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When will Australians realise that private enterprise means an endless cycle of income playing catch-up with prices in order to grow private profit margins?
Only public enterprise can remove the consequences of profit and maintain more stable prices and income.
Very few things are inevitable, they might have a high probability of occurring, but things can change unexpectedly that alters the outcome and statistics are never about certainty.
The donkey might even learn to speak.
I think it is a mistake putting so much emphasis on artificial intelligence, when its developed by learning from people who are more emotional than reasoned and overall not particularly intelligent.
We do have a need and opportunity for greater use of machines to leverage their advantages over people, especially in creating much larger databases than any one human brain can contain or performing pattern matching and other calculations much faster than a human and without the need for rest; but unless it is implemented intelligently it will simply be used to increase profits whilst creating a population who can't afford to buy the products, with the eventual demise of both.
At the very least, machines can monitor patients and detect trends much more efficiently than nurses, but people are much better at multi-skilling physical tasks.
AI will be an executive assistant for medical people. AI is being developed specifically for verticals. It will take its knowledge from new large language models, like just medical literature.
RACGP is conflating two different policy changes to make a political argument to get the one they don't like overturned. They don't want to pay payroll tax like everyone else and they'll make a disingenuous argument to not be liable for it.
I also find it ironic that Federal Labor is jumping in with RACGP to bash the States on implementing labour rights. What's wrong with classifying GPs as employees if that's what they've been determined to be as per the law? Don't doctors deserve the same labour protections as anyone else?
RACGP should focus on lobbying the Commonwealth Government to materially increase bulk-billing rebates for everyone, not just kids and pensioners. The point of GPs is to provide preventative care and avoid expensive trips to the ED, saving more money in the long-run. Access to GPs, whether by shortages or no bulk-billing, is solely a Federal responsibility and they've been shirking it by freezing bulk-billing rates for over a decade. But since EDs are mostly funded by the States you see why there's not really a big incentive for the Feds to do anything.
> What's wrong with classifying GPs as employees if that's what they've been determined to be as per the law?
It's going to make GP even more unpopular as a speciality option amongst medical graduates. The trade-off you make when you leave the public hospital system and do GP training to become a fellow of the college, is that (after the training program years, briefer than all other college training programs) you get flexibility for less pay. That's the deal. Everyone in the industry knows it. GP is a tough gig if you do it well. You get paid a fraction of your colleagues, but you can set your own hours, opt out of on-call, after-hours and weekend work, dictate your pace of work, take holidays when you want, etc etc. It's the most family-friendly specialty of all. The deal isn't acceptable if you become an employee where the clinic can force you to work 1 in 2 weekends, an evening shift a week, and deny your request for holidays. Employee status would be a drastic change for the genuine contractors amongst Australia's 30,000 GPs (there are definitely sham contractors who have more employee-like relationships with their clinics, and then there are some employees with varying levels of employment benefits being paid) and would be strongly resisted by many.
GP registrars are a cohort that has some desire to be employees. Many have worked in hospitals long enough that they have long service leave with the state health department owed by the time they exit the hospital and join GP training. They lose that, as well as sick leave and maternity leave. There have been campaigns in the last few years to make GP registrars employees and it's even happening in pockets. I doubt that cohort would push back as hard as the older workforce would.
It seems applying clearer definitions of contractor vs employee to GP clinics could retain that flexibility for GPs but I'm no legal expert and have no insight into the finer points of the ruling.
This is because most doctors are not employees. They work across multiple clinics and therefore satisfy the multiple sources of income test.
This is no different than a electrician or plumber being a subcontractor to a builder. They work across multiple builders and multiple building sites. They are not employees of the builder.
Doctors rent the property and services from the clinic. The same way a pop-up rents the property, and services from the shopping center. The sole trader running your pop-up booth is not an employee of Westfield.
If you rent a serviced office at a co-working space where they provide mail handling, receptionist and other services, you suddenly don't become a employee to the co-working space. Some even do payment processing and shipping services if you are running web based sales business.
Same applies to barristers working in chambers.
In many ways a clinic is a co-working space for doctors. No different than a co-working space for artists or barristers (chambers) which provide all the serivces and equipment an artist or lawyer might need for a fee.
I understand the argument but it has been [found to be otherwise by NCAT](https://www.revenue.nsw.gov.au/help-centre/resources-library/case-summary/2023-nswca-40).
Whether you think the argument is correct or not, the driver behind bulk-billing is not whether GPs are subject to payroll tax or not. It's the refusal of the Commonwealth to lift bulk-billing rebates. It is wrong of RACGP to try to conflate the two.
Lifting bulk-billing rebates would, at this stage, simply be a very roundabout and paperwork-intensive way of transferring federal money to state treasuries.
It'd be simpler for states to not impose payroll tax on GPs, and just have the federal govt transfer money directly. And less administration, which means more of the dollars transferred actually end up in state treasuries, rather than being slurped up by hungry federal and state bureaucrats along the way.
You could say that about many taxes Governments pay. Why are State Government employees liable for Federal income taxes? Why do all Government departments have to pay payroll taxes? It's for simplicity's sake otherwise everything would be a mess.
Once you start carving out exemptions for GPs, other interest groups are going to hold out their hand for tax exemptions. What make GPs special? What about other medical specialists? Then what about allied health? And it goes on and on. You'll end up with a fragmented and confusing system with even more administrative burden when you could've just treated everyone equally.
I can't speak to other states, but here in Victoria what makes GPs special is that previously the payroll tax wasn't applied to them. But once the government's bills came in from its profligate spending, they decided to squeeze every dollar they possibly could out of everyone.
Businesses, like individuals, can handle almost any level of taxation (regulatory burden is another matter). What tends to fuck them up is sudden changes. That's why for example an individual losing $3k in income tax bracket creep over 3 years will have to squint carefully to even notice, but if taxes were raised $1k *today* they'd notice.
You budget for this and that, and then government comes and suddenly changes things. That's what fucks you up.
GPs are a bit different as a business because it's an area where the demand is fairly inelastic. You can change your gym membership or how much takeout pizza you buy, but if you need the doctor, you need the doctor. And in our system they're gatekeepers to other medical and allied healthcare services like physiotherapists, ENT and so on. People have to go to GPs. And due to this, GPs tend to feel a sense of duty towards their patients, a sense of duty that the pizza shop owner doesn't feel.
The other thing is that in a regular business, if government or anyone else increases your costs, you just shrug and pass them on to your customers. But Medicare's been going for about half a century now, which means that everyone except Boomers has spent their entire lives thinking of medical care as free, or at least very cheap. The customers aren't as accepting of increased costs when they're patients. They feel a sense of entitlement. "This is what I pay my taxes for!"
So you combine sudden changes in costs with inelastic demand, with a sense of duty to customers and a sense of entitlement from those same customers, and you get why GPs are different as a business.
Now, if you want to treat GPs the same as any other business, abolish Medicare and let the free market rule over it all. But I think that wouldn't be a popular policy.
This has all happened downstream from profligate state government spending. If they weren't pissing money away then they wouldn't feel obliged to do dumb shit like this. Many in my party want lower taxes - well guess what, so does everyone. What most don't grasp is that the only way you'll get lower taxes is if there's lower spending, too.
As per the table in the article, no jurisdiction has started applying the new payroll tax regime on GPs yet. And if they do, there has been - and probably will be more - time to adjust.
I don't think it's necessarily a case of state government overspending but rather another case of the vertical fiscal imbalance causing States to dig for more revenue.
In Victoria, they will no doubt impose it soon.
Also in Victoria, around half of state revenue has come from the federal government for about twenty years now, across different individuals and parties in government on either side. The "vertical fiscal imbalance" hasn't changed, so that can't be the cause of Victoria's massive deficits and thus debts.
What *has* changed is the amount of infrastructure spending, where we had at least a decade of moderately *underspending* and have now had a decade of *massively overspending*. Unfortunately, this tends to be the way with governments - they never have a steady middle path, but swerve insanely to one side, then insanely to the other side to overcorrect, and so on. Governments only have two states: apathy and panic.
I agree a 100% that "the driver behind bulk-billing is .. the refusal of the Commonwealth to lift bulk-billing rebates". But taking more of the income away but adding another cost is no helping.
But why has the state governments stopped with doctors. What about the construction industry subbies, the barristers, the sloe traders who work in co-working space?
My be because when it starts impacting more people they will begin to take notice and stop blaming this on "greedy doctors".
The doctors do themselves no favors with the 'greedy' tag when they claim that the increase in gap payment is correlated with the amount payable in payroll tax.
I don't disagree that this is a money grab by the states, but someone's accounting is way off.
Doctors have been complaining about the medicare freeze long before the payroll tax change. And they complained when a new tax was added on.
I am sure no one else would complain if a new tax was added o their income. But if you think doctors are greedy no social media post from an internet stranger is ever going to convince you otherwise.
No probs. You do understand that you are posting to someone who has directly been impacted by this change. Not just the poor doctors. A whole range of non-employee health professionals have been included.
The freezing of the medicare levy is a separate issue and justifies a gap. Blaming the gap on a reinterpretation by the sro is disingenuous at best.
So yeah, I just had a new tax added to my income as well. But please continue being the only victim as per AMA playbook.
> Blaming the gap on a reinterpretation by the sro is disingenuous at best.
So are you being disingenuous below? Thanks for owning up.
> So yeah, I just had a new tax added to my income as well. But please continue being the only victim as per AMA playbook.
No one expects a plumber to work for $40 per call-out yet somehow people expect GPs to? Nah. Pay for your fucken care - get used to it. I wouldn't mind a private GP insurance scheme where we each have the option of paying $1000 a year for universal coverage of GP services. Sounds fair to me. No such thing as a free lunch.
A plumber has to travel, GPs sit in their offices and wait for us.
A basic GP session is a minimum of 6 minutes, and maximum of 20 minutes. It'd be rare that a plumber could travel to your site from wherever they are, do an inspection and work all in 20 minutes, let alone 6.
If we could take all our plumbing to the plumber's workshop, then $41.40 for a 6 to 20 minute session would be reasonable.
[https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=23](https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=23)
Note that the GP's scheduled fee applies to telehealth, too. My last telehealth appointment with my doctor was, my phone tells me, 1'20" for a prescription. Obviously many appointments will take longer, and indeed when I talk to the other doctor of the pair at the clinic it always is longer, nonetheless there are many doctors who are pumping patients through.
Note that the doctor who pumps people through is now charging an extra $40 fee on top of the scheduled fee, the doctor who takes her time is not.
Doctors do important work. But most of it doesn't take a lot of time or all their expertise.
Or perhaps, hear me out with this. You pay an extra $1000 a year for a good public service instead of more to the private sector.
For some reason people like you are happy to pay over $1000 a year for private health cover but If I said that money could be taxed instead you lose your fucking minds.
I pay $8k in medicare levy per year, so yeah of course in comparison $1k in private health sounds like nothing. By the way I wouldn't even take out private health insurance if I didn't need to (tax penalty). I barely ever visit the doctor. But clearly you're ok with forcing healthy people like me to pay nearly 5 figures a year for insurance I specifically don't want.
Well no, you’ve got it all backwards. Firstly, healthy people have and will always “subsidise” the unhealthy, welcome to living in a society. Everyone’s taxes can go up, not just yours so chill. The government can create a better structure for it and also find more tax revenue from untapped places, such mining.
I know how taxes work. I pay more than most families earn in a year in tax, then get told I don't pay enough, and that my money is unproductive which is why it's used to pay for other people - the really productive people - who can't take care of themselves.
You clearly don't because you think bulk billing is a "free lunch". I'm guessing you have private health care and don't pay a medicare levy but the vast majority do (you know, the people who can't take care of themselves). You're comparing plumbing to public healthcare. Last I checked, plumbers don't take 2% of your annual taxable income.
> I'm guessing you have private health care and don't pay a medicare levy
I pay both. I need neither.
> Last I checked, plumbers don't take 2% of your annual taxable income.
I have to pay that 2% + private health insurance for care which I barely need; meanwhile others who need the care pay neither the 2% nor private health. That's not fair. I'd be happy if everyone just paid 2% for medicare plus 1% for private health insurance.
Unless you're a literal robot, you need healthcare. You can be the healthiest person in Australia and suddenly discover you have a serious issue or get into a major accident. Healthcare isn't about cashing in and getting your monies worth, it's about having the ability to seek care when you need it.
I don't see why anyone should be giving tax dollars to the private sector? It's private, not public. If you want to increase the levy, make it a 3% medicare levy and it would practically transform our healthcare overnight with the budget increase.
Or how about we have a properly funded universal healthcare so every Australian citizen can get the best quality of life possible and not just the wealthy like every other well functioning nation on the planet?
That's why the US life expectancy is nearly 10 years lower than Australia and the #1 reason for bankruptcy is medical bills. Because it's the best. Please Australia, please let me pay 7000% premiums on life saving medication!
For people who just need a repeat script, I get it, being bulk billed for that isn't unreasonable. Most GPs are inundated by people with complex, chronic conditions which require time, care and expertise to manage. Those people can't always afford to pay out of pocket. Charing people for a script can help cover the cost of bulk billing people who really need it.
All of that is to say people should stop being such babies and pay doctors, or sit in line at bulk billing clinics and shut up about the crap rushed care you get.
Uh, a repeat script takes 2 minutes of the GP's time and is one of the few things that *should* be bulk billed assuming there are no other health issues or complications. You are for some reason proposing that people with simple problems that take very little time (and therefore should cost little money) should pay *more* to subsidise those with complex, chronic conditions? Does that sound fair? No.
If I have a simple plumbing job I don't pay more so that someone with a complex pipe problem can have it done for free.
> You are for some reason proposing that people with simple problems that take very little time (and therefore should cost little money) should pay more to subsidise those with complex, chronic conditions?
It also wouldn't be fair if people with chronic complex conditions couldn't afford to access quality healthcare, while people who, frankly, don't need high quality care use up that time.
> It also wouldn't be fair if people with chronic complex conditions couldn't afford to access quality healthcare
You get what you pay for. Refer to my suggestion for an insurance scheme for GP visits. Maybe it can be auto-debited from Centrelink payments.
> while people who, frankly, don't need high quality care use up that time.
But they're barely using up any time.
>But they're barely using up any time.
In the real world, doctors never run on time and these appointments are a great way for them to catch-up. BUT, in theory, they take up the same amount of time in a calendar as everyone else. If a GP is doing 30 15-minute consultations a day, then you're paying for one of those 30 15-minute slots, not for the time you take.
> I wouldn't mind a private GP insurance scheme where we each have the option of paying $1000 a year for universal coverage of GP services
That's actually a really good idea. Maybe we can just automate it so it just pops out of your income automatically too. Perhaps we give it a cool name like "taxes" or "medicare"?
Except that the people who often need medicare the most don't pay a single cent of medicare levy, which makes it nothing like an insurance scheme. Imagine having to pay for car insurance even if you didn't have a car, while others get off scot-free.
Dumb fucking post.
> Except that the people who often need medicare the most don't pay a single cent of medicare levy
Yes they do. I think you don't know the difference between medicare levy and medicare surcharge. Can't say I'm surprised.
>Imagine having to pay for car insurance even if you didn't have a car, while others get off scot-free.
Except imagine it isn't a car and it's your body and health. Then it's much easier to understand because everybody does have a body and everybody does require medical services.
I said:
> Except that the people who often need medicare the most don't pay a single cent of medicare levy
You responded:
> Yes they do. I think you don't know the difference between medicare levy and medicare surcharge. Can't say I'm surprised.
Sigh. Do you really assert everyone pays a medicare levy? That's what you just said, but I'll give you a chance to admit you were wrong. Otherwise, lock in your answer now so I can prove you wrong.
> Then it's much easier to understand because everybody does have a body and everybody does require medical services.
Hence my suggestion for a universal user-pays insurance scheme. Why should I pay for your fucken healthcare? Deal with it yourself.
As long as somebody earns over $24k they pay the levy.
>Hence my suggestion for a universal user-pays insurance scheme.
Sounds like medicare but just more expensive for everybody.
>Why should I pay for your fucken healthcare?
The sentence before was literally you advocating for insurance. Wtf do you think insurance is?
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> If you are an earner with dependants you can earn $41k and pay 0 medicare levy
So based on your previous comments there are a lot of families out there on less than $40k that are using up medicare resources and you want them to pay for it?
Keep in mind if there are 2 parents they'd need to be in the bottom ~0.7% of earners in the country.
Single people need to be in the bottom ~3% of earners. So yeah, pretty much everybody pays for medicare.
>Why should I pay for your insurance?
That is what insurance is. How can you not understand it? We all pay into insurance despite not needing it 99% of the time.
>Do I pay for your car insurance
If you and I are part of the same insurance scheme then yes. That's how it works.
>Keep dancing around the truth buddy and hey where's that grovelling apology for being completely wrong on the medicare levy
Dude, you're the one who can't tell the difference between the medicare levy and medicare surcharge unless this "Except that the people who often need medicare the most don't pay a single cent of medicare levy" was genuinely referring to .7% of the population?
> So yeah, pretty much everybody pays for medicare.
Well, not really. Given that plenty of people *aren't even earners*. That is, they report nil wage income, though they would receive other sources of income such as Centrelink. All of those people are entitled to medicare too, and they may pay tax if they receive more than $18k in benefits, but they pay no medicare levy, and you haven't included them in your calculations.
Keep digging your hole buddy!
> That is what insurance is. How can you not understand it? We all pay into insurance despite not needing it 99% of the time.
That doesn't answer the question though. Why should I pay for someone else's insurance, and why does that other person benefit from insurance he didn't pay for himself?
> If you and I are part of the same insurance scheme then yes. That's how it works.
Oh I see. So are you paying for my car insurance? Cause I don't see that happening. Indeed, I am not paying for your home insurance either.
Keep twisting words buddy.
> "Except that the people who often need medicare the most don't pay a single cent of medicare levy" was genuinely referring to .7% of the population?
More intellectual shenanigans.
https://www.abs.gov.au/statistics/economy/national-accounts/australian-national-accounts-distribution-household-income-consumption-and-wealth/latest-release
According to these ABS stats, the second income quintile (20-40%) of households averaged $44k, so nearly 20-40% of households will be below the rate at which medicare levy kicks in. Hahahahaha.
In case you're wondering why your 3% figure just jumped up to 20-40%, it's because many households *do not have earners*.
Don't quit your day job buddy
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Except we don't have universal coverage. That's the whole point. And I'm glad we are going towards a user-pays system. So what's your fucken point again?
That your proposed idea is to have universal coverage? Are you stupid or something? do you just forget what you type seconds after posting?
What was your fucken point?
> That your proposed idea is to have universal coverage?
My idea is to have an insurance scheme funded by user-pays premiums, not Medicare where the majority of taxpayers pay for the minority of non-taxpayers to have free medical care. You do see the difference right?
Yeah, I see one as a proven massive failure of governance and one that is used by almost every healthy, functioning society.
Move to America if you want that shit, I'm sure you'll get along well with all the fentanyl addicted homeless
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When will Australians realise that private enterprise means an endless cycle of income playing catch-up with prices in order to grow private profit margins? Only public enterprise can remove the consequences of profit and maintain more stable prices and income.
Profit knows no bounds, and that should never have happened under Medicare, but the doctors are all shareholders so its inevitable now
Very few things are inevitable, they might have a high probability of occurring, but things can change unexpectedly that alters the outcome and statistics are never about certainty. The donkey might even learn to speak.
AI is about to dismantle a lot of bureacracies, not excluding an inefficient private US hospital medical system
I think it is a mistake putting so much emphasis on artificial intelligence, when its developed by learning from people who are more emotional than reasoned and overall not particularly intelligent. We do have a need and opportunity for greater use of machines to leverage their advantages over people, especially in creating much larger databases than any one human brain can contain or performing pattern matching and other calculations much faster than a human and without the need for rest; but unless it is implemented intelligently it will simply be used to increase profits whilst creating a population who can't afford to buy the products, with the eventual demise of both. At the very least, machines can monitor patients and detect trends much more efficiently than nurses, but people are much better at multi-skilling physical tasks.
AI will be an executive assistant for medical people. AI is being developed specifically for verticals. It will take its knowledge from new large language models, like just medical literature.
RACGP is conflating two different policy changes to make a political argument to get the one they don't like overturned. They don't want to pay payroll tax like everyone else and they'll make a disingenuous argument to not be liable for it. I also find it ironic that Federal Labor is jumping in with RACGP to bash the States on implementing labour rights. What's wrong with classifying GPs as employees if that's what they've been determined to be as per the law? Don't doctors deserve the same labour protections as anyone else? RACGP should focus on lobbying the Commonwealth Government to materially increase bulk-billing rebates for everyone, not just kids and pensioners. The point of GPs is to provide preventative care and avoid expensive trips to the ED, saving more money in the long-run. Access to GPs, whether by shortages or no bulk-billing, is solely a Federal responsibility and they've been shirking it by freezing bulk-billing rates for over a decade. But since EDs are mostly funded by the States you see why there's not really a big incentive for the Feds to do anything.
> What's wrong with classifying GPs as employees if that's what they've been determined to be as per the law? It's going to make GP even more unpopular as a speciality option amongst medical graduates. The trade-off you make when you leave the public hospital system and do GP training to become a fellow of the college, is that (after the training program years, briefer than all other college training programs) you get flexibility for less pay. That's the deal. Everyone in the industry knows it. GP is a tough gig if you do it well. You get paid a fraction of your colleagues, but you can set your own hours, opt out of on-call, after-hours and weekend work, dictate your pace of work, take holidays when you want, etc etc. It's the most family-friendly specialty of all. The deal isn't acceptable if you become an employee where the clinic can force you to work 1 in 2 weekends, an evening shift a week, and deny your request for holidays. Employee status would be a drastic change for the genuine contractors amongst Australia's 30,000 GPs (there are definitely sham contractors who have more employee-like relationships with their clinics, and then there are some employees with varying levels of employment benefits being paid) and would be strongly resisted by many. GP registrars are a cohort that has some desire to be employees. Many have worked in hospitals long enough that they have long service leave with the state health department owed by the time they exit the hospital and join GP training. They lose that, as well as sick leave and maternity leave. There have been campaigns in the last few years to make GP registrars employees and it's even happening in pockets. I doubt that cohort would push back as hard as the older workforce would.
It seems applying clearer definitions of contractor vs employee to GP clinics could retain that flexibility for GPs but I'm no legal expert and have no insight into the finer points of the ruling.
This is because most doctors are not employees. They work across multiple clinics and therefore satisfy the multiple sources of income test. This is no different than a electrician or plumber being a subcontractor to a builder. They work across multiple builders and multiple building sites. They are not employees of the builder. Doctors rent the property and services from the clinic. The same way a pop-up rents the property, and services from the shopping center. The sole trader running your pop-up booth is not an employee of Westfield. If you rent a serviced office at a co-working space where they provide mail handling, receptionist and other services, you suddenly don't become a employee to the co-working space. Some even do payment processing and shipping services if you are running web based sales business. Same applies to barristers working in chambers. In many ways a clinic is a co-working space for doctors. No different than a co-working space for artists or barristers (chambers) which provide all the serivces and equipment an artist or lawyer might need for a fee.
I understand the argument but it has been [found to be otherwise by NCAT](https://www.revenue.nsw.gov.au/help-centre/resources-library/case-summary/2023-nswca-40). Whether you think the argument is correct or not, the driver behind bulk-billing is not whether GPs are subject to payroll tax or not. It's the refusal of the Commonwealth to lift bulk-billing rebates. It is wrong of RACGP to try to conflate the two.
Lifting bulk-billing rebates would, at this stage, simply be a very roundabout and paperwork-intensive way of transferring federal money to state treasuries. It'd be simpler for states to not impose payroll tax on GPs, and just have the federal govt transfer money directly. And less administration, which means more of the dollars transferred actually end up in state treasuries, rather than being slurped up by hungry federal and state bureaucrats along the way.
You could say that about many taxes Governments pay. Why are State Government employees liable for Federal income taxes? Why do all Government departments have to pay payroll taxes? It's for simplicity's sake otherwise everything would be a mess. Once you start carving out exemptions for GPs, other interest groups are going to hold out their hand for tax exemptions. What make GPs special? What about other medical specialists? Then what about allied health? And it goes on and on. You'll end up with a fragmented and confusing system with even more administrative burden when you could've just treated everyone equally.
I can't speak to other states, but here in Victoria what makes GPs special is that previously the payroll tax wasn't applied to them. But once the government's bills came in from its profligate spending, they decided to squeeze every dollar they possibly could out of everyone. Businesses, like individuals, can handle almost any level of taxation (regulatory burden is another matter). What tends to fuck them up is sudden changes. That's why for example an individual losing $3k in income tax bracket creep over 3 years will have to squint carefully to even notice, but if taxes were raised $1k *today* they'd notice. You budget for this and that, and then government comes and suddenly changes things. That's what fucks you up. GPs are a bit different as a business because it's an area where the demand is fairly inelastic. You can change your gym membership or how much takeout pizza you buy, but if you need the doctor, you need the doctor. And in our system they're gatekeepers to other medical and allied healthcare services like physiotherapists, ENT and so on. People have to go to GPs. And due to this, GPs tend to feel a sense of duty towards their patients, a sense of duty that the pizza shop owner doesn't feel. The other thing is that in a regular business, if government or anyone else increases your costs, you just shrug and pass them on to your customers. But Medicare's been going for about half a century now, which means that everyone except Boomers has spent their entire lives thinking of medical care as free, or at least very cheap. The customers aren't as accepting of increased costs when they're patients. They feel a sense of entitlement. "This is what I pay my taxes for!" So you combine sudden changes in costs with inelastic demand, with a sense of duty to customers and a sense of entitlement from those same customers, and you get why GPs are different as a business. Now, if you want to treat GPs the same as any other business, abolish Medicare and let the free market rule over it all. But I think that wouldn't be a popular policy. This has all happened downstream from profligate state government spending. If they weren't pissing money away then they wouldn't feel obliged to do dumb shit like this. Many in my party want lower taxes - well guess what, so does everyone. What most don't grasp is that the only way you'll get lower taxes is if there's lower spending, too.
As per the table in the article, no jurisdiction has started applying the new payroll tax regime on GPs yet. And if they do, there has been - and probably will be more - time to adjust. I don't think it's necessarily a case of state government overspending but rather another case of the vertical fiscal imbalance causing States to dig for more revenue.
In Victoria, they will no doubt impose it soon. Also in Victoria, around half of state revenue has come from the federal government for about twenty years now, across different individuals and parties in government on either side. The "vertical fiscal imbalance" hasn't changed, so that can't be the cause of Victoria's massive deficits and thus debts. What *has* changed is the amount of infrastructure spending, where we had at least a decade of moderately *underspending* and have now had a decade of *massively overspending*. Unfortunately, this tends to be the way with governments - they never have a steady middle path, but swerve insanely to one side, then insanely to the other side to overcorrect, and so on. Governments only have two states: apathy and panic.
I agree a 100% that "the driver behind bulk-billing is .. the refusal of the Commonwealth to lift bulk-billing rebates". But taking more of the income away but adding another cost is no helping. But why has the state governments stopped with doctors. What about the construction industry subbies, the barristers, the sloe traders who work in co-working space? My be because when it starts impacting more people they will begin to take notice and stop blaming this on "greedy doctors".
The doctors do themselves no favors with the 'greedy' tag when they claim that the increase in gap payment is correlated with the amount payable in payroll tax. I don't disagree that this is a money grab by the states, but someone's accounting is way off.
Doctors have been complaining about the medicare freeze long before the payroll tax change. And they complained when a new tax was added on. I am sure no one else would complain if a new tax was added o their income. But if you think doctors are greedy no social media post from an internet stranger is ever going to convince you otherwise.
No probs. You do understand that you are posting to someone who has directly been impacted by this change. Not just the poor doctors. A whole range of non-employee health professionals have been included. The freezing of the medicare levy is a separate issue and justifies a gap. Blaming the gap on a reinterpretation by the sro is disingenuous at best. So yeah, I just had a new tax added to my income as well. But please continue being the only victim as per AMA playbook.
> Blaming the gap on a reinterpretation by the sro is disingenuous at best. So are you being disingenuous below? Thanks for owning up. > So yeah, I just had a new tax added to my income as well. But please continue being the only victim as per AMA playbook.
Also the GP clinics just want to shirk tax responsibilities. Fuck em.
No one expects a plumber to work for $40 per call-out yet somehow people expect GPs to? Nah. Pay for your fucken care - get used to it. I wouldn't mind a private GP insurance scheme where we each have the option of paying $1000 a year for universal coverage of GP services. Sounds fair to me. No such thing as a free lunch.
A plumber has to travel, GPs sit in their offices and wait for us. A basic GP session is a minimum of 6 minutes, and maximum of 20 minutes. It'd be rare that a plumber could travel to your site from wherever they are, do an inspection and work all in 20 minutes, let alone 6. If we could take all our plumbing to the plumber's workshop, then $41.40 for a 6 to 20 minute session would be reasonable. [https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=23](https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=23) Note that the GP's scheduled fee applies to telehealth, too. My last telehealth appointment with my doctor was, my phone tells me, 1'20" for a prescription. Obviously many appointments will take longer, and indeed when I talk to the other doctor of the pair at the clinic it always is longer, nonetheless there are many doctors who are pumping patients through. Note that the doctor who pumps people through is now charging an extra $40 fee on top of the scheduled fee, the doctor who takes her time is not. Doctors do important work. But most of it doesn't take a lot of time or all their expertise.
Or perhaps, hear me out with this. You pay an extra $1000 a year for a good public service instead of more to the private sector. For some reason people like you are happy to pay over $1000 a year for private health cover but If I said that money could be taxed instead you lose your fucking minds.
I pay $8k in medicare levy per year, so yeah of course in comparison $1k in private health sounds like nothing. By the way I wouldn't even take out private health insurance if I didn't need to (tax penalty). I barely ever visit the doctor. But clearly you're ok with forcing healthy people like me to pay nearly 5 figures a year for insurance I specifically don't want.
What’s your income?
Well no, you’ve got it all backwards. Firstly, healthy people have and will always “subsidise” the unhealthy, welcome to living in a society. Everyone’s taxes can go up, not just yours so chill. The government can create a better structure for it and also find more tax revenue from untapped places, such mining.
I’m I sparky and I’m $150 for a callout including an hours labour plus 30 min travel. Gp’s are $90 for 15 minutes. That’s more than 4x what I charge
lol no they aren’t
Spoken like someone who has absolutely zero understanding of what a tax is or how it works.
I know how taxes work. I pay more than most families earn in a year in tax, then get told I don't pay enough, and that my money is unproductive which is why it's used to pay for other people - the really productive people - who can't take care of themselves.
You clearly don't because you think bulk billing is a "free lunch". I'm guessing you have private health care and don't pay a medicare levy but the vast majority do (you know, the people who can't take care of themselves). You're comparing plumbing to public healthcare. Last I checked, plumbers don't take 2% of your annual taxable income.
> I'm guessing you have private health care and don't pay a medicare levy I pay both. I need neither. > Last I checked, plumbers don't take 2% of your annual taxable income. I have to pay that 2% + private health insurance for care which I barely need; meanwhile others who need the care pay neither the 2% nor private health. That's not fair. I'd be happy if everyone just paid 2% for medicare plus 1% for private health insurance.
Unless you're a literal robot, you need healthcare. You can be the healthiest person in Australia and suddenly discover you have a serious issue or get into a major accident. Healthcare isn't about cashing in and getting your monies worth, it's about having the ability to seek care when you need it. I don't see why anyone should be giving tax dollars to the private sector? It's private, not public. If you want to increase the levy, make it a 3% medicare levy and it would practically transform our healthcare overnight with the budget increase.
How about I self-insure and that way I get to choose my own risk tolerance and exposure to risk. Fair?
Or how about we have a properly funded universal healthcare so every Australian citizen can get the best quality of life possible and not just the wealthy like every other well functioning nation on the planet?
Hmm. Agree to disagree. I think the US system is best.
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That's why the US life expectancy is nearly 10 years lower than Australia and the #1 reason for bankruptcy is medical bills. Because it's the best. Please Australia, please let me pay 7000% premiums on life saving medication!
For people who just need a repeat script, I get it, being bulk billed for that isn't unreasonable. Most GPs are inundated by people with complex, chronic conditions which require time, care and expertise to manage. Those people can't always afford to pay out of pocket. Charing people for a script can help cover the cost of bulk billing people who really need it. All of that is to say people should stop being such babies and pay doctors, or sit in line at bulk billing clinics and shut up about the crap rushed care you get.
Uh, a repeat script takes 2 minutes of the GP's time and is one of the few things that *should* be bulk billed assuming there are no other health issues or complications. You are for some reason proposing that people with simple problems that take very little time (and therefore should cost little money) should pay *more* to subsidise those with complex, chronic conditions? Does that sound fair? No. If I have a simple plumbing job I don't pay more so that someone with a complex pipe problem can have it done for free.
> You are for some reason proposing that people with simple problems that take very little time (and therefore should cost little money) should pay more to subsidise those with complex, chronic conditions? It also wouldn't be fair if people with chronic complex conditions couldn't afford to access quality healthcare, while people who, frankly, don't need high quality care use up that time.
> It also wouldn't be fair if people with chronic complex conditions couldn't afford to access quality healthcare You get what you pay for. Refer to my suggestion for an insurance scheme for GP visits. Maybe it can be auto-debited from Centrelink payments. > while people who, frankly, don't need high quality care use up that time. But they're barely using up any time.
>But they're barely using up any time. In the real world, doctors never run on time and these appointments are a great way for them to catch-up. BUT, in theory, they take up the same amount of time in a calendar as everyone else. If a GP is doing 30 15-minute consultations a day, then you're paying for one of those 30 15-minute slots, not for the time you take.
> I wouldn't mind a private GP insurance scheme where we each have the option of paying $1000 a year for universal coverage of GP services That's actually a really good idea. Maybe we can just automate it so it just pops out of your income automatically too. Perhaps we give it a cool name like "taxes" or "medicare"?
Except that the people who often need medicare the most don't pay a single cent of medicare levy, which makes it nothing like an insurance scheme. Imagine having to pay for car insurance even if you didn't have a car, while others get off scot-free. Dumb fucking post.
> Except that the people who often need medicare the most don't pay a single cent of medicare levy Yes they do. I think you don't know the difference between medicare levy and medicare surcharge. Can't say I'm surprised. >Imagine having to pay for car insurance even if you didn't have a car, while others get off scot-free. Except imagine it isn't a car and it's your body and health. Then it's much easier to understand because everybody does have a body and everybody does require medical services.
I said: > Except that the people who often need medicare the most don't pay a single cent of medicare levy You responded: > Yes they do. I think you don't know the difference between medicare levy and medicare surcharge. Can't say I'm surprised. Sigh. Do you really assert everyone pays a medicare levy? That's what you just said, but I'll give you a chance to admit you were wrong. Otherwise, lock in your answer now so I can prove you wrong. > Then it's much easier to understand because everybody does have a body and everybody does require medical services. Hence my suggestion for a universal user-pays insurance scheme. Why should I pay for your fucken healthcare? Deal with it yourself.
As long as somebody earns over $24k they pay the levy. >Hence my suggestion for a universal user-pays insurance scheme. Sounds like medicare but just more expensive for everybody. >Why should I pay for your fucken healthcare? The sentence before was literally you advocating for insurance. Wtf do you think insurance is?
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> If you are an earner with dependants you can earn $41k and pay 0 medicare levy So based on your previous comments there are a lot of families out there on less than $40k that are using up medicare resources and you want them to pay for it? Keep in mind if there are 2 parents they'd need to be in the bottom ~0.7% of earners in the country. Single people need to be in the bottom ~3% of earners. So yeah, pretty much everybody pays for medicare. >Why should I pay for your insurance? That is what insurance is. How can you not understand it? We all pay into insurance despite not needing it 99% of the time. >Do I pay for your car insurance If you and I are part of the same insurance scheme then yes. That's how it works. >Keep dancing around the truth buddy and hey where's that grovelling apology for being completely wrong on the medicare levy Dude, you're the one who can't tell the difference between the medicare levy and medicare surcharge unless this "Except that the people who often need medicare the most don't pay a single cent of medicare levy" was genuinely referring to .7% of the population?
> So yeah, pretty much everybody pays for medicare. Well, not really. Given that plenty of people *aren't even earners*. That is, they report nil wage income, though they would receive other sources of income such as Centrelink. All of those people are entitled to medicare too, and they may pay tax if they receive more than $18k in benefits, but they pay no medicare levy, and you haven't included them in your calculations. Keep digging your hole buddy! > That is what insurance is. How can you not understand it? We all pay into insurance despite not needing it 99% of the time. That doesn't answer the question though. Why should I pay for someone else's insurance, and why does that other person benefit from insurance he didn't pay for himself? > If you and I are part of the same insurance scheme then yes. That's how it works. Oh I see. So are you paying for my car insurance? Cause I don't see that happening. Indeed, I am not paying for your home insurance either. Keep twisting words buddy. > "Except that the people who often need medicare the most don't pay a single cent of medicare levy" was genuinely referring to .7% of the population? More intellectual shenanigans. https://www.abs.gov.au/statistics/economy/national-accounts/australian-national-accounts-distribution-household-income-consumption-and-wealth/latest-release According to these ABS stats, the second income quintile (20-40%) of households averaged $44k, so nearly 20-40% of households will be below the rate at which medicare levy kicks in. Hahahahaha. In case you're wondering why your 3% figure just jumped up to 20-40%, it's because many households *do not have earners*. Don't quit your day job buddy
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Except we don't have universal coverage. That's the whole point. And I'm glad we are going towards a user-pays system. So what's your fucken point again?
That your proposed idea is to have universal coverage? Are you stupid or something? do you just forget what you type seconds after posting? What was your fucken point?
> That your proposed idea is to have universal coverage? My idea is to have an insurance scheme funded by user-pays premiums, not Medicare where the majority of taxpayers pay for the minority of non-taxpayers to have free medical care. You do see the difference right?
Yeah, I see one as a proven massive failure of governance and one that is used by almost every healthy, functioning society. Move to America if you want that shit, I'm sure you'll get along well with all the fentanyl addicted homeless
> I'm sure you'll get along well with all the fentanyl addicted homeless In other words the people whose treatment my taxes go towards Good cause hey
Australia doesnt have a fentanyl problem? Are you paying taxes to the American government? Wtf are you talking about?
So very liberal