Speech to the Doctors' IBNR Rally, Sydney - AMA President, Dr Bill Glasson "Let's drive a chevy through the IBNR levy!"
**Check Against Delivery
Good morning, fellow doctors.
Look, I don't want to beat around the bush or take up too much of your precious time.
This is what AMA members are asking.
Are we returning to a claims incurred or discretionary cover? NO!
Are premiums continuing to rise? YES!
Is a long-term care and rehabilitation scheme in place? NO!
Will the IBNR levy be charged? YES!
Is there an exceptional claims or 'blue sky' scheme in place that won't return the cost to MDOs, doctors or their patients? NO!
So, then, are doctors still being made to carry the can and foot the bill for a legally and societally driven system of litigation that is unsustainable and unaffordable? YES!
Are doctors happy? NO!
Are our patients happy? NO!
I think back to the pre-UMP collapse days when the only problem we had was unaffordable premiums with a sense of nostalgia.
We have stated openly that we will not accept the IBNR levy unless certain conditions were met...and they haven't been met.
There is no universal consistent indemnity reform
We do not have a long-term care scheme in place or within cooee of being in place.
The Government's IBNR levy is imminent...if they have their way.
In good faith, we asked for certain things - simple achievable things - to be put in place before a levy was considered.
Our good faith has been ignored. So, what do we do?
We have got to stop this IBNR levy, that's what.
I'm angry, you're angry, all doctors are angry.
It is yet another chapter in the dud book that is called medical indemnity.
It is yet another chance for the Government to dip its hand into your pocket to pay for something that is not your fault.
And sadly it will mean another unnecessary increase in the cost of health for our patients.
But only if we let them. We've got to stop it.
As I have said, doctors are still very angry and confused about the IBNR levy.
They have received no assurance that the money won't go into another 'black hole' as new tail liabilities emerge.
They know it won't be the end of the story.
Our patients, too, are angry and confused and uncertain about the future of their health care.
They don't even know what IBNR means.
To those in the know, IBNR means Incurred But Not Reported.
But it could also mean any of the following:
Income Being Needlessly Ripped-off levy
Idiotic Bureaucratic Nitpicking Requirement levy
I'm Being Nobbled Repeatedly levy
Incremental Bloody New Retarding levy
I've Been Nearly Ruined levy
Insane Balmy Nutty Ridiculous levy
Or even the Impractical Backward Negative Reactionary levy.
It just does not make sense whatever way you look at it or whatever you call it.
The whole medical indemnity system is sitting on the edge of the precipice and they think this levy would stop the inevitable. Wrong.
The Government, the profession and the community must work together to get this thing right once and for all.
As you know, Senator Coonan has now announced the final details of the levy and the Health Insurance Commission will be sending invoices for the IBNR levy for payment by the first of November.
That's about ten weeks away. Plenty of time to get things changed.
As things stand, failure to pay this levy will be treated like a tax debt.
It will have a serious impact on sections of the medical workforce.
I have labelled the levy Patterson's Curse, in honour of the Health Minister.
To share the blame I have also labelled it Coonan's Plague, in honour of the Assistant Treasurer.
I think we can safely assume that neither the Health Minister nor the Assistant Treasurer will lift a finger to have the IBNR levy stopped.
They have neither the will nor the drive. They are powerless. Worse, they don't seem to understand the politics of it. It's all about access and affordability for patients. Simple. But dangerous if ignored.
We now have to go over their heads straight to the Prime Minister.
We have done this before and every time we have got results.
Why? Because the Prime Minister has finely tuned political instincts.
He knows this levy not only hurts doctors.
He knows it will hurt patients and communities.
He knows it will hurt towns and suburbs where people vote.
He knows the risks.
He will not allow the IBNR levy to become known as Howard's End.
I will be meeting the Prime Minister on the 1st of September in Sydney. I will present him with a compelling case.
But first I will thank him for his efforts in salvaging the medical indemnity crisis to this stage.
Without John Howard's personal intervention, there is no doubt that UMP would have fallen over and taken a few more MDOs with it.
There would have been a crisis within a crisis.
I will then tell the Prime Minister that his Ministers have failed to see that in the great scheme of things the benefits of scrapping the levy far outweigh the benefits of imposing it.
The supposed benefits to the Government's budget bottom line do not justify the pain that will be inflicted on patients and the community through further disruptions to their access to doctors and the inevitable increased costs of health services.
Is it worth it? No, it is not.
There are as many as 20,000 doctors who will be affected by this weed for up to seven or more years to come.
That adds up to a hell of a lit of patients and a hell of a lot of voters who won't be happy if this thing is not fixed.
I remind you that the AMA has managed to achieve some important concessions:
- Retiring doctors over 65 will be exempt (but not for any deferred payment from a contribution year before they retired)
- Doctors who have a pattern of earnings of less than $5000 will be exempt
- Doctors who moved from private to public practice prior to May 2001 will be exempt
- Assistance will be given to GP registrars who undertaking procedural training.
But we are determined to do more. We're going for the whole box and dice - NO IBNR LEVY!
Please allow me to get technical and scientific for a minute....
The AMA remains opposed to the levy because national consistent State tort law reform has still not been achieved.
While I note with pleasure that the ACT Government has at last seen the light about caps and thresholds, the long term care scheme is still not happening and premiums continue to rise.
Some doctors want to defer their first contribution years' payment - to see how it all pans out.
Under the legislation they can apply to do this, but only once.
That payment deferred will have to be paid the year after the last contribution year (yet to be determined) - that is, the biggest payment might have to be paid eight years away from now.
There are some perils in this, and doctors should make their own decisions, depending on their age, future plans and financial situation.
The more doctors who obtain deferments, the more all those levied will have to pay, which may mean a longer contribution period - to cover the lost interest to the government in the earlier years.
We worry also that seeking a deferment of the levy implies acceptance of the levy.
Do we accept the levy? No.
Is it too late to oppose it? Not if a better total solution can be found. And we have got to find it. We will take the Prime Minister with us on that search.
We know that the current tort compensation and medical indemnity scheme is not sustainable.
It fails patients, doctors and the community.
It provides large compensation for some, but inefficient lump sum amounts that often get spent too quickly and don't last the distance can leave the injured person to fall back into the social security system.
A new model needs to be devised, and one which meets the needs of all the catastrophically injured in particular.
The AMA welcomes the Government's announcement that it will move to the next stage of analysis of a long-term care and rehabilitation scheme for the catastrophically injured. But this may take too much precious time.
To help put pressure on, I announce today that the AMA is establishing an advisory group, a think tank, of relevant experts to devise a fair and affordable and socially equitable medical compensation and indemnity scheme.
This group will complement the work the government is undertaking on the long-term care scheme and act as a catalyst to keep them moving at pace.
In the meantime, an interim solution is needed to replace the mish-mash of subsidies and schemes and levies of the Band-Aid 'medical indemnity package'.
The interim solution is simple.
We have asked the Government to extend its 'high-cost' subsidy and pay all the future long-term care costs of the catastrophically injured above $500,000 in any settlement or award.
If this happens, the IBNR liability will diminish.
The levy will not be required.
Patients will be able to access affordable quality health care.
The Federal Government can't afford not to absorb this cost - and it will be for a short time only...if governments at all levels work together with speed on a sustainable long term medical indemnity and compensation system.
In the longer term, the community will be better served with a community funded long-term care and rehabilitation scheme that provides care needs, rather than a government funding system that merely forks out money.
The AMA will work with the government on the best way of establishing this scheme by providing an expertly thought-out new indemnity model in which a long-term care scheme for the catastrophically injured can be incorporated.
In the meantime, we must speak out against an unfair and unjust new tax on doctors and patients.
My fellow doctors, we must drive a Chevy through the IBNR levy.
Thank you.