Medicare co-payment issues ... when will we ever get a government with a social conscience and solid sense of public finance?

Medicare co-payment issues ... when will we ever get a government with a social conscience and solid sense of public finance? Photo: Peter Braig

When, oh when, will this 40-year wheel-turning-and-yet-being-forever-still end? The latest Medicare co-payment issue indicates that it will not be any time soon.

A few months into a Coalition government and we have more of the same old, same old.

Labor comes to power. Has worthwhile big-picture changes for the great public good. Most of the great reforms come from Labor. But Labor is hopeless at organising finances. Runs up big debt. Cannot control the public credit card. Combines this with more favours for union mates who fund Labor than is good for the country or the party. Gets turfed out.

Tories come in. Go for the jugular at Labor big-ticket reforms that help the masses using the guise of sorting public finances for the national good. Move even more of the public wealth to the privately wealthy who fund the Coalition. Start annoying even the middle classes with their meanness, insularity and small-mindedness. Get turfed out of office.

And off we go again. When will we ever get a government with a social conscience and a solid sense of public finance? Never, I suspect, if the past three months is any guide.

Oozing charm from every pore, Tony Abbott oiled his way into government. He never sincerely meant to match Labor's big-ticket education and disability reforms. He merely wanted to neutralise them and then, after the election, get out the little chisel, like Malcolm Fraser and John Howard, and tap away at Medicare, the Pharmaceutical Benefits Scheme, childcare and Labor's social changes, hoping they would be undermined to extinction.

The mass of research in economic psychology and health financing would tell any diligent member of Parliament that a Medicare co-payment in the long term will do more harm than good and will cost the public purse more than it saves.

But the Calvinist mentality runs strong even in the now heavily Catholic Coalition ministry. Fraser's no free lunch is alive and well.

So everyone must pay $6 to go to the doctor. Forget the administrative nightmare. Forget the exodus to free hospital emergency departments. Forget the further administrative nightmare in an emergency department if the $6 is applied there as well (in an attempt by the states to staunch the flow of people for whom $6 matters). Forget the likelihood that many people will delay or avoid going to a doctor if they have to pay $6, with a resulting higher future public health bill.

Sure, the Coalition has not adopted the plan, which came from Terry Barnes, a former health adviser to Abbott. But it has not yet said no to it.

This is a detestable aspect of modern politics - kite-flying. A policy is floated by a related third party or by leaking to test popular reaction. If the reaction is too visceral, the kite can be brought to ground with no damage done. The method shows political parties are not interested in objective, evidence-based policymaking but seeing what they can get away with to help their ideological aims, constituency or donors.

There is no evidence of significant over-servicing in Medicare. To the contrary, cost is keeping people away, especially from dental care.

There are, of course, circumstances when people will flock to a freebie with poor overall outcomes. All the first-home buyers' schemes are good examples. People flocked to them and drove the price of housing up far more than the grant was worth.

But this is not the case for doctors. By and large, people do not like going to the doctor. Moreover, doctors and their support staff are not fools. They can pick an over-servicer kilometres away and quickly devise methods of discouragement.

The whole thing smacks of a lack of empathy and understanding for the way the other half lives. It is just like Fraser's attempt in the 1980s to thwart tax avoidance by imposing a penalty tax on children's income. He saw the world through the eyes of a pastoralist splitting income among the offspring, not the world of the boy with a paper round to help with the family housekeeping.

On the Labor side, the lack of empathy with small business is equally lacking.

It is not the occasional going back on an election promise when circumstances change that irritates people. Rather it is the wholesale pre-election presentation of a political party's aims to govern in the best interests of all and then afterwards dividing the spoils among mates and supporters or pursuing some blind ideological agenda irrespective of the general good or the evidence.

And spare us hand-picked ''independent'' inquiries to come up with positions predetermined by the government. We have a perfectly good public service and expert bodies like the Productivity Commission to provide evidence and advice on how to deal with problems of the day.

And over-servicing in Medicare is not one of them.

OUR household plan to do our bit for the planet without inflicting any long-term personal pain has borne fruit.

We have replaced 35 halogen 50-watt downlight globes with LED five-watt globes. Our (hitherto embarrassingly astronomic) quarterly electricity bill has come down by more than $200.

We also put in a more efficient swimming pool pump.

I know, it all sounds a bit hypocritical. If I were serious, I should wear a hair-shirt and live in a cave.

But the important point is that it is precisely the people with 35 halogen downlights and swimming pools that need to change their ways if climate change is not to ravage us all. Unfortunately, the well-off can afford not to do it and the less well-off, on the other hand, cannot afford to do it.

Nonetheless, the prices of solar gear have come down so much in the past few years that even retrofitted LED lights and solar panels are a no-brainer. They pay for themselves very quickly and thereafter all is money saved. Reducing demand for coal-driven energy is another side effect.

The trick is to work out how to apply this to rental properties where the tenant pays for the electricity but the landlord pays for infrastructure.

And a word to Maurice Newman, the chairman of the Prime Minister's Business Advisory Council: this is not delusional, nor a religious climate crusade. It is just good sense.

crispinhull.com.au