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The decision to appoint to the Pharmaceutical Benefits Advisory Committee a former chief lobbyist for the drug industry clearly indicates that the provision of affordable drugs to all Australians is no longer a prime concern of the Howard Government.

Why has this government, with its stated commitment to Medicare and the public health system (in which supply of affordable drugs is essential), chosen to weaken this committee? Why is the government prepared to pay more for drugs than it needs to?

Of course the drug industry, comprising as it does some of the world's largest multinational corporations, is a powerful and rich lobby group with a capacity to donate large sums of money to those it wishes to influence (they even offered me a free ticket to the Australian Open just because I might prescribe their drugs).

But one has to look further than that. With such an important issue as health, the decision must fit with the long-term thinking and ideology of the government. Why would it want its own government drug bill to skyrocket? What possible sense is there in such a decision?

To answer that, one needs to look at this government's actions since it came to office. To its credit, childhood immunisation rates have increased substantially (at very little cost to the taxpayer). It has pursued some promising options to improve coordination of health care. The cost of these initiatives has been in the millions.

But where has it spent large sums of money? Has it been in areas that promote the egalitarian society about which the Prime Minister waxed lyrical on Australia Day?

Sadly, the answer is no. The big money has been spent on the private health industry. Nearly $3billion of taxpayers' money has been paid to the private health insurance industry (through the private health insurance rebate) to provide health care to the 45 per cent of Australians who can afford to choose. The other 55 per cent have one choice: the underresourced public system.

So how does the decision about drugs fit with these actions? The consequence of a blowout in the government drug bill will be that the government will have to look at the viability of the Pharmaceutical Benefits Scheme (which subsidises our drugs for $21.90 or $3.50 co-payment). The government will increase this co-payment, and private health insurance will be invited to take up the slack. Those who can afford private insurance will pay higher premiums to cover the cost of the drugs; those who can't will struggle with the increased co-payments; and many will just go without.

An alternative may be to introduce a means test for people seeking subsidised drugs. The outcome will be similar. Those who can afford private insurance will get the drugs but pay higher premiums, and the drugs will be more expensive. Those who pass the means test will get a restricted number of drugs, and those who are around the means test cut-off (the battlers John Howard likes so much) will be wondering why they are being punished.

The drug industry will make even bigger profits and the private health insurance industry will increase its turnover. Patients will either pay more or miss out.

Either way the government will use the increased cost of drugs as an excuse to get people to pay more from their pockets to the health industry.

At first there will be a cost to the government, just as the present $2.8 billion support of the private health insurance industry is a cost. But then the government will say: "This is still too expensive. We must reduce government involvement in health-care provision. Let's just provide health care and drugs to the most needy, and let the private sector sort out the rest. Public provision of health care for all is not really sensible. The private sector does it better. (Ignore the fact that private medicine is much more expensive than public medicine.) Let's remain committed to Medicare, but only for the desperate and needy."

Thus we will eventually see the government's true agenda: small government; a flourishing, expensive, wasteful private sector; a safety net for the desperate; and the destruction of our universal health insurance scheme (Medicare), which aims to provide high-quality care to all irrespective of income. The result: a more divided society where the well-off enjoy themselves, the very poor have a second-class safety net, and those in between struggle to afford private health insurance.

Whatever happened to our egalitarian society?

Dr Tim Woodruff is vice-president of the Doctors Reform Society. E-mail.

This story was found at: The Age

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