Labor’s Cancer Care Policy and the Australian Constitution
The Australian Constitution and Labor’s Cancer Care Policy.
As we ever so slowly move towards the Australian Federal Election, both major parties are presenting their health policies. Labor has promised a 2.3 billion dollar boost to cancer care in Australia. A significant proportion of the funds are for ‘free’ diagnostic procedures including x-rays, mammograms, CT Scans and MRIs. It also includes $433 million for ‘free’ consultations with oncologists and surgeons through converting these services to bulk-billed Medicare items so patients no longer have to pay a proportion of the Medicare Benefit Schedule (MBS) Fee. Labor has pledged that they will provide a bulk-billing incentive payment, similar to that currently available for primary care. While this is likely to increase the number of patients without out-of-pocket costs, this cannot be guaranteed.
Australia is one of the few advanced economies that doesn’t have some method of fee control for privately practising doctors. This is due to a quirk in the Australian Constitution which prevents ‘any form of civil conscription’ for dentists and doctors. This protection is not granted to other Australian citizens. This clause was included via referendum in 1946. The insertion of the clause was a result of the Federal Government’s attempt to overcome political opposition by doctors to the introduction of the Pharmaceutical Benefits Scheme. The referendum was to allow the Federal Government power to administer some significant health programs which it previously did not have. Doctors were nervous that the amendment to the constitution provided a power to nationalise medicine and dentistry and the ‘civil conscription’ clause was inserted to prevent this. Sally Wilde has written a fascinating article of the politics of the time that resulted in this outcome. .
The consequences of these few additional words in the constitution have constrained health policy in Australia. Labor’s policy, while worthy and apparently well thought through cannot guarantee that any services will be delivered for free as doctors have a constitutional right to charge what they wish, although it is likely that the proportion of bulk-billed services will increase.
Out of pocket costs, as a result of the difference between the MBS fee and what a doctor actually charges, continues to be controversial in Australia  and has received significant publicity. The Australian Senate inquiry into the ‘Value and affordability of private health insurance and out-of-pocket medical costs’  report recommends that the Department of Health publish doctors’ fees in a searchable database. Alternatively, it has been suggested that MBS rebates not be available to doctors who charge excessive fees – although neither major party has included this proposal in their health platform.
Overall, while implementation of the Labor policy will face some hurdles, it is certainly an attractive proposition for cancer patients and also for those providing technologies used in the diagnosis and treatment of cancer.
 Sally Wilde ‘Serendipity, Doctors and the Australian Constitution’ Health and History Vol.7, No 1 (2005) pp 41-48
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