We see their spokespeople quoted in the papers and their ads on TV, but beyond that we know very little about how Australia’s lobby groups get what they want. This series shines a light on the strategies, political alignment and policy platforms of ten lobby groups that can influence this election.
Late-19th-century American journalist Ambrose Bierce once defined politics as “a strife of interests masquerading as a contest of principles”. Health politics today is similarly riddled with self-serving interest groupsthat masquerade as something else. The Australian Medical Association (AMA) is a key player in this strife.
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Who it represents
The AMA is sometimes referred to as the “doctor’s union”, in reference to its muscle and zeal in protecting its members’ interests, if not its formal industrial status. Salaried medical practitioners employed in public hospitals, for example, are represented industrially by the Australian Salaried Medical Officers’ Federation. Visiting medical officers are represented by state-based associations that often have close links to the state branch of the AMA.
The AMA was formed in 1962 with the merger of the Australian branches of the British Medical Association. It now has around 30,000 members, about 30% of the medical profession. This is a significant decline from its heyday 50 years ago when almost all medical practitioners were members (if only to receive its academic publication, the Medical Journal of Australia).
The AMA is strongly committed to ensuring it represents – and is seen to represent – a “medical voice”. The spokesperson for the AMA is typically its president, with the non-medical chief executive, quaintly titled the secretary-general, rarely seen in the public domain.
Key competitors
The AMA is the most diverse of the medical profession’s advocacy groups. This is both its strength and weakness. Although some causes unify medical practitioners – preserving their autonomy, for example – the interests of general practitioners and specialists do not always align. This was most recently seen when the private pathologists negotiated a deal with government which potentially advantages the pathology companies at the expense of general practices.
More cohesive medical groups (such the Royal Australian College of General Practitioners and others that represent surgeons, obstetricians, and so on) may be potential allies with the AMA but may also pursue a distinct policy position.
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Because these speciality groups have a narrower barrow to push, they can often respond to policy changes more quickly than the AMA.
The pathology companies’ interest groups, Pathology Australia and the Royal College of Pathologists of Australia, for instance, were quicker than the AMA to mobilise against proposals in the 2016 budget to remove the pathology bulk billing incentive with a Don’t Kill Bulk Bill campaign, which included petitions and posters in pathology collection centres.
Contemporary campaign
The 2015 budget announced an extension of the freeze of Medicare rebates for another two years, until 2020. Labor introduced a seven-month deferral of indexation in 2013 but this was converted into a freeze on indexation in the infamous 2014 Abbott-Hockey budget.
If the freeze continues, the gap between practice costs and revenue will increase, and bulk billing rates are likely to fall.
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This makes the current election an important one for patients and the medical profession. The AMA has opposed the freeze, pointing out the potential adverse impact on patient access if out-of-pocket costs were to increase. Here we see a nice coincidence of interests between the medical profession and patients, as the freeze cuts first into medical practice revenue and only impacts patients if doctors increase their fees.
Labor has announced it will end the freeze funded by rolling back company tax changes. The Greens have also announced a rollback of the freeze.
Only 30% of specialist consultations are bulk billed compared to 83% of general practice consultations. The impact of the freeze is therefore greater on general practitioners, who would have to introduce more widespread billing, compared to specialists who would only need to adjust fees already charged.
The Royal Australian College of General Practice has also argued stridently against the freeze and run television ads on this issue.
Political alignment
The AMA is conservative in orientation. Two of its former presidents entered party politics as Liberals: Bill Glasson ran twice for the Liberals in Queensland and Brendan Nelson was a one-time leader of the Liberal Party.