I can think of no more significant benefit from community contributions in health than to invest in cure and discovery research by our people for our people … As a result, it may be an Australian who discovers better treatments and even cures for dementia, Alzheimer’s, heart disease or cancer. If we start investing now, this new and historic commitment in medical research may well save your life, or that of your parents, or your child.
Federal Treasurer Joe Hockey, Budget speech, May 13
It’s been a while, but I’m still here. Cancer treatment is an absorbing, revealing, boring, depleting experience, sometimes all on the same day. The drugs used to treat cancer have powerful side effects, and the drugs to alleviate their side effects have side effects, and sometimes these drugs also provoke allergies, both allergies to the drugs, and triggered allergies to other things.
Cancer is also administratively taxing—there are forms, and appointments, and deadlines, and things to remember, all at a time when chemotherapy and Mariana Trench depths of fatigue make it quite hard to finish sentences.
Then there’s the way cancer messes with the people who love you, and disrupts their experience of work, school, and everyday life, and at the same time surrounds you with the kindness of both friends and strangers. All of this deserves time and care and attention.
And finally there’s the weird billboard politics of cancer, which means that it rears up when you least expect it. This week my daughter joined a local soccer team, and I found myself frozen at the washing machine holding up a soccer shirt that says “Are You Breast Cancer Aware?”
Gosh, yes we are, thanks for asking.
Cancer also popped up this week in Australia’s Federal budget, as our Treasurer tried to sell a proposed services tax on GP visits, blood tests, diagnostic imaging and prescriptions that will disproportionately whack patients in cancer treatment, in the name of an imaginary Australian funded by revenue from this impost who finds a cure for cancer. You couldn’t make this up.
Because I’ve had more to do with Medicare in the last six months than I have in the twenty years since I emigrated, I really mind about this rubbish. The fact that my breast cancer was diagnosed at all was the result of GP visits when I was reluctant to think that I had something to worry about. GPs are critical to early cancer detection; any barrier to GP access is one that risks much more significant costs to our public health system later on. So it really doesn’t even make sense from the perspective of health budgeting.
When copayment for health services was first mooted, we heard quite a bit about behavioural economics: if people had to pay for their access to no-longer-universal healthcare, they’d be more conservative in their use of it. So it was genuinely surprising when copayment extended to pathology services. Are we really now suggesting that chemo patients, as well as others with chronic disease, should think twice about out-of-hospital blood tests or X-rays? Or do we think these patients should rock up to Emergency Departments and hospital pathology departments (which are two different things) to get their blood taken? Even though chemo patients specifically require disruptive special treatment when they get there, because of their heightened risk of infection?
On the other hand, do we really think that local pathology collection centres will run more efficiently if they have to figure out how to process these copayments for everyone, now they’re not allowed to take cash?
The Treasurer’s answer to this has been to swerve towards another imaginary Australian, an idler with all the wrong priorities. I was standing in the middle of my kitchen on Thursday morning when this insulting nonsense came out of the radio:
But, but, I’d say to you, Chris, one of the things that quite astounds me is some people are screaming about $7 co-payment. One packet of cigarettes cost $22. That gives you three visits to the doctor. You can spend just over $3 on a middy of beer, so that’s two middies of beer to go to the doctor.
Let’s have some perspective about the costs of taking care of our health. And is a parent really going to deny their sick child a visit to the doctor which would be the equivalent payment of a couple of beers or one-third of a packet of cigarettes?
This is a crude and stupid switch from the conventional “price of a cup of coffee” device governments flourish when they want to persuade us that rising costs are trivial. Trading beer and cigarettes for healthy choices is just so much more obvious. It’s the foundation of responsible citizenship, isn’t it?
Except that, as the interviewer wearily pointed out, this stereotype of the delinquent parent choosing another beer over their children’s health trivialises the pressure on low-income families, that aren’t confined to simple choices between one modest thing and another. Sometimes neither are within reach, even if this is very hard to imagine from a more privileged position.
So now think about the parent on welfare in a country town whose sick child’s health visits includes travel costs, that will now be hiked up by rising fuel prices. Or imagine the parent of a sick child who’s also trying to hang on to part-time study, facing rising tuition costs and the prospect of significantly increased interest rates on deferred loan repayment.
And these imaginary parents aren’t sequestered from the rest of the economy. So have a think about the person who’s serving that beer: probably young, perhaps also a uni student, maybe another parent, about to be hit by changes to welfare for the under 30s. Discretionary spending on small items like a cup of coffee or a beer aren’t trivial to the casual workforce sector they hold up, who in turn are making choices about what they can afford. The retail and services precariat are always the canaries in the mine of consumer sentiment, the first to feel it when a combination of factors limits the money left over from food, rent and cost to work. This is behavioural economics.
Anyone can play the game of the imaginary Australian, and sometimes it’s good for us to do this—it’s a really basic exercise in political empathy. But the point of a universal healthcare system is that we don’t have to trade in these limiting stereotypes. Instead, we accept that we all win when these most basic healthcare services aren’t withheld—from anyone—for the price of a couple of beers.
So as both a taxpayer and a public health cancer patient, and with all due respect to my university colleagues in medical research, I don’t care whether cancer is cured by an Australian. I don’t. But I really do care about the experience of other Australians living with serious and chronic illness. If making it easier to see GPs, access pathology services and fill prescriptions helps reduce the numbers of people who go on to need hardcore (and costly) medical care, and then also reduces the cost of living through treatment itself, that really is something to defend.