The untouchables
The AMA operates without competition or counterpoint. So why does it get a free pass from both government and the media?

Image by Adrian Clark (Flickr).

The prime minister was solemn in parliament last week after the announcement that his government’s Medicare reform had been killed off. “What I well and truly learnt in my four years as a health minister,” he said, “was if you want to bring about effective health reform in this country it is best done, in fact, often it is only done with the broad support of the medical profession.” His disposition wasn’t that of the Catholic penitent, which political observers and would-be psychoanalysts are wont to foist on him. This was a grudging return to Liberal Party first principles.

A Liberal prime minister backflipping in the face of a union campaign sounds fanciful, but it is precisely what occurred. The Australian Medical Association (AMA) is, a conservative friend of mine quipped, the Liberal Party’s CFMEU: organised and uncompromising, with the ability to give even a friendly party in government as much heartburn as it does help.

In mid December 2014, then health minister Peter Dutton announced the GP co-payment 2.0: a rebate-reduction policy. The policy represented a threat to the front line of the medical industry. The government was asking doctors to take an upfront hit to the Medicare rebate and to recoup the gap from patients, effectively outsourcing its tax collection. The AMA risked, for perhaps the first time since they had opposed the introduction of Medicare in the 1970s, being viewed as the bad guy. They embarked on a community-level campaign akin to the ACTU’s crusade against WorkChoices – with both policies subsequently declared by Tony Abbott as “dead, buried and cremated”.

White-collar groups call themselves associations to avoid the stigma of unions, which are widely distrusted and increasingly irrelevant. Involved in the day-to-day political debate yet also able to soar above it, the AMA uses the language of care and duty to disguise their monotonous entreaty for ever more money.

There are no other effective doctors’ groups, meaning the AMA operates without competition or counterpoint. The Labor Party is as uncritical of it as the Liberals, and although the AMA has the occasional stoush with the nurses’ union, over issues such as NSW Labor’s proposal to establish nurse-run clinics, it remains the untouchable apex of authority on health policy.

The media too gives it a free pass, reflexively reporting its policy positions. AMA HQ is a slick operation: always on hand with press releases and doorstops, providing a handy rejoinder to any story on health policy. If the AMA is at odds with a government announcement, it’s not uncommon for media outlets to skip seeking a statement from the Opposition. Even the murky nexus between doctors and big pharmaceutical companies is rarely examined. By way of contrast, see the (rightful) scrutiny and scepticism teachers’ unions to which are subject by the media.

The government is now said to be considering a proposal with the full support of the AMA that would give doctors the discretion to charge as they please on top of the Medicare rebate, which would mean doctors’ incomes will increase without a reduction in government health spending.

Reform without structural change to health spending while increasing doctors’ salaries is rent-seeking of the highest order. It is difficult to see exactly what is in it for the government, which has found its niche: being pro-business without being pro-market – asking some of the most marginalised people and the organisations that represent them to embrace austerity economics while corporate welfare continues apace.

This sweet direct-billing deal appears to be without conditions, such as making ongoing prescriptions (contraceptive pills, for instance) available over the counter, an act which would reduce the number of GP visits. Benefiting without carrying any burden in an industry so heavily regulated by government, so heavily funded by government, and which enjoys such easy access to government is soft “crony-capitalism”.

And so we are left with the bizarre application of public ethics, whereby certain groups are considered good by virtue of their professional or educational status. The AMA, a lobby group masked by the cloak of their profession, continues to operate free of inquiry despite being the recipient of government funding to the tune of around $20 billion annually. No group in the public sphere should be impervious to scrutiny, especially not when it benefits so handsomely from both government policy and funding.

Elle Hardy

Elle Hardy is an Australian journalist based in the United States. She can be found at www.ellehardy.com

@ellehardy

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