I think introducing price signals/market mechanisms into the medical services field will corrupt the decision making processes and result in worse outcomes overall. The last thing we want to do is head towards the screwed up heath system the US has.

    As opposed to the UK system.

  80. Obio

    m0nty #1132766, posted on January 3, 2014 at 11:06 am
    A rare injection of reality by desipis into a stream of Cat stupidity.

    Monty displaying his usual lack of understanding/knowledge of a topic.

  81. Obio

    boy on a bike #1132778, posted on January 3, 2014 at 11:14 am
    From the UK – wonder if the same is happening here? This wouldn’t help.

    Fathers experience over 40 years was that getting doctors to move to a country practice was very hard and getting female doctors was almost impossible.

  82. rebel with cause

    the smart thing to do would be to pay people to have regular check ups to ensure medical issues are dealt with before they become serious and expensive to remedy.

    It’ll be a cold day in hell before I’m dropping in to visit a quack when I’m perfectly well. You seem to be under the misapprehension that your local GP can tell if you have cancer or not just by giving you a quick once-over. You’re in for quite a surprise. Best of luck with the unnecessary, invasive medical procedures you’ll be having.

  83. Tel

    You seem to be under the misapprehension that your local GP can tell if you have cancer or not just by giving you a quick once-over.

    Remember how up in arms the regular doctors got over the idea of full body scanners? They were jumping up and down to tell people that there was absolutely no benefit, could not reliably detect anything, and the radiation is bad for you.

    Needless to say, when full body scanners got introduced into every airport and made compulsory, suddenly the radiation was perfectly healthy, but that’s another story I guess.

  84. Funny you ask that given you think that $5 per year is going to make people irrational.

    I never said that. I said the problem that this “solution” is attempting to fix is a result of already existing irrational behaviour. I’m asking why you think (dis)incentives founded on a presumption of rational behaviour will predictably work on people who are already behaving irrationally.

  85. JC

    IT is basically right. Nearly all GPs are now a referral service. Occasionally you’ll find one like mine, who really knows his stuff.

    Desipis:

    Why would you describe a government fee of $5 in a command and control system as even close to market determined?

    Take note, when fatboy agrees with you, get off that train ASAP.

  86. JC

    I’m asking why you think (dis)incentives founded on a presumption of rational behaviour will predictably work on people who are already behaving irrationally.

    Stop being an idiot. Overusing a service, in this case a government funded one, isn’t behaving irrationally at all. The incentive, free use of a service, is what is causing the problem. People are rationally responding to incentives.

  87. rebel with cause

    people who are already behaving irrationally.

    Who says? I’d imagine if you’re on welfare and visiting the GP is free you’d be popping in quite a bit. Not like you have anything else to do with your time and you know the GP will have to listen to you talk about yourself for at least 15 minutes – probably the highlight of your day day.

  88. Lem

    Rebel, I’m guessing your not a woman who wants to reduce her cervix cancer risk? I’m thinking “perfectly well..pap smear..oh you have CIN 3..minor day procedure..live happily ever after” versus “look at that I’m bleeding all the time..oh you have an invasive cervix cancer extending to your ureters..we can give you radiation to help stop the bleeding because it is inoperable.. And then you will die from renal failure or central recurrence and major haemorrhage (hope you don’t get a bowel fistula from direct tumour spread, that’s really unpleasant”…

    I am guessing you are 15 years of age.Nobody could be so ill informed or still thinking so concretely as an adult, surely?

  89. JC

    Remember how up in arms the regular doctors got over the idea of full body scanners? They were jumping up and down to tell people that there was absolutely no benefit, could not reliably detect anything, and the radiation is bad for you.

    They are bad and may actually create worse outcomes. Countless people are unaware of cancers and tumors in their bodies, but don’t actually die from that disease.

    Full body screening will only become useful once there are cures or strong management therapies for cancers. Until that happens scans are basically useless and cause all sorts of problems.

    Needless to say, when full body scanners got introduced into every airport and made compulsory, suddenly the radiation was perfectly healthy, but that’s another story I guess.

    Cat scans do emit a lot more radiation than the airport variety as those aren’t cat scans.

  90. .

    desipis
    #1132929, posted on January 3, 2014 at 12:47 pm

    Funny you ask that given you think that $5 per year is going to make people irrational.

    I never said that. I said the problem that this “solution” is attempting to fix is a result of already existing irrational behaviour. I’m asking why you think (dis)incentives founded on a presumption of rational behaviour will predictably work on people who are already behaving irrationally.

    Hence why I said “think” and not “say”.

    Part of the reason why people are irrational are because there is no pricing and the lack of pricing creates time inconsistenticies for them.

  91. JC

    Dot

    It’s not irrational in the least to over consume a free service. A simple demand curve would show that.

  92. .

    Remember how up in arms the regular doctors got over the idea of full body scanners? They were jumping up and down to tell people that there was absolutely no benefit, could not reliably detect anything, and the radiation is bad for you.

    Widespread use of MRIs for men could wipe out premature deaths from prostate cancer. I was told so by a MRI specialised radiographer.

    Unless a combined oncologist/radiologist tells me otherwise, I can reliably rely on their authority.

    MRIs of course don’t give you anyhwhere near the dose of radiation like an X ray would etc.

    There is no problem. Keyhole surgery could be done for biopsies.

    This should be cheap.

    There are some good doctors givin us comment on the cat, but at the end of the day, their union, the AMA, aims to be a cartel.

  93. .

    Yes JC but note I am talking about a time inconsistency.

    Desipsis has only mentioned two cases: ‘model citizens’ and ‘norm’.

    Not mentioned by Depsipsis are the time wasters etc.

  94. JC

    Doc

    Fair enough, but MRI’s are not Cat Scans as they are an entirely different technology. There is nothing to stop a person requesting an MRI for a prostate check up. I’ve done it. All you do is fork out the 600 odd bucks.

    Full body scans are basically a Cat Scan of the body which of course doesn’t pick up everything and when it does, it may cause problems in terms of treatment decision.

  95. JC

    Not mentioned by Depsipsis are the time wasters etc.

    Fair enough.

  96. Lem

    Dot an appeal to the authority of a person who runs an MRI machine is beyond laughable. Most men will not die from their prostate cancers. Not only will routine MRI not reduce mortality from this cancer, but it is outrageously expensive.

    For more reading on this and other health issues go to PubMed which is free and do a search of the medical literature. It is free.

    And ps I am not a member of the “cartel” as you call the AMA.

  97. .

    Yes well I suppose I was confused. A fully body MRI would cost quite a bit.

    You’ve got to ask why before you start rationing though.

  98. JC

    Most men will not die from their prostate cancers.

    But some do, especially men in their 50′s who end up getting it.

  99. .

    That said Lem I’d rather not have a prostate cancer before something else pops my clogs. Or at least before old age.

    Clearly I called the organ grinders, monkeys, and to that I apologise to both parties.

  100. Lem

    No hard feelings. I’m going back to work.

  101. JC

    I’m not sure if it’s changed, but medicare doesn’t cover a GP ordered MRI, so you can basically cajole a GP to request it. You’re just paying for it.

  102. Part of the reason why people are irrational are because there is no pricing

    How much of a part? How significant is it compare to all the other psychological aspects of the decision to seek medical care?

    Desipsis (sic) has only mentioned two cases: ‘model citizens’ and ‘norm’.

    I’ve talked about two cases: those who over-consume and those who under-consume. A price signal will cause both cases to presumably consume less. The question is whether the reduction in cost to the system from the lower short term consumption of those who over-consume will be less than increase in cost of causing those who already under-consume, to consume even less and increase their long term costs.

    Not mentioned by Depsipsis are the time wasters etc

    “Time wasters” would fall in the over-consumption category.

  103. Habib

    The proposed co-payment doesn’t apply to health card holders and others who mostly over-use and abuse bulk billing, so in reality it’s another impost and cross subsidy levied on those already being hosed through taxation and the Medicare levy. I’d be all for it if it was across the board, and reflective of actual cost.

    That or the repeal of Medicare of course, the ideal but most unlikely outcome.

  104. rebel with cause

    Lem – they wouldn’t be giving me a pap smear, don’t have the tackle for that so to speak.

    There’s no reason why pap smears couldn’t be taken by a nurse anyway – your GP just sends the results away to a lab! All part of the doctors monopoly on health services.

  105. .

    Desipis I disagree there are only two categories of patient.

    There are at least three catrgories.

    1. Model citizens.
    2. Time wasters.
    3. People who underconsume and then overconsume as they become very ill due to lifestyle choices of underconsumption.

    If you are given rational options, you will act more rationally. ‘But raitonal actors always act rationally” – well they do the best they can given time inconsistencies. They can still choose second best solutions etc. Their budgets can be altered and their preferences can’t be changed but they can be given indifferent options.

    You haven’t explained why people can make rational decisions about hosuing and food but not medical care, or why they are unrelated, or why psychology on works detrimetally with healthcare, you have only objected to those notions.

  106. Tel

    Full body screening will only become useful once there are cures or strong management therapies for cancers. Until that happens scans are basically useless and cause all sorts of problems.

    Ordinary members of the public, knowing stuff? About themselves? Tsk, tsk, no end of problems. Can’t have that. Next thing they will be reading books and we will have non-government approved learning on our hands.

    They had to ban genetic testing on the same basis, people knowing too much… they might start thinking they are smarter than their doctors, rising above their station. Worse than that, asking questions. Yes, questions!

    Yes well I suppose I was confused. A fully body MRI would cost quite a bit.

    You’ve got to ask why before you start rationing though.

    Like any technology-based product, the per-unit cost goes down when more units are sold. Also, a typical MRI machine spends a fair bit of time idle and it doesn’t take a genius to operate one. Purely “check-up” scans can be done in the idle time and if the patient needs to pop in at 9PM after a work day, no problem really.

    Last scan I had done I noted that there were two prices, the Medicare price and the Workers Comp price (more than double). If you just walk in off the street with cash you pay the Medicare price. Weird huh?

    Also, they refused to provide an electronic copy, only film (which increases the cost). Yes the machine could do it, and they use electronic copies internally, but for some reason the industry in Australia won’t accept any electronic images (or so I’m told).

  107. Tel

    3. People who underconsume and then overconsume as they become very ill due to lifestyle choices of underconsumption.

    I have yet to see any evidence that visiting the GP less often makes you more likely to get sick.

    Catching the train every day, now that is most certainly a lifestyle choice that makes you more likely to get sick. I’ve tested that one myself.

  108. Notafan

    I agree; it should be co-payments for everyone or no-one emergencies rooms included.
    How about something like thecurrent 2 tier system for prescription medicine?
    $5 for welfare recepients and $1o for everyone else. Doctors can still decide to waive the co-payment if they wish, they just get less back from medicare.

    Isn’t medicare one of the main reasons for the budget blow outs. With an aging population that isn’t going to go away.

  109. Dan

    In pre socialised medicine days, doctors covered “charity cases” costs pro bono. I imagine if there is a family who truly cannot afford $6, then any doctor would consider doing the same.

    Give me a break. I’m sure there are indeed dirt-poor families around but most people are able to pay electricians, plumbers, barbers, why should medical care be so devalued.

  110. wreckage

    There’s no reason why pap smears couldn’t be taken by a nurse anyway

    A big part of the problem, I hear from people in health care, is that since seeing the nurse is free, and seeing the doc is free, everyone wants everything done by the doc. So it makes sense to have a co-payment for seeing the GP, and no or lower co-payment for seeing the nurse.

    The idea of this nominal fee is to discourage serial doctor’s visits chewing through the healthcare budget, which is a shared pool.

    Since seeing the doctor is free, we can assume under-serviced patients are NOT responding to price signals. And there isn’t a lot of hard evidence that there are a large number of under-serviced patients, apart from those isolated by geography.

    You can’t argue that people over-using a free service are acting irrationally. In economic terms they are acting perfectly rationally. Economic “rational” is its own animal, meaning little more than people spending as they see fit to gain what they most want at the price they can most afford, and on the broad averages it always applies.

    For example: you might say someone smoking cigarettes is acting irrationally, since the smokes will kill ‘em, or because they’re addicted and can’t help themselves. But the fact is that smokers respond to price signals in a perfectly rational way. To the extent that they exhibit typical brand loyalty they will consume less as the price goes up. After a certain point they quit or switch to a cheaper alternative.

    This is exactly what economics “rational behaviour” predicts, and it’s exactly what has happened.

    Cocaine would be another example. It’s hideously expensive in Australia, so people don’t use it, or substitute another drug. It’s an example of addicts using something that is harming them, yet acting rationally.

  111. Infidel Tiger

    The medical system would be fine if it went back to what it used to be: A counselling service for hysterical women. Real men only see the doctor to haves their death certificate signed.

    Most medication you need will more than likely already be in your wife’s bathroom. Just rifle through her drawers until you think you see what might help.

  112. rebel with cause

    Too right Wreckage. All this talk about people over-consuming or under-consuming healthcare sounds like central planning to me. Individuals aren’t over-consuming or under-consuming from their own perspective, but from the perspective of the central planner who requires that they go to the GP x times per year so that the cancer they will get can be picked up and they can go to hospital y for timely treatment. But if they go x+1 times then the equation goes negative, and if they go x-1 times then there is a chance they might just rock up at any old hospital expecting treatment for a cancer more advanced than the model indicated…

    Take this discussion of centrally planned health care elsewhere!

  113. Dan

    Why shouldnt someone pay a fee to see a nurse? They have trained, they are skilled and should be paid at market rates (ideally)

    the goal is to minimise expenditure using price signals the smart thing to do would be to pay people to have regular check ups to ensure medical issues are dealt with before they become serious and expensive to remedy.

    Overall there is basically nothing that can be sorted out at a “checkup”. There are discrete exceptions. Pap smears (which a nurse could indeed perform), mammograms in higher risk groups (no GP needed). Maybe screening for BP and lipids now and then. My impression after spending a few months in GP training was that around 90% of the visits I witnessed served no medical purpose.

    Forget the copayment, if you wanted to reduce services:
    High volume walk-in-out vaccination booths at the shopping centre
    Pap screens at a Pap Centre in the CBD (only), no doctor involved
    No rebate if coming in for flu-like symptoms
    One prescription lasts forever.
    Legal sanctions for prescription of antibiotics for the common cold
    And for ED visits: breathalyse the punters as they come in, if>.05 it’s user pays.

    I can dream

  114. DrBeauGan

    Desipis, stupidity incurs costs. These costs may be born by the stupid or by the rest of us. If by the rest of us, there will be more stupidity. I think we already have plenty.

  115. dot,

    You haven’t explained why people can make rational decisions about hosuing(sic) and food but not medical care, or why they are unrelated,

    I don’t think they do, per se. However the content and impact of the irrational elements in those contexts is separate from that of medical decisions. The elements of a persons psychology, culture, knowledge (etc) related to choosing what to eat will be different to that related to choosing where to live which will be different from that related to choosing whether to go see a doctor. You need to examine each context separately to determine how decisions are made and what impact those issues will have on the ‘rationality’ of the decision.

    If you have clear evidence that people will make rational decisions about when to go see a doctor, by all means present it. You haven’t explained why you believe everyone behaves rationally, or why you think price incentives will make people behave more rationally:

    If you are given rational options, you will act more rationally.

  116. Foggyfig

    Sorry, Dan, but why should I have to travel nearly 3 hours to have a PAP smear done in the fucking CBD.

    A town nearby actually has a Nurse Practioner that does PAP smears and I also know that another town has had Nurse Practioners do PAP smears for nearly 10 years.

  117. Tel

    High volume walk-in-out vaccination booths at the shopping centre.

    That’s a very sensible suggestion. But actually we already have all the bits, you just need to allow your local chemist to keep one registered nurse on staff and do it there in the chemist shop. If someone forgets and comes back for an extra shot by mistake then it isn’t the end of the world, and could happen at a medical center anyhow.

    Probably they wouldn’t even need full nurse training, just a certificate to say they can point a needle in the right direction and know how to clean their hands.

  118. Dan

    Tel, the MRI shows you shapes but you cant even begin to plan treatment until you know what the hell you are actually dealing with. A lump on the liver, a large prostate, a cyst in the brain, if these are found, and are asymptomatic, what is the next step.

    I mean really,if you have or have had one of these done, and they found a .5cm squared cyst-like object in your liver, and no-one could say if it was new or old, and you had no symptoms, what would you do about it?

  119. rebel with cause

    Accordign to Robert Hanson, spending on medicine makes almost no difference to health outcomes anyway:

    In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. (At least they do not in studies with enough good controls.) It has long been nearly a consensus among those who have reviewed the relevant studies that differences in aggregate medical spending show little relation to differences in health, compared to other factors like exercise or diet.

  120. Pickles

    I got a bit of glass dug out of my foot yesterday. Charged $70. Full family private cover etc and I still had to pay $35 of the $70.

  121. rebel with cause

    Desipis’ argument flies in the face of the evidence provided by both the RAND Health Insurance Experiment and the Oregon Medicaid health experiment. Where is the evidence that increased spending on ‘preventative health’ reduces healthcare costs?

  122. Probably they wouldn’t even need full nurse training, just a certificate to say they can point a needle in the right direction and know how to clean their hands.

    Pharmacists can and should be trained to administer vaccinations. Easy.

  123. Tel

    I mean really,if you have or have had one of these done, and they found a .5cm squared cyst-like object in your liver, and no-one could say if it was new or old, and you had no symptoms, what would you do about it?

    Me personally? I wouldn’t do anything the first time, but I’d make sure the same area got scanned every few years and if it was changing I’d find someone with sufficient dexterity to poke a thin needle in and pull out a sample. Presuming I was allowed to have any choice in the matter, which is increasingly unlikely in this country. The whole idea of regular check ups is that you have some history to work from… but a regular visit to the GP won’t achieve that, because they check what? Your blood pressure (I do that already) and maybe your weight (I do that already).

    http://www.mydr.com.au/tests-investigations/liver-biopsy

    Nothing exceptionally freaky in that lot… presuming it gets done competently.

  124. Dan

    Philippa given that millions of people self-administer insulin, heparin, IVF drugs, it’s not as though pharmacists will need to enter a long training program!
    The worry is anaphylaxis so the injector should know how to treat this. Then again I think everyone should know basic life support. Teaching that at schools would actually be cost effective and would save lives, unlike funding MRIs of the worried well.

  125. DrBeauGan,

    Desipis, stupidity incurs costs. These costs may be born by the stupid or by the rest of us. If by the rest of us, there will be more stupidity. I think we already have plenty.

    Bad luck incurs costs. These costs may be born by the unlucky or by the rest of us. If by the unlucky, there will be more resentment and greed. I think we already have plenty.

    Personally, I would rather have a bit more stupid, than a bit more resentment and greed.

  126. .

    Desipis you have been prevetned with evidence re RAND Corp and Oregon Medicaid.

    Please respond to that because you keep on trying to refute what I’m saying about fairly uncontroversial economics whilst referring to evidence and literature and never giving those a second mention.

  127. Petros

    The Irish introduced a small payment to attend an emergency department on a weekend and it led to something like a one third reduction in attendance. Anyone with experience in ED will tell you that lots of people who attend are there for trivial reasons. If you don’t know someone that works in one, please don’t comment. Too many laypeople have no idea what goes on in the hospitals. FWIW I agree with the $30 co-payment fee, but it needs to be for everyone. No exemptions.

  128. GRP

    A few points. Prostate cancer diagnosed with PSA test, followed by biopsy. MRI used to determine spread.
    No radiation with MRI, one of the advantages over CT.

  129. Dan

    Desipis do you spend much time in EDs? Substance abuse including alcohol often represents a majority of presentations. These days your average person can buy amounts of alcohol which are in a practical sense infinite, i.e. people can afford to drink themselves into a coma whenever they like. It is crazy that we dont charge people the full cost of their ED stay.

  130. Infidel Tiger

    What’s the call out fee for a sparkie or plumber?

  131. Tel

    http://www.terrywhitechemists.com.au/healthprograms/index/detail/?id=419

    Looks like some chemists do have a nurse that comes in for flu shots at regular times, you have to book, etc.

  132. wreckage

    If you have clear evidence that people will make rational decisions about when to go see a doctor, by all means present it.

    Easy. Most people see a doctor if they get sick.

    You haven’t explained why you believe everyone behaves rationally, or why you think price incentives will make people behave more rationally:

    You are again confusing economic “rational” with “rational” more broadly. Simply put, price signals cause people to prioritize resources. Zero price is a price signal. The argument is not that people will “act more rationally” but that they do, on average, act rationally inasmuch as they prioritize spending, and they do, on average, act rationally in that they consume lots and lots of a good that costs zero. (Unless they hate the good but depend on it, like inferior staple foods, when they will consume less of it if it costs zero, because it frees up money to buy preferred foods; for example, if rice costs less people eat more chicken.)

    If you argue against this, you are arguing against one of the few consistently proven facts of economics – and yes, there are economists that argue against this, in favour of a command economy, just as there are farmers that believe a hornfull of cow poop at the full moon will maximise yields across hundreds of hectares.

    You are arguing against the established “facts”. You are the one who has to prove your case. The fact that amongst your circle of friends no-one believes in economics is not relevant. There are groups of people amongst whom nobody believes in vaccines, or everybody believes Monsanto is behind a global conspiracy to ruin our food and health.

    You need to examine each context separately to determine how decisions are made and what impact those issues will have on the ‘rationality’ of the decision.

    Not in economics. The net result of the varied factors, and the preference for each over any alternative, IS rationality, in the market sense. It assumes that whatever people buy, they have done so because they wanted to, and that’s about it.

    That said, there is no good evidence that people generally make worse decisions than that of their intellectual betters, and a great deal of evidence that they make better ones. People who genuinely can’t make decisions for themselves need to be institutionalized; you’re arguing that the majority of people are effectively insane and need to have health care taken out of their control. I guarantee you that the less engaged people are in their own healthcare decisions, the worse the outcomes will be.

  133. .

    Tell you what IT we can get into Parliament as a single issue party.

    We’ll call our party What Moochers Want, we will call the policy Tradiecare and by gum if people don’t want bulk billed tap washer changes, they’re irrelevant right wing loons!

    We need to because there are irrational people waiting out there with unchanged tap washers despite the low price already.

  134. JC

    Tel

    Stop jumping over make believe puddles. I never suggested we ban full body scans. If you want one, be my guest. Get your small toe scanned and re-scanned for all I care.

    My point which you seemed to have missed is that they may not just be useless but cause different sorts of headaches.

  135. Notafan

    You only need to spend one Friday night in an ED to get the picture. Lots of non-urgents who didn’t bother going to the GP during the day and then the drug and alchohol affected. …

  136. .

    Well said wreckage. Desipis is clinging to some shaky theories with a cracked ediface of evidence.

  137. Alain

    Nurse practitioners are a rort. Just look at the entrance requirement for a nursing “degree” and you will quickly realise why you don’t want a nurse doing anything with you medical wise.

  138. .

    Maybe so, but paying a doc $65 or more plus the flue vax to do what a heroin junkie can do seems a bit rich.

  139. wreckage

    Bad luck incurs costs. These costs may be born by the unlucky or by the rest of us. If by the unlucky, there will be more resentment and greed. I think we already have plenty.

    Not an argument. An assertion. Layers of assertion. First, you imply that there are only two alternatives: totally free healthcare or social breakdown. False dichotomy (and absurd, to boot.) Next, you assert that there are two positions being argued here: one, your own, compassion. The other, zero compassion, zero charity, zero safety net. False dichotomy again. Last, you’re implying that paying ANY of the costs of one’s own misfortune is immoral and cruel. But only with respect to GP visits, not housing, food, etc.

    Presumably it is also immoral and cruel for people to choose to self-insure for injury, lost work, possibly even public liability where that entail injury? Care to cover my insurance costs for me? After all they’re only needed in the case of misfortune.

  140. wreckage

    Nurse practitioners are a rort. Just look at the entrance requirement for a nursing “degree” and you will quickly realise why you don’t want a nurse doing anything with you medical wise.

    Total bullshit. What are you smoking?

  141. Dan

    Uh Alain what training program do you propose so that someone can administer vaccines, do Pap smears, order an X-ray of an ankle and apply a plaster etc? They may be ‘medical’ tasks but they dont require decades of intensive training.

  142. Habib

    Anyone notice the item during the week about GPs pulling 600+K for bulk-billed home calls on Medicare (something snuck in by the previous “government”)? I’ve said for years that the AMA is the most militant, self-interested trade union in the country. Wish I could capitalise my profits, andd socialise my losses.

  143. Desipis you have been prevetned with evidence re RAND Corp and Oregon Medicaid.

    As far as I can tell that was a two year study. I don’t think that’s long enough to determine long term impacts on health (and hence long term impact on health costs) from the short term increase in medical service usage.

  144. JC

    Nurse practitioners are a rort. Just look at the entrance requirement for a nursing “degree” and you will quickly realise why you don’t want a nurse doing anything with you medical wise.

    What level of IQ would you require to administer an injection, take a throat swab, take blood for a test, take a temp or blood pressure? You don’t have to be Einstein.

  145. Tel

    I’ve said for years that the AMA is the most militant, self-interested trade union in the country.

    You are being rather unfair to the banking cartel… they might feel a bit left out.

  146. JC

    Desi

    Stop being an idiot. A $5 co payment is not going to cause rioting in the streets and people going homeless. You need to up the argument levels from the Woe man’s site to preform adequately here.

  147. The argument is not that people will “act more rationally” but that they do, on average, act rationally inasmuch as they prioritize spending, and they do, on average, act rationally in that they consume lots and lots of a good that costs zero.

    Well if that’s the way you’re going to define rationality, then you’re going to have to show that the way people prioritize spending (“act rationally”) on medical expenditure produces the best outcomes (i.e achieves good health outcomes with minimal costs).

  148. Nurse practitioners are a rort. Just look at the entrance requirement for a nursing “degree” and you will quickly realise why you don’t want a nurse doing anything with you medical wise.

    Total bullshit. What are you smoking?

    Erm – I taught in a university based school of nursing for 6 years, and I’m afraid I agree with Alain.

    There are many excellent nurses: smart and genuinely caring people who do really well at both theory and prac in a course. These ones usually leave nursing after a couple of years, or go into admin or a higher degree as fast as they can.

    There are the average ones in the middle, and they usually leave after 5 years, and perhaps might go back part-time to nursing as they raise their families.

    The duds at the bottom tend to stick to the public health system like glue. They have a way of getting into positions of authority by attrition, and then proceed to make everyone else’s life a misery, especially anyone who might make them look bad by doing a better job. They are one of the reasons that the smart and average ones leave the profession.

    The real duds – the ones who are lazy and borderline dangerous – usually end up working in aged care, both residential and community.

    This is the voice of bitter experience.

  149. Notafan

    Anyone notice the item during the week about GPs pulling 600+K for bulk-billed home calls on Medicare (something snuck in by the previous “government”)? I’ve said for years that the AMA is the most militant, self-interested trade union in the country. Wish I could capitalise my profits, andd socialise my losses.

    That is not surprising. Old people in nursing homes and they are only visited out of hours? There are lots of people looking for ‘opportunities’ in the health care industry and that was one of them. Another I think was the ‘heart checks’ being advertised on TV thoughI think they squashed that pretty quickly. The new one I am seeing around is Skin Cancer clinics and I assume there is a nice little earner in that too.

  150. Combine Dave

    So what’s the problem?

    Given that everyone everywhere (with a few exceptions, the poor, elderly etc) are being forced to pay a gap already……..

  151. Dan

    If they are providing the out of hours service for $130 including travel time then they are cheaper than my plumber. I don’t see how the finances are a problem, except that the patient should be paying, not the taxpayer, so demand isnt inflated by the zero price.

  152. Dan

    The AMA are lefties who wasted my money on harebrained social engineering ideas until I stopped paying.

  153. Empire Strikes Back

    I’ve said for years that the AMA is the most militant, self-interested trade union in the country.

    Gangsters in sincere grey flannel suits. They make the AWU look like the rank amateur mafiosi they really are.

  154. Dan

    Given that MBS rebates in my specialty have declined in real terms by 70% since the inception of Medicare, the AMA clearly havent used their militancy effectively.

    Ben Keneally, CEO of the largest east coast medical deputising company Home Doctors Service, said his company performed 360,000 after-hour home visits each year that were bulk billed.

    He said they hired around 300 doctors who were a mix of overseas and local doctors.

    So unless he is lying, the average income before the company’s cut is clearly 360,000/300 x 130 = $156,000 per year, which is fine but pretty far removed from $600,000. I would venture that charging $130 total before all costs including travel each way and handing a cut to the agency as well would make an income of $600,000 extremely unlikely.

  155. Tel

    The new one I am seeing around is Skin Cancer clinics and I assume there is a nice little earner in that too.

    At least in the case of skin cancer clinics they do make an effort to do real checking. They shine lights on your skin and run over with a magnifying glass. I mean, I can’t tell you for sure they are going to find everything, but at least they are having a good look.

    It would be good if there was a way to check which ones had better statistics than the others, but then you would need a trusted neutral third party to keep score… and not much chance of finding one of those, is there?

  156. Habib

    Regarding nurses being able to perform basic functions, in the military medics can stabilise wounded, perform airway clearance, administer narcotics and generally deal with trauma that’d make most GPs pass out or soil themselves.

    I call market restriction.

  157. Leigh Lowe

    The new one I am seeing around is Skin Cancer clinics and I assume there is a nice little earner in that too.

    Look, I don’t mind that one.
    The most annoying thing is to go a a GP and to be asked .. “This mole between your shoulder blades? Is it new? Has it changed?
    A comparative photographic record marked on a body map is a great way to detect potential skin cancers early, and early intervention is highly successful.
    Having said that, they are bloody expensive.

  158. Habib

    Even field grunts know how to apply tourniquets, deal with sucking chest wounds and burns and such.

  159. Dan

    Uh Habib, what is your point? Nurses do every single one of those things.

  160. Habib

    My point exactly, why do minor matters require attention from a GP?

  161. Foggyfig

    If you think the requirements for nurses are bad, check out the ATAR for Victoria teaching courses in 2102. Bloody 43 - no wonder the libs are arguing that it is quality teachers needed not more money.

  162. Rebel with cause

    Phillipa – as you would know bullying is also rife in the private system too, with the bullies protected by the union. The good and average nurses suffer as a result of the ANF.

  163. Phillipa – as you would know bullying is also rife in the private system too, with the bullies protected by the union. The good and average nurses suffer as a result of the ANF.

    Oh heavens yes. I’m sorry if I singled out the public health system, but that’s what I’m most familiar with.

    And yes, the ANF has a lot to answer for. I wonder what membership numbers are like these days, though – just how representative are they?

  164. Toiling Mass

    Regardless of what the actual argument is, the claim – the bit that elicits the emotional response that leftists rely upon – will be that any reduction in the number of people turning up to GPs will be people (mostly starving elderly and barefoot mothers who sleep in hallways with their brood of dirty-faced wide-eyed innocents) that desperately needed to see a doctor and were prevented by the malicious greed of the rich who always take and refuse to give back.

    Something like that.

  165. This thread is a fine example of the greatest weakness of the Cat regulars: someone with domain knowledge, who can demolish their generic ideology with specific arguments based on experience. Well done desipis.

  166. .

    Yeah…you can’t get time series data though?

    There is nothing to prove in advocating the co payment. In the very least it is otherwise other people’s money.

    Those advocating for more, not less Government spending must justify their case.

  167. The Hunted Mind

    They seriously need to make sure they don’t leave health care card holders without a co-payment. Even if they reduce it it $1 for them. They can always raise it later at the same time as everyone else’s. If they don’t introduce it now then doing it later would involve imposing something ONLY on them. That will never happen.

  168. .

    m0nty
    #1133319, posted on January 3, 2014 at 5:31 pm

    This thread is a fine example of the greatest weakness of the Cat regulars: someone with domain knowledge, who can demolish their generic ideology with specific arguments based on experience. Well done desipis.

    Except that didn’t happen at all. Quite the opposite.

  169. JC

    Monster,

    Shoo off and stop pretending you would even know a good argument from a bad one, you big fat leftist idiot.

    Go on, shoo.

  170. Here is JC, the man whose domain knowledge extends only as far as the range of designer jeans at Just Jeans.

  171. DrBeauGan

    Desipis, you are providing an opportunity for the stupid to relabel their stupidity as ‘bad luck’. They already do this on a massive scale. Insurance was invented long ago as a cure for bad luck. There is no cure for stupidity.

  172. squawkbox

    Run a marathon or two, Monty, and you may be able to shop there yourself.

  173. Tardell G

    I think if the fee was a $1 gold coin donation, you’d still have retards like Munty and Sepsis braying donkey like, about the “war on poor people”.

  174. Those advocating for more, not less Government spending must justify their case.

    You don’t get to have your arguments presumed true unless proven otherwise. You have as much obligation to prove that less government spending is better as those who argue the opposite have to prove that more government spending is better.

    monty – thanks. But I’m off for the weekend now, and I have far more constructive things to do than more SIWOTI.

  175. squawkbox

    Y

    ou don’t get to have your arguments presumed true unless proven otherwise. You have as much obligation to prove that less government spending is better as those who argue the opposite have to prove that more government spending is better.

    Garbage – government spending comes from the pockets of the people, it isn’t distilled from unicorn farts. A burglar might as well argue that the householder must prove his possession of his own property is a superior outcome from the burglar possessing it.

  176. wreckage

    Desipis hasn’t presented any domain knowledge. Just a string of assertions that start at unsupported and work up from there. I’ve presented plenty of basic arguments for rationality, and how it works, and an explanation of why “rational” doesn’t mean “exactly as desipis would have it” AND the problems with predicating anything on “exactly as desipis would have it”.

    Desipis has declined to engage with any of that, apart from to sulk furiously about “rational” not meaning what he/she would like it to mean!

    In other venues, my commentary from “people with domain knowledge” is that users absolutely overwork the free GPs and that a co-payment would definitely help. So that gives me a 1:1 ration, so I move on to the economics arguments; and that is where desipis is arguing from ignorance, consistently and repeatedly.

    I may not be able to discuss medical outcomes, but desipis hasn’t provided anything in that realm beyond assertions quite vague and not even backed up with a good argument; and in economics desipis doesn’t get the very basics, nor the necessary logical implications of his/her own argument. It’s like arguing with someone that insists breakfast cereal is bad for you, because bacon causes high cholesterol.

  177. .

    You don’t get to have your arguments presumed true unless proven otherwise.

    Yes we do. It’s not your money.

    You have as much obligation to prove that less government spending is better as those who argue the opposite have to prove that more government spending is better.

    We have provided evidence and solid theory. You have avoided answering questions. A friendly Senate will likely pass the policy.

    You haven’t said much wrong because you are being generally too evasive to be wrong.

  178. JC

    You don’t get to have your arguments presumed true unless proven otherwise. You have as much obligation to prove that less government spending is better as those who argue the opposite have to prove that more government spending is better.

    You were informed earlier there numerous studies which show this. It’s now up to you to prove the old soviet command control model works.

    Your commie pal- fatboy- can also try.

  179. JC

    Run a marathon or two, Monty, and you may be able to shop there yourself.

    Lol, he currently shops at maternity stores for jeans. Americans call them mommy jeans.

  180. candy

    I think if the fee was a $1 gold coin donation, you’d still have retards like Munty and Sepsis braying donkey like, about the “war on poor people”.

    That’s a great idea. Apparently the co-payment does not apply to pensioners anyway as the idea stands, so who could really complain too much about a $1 or $2 donation from all pensioners. The revenue could be churned back into NDIS and no-one could really whinge about that, so all good.

  181. wreckage

    Studies on government provision of services have found that – on average – government owned services are much more expensive and somewhat inferior. Broad analysis usually finds that government spending does not work very well for procuring or targeting services or goods; this should be so obvious as to be tautological; it is absolutely true and needs no defense to say that the average person understands their own needs better that a departmental head in an office in Canberra does.

    People know better how to run their own lives, and it is necessary to let them do so. I can back that up from “domain knowledge” from people who work in mental health.

    So I take as “reasonably likely to be fact” the following, based on my own information sources.

    People can, and need to, manage their own affairs. – from a person who knows.
    Government tends to be bad at service delivery. – from people who know.
    People overuse GP services. – from a person who knows.

    Desipis has not even presented a clear and consistent argument as to why any of these might be untrue, let alone any evidence that they are more often wrong.

  182. Friendly Senate? As if Clive would support this.

  183. .

    Yes he would monty. Read the PUP policies.

    Somehow you know more than Palmer and what his policies say.

    What you’re telling me to believe whatever you say.

  184. wreckage

    Insurance was invented long ago as a cure for bad luck.

    Desipis’ argument demands that insurance is immoral and cruel. Probably Desipis disapproves of insurance; I know people who hate insurance and insurance companies. So all we have to do is get rid of insurance in favour of some counter-productive medieval bullshit that insurance evolved to replace, and everything will be better and more moral… even if it doesn’t work very well.

    Because it’s totally OK to force people to comply with your own moral ideals.

  185. JC

    Wreckage

    Scott Sumner whacked a couple of Krugman’s front teeth out over the issue of public vs private provision of government services.

    Big mouth Krugman suggested that entities like medicare producer cheaper services than private insurers. Scott sarcastically agreed explaining the one reason is that there’s an estimated $200 to 250 billion fraud committed against Medicare annually because of it’s lax administrative checks.

  186. Palmer is a populist, he knows Medicare is untouchable.

    This is a useless thought balloon, floated in silly season by a flailing, failing government to no effect.

  187. wreckage

    m0nty, it always makes me feel better when you start running around naked declaiming doom on Abbott and drawing on yourself with poop.

  188. .

    Desipis’ argument demands that insurance is immoral and cruel

    Something to do with being too expensive that won’t take it up when it is free.

    So what about being coerced to pay for those people?

  189. David Pope depicted this story best the other day as Abbott on a jetski, with the tatty balloon trailing behind as he created noise pollution for bemused beach battlers.

  190. wreckage

    A GOOD person would WANT to pay for them so it is GOOD to force a person to pay for them.

    In that way, people can be made GOOD. By force. But it’s only OK to use force when you are GOOD and making people be GOOD. Indeed, since desipis is GOOD and therefore only wants GOOD things, it is simple to categorise force into GOOD and BAD:

    GOOD force is used on people other than desipis, to make them be like desipis.
    BAD force is used on desipis by other people.

    It’s all so simple.

  191. .

    Pope is incorrect and his comment is hysterical.

  192. squawkbox

    m0nty, it always makes me feel better when you start running around naked declaiming doom on Abbott and drawing on yourself with poop.

    Wreckage, you owe me and every other Catallaxy viewer a crate of Scotch to erase that particular mental image from my mind.

  193. JC,

    It’s now up to you to prove the old soviet command control model works.

    Q.E.D. The system isn’t broken. Trying to “fix” it will likely just fuck it up.

  194. Tel

    Trying to “fix” it will likely just fuck it up.

    You only have to look at Obamacare to see what could go wrong. Maybe we let the dust settle over there and use that to plan our next move. I predict it’s gonna get ugly.

  195. JC

    The system is broken and broke , you twit. The levy is supposed finance the insurance but goes nowhere near to doing so.

    Smarten up if you don’t want to end up like fatboy , a figure of derision and ridecule at the cat.

  196. .

    Desipis has a strange argument that liberalisation is good, except for this one.

  197. JC

    Why yes, Dot. Market forces stop at the doctor’s door. You know that.

  198. sdfc

    Health is far from a perfectly competitive market.

  199. JC

    How can it be with the elephant in the room, sdfc?

  200. Toiling Mass

    wreckage, that exposition reads so much like Plato it is not funny – aw fuckit, yes it is.

    All it would take to turn it into one of his dialogues would be to depict a hapless opponent* repeatedly conceding “Yes, that would seem to be true” and “It could not be otherwise.”

    *I would not consider Monty, Tony N, Numbers etc for this as they actually are hapless, whereas Plato’s opponents were quite successful in Athenian society and only became mentally feeble as foils under Plato’s pen.

  201. sdfc

    JC

    The nature of the market, high barriers to entry, information asymmetries, that health expenditure is generally involuntary. Stuff like that.

  202. Tel

    sdfc: … high barriers to entry …

    So name some of these barriers to entry, then identify whether they are created by government regulation or whether there’s a natural reason for them.

  203. JC

    that health expenditure is generally involuntary. Stuff like that.

    How voluntary is food expenditure, SDFC? The food market, at is relatively free (not total) and generally involuntary. You don’t eat, you die.

  204. sdfc

    JC

    Come on you can do better than that. Food is a far more competitive market than health. There are far more food products and outlets for a start. I suppose I could always go to competing services like a naturopath or the people with the water I suppose.

  205. JC

    Come on you can do better than that.

    naaaa not necessary. You already lost the argument.

    Food is a far more competitive market than health.

    Well yes under the current circumstances it is.

    There are far more food products and outlets for a start.

    Stop being an idiot. It’s 2014 and stopping the idiocy should have been your new year resolution.

    I suppose I could always go to competing services like a naturopath or the people with the water I suppose.

    Why shouldn’t you be able to shop around for medical care? Why shouldn’t providers advertise their prices? Why shouldn’t hospitals specialize in a few types of treatment and thereby obtaining economies of scale.

    I’m betting the soviet model has actually retarded better medical care.

  206. will

    Come on you can do better than that. Food is a far more competitive market than health. There are far more food products and outlets for a start. I suppose I could always go to competing services like a naturopath or the people with the water I suppose.

    There are many doctors and many hospitals – consumers have a wide choice. The US & Thai market indicates it would be even wider without government interference.

    I can’t see how you can dig yourself out of the ‘stupid hole’ now.

  207. sdfc

    You haven’t really said anything there. Lots of words though.

  208. sdfc

    So Will on what basis is health even close to a perfectly competitive market. Time for the positive argument now.

  209. .

    sdfc
    #1133462, posted on January 3, 2014 at 7:09 pm

    Health is far from a perfectly competitive market.

    So what? It wouldn’t make a difference to the current issue of this post anyway.

  210. sdfc

    I support the levy Dot.

    The further away from perfect competition the greater the argument for government intervention.

    Will

    Don’t know about Thailand but the US health system was decidedly inefficient in terms of coverage.

  211. JC

    SDFC

    Stop confusing the US health system with the US health insurance system as they aren’t the same. Doctors are far more will to take risk in terms of treatment than our protocol infested system.

  212. .

    It is not a levy, sfdc.

    Pure price discrimination is totally removed from perfect competition yet it is just as efficient. You’re not compeltely theoretically correct and the empirics show that the idea that the less close to PC a market is, the more it needs to be regulated, is nonsense.

    You haven’t even considered government failure.

  213. sdfc

    Dot

    Pure price discrimination is a feature of perfect competition. To sell your last unit at marginal cost.

    Less than perfect competition means lower output at higher prices.

  214. sdfc

    Everyone’s a price taker eventually. It’s just that the price is higher.

  215. .

    All units are sold at MC for the price taker in PC. The final unit is sold at MC for pure price discrimination.

  216. sdfc

    You’re right, how could I forget the horizontal demand curve. Does health have a horizontal demand curve? Or any market for that matter?

  217. .

    Your strawman. Go beat it up in private.

    A doctor could charge with pure price discrimination and it would be just as efficient.

  218. wreckage

    Here’s the positive argument: health is a market. It acts broadly like a market. (Agriculture acts like a market, even though farmers do not have a choice as to when to sell their goods, especially fresh goods. This would seem to be roughly equivalent to the lack of choice as to when you NEED to see a doctor. Risk is nothing new, moreover, generally, markets deal with it better than governments anyway.)

    Pretending it is not a market is stupid and counterproductive. It is a market, just like everything else. As with everything, acting consistently on the basis of how you think things ought to be, rather than how they are, is 100% certain to cause serious problems that could otherwise be avoided. Hayek’s argument, if you’d bother to read it, is that the messier things are and the more uncertain knowledge is, the more necessary it is to look to the marketplace to solve the problem, rather than attempting rule-by-fiat.

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