Word from the last bulk-billing GP in Cowper

We are one of the richest countries in the world and can afford to provide free healthcare. Government needs to stop lying about it.

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Last week I was contacted by ABC radio and then the commercial TV stations as, apparently, I am the last bulk-billing GP in the electorate of Cowper on the mid-north coast of NSW. I run my own clinic in Bellingen and have been struggling to continue to offer bulk billing to our patients.  

You could say the people of Cowper, a very safe National party seat ideologically opposed to “socialist” medicine such as universal free Medicare, have been hoisted by their own petard and now have to face the reality of their voting choices.  

I asked a woman handing out Nationals party brochures at a recent federal election about this and she said she didn’t really know much about it but that you paid for specialists, you didn’t pay for GPs. Is this naive or wilful ignorance?  

Recently a patient asked me to do a referral under a GP management plan/team care arrangement as then Medicare would “cover half the cost to see a physio”. That’s some good PR.  

Everyone else providing healthcare or even alternative medicine appears to be able to convince people that they are worth whatever costs they charge and can deflect the fact that they don’t bulk bill, yet GPs are seen as public servants who should be available at any time, should work for free (“it’s just a script or referral, do I really need an appointment?”) and are heartless and money grabbing if they charge a $20 or $40 gap.  

I tried to introduce a gap around 18 months ago but still end up bulk billing around 95% of my patients as I find it difficult to charge a gap when people are struggling so much, especially with housing. As the other GPs who have abandoned bulk billing know, our costs have gone up and bulk billing is not sustainable, therefore I don’t see myself doing this for much longer. Then I will have to make the decision to firmly charge a gap to all or close my doors, as I strongly believe that healthcare is a fundamental human right and therefore should be provided to everyone for free.  

There has been a lot of debate over the past couple of weeks about the lack of bulk-billing GPs but several issues have been missing from those debates.  

Why is it that the lack of bulk-billing GPs is the worst crisis in healthcare and GPs are terrible for not providing bulk billing? Why not the lack of bulk-billing specialists, allied health or public specialist clinics? Or the waiting times to see specialists or get tests?  

My patients can wait 12 months to see a specialist and two years for surgeries. I can’t get urgent outpatient scans for patients, even with emergencies like suspected DVTs and our local radiologist has now stopped bulk billing. I have patients who literally say they cannot afford to pay me as they just had to pay their specialist.  

Why is it that a GP charging a $40 gap is horrific but a cardiologist charging $600 is not mentioned? Why is it that private health insurance doesn’t cover GP services yet they cover alternative health and we waste $7 billion per year on the private health insurance rebate?  

GPs only cost around $11 billion per year. Problem solved right there, and that’s not even using any nuclear submarine money. Abandon the subs and we have over $386 billion to invest in public housing, schools, universities, hospitals, Medicare, increasing Centrelink payments, and providing public dental services.  

Or keep the subs and get rid of the stage 3 tax cuts and tax mining adequately. Or introduce a tax bracket above the 45% maximum. Why does someone earning $180,000, $500,000 or $20 million pay the same 45%? Why do we have billionaires? 

As GPs, the way we bill our patients is a political act. When I finish a consult, I have to consider the ambiguous and vague nature of Medicare billing codes and my risk of fines if I were audited. I have to decide if the way I bill will affect someone’s access to healthcare or their ability to pay their next bill, and also if, by bulk billing, I am shielding patients from the reality of how dire the healthcare system is in Australia at present. In Bellingen, I ask if I am worth even a portion of the $200 the local alternative health provider charges for a colonic or metaphysical massage?  

I feel all these issues viscerally (not the colonic) and cannot act in a way consistent with my core philosophical beliefs as these principles are often in conflict. Working as a GP in that environment is not financially or ethically sustainable. 

Much has been said about solutions to this and how much they will cost but how much will it cost not to address these issues?  

If we do not invest in ensuring everyone has access to these basic needs, the cost to society will be far greater in terms of missed or late diagnoses, the inability to intervene to prevent health conditions or adverse outcomes, increased emergency presentations, increased mental health problems, drug and alcohol abuse, domestic abuse, increased family stress and poorer outcomes for children.  

We are one of the richest countries in the world and can afford to provide free healthcare. Our society has become increasingly unequal and GPs have for too long hidden the crisis in healthcare by taking a personal cut in our incomes by continuing to bulk bill due to empathy and guilt.  

We have tried to convince politicians of the value of an adequately funded primary health system and they have ignored us.  

We don’t need complicated reforms. Medicare is a great system, it just needs to be funded adequately and we need to stop wasting money on piecemeal private industry solutions to our health crises. We need to adequately fund all healthcare under Medicare, including dental, mental health, allied health and specialist services. We need the government to recognise the incredible value that GPs provide in our healthcare system.  

It’s time for patients to demand this from their politicians and not believe the lies that we cannot afford this.  

Dr Kelly Hamill is a GP in Bellingen. She also has a BA in Philosophy and previously worked for Greenpeace, Amnesty International, the Bodleian Library at Oxford University, and pro bono for the Medevac program for refugees on Manus Island.