‘If you’ve stuck something in a place where you shouldn’t have stuck something [then you should pay],’ says former PM adviser

People who injure themselves while drunk or “stick something where it does not belong” should pay for their hospital treatment, says the policy consultant behind the $6 GP co-payment plan.



Terry Barnes, a former health adviser to prime minister Tony Abbott, faced the Senate select committee into the government’s commission of audit on Tuesday as part of its examination of his health reform proposals.

He told senators that he had not modelled the potential cost to the health system of his $6 GP co-payment push but suggested that people should also pay to use the emergency department of a hospital on a “discretionary” basis.

“If someone presents to the emergency department who has injured themselves in a drunken incident for instance, self inflicted, should the taxpayer be expected to pay the full cost of cleaning up the mess?” he said.

When asked to expand on the idea he said smokers and people who are overweight should not have to pay to use hospitals as they fall within the health risks of the general population.

“If you present to an emergency department, if you’ve stuck something in a place where you shouldn’t have stuck something [then you should pay],” he said.

When asked if a toddler who has stuck a biro tip into themselves fell into that category he replied: “I would give them the benefit of the doubt but if you presented with a milk bottle in a place it shouldn’t be as a grown adult I think that’s something I don’t really feel our emergency department should deal with but they do.”

Barnes, who is principal of Cormorant Policy Advice, admitted he had not factored potential extra pressures on hospitals into his push for people to pay $6 to visit a doctor and did not know if the costs could outweigh the benefits.

“My brief was not to focus on those bigger pictures; it was simply to model or update the 1991 measure as I’ve pointed out elsewhere when I was initially responding to criticisms about this. Imposing a similar or matching price signal on GP services in emergency departments is one way of managing those pressures,” he said.

Barnes said it was not an unreasonable thing to get people questioning if they really needed to go to the doctor and health costs per person were increasing.

“It’s interesting and I’m not going to claim the whole country behind me in terms of my assumptions,” he said.

“But certainly in terms of reaction to this proposal, the thing that surprised me is that people who are less well off, people who do have chronic illnesses, people with small children, valued those services very highly and are prepared to either consider it or pay it,” he said.

Stephen Duckett, from the Grattan Institute, told senators the co-payment idea was counter to previous government policy which was to encourage people to go to the doctor before they got too sick and ended up costing the health system more.

“We also know people on lower incomes have higher instances of illness so it would be a double whammy in that sense,” he said.

The hearing also heard from welfare expert Ben Phillips, of the national centre for social and economic modelling at the University of Canberra.

He said Australia had a “pretty well targeted” system although he would be concerned if certain areas of welfare were reduced, singling out Newstart and the youth allowance.

But he said the cost of living was much less of an issue than people thought.

“For this one the perception is very strong; in this instance it’s not so much about the reality but the expectations,” he said. “We are doing a lot better but you see your neighbours doing better and you want more.”

The age pension, in particular, took up a huge part of the welfare budget and could be reviewed.

“The general statement I’d make about welfare payments in Australia is they don’t tend to be increasing as share of GDP, as a share of expenditure or as a share of revenue,” he said.

“So at this point in time there is not a suggestion for a reduction.”

He said there were “small elements” of so-called middle-class welfare but most welfare went to low-income earners who needed it.

“Certainly worthwhile having an independent group looking into the state of finances of the country; I’d be interested to see what the recommendations are in my area of expertise,” Phillips said.

“I would be looking for those on the low-income spectrum to be beneficiaries [of the commission of audit]. I’d be concerned if there was reduction in their payments. I’d be interested to see what changes there will be in regard to pension.”

Australian Council of Social Service chief executive Cassandra Goldie told the hearing a representative from the community sector should have been on the board of the commission of audit.

“We’re concerned about the process. It does appear it will be essentially behind closed doors leading into a budget,” she said.

She likened it to when the Gillard government moved 80,000 single mothers on to the Newstart allowance without warning.

“We’ve seen the savage socio-economic implications of that because there was no process to engage with the government properly,” she said.