News from everywhere

Protecting Medicare?

The federal government has been trying to edge us closer to private health care for many years. It continues to subsidise private health in the form of the Private Health Insurance Rebate. Kay Patterson’s health package ‘A Fairer Medicare’ planned to allow people to take out insurance to cover the gap between doctors’ fees and the Medicare rebate. Private health care costs governments substantially less than public health care. It looks better on the bottom line. So why is ‘cuddly Abbott’ (as Labor Health spokesperson, Julia Guillard, called him) now spending $2.4 billion on public health?

One answer is that it’s election countdown time. Australians expect free or highly subsidised health care.

When Howard said in 1987 that Medicare was ‘one of the great disasters of the Hawke government’ he could not have known how much the concept of free and universal health care would become part of the Australian psyche. How it would be one of the biggest obstacles the bulldozer of Liberal Party economic reform would have to face. So much so that in 2004, Howard would need to be seen to embrace Medicare. Announcing ‘MedicarePlus’ he vowed to protect ‘one of the best health systems in the world’.

But the Medicare that Howard claims to protect is a system in decline. In 1987 the amount a doctor received for bulk billing was adequate as full payment. Now with a payment of $25.70, bulk billing is almost untenable.

‘MedicarePlus’ offers a complex series of reforms including a $5 incentive to bulk bill children, pensioners and concession card holders; a safety net to protect people from rising costs and money to recruit more doctors and nurses. At a cost of $2.4 billion it is certainly more generous than Kay Patterson’s $900 million ‘A Fairer Medicare’.

No doubt the additional expenditure helps. More patients will benefit. Out-of-pocket expenses will be reduced. Doctors will be better off and will be able, for a while, to continue to bulk bill targeted patients. But ‘MedicarePlus’ is still a two-tier system. The rich will be able to afford to go to doctors who charge more; the poor will not. And Medicare will exist as a safety net rather than a universal system of health care. Those who must rely on the safety net will be the least empowered in our society. What will happen when the value of subsidies like the extra $5 for bulk billing decreases? Will the government be willing to pledge more money without an election looming?

‘Medicare Plus’ is designed by Howard and Abbott to avoid accusations of dismantling Medicare. Howard says they have ‘listened to the Australian people’, but he is throwing money at a failing system. ‘MedicarePlus’ is an attempt to prop it up for a while. When it comes crashing down, after the next election, private health insurance funds will be waiting quietly in the wings.

Kathryn O’Connor

Global village
Life in Madrid

If it wasn’t for the minor fact of having six million other people as neighbours, life in Madrid could sometimes be mistaken for life in a Spanish village.

At the end of our street, on any afternoon after the siesta hour, old men in berets sit with old women on wooden benches to discuss the day’s events, pass on the gossip of the barrio or simply watch the world go by with the enigmatic gaze of the ancients. Every week, I hear the mournful whistle of the old knife sharpener who passes along our street, fighting to be heard above the car horns and amid the general Spanish disregard for noise. His whistle summons the cooks of Madrid from their apartments to the street, where he refashions their blades on a pedal-powered sharpener. If it wasn’t for the clamour all around him, to which he invariably seems oblivious, this man (also in a beret) could have been strolling through the quiet streets of San Martin del Castañar or any other pueblo across rural Spain.

Madrid is also the sort of place where you get to know the local personalities. There’s Rosa, the portera (loosely translated as caretaker) of our building, who has a heart of gold, makes it her business to know everybody else’s business and accosts all unauthorised visitors to the building in her role as the maternal guardian of those of us who are fortunate enough to live here. Or there is Luis, the watchman at the underground car park across the road who, every Monday morning, announces for the benefit of the whole street the weekend’s football scores.

On the numerous occasions when world events invade the city, the response, too, is sometimes that of the village. When I was in Australia in February, I watched television coverage of the mass anti-war protests across the world. As soon as the coverage shifted from serious-faced protesters in Sydney and Berlin to a happy crowd of demonstrators singing and dancing, I recognised the energy of the Spanish village fiesta and knew that it had to be Madrid. Back in Madrid a month later, on a cold night in March and at the height of Spanish public opposition to the war in Iraq, I was washing the dishes when our street erupted in a cacophony of noise. I have to confess that at first I didn’t notice. When it continued, we went out onto the balcony to be greeted by the sight of all the other balconies filled with Madrileños banging their pots and pans in protest against the war. Across the city, the scene was played out simultaneously in perhaps the most creative (and noisiest) protest among many.

Ride in the lift of any office building across the city and you’ll be greeted by every person who gets in, and then wished well by everyone who departs. On the streets, pedestrians, particularly the elderly, routinely step out onto the road and seem genuinely surprised (and even irritated) to find a vehicle bearing down upon them.

Yet for every vestige of village-Madrid, this is also a city which does things on the grandest possible scale, making it one of Europe’s liveliest and most extravagant cities.

This is the city of Real Madrid, a team of outrageous football (soccer) talent containing an unparalleled gathering of Zinedine Zidane, Luis Figo, Ronaldo, Raul and  Roberto Carlos. This is football royalty with all of the attendant expectations. At one game last year, the team was roundly booed when they could only win 3–1. When their only trophy at the end of the season was the Spanish Primera Liga, the coach and club captain were unceremoniously sacked, even as 300,000 Madrileños crowded together to celebrate in the Plaza de Cibeles.

With the arrival last summer of David Beckham and his celebrity wife, Victoria, it appeared as if Los Galacticos were set to become the most perfect team in history. Football quickly took backstage, however, as it became apparent that David Beckham and the city of Madrid were made for each other. In the Spanish capital, a passionate love of celebrity runs deep. It was in Spain that Hola magazine (which later grew into the worldwide juggernaut Hello) was born. Every night, Spanish television is awash with talk shows passing judgment on The Next Big Thing (the wife of a bullfighter, the chances that the Beckham marriage will survive), all at the tops of their voices.

But even Beckham was upstaged at the beginning of last November when it was announced that the very eligible bachelor, Prince Felipe (the king-in-waiting), was to marry a glamorous TV presenter. The city went into a frenzy, above even its usual buzz of rumour and celebration, as every aspect of the betrothal was dissected. At the end of it all, every analyst confirmed that this was truly a marriage made in heaven.

For those of us lesser mortals who live in Madrid, it is this strange harmony of village values with a city of significance that is so compelling. For an Australian, Madrid feels like the clamorous centre of the world, calling everyone from beggars to Beckham. And yet as I walk down the street I can still be certain that people will know my name.

Anthony Ham

This month’s contributors: Kathryn O’Connor is an emergency doctor and a freelance writer; Anthony Ham is Eureka Street’s roving correspondent.



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