Letter to the Editor — Grattan Report

The Grattan Report document is a good piece of work that draws many wrong conclusions.

When I see wrong conclusions from smart people, I wonder whether it was massaged to support an ulterior motive.

The fact the Report was written up in every major media outlet on a single day, means it was pushed out by a powerful force. When I see this coordination, I think propaganda and I wonder why.

Firstly, we must address the urban myth about our medical colleges “not training enough specialists”. Specialists are trained in public hospitals, not inside a medical college. 

If public hospitals are not doing enough surgery or outpatient clinics, then we cannot train more specialists — simple math. 

Medical colleges set the syllabus, examine the candidates, and recommend to public hospitals which ones are of a high standard. 

It is the public hospitals that are the bottleneck in training more specialists.

Secondly, the Medicare rebate is out of date. It has no meaning in the commercial world. It has not been indexed from its inception in 1980. 

It has been frozen and cut and has never kept up with inflation or average wages. Therefore, as a metric of a medical service, it is unreferenced and meaningless. 

Thirdly, specialist fees are driven by real-world overheads such as wages, insurance, electricity, leasing, IT expenses, and the increasing cost of medical equipment that is largely imported from overseas. 

The most egregious aspect of this coordinated media blitz is the smokescreen that it provides for the woeful failure of public hospitals.

Inadequate surgical volumes, reduced medical outputs, inefficiencies and bureaucratic wastage feature squarely. 

If the public hospital was operating in a reasonable manner, then people would not need private specialists in the numbers they do.

Our governments are outsourcing by proxy into a highly inflationary private environment and then complaining about the outcome.

If medical services were cheap to provide, governments would not have trouble funding them. 

Finally, there was an implied threat to remove Medicare rebates if specialists charge more than the Federal Government allows.

Since the Medicare patient rebate is uncalibrated, unrepresentative, and unindexed, it serves no useful metric for specialist services. 

Remember, the Medicare rebate belongs to the patient, not the doctor.

If the patient’s rebate is withdrawn by the Government, then specialists would go the way of dentists and charge their own fees regardless.

The small proportion of the fee, which is now represented by the Medicare rebate, makes it a polite contribution but nothing more.

Most patients would be furious if the rebate was withdrawn and every specialist in Australia would make it quite clear who has increased their out-of-pocket costs. 

Dr Peter Sumich
President
Australian Society of Ophthalmologists