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What did Australia have before Medicare? ‘A ramshackle system’

Email Before Bob Hawke's Medicare, a visit to hospital forced many Australians into bankruptcy By social affairs correspondent Norman Hermant

Posted May 18, 2019 05:19:50

A black and white image of Bob Hawke at a microphone. Photo: The introduction of Medicare is considered one of Bob Hawke's signature achievements. (Supplied: National Archives of Australia) Related Story: Lying close to death in hospital at age 17, Bob Hawke had an epiphany Related Story: Former PM Bob Hawke dies aged 89 Related Story: Election campaign lesson No.1: don't mess with Medicare Related Story: The ABC's Barrie Cassidy once worked for Bob Hawke. Here's what he admired most about him Map: Australia

It was a huge change for Australians — not only from a medical care point of view, but for financial security.

With the death of former Prime Minister Bob Hawke, many are pointing to the introduction of Medicare as one of his signature policy achievements.

Before Medicare, most Australian families had to pay for private insurance to cover their expenses in hospital.

Author and associate professor Jim Gillespie from the University of Sydney said once you were in hospital, the clock was ticking.

"If you earned more than a certain amount of money, you'd have to pay. So, you'd have to have insurance for hospital or you'd have to pay out of your own pocket," he said.

1987 Labor Party poster "Medicare. It's worth keeping" Infographic: The Labor Party campaigned to keep Medicare in 1987 election. (Supplied: Australian Labor Party)

Mr Gillespie said insurance could also run out during a hospital stay.

"Like private health insurance today, if you were on a lower level of it, which most people would've been on, you'd be covered for a certain number of days of hospitalisation. And people tended to stay in hospital much longer then," he said.

This meant when someone needed hospital treatment, often many families quickly faced enormous financial pressure.

Queensland had universal access to hospital care, but other state and territory systems were means tested.

Medical expenses drove families into poverty

The situation in Australia before Medicare was similar to America today — medical expenses could push families into poverty.

"Hospital and medical expenses were one of the largest reasons for personal and non-business-related bankruptcy before Medicare," Mr Gillespie said.

"After Medicare they actually removed it from the published list of reasons because it fell so low."

The goal of Medicare was to greatly improve access to good medical care.

Bill Bowtell was the chief of staff for health minister Neal Blewett when Medicare was introduced in 1984.

"Before Medicare we had a very ramshackle system," he said.

"There was private insurance, but it was very inefficient."

Photo of Bill Bowtell, who was Chief of Staff for the federal Health Minister Neal Blewett in 1984 sitting in his backyard. Photo: Bill Bowtell described the previous system before Medicare as 'ramshackle'. (ABC News: Daniel Fermer)

Mr Bowtell said there was no social safety net for those on the bottom of the economic ladder with health issues.

"A lot of poorer people who couldn't afford insurance were really reliant on charity or the goodwill of the doctors or some other form of support," he said.

"People were going without treatment. They couldn't afford going to doctors. They certainly could not afford expensive procedures in hospitals."

No bulk-billing, fees paid upfront

Maureen Buckingham was newly married and living in Sydney in the 1980s.

She remembered what it was like when you got sick before Medicare — even if you had private medical insurance.

"There were certainly times when you'd think twice. Do I really need to go to the doctor? Maybe I can struggle through [and] get there on my own," Ms Buckingham said.

Before Medicare, there was no bulk-billing, so the fees for a visit to the doctor had to be paid in full up front.

That changed once Medicare was implemented.

"I can clearly remember going to a doctor in my suburb in Sydney, they would accept you paying the difference. It might have been $7 or $8," she said.

"That's all it would cost me. I didn't have to find all the money and then wait to get it back. Critical when you don't have much money in the bank account."

External Link: YouTube: Medicare advertisement

Despite the advance Medicare brought in terms of access to subsidised medical care, the program was not universally popular.

The Australian Medical Association (AMA), which represents the nations' doctors, was vigorously opposed to the change.

"Right at the beginning, it was thought that there was an intrusion in the relationship between the doctor and their patient," AMA president Tony Bartone said.

"As well intentioned as it was in term of the universality of access … there was a concern that there would be government interference."

At the time Medicare was introduced in 1984, the AMA was heavily influenced by developments in the United Kingdom, particularly the National Health Service.

"There was a concern … potentially unintended consequences along the NHS-style system, that we know is struggling and continues to struggle, would eventuate," Dr Bartone said.

Over the years, Dr Bartone said the AMA's position on Medicare had gradually shifted.

"Universality of access is a fundamental right and a fundamental equity issue … from that point of view, the AMA welcomes the history and the evolution that has led to today," he said.

The ad reads: "This card will cure one of your biggest headaches." Infographic: A Medicare ad ran in the Sun Herald in October, 1983. (ABC News: Archives)

In the years after Medicare, Ms Buckingham recalled there was still considerable debate about the program.

Some of those who could afford private insurance before its introduction found some visits for specialists were no longer covered.

"No system is perfect … there were some exceptions with a specialist where you thought, hang on, we pay this private health insurance, we got back more before Medicare than after," Ms Buckingham said.

"But we were also aware there were so many people that couldn't afford even private health insurance and they had no cover whatsoever, much as America is."

"The vast majority of low or no-income workers, were going to be able to have their basic medical needs met. That kind of outweighed what you lost."

A cartoon of Neal Blewett holding a Medicare card. Infographic: A Sydney Morning Herald Medicare special features a cartoon of then-health minister Neal Blewett. (ABC News: Archives)

Topics: health, government-and-politics, health-policy, federal-election, australia

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