Ideas@TheCentre – The Centre for Independent Studies

Ideas@TheCentre

Ideas@TheCentre brings you ammunition for conversations around the table.  3 short articles from CIS researchers emailed every Friday on the issues of the week.

A more competitive Medicare

David Gadiel

27 March 2015

ideas-image-150327-1Since the 1960s, the Commonwealth has pursued a series of wasted policies to limit out-of-pocket charges and to set with certainty what doctors charge and what patients pay in all circumstances. Since the early 1990s, it’s variously tried to anchor these policies around the so-called Medicare Schedule Fee.

This has resulted in public policy ricocheting between diametrically opposed objectives. On the one hand, the Commonwealth has sought to encourage bulk billing via incentive payments (costing more than $0.5 billion a year) that reward GPs for limiting their charges to 100% of the Schedule Fee to Concessional patients; and on the other, it’s repeatedly attempted to mandate a statutory GP co-payment – using the Schedule Fee as a marker.

The problem is that Government has no constitutional power to fix doctors’ fees. The Schedule Fee is no more than a ‘fee for benefit’ purposes. GPs are willing to bulk bill for over 80% of their consultations at a 100% of the Schedule Fee and to collect the bonus in the case of Concessional patients, but where local conditions permit, they’re quite happy to charge what the market will bear.

Government should abolish the Schedule Fee together with the bonus for bulk billing, and save itself the cost and contradiction of paying GPs for doing so.

Co-payments would become the business of doctors rather than governments. This would concentrate the minds of health consumers on what doctors charge instead of what government pays; it would also engineer a systemic shift towards greater competiveness in setting all medical fees, as in the deregulated markets for medical services of New Zealand and Singapore and create thereby a focus for ultimate removal of private medical price signals remaining in the market — both for GP and specialist services — essentially, the AMA Fee List.

GPs who were concerned about co-payments creating a barrier to primary preventive health services could obviously continue to set fees equivalent to the Medicare benefit.

 

David GadielDavid Gadiel is a Senior Fellow at the Centre for Independent Studies. His latest research, Towards a More Competitive Medicare: The case for deregulating medical fees and co-payments in Australia, was published on 23 March 2015.

 

Why Britain could be headed for chaos

Peter Saunders

27 March 2015

ideas-image-150327-2Peter Saunders files the first of his reports on the coming British general election.

When the 2010 UK General Election ended in stalemate, and the Conservatives and Liberal Democrats formed a coalition, they agreed on four important constitutional reforms that could have a major impact on what happens this time around.

The first was an agreement to introduce fixed-term parliaments, removing the power of Prime Ministers to choose when to call an election.  The aim was to prevent David Cameron from terminating the coalition early at a time advantageous to him.  If, as opinion polls suggest, the next election also results in a hung parliament, this fixed term rule could cause problems.  None of the smaller parties is keen on another coalition, so the Conservatives or Labour might have to form a minority government.

Under the old arrangements, the Prime Minister could call another election in the hope of gaining a full majority).  But under the new law, there is no mechanism by which a Prime Minister with a small or no majority can attempt to strengthen his position.  Britain could be heading for a period of debilitating political instability.

The second constitutional change was a referendum on electoral reform.  The Liberal Democrats wanted to replace the ‘first-past-the-post’ system, claiming (correctly) that it is unfair on smaller parties.  So in 2011, a referendum was held on a proposal to move to an Australian-style Alternative Vote system, but this was rejected by voters.

The third constitutional change — reform of the House of Lords, making 80% of the seats directly elected — also failed when 93 Conservative back-benchers opposed it at second reading.  Following these two set-backs, the Liberal Democrats then retaliated by withdrawing support for the fourth measure, a fundamental review of parliamentary boundaries.  This means the 2015 election will be fought on the old boundaries which heavily favour Labour.  If Labour and the Tories both got the same number of votes, Labour would win up to 40 more seats.

Don’t be surprised if on May 7, the Conservatives win most votes but Labour forms a government.

 

Peter SaundersPeter Saunders is a Distinguished Fellow of the Centre for Independent Studies.

 

Same-sex marriage isn't same-sex parenting

Simon Cowan

27 March 2015

ideas-image-150327-3There’s no one case ‘against’ same-sex marriage, but a common theme is that same-sex parents aren’t as good for kids as biological ones.  This is centred on the premise that marriage is primarily about raising children, but the premise is flawed. The nexus between marriage and children is already irreparably broken — and not by same-sex families.

There was once strong social pressure to ensure parents were married and stayed married. This even led to routine adoption of babies of unwed, mostly teenage, mothers between the 1950s and mid-1970s. There was a time when having children out of wedlock carried a social stigma. It no longer does.

The rate of ex-nuptial births (those outside a registered marriage) remained under 10% between 1910 and 1970, but has risen steadily since. By 1990 it was over 20% and by 2010 had reached 34%. Additionally, the 2011 census found more than one in three couples (married and defacto) are childless.

Moreover, in many ways the legal rights of defacto couples are now all but indistinguishable from married ones. People are getting married without having kids and people are having kids without getting married.

The legal and societal position of married parents (gay or straight) vs unmarried parents is a serious challenge to the notion that there remains a traditional meaning of marriage to uphold.

Hence the rhetorical sidestep of same-sex marriage opponents to focus on heterosexual, biological parenting vs LGBTI parenting, which brings an obvious disconnect: preventing same-sex marriage will not prevent same-sex families.

The law doesn’t recognise the prerequisite of same-sex marriage before allowing same-sex couples to become parents. Same-sex couples can adopt in NSW, WA and Tasmania (with moves for similar laws in Victoria and South Australia). Lesbians can access IVF, and surrogacy has long been accessed by same-sex couples.

As at June 2012, the ABS noted there were 41,000 Australian same-sex couple families. The 2011 census found 12% of same-sex couples had children living with them. There are also undoubtedly LGBTI people among the 961,000 one-parent families in the 2012 data. Same-sex parenting exists in the absence of same-sex marriage and will continue to do so.

The simple fact is that, for good or ill, society has moved past the ‘traditional’ meaning of marriage. While anyone is welcome to campaign for its return, seeking to uphold that meaning solely in respect of LGBTI couples is ignoring decades of social change.

 

Simon CowanSimon Cowan is a Research Fellow at The Centre for Independent Studies.