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AMA President's Statement

24 May 2013

Transcript:        AMA President Dr Steve Hambleton, AMA National Conference, 24 May 2013

Subject:            President’s statement - The politics of health

Colleagues and guests, I would now like to provide an overview of what the AMA has been doing over the past year and what we have planned for the months ahead.

It is a critical time for health and medicine in this country.

We are just months away from a Federal election.

If the polls stay the way they are now, we will see a change of Government.

With that, we will see a shift in policy direction that may affect many things in our community, including how health services are delivered.

The Gillard Government, however, is refusing to concede and will continue their battle to win votes right up until Election Day.

Until recently, health was not figuring too much in people’s thoughts as being a major vote changer.

There has not been a big political debate about structural changes to health.

Instead, there are points of difference in some policy areas - as we saw on Q&A recently.

People have been focused on education, the carbon tax, the Budget deficit, immigration, and border protection.

And the Government has been pinning its electoral hopes very much on DisabilityCare and the Gonski reforms.

But then came the Federal Budget and we saw around $1.8 billion ripped from health care.

The Budget contained a quadruple hit on patients that will have long-term impacts on their ability to pay for their health care needs.

Like the Four Horsemen of the Apocalypse, four key Budget decisions will combine to wreak havoc on Australian families.

Budget decision number one is to defer indexation of the Medicare Benefits Schedule (MBS) from 1 November 2013 to 1 July 2014 – a freeze of eight months.  That’s $664.3 million from rebates.

Budget decision number two is to cap work-related self-education expense tax deductions to $2000 a year.

This measure, estimated to provide savings to the Budget of $514.3 million, will have a devastating effect on medical education for doctors.

Budget decision number three is to increase the upper Medicare Safety Net threshold to $2000.

This means that families that incur high or numerous health care costs in one calendar year will pay more and more without relief. 

This is another  $105.6 million of costs transferred to patients!

Budget decision number four - which just compounds the above - is the phasing out of the medical expenses tax offset, which adds another $963.5 million - taking the extra total cost to patients to over $1 billion.

The Government is targeting sick Australians to help fix their Budget black hole.

GPs and specialists cannot absorb these new imposts and will have to pass on costs to their patients.

This Budget means that people will pay more for their health care every time they visit their doctor, year after year.

The sicker that people are, the more they will pay.

For some families, the changes to the Medicare Safety Net mean that they will need to accrue significantly more health care bills before they get financial support.

At the end of the year, when the same family expects to claim something back on the medical expenses tax offset, they will be told that that has been scrapped too.

The chronically ill, the elderly, young families, accident and trauma victims, and our war veterans will be among the hardest hit by these life-changing Budget decisions.

It will almost certainly drive patients towards an already stressed public hospital sector.

At the same time, doctors will find it harder to improve their skills and knowledge to help their patients.

Self-education is a key element of quality medical practice.

Doctors need to build on their skill base throughout their careers as new medicines, new surgical techniques, and new technologies become available.

Medical education is expensive and large numbers of doctors – especially GP proceduralists, rural doctors and surgeons – need to upgrade their skills across multiple disciplines on a regular basis.

In order to be able to continue to provide the highest possible quality care to their patients and their communities, these doctors need to keep learning and studying.

They must attend courses and conferences, both locally and oversees.

But the costs build up.  A local anaesthetics conference for a rural doctor, for example, can cost around $4000 for just one meeting.

This Budget measure risks seriously downskilling the Australian medical workforce and, again, it is ultimately the patients who will miss out.

In its entirety, this Budget is very bad news for the health system.

The changes not only involve funding cuts and tax penalties and reduced safety nets, they combine to undermine the long-term sustainability of quality health services and access to quality health services, while tipping the balance to the public sector.

The AMA – your AMA – will fight these changes.  We have a very clear election agenda.

The self-education reforms are, to put it bluntly, downright dumb.

They have angered a lot of people across the professions.

It is a misguided policy that has been coated with the class warfare language of first class airfares, five star hotels, and overseas ski trips.

This is not the reality of quality medical education for most doctors.

It is a misguided policy that strikes at vital medical education that saves lives.

The AMA has been leading the fight against these reforms since the day they were announced.

Other professional associations are looking to the AMA for leadership.

We issued a media release just after the announcement and I did many media interviews.

We met with the Treasurer’s Deputy Chief of Staff within days.

We had immediate contact with the Health Minister's office to highlight our concerns.

We had immediate contact with the Shadow Health Minister's office to highlight our concerns.

We initiated contact with several professional groups who have a similar interest in the issue.

Other groups – dentists, engineers, veterinarians, small business – contacted us.

We sent a letter to all Federal Politicians opposing the changes.

We distributed a template letter for the State AMAs to use.

We sent an e-mail to all AMA members about the issue, with a request for them to:

  • be part of the AMA poll;
  • write to their local member; and
  • post comments on the AMA website.

We issued a second media release highlighting the 4500 poll responses we received and the hundreds of comments from doctors detailing how their medical education would be impeded.

We made effective use of Facebook and Twitter, with the AMA Council of Doctors In Training Facebook page attracting more than 36,272 views of a poll that has been up for 4 days – such is the power of social media.

We raised the matter directly with the Secretary of the Commonwealth Department of Health and Ageing.

We raised the issue at the Committee of Presidents of Medical Colleges Meeting on 9 May to encourage the Colleges to be more vocal.

The AMACDT Chair has written to all Trainee Committees to highlight the issue and encourage them to be part of the AMA’s campaign.

The AMACDT Chair has written to all state DiT Chairs regarding the issue and seeking collaboration.

And we are conducting another web-based poll to ascertain the costs of training and education for doctors.

Let there be no doubt – the Federal AMA is running very hard on this issue.  And we’ve only just begun.

I would now like to mention a number of our other activities and successes over the past year.

Our advocacy, Government relations and media work is detailed in our Annual Report, which should be in your Conference satchel.

The video also covered many of our greatest hits.

Matters that require special mention include:

  • the AMA managed to gain funding from Commonwealth for additional intern positions last year;
  • the Release of the Health Workforce 2025 workforce plan was a direct result of the AMA 2010 intern summit;
  • we lobbied the Government to ensure that salary packaging concessions for public hospitals were not targeted in this year's Budget;
  • we lobbied the Government to ensure that its Review of Medicare Chronic Disease Items did not result in a cut in funding for these items as part of the 2013 Budget;
  • we mounted a strong defence against the Australian Nursing Federation pay claim for practice nurses, which has seen many practices removed from the list targeted by the ANF and also helped slow the ANF's push to rope practices into the claim.  A decision is likely to be handed down soon;
  • the AMA is at every table with the Government and its agencies – the Australian Commission on Safety and Quality in Health Care (ACSQHC), NeHTA, the Independent Hospital Pricing Authority (IHPA), the National Health Performance Authority (NHPA), Health Workforce Australia, etc - to provide advice to inform policy;
  • after much AMA lobbying, DoHA has created consultative committees for the reviews of MBS items. The AMA is the only medical group that has a seat at each and every one of the review committees.
  • we gained ACCC authorisation on GP fees;
  • we secured funding for Doctor’s Health Advisory Services;
  • we strongly supported the establishment and funding of DisabiltyCare, following years of lobbying for a long term care scheme;
  • we helped launch the Australian Academy of Science booklet,The Science of Immunisation, and use it as a key resource in our constant promotion of immunisation;
  • we made a submission to the Government inquiry into air quality and health, which led to extensive media coverage;
  • we raised issues around alcohol marketing to young people and held a Summit at Parliament House;
  • we strongly promoted organ donation;
  • we advocated for better health care for prisoners, asylum seekers, and people in detention;
  • we issued our annual AMA Public Hospital Report Card;
  • we raised our concerns about climate change and health;
  • we released More Than Just a Union: A History of the AMA in our 50th year;
  • we championed GP Infrastructure Grants, and questioned GP Super Clinics;
  • we called for improvements to the PCEHR;
  • we called for an end to the hospital funding ‘blame game’
  • we issued the much-loved AMA List of Medical Services and Fees;
  • we advocated strongly for improvements in Indigenous Health through the Closing the Gap programs;
  • we fought hard for quality health services for defence personnel;
  • we issued warning about the health dangers of energy drinks; and
  • we lobbied for action on problem gambling.

You can see that we have been busy.

24 May 2013

CONTACT:         John Flannery                       02 6270 5477 / 0419 494 761  
                          Kirsty Waterford                  02 6270 5464 / 0427 209 753

Published: 24 May 2013