Doctors are being asked to play God and decide who are the 'deserving poor', and if they choose not to charge the GP copayment, the cost will be coming out of their own pockets, writes Tim Woodruff.

The announcement that the proposed $7 GP co-payment will be replaced by a $5 rebate cut to GPs when they see non-pensioners and non-concession card holders is a kick in the guts to working Australians, and a threat to affordable health care for all but the rich.

The intention of the Government is unchanged. It still regards its budget policy as a good policy, but one that isn't possible to legislate.

It wants doctors to charge co-payments. It wants patients to see doctors less often, claiming that patients see doctors too often despite a complete lack of evidence for such a claim.

The Federal Government completely ignores the fact that patients are not in a position to know whether their apparently minor complaint is an indicator of a life-threatening condition. We doctors want patients to come with apparently trivial complaints like indigestion which is really a heart attack, a tiny foot ulcer which is really the first stage of gangrene leading to amputation, some bleeding from the bowel which isn't piles but instead totally curable bowel cancer. We can save lives.

This policy is forcing working Australians to pay twice for health care - once through taxes and the Medicare levy, and again through the co-payment.

A parallel is worth considering: there is no co-payment for police care if a person's car is being stolen. Taxes pay the total cost of care. Thus, we provide more support for care of property than for care of our health. This proposal aims to reduce that support for health even more.

The co-payment is a price signal, but at $5 it signals nothing to a rich politician on $200,000 a year, even with 50 visits for the family over the year. For a low-income-earning family on $50,000, paying off a mortgage, it is a kick in the guts.

As a price signal it will work, and lives will be lost.

This is also an attack on doctors. It is putting them in the invidious position of deciding whether to maintain their own income by charging patients the $5 that they will lose from the rebate, or accepting an income cut of more than 15 per cent for every patient they continue to bulk bill. It is asking doctors to play God and decide who are the 'deserving poor'.

Many doctors prefer not to do this but will be forced to do so or accept an income cut, something which is not being asked of any politician or public servant.

The further effect of these changes will be to see co-payments rise well above the $5 suggested. Many doctors will charge more to cover the costs of collecting the payment or to cross-subsidise the bulk billing of other patients. Freezing the rebate for another four years (i.e. not rising with inflation) and changed rules for short consultations will also add pressure to increase copayments and abandon bulk billing, even for pensioners and card holders. Once co-payments become standard, they just keep on rising.

Whilst many might see this proposal as a change for the better because pensioners and card holders are now partially exempt, the truth is otherwise. The backdown is political. The ideologically driven policy remains unchanged i.e. to destroy Medicare as a system of universal public health insurance, with premiums through taxes according to capacity, and benefits available to everyone according to need.

This proposal progresses that destructive agenda as it will further entrench the idea of co-payments as justified and reasonable policy despite the evidence of the grossly inequitable effects of such extra charges.

With the current 80 per cent bulk billing rates, most working Australians have been able to access GPs. It is about to change. Combine this proposal with the Federal Government's encouragement of private health insurance to cover the rising GP copayments, and the stage is set for the rich to get better GP services while the rest must accept second rate or unaffordable access. A two-tiered health system. That's what Americans have.

We should have a debate about our health system. Inefficiencies exist, but money can be saved without affecting the fair go which ordinary Australians deserve.

Instead the Federal Government has chosen to withdraw money from the most efficient part of the health system i.e. primary care and general practice, while ignoring many areas of potential savings which might make our health system more efficient and more equitable.

Tim Woodruff is currently the vice-president of the Doctors Reform Society and a specialist physician working in private rheumatology practice in Melbourne. View his full profile here.