It’s not obvious who sets health care policy in Australia and it’s not obvious for whose benefit it even is. But if you follow the money, one can generally conclude that whoever sets policy, it’s not for the benefit of the general populace and taxpayer.

But by whom and for whom is Australian health care policy you may ask? Well, who are the biggest, ugliest and most militant unions in Australia? Here’s a hint. It’s not the CFMMEU or the ETU or the PSU.

It’s the unions that represent the healthcare “service providers”: the Australian Medical Association, the Pharmacy Guild and the various specialist colleges. These same people whose members provide the advice to government that has led to various lockdowns and associated Covid response policies.

But what is the objective of these professional health care unions anyway? Like all other unions, they pretend to advocate for the public interest, but are primarily interested in increasing the wages and conditions of members at the expense of someone else. And they do this through pushing policies and activities to reduce competition, increase barriers to entry and increase prices paid by consumers.

How do they do this? Well. To start with, despite external appearances, the bulk of Australian doctors and pharmacists are public servants because the vast bulk of their revenues and salaries come from the government. A provider number is a licence to print money. Hang a shingle, accept clients, get someone else (the taxpayers) to pay you.

When questions come up of foreign doctors and pharmacists, what is the general reply? No ticket, no start.

So how do these professional health care unions get favourable regulatory treatment? The same way every other public sector unions exerts its influence; it captures the Government.

Take this little nugget from the weekend newspapers:

Federal Health Minister Greg Hunt has put Australian health funds on notice that the government does not support the local industry creeping into US-style managed care, as concerns grow that insurers are already seeking to influence the delivery of healthcare services.

Ooga-booga. Scary, scary. American managed health care.

But what is managed health care?

Simply stated, managed care is a system that integrates the financing and delivery of appropriate health care using a comprehensive set of services.

In English, that means that the people financing health care also own the healthcare services. You know like the government both financing health care and owning hospitals. OMG.

But why the cry and why now?

Because, private health funds, who the government is slowly trying to strangle, have been buying up hospitals and other service delivery mechanisms so that they can try to reduce their costs. Something that the other managed care groups, ie government hospitals, are not so good a doing.

And for whom is this private health fund ownership of hospitals a problem? The doctors and the specialists, because they can’t capture them like they capture the government.

The Pharmacy Guild went nutso when the supermarkets wanted to go into the pharmacy business in direct competition with Pharmacy Guild members. What is the biggest threat to the incumbents? Competition.

So when Hunt says “government does not support the local industry creeping into US-style managed care”, what he is actually saying is get stuffed to Australian taxpayers and get stuffed to the Australian people. It’s the doctors and pharmacists that the government most cares about.

Perhaps some advice from Friedrich Nietzsche to the Health Minister is warranted:

The most common form of human stupidity is forgetting what one is trying to do.

Hunt’s job is not to make doctors and pharmacists rich. Actually, what is Hunt’s job other than to throw people’s money around and give to favoured groups?

Stephen Spartacus regularly writes at Sparty’s Cast.

Anthony Tassone of the Pharmacy Guild responds:

The article in the Spectator by Stephen Spartacus asks, “Who benefits from health care” and then goes on to suggest that it’s the “biggest, ugliest and most militant unions in Australia” which he claims to be the Pharmacy Guild, the Australian Medical Association and specialist colleges – in other words the usual suspects and easy targets when seeking to attack the representatives of health professionals.  

I don’t presume to speak on behalf of the AMA or the colleges, but I can certainly disavow Spartacus of his misguided notions about community pharmacies and their role in the health system of Australia. 

First up he asserts that it is “not obvious who sets health care policy in Australia and it’s not obvious for whose benefit it even is”.  

A little research would have revealed that policy is set by the government and bureaucracy but groups, such as those he has chosen to name, provide specialist and expert input. This system, a feature of the democratic process, ensures the best possible policy decisions are made. Of course, they are not always perfect, and flaws can appear, but I shudder to imagine what decisions would be made without input from those who know what they are talking about and represent the very health professionals who care for patients every day. 

Spartacus claims groups like the Guild are only interested in increasing the wages and conditions of our members and I unashamedly agree that we do seek to ensure our members have good wages and conditions. Australian’s 5700+ community pharmacies are small businesses and need to operate in an environment that enables them to run their practices sustainably.  If they can’t, they close – and the communities they serve suffer. 

Getting a head of steam up Spartacus accuses the Guild of reducing competition.  It is a laughable assertion which again displays lack of research or understanding of the sector. With over 5700 individually owned community pharmacies with over 4000 different individual proprietors you can hardly claim there is a lack of competition when compared to the duopolies and oligopolies that pervade in deregulated markets such as supermarkets, petrol and liquor 

I agree to some extent when he says pharmacists are public servants, but only to the degree that they dispense PBS medicines which form the basis of the government’s medicine policy. The PBS is the gold standard internationally for medicines accessibility and this accessibility is only enabled by the broad spread of the community pharmacy network across the whole country, and the close corporation and collaboration between the Guild and the government.  

This co-operation has also enabled the government to save billions of dollars in health costs over the past decade, particularly through price reductions to subsidised medicines through the ‘PBS price disclosure policy’.  This policy has helped contain costs of medicines for the Australian taxpayer and create headroom for the listing of new and often expensive potentially life-saving therapies.   

Such economic efficiencies whilst maintaining a high stand of service delivery within community pharmacy simply has not been seen in other parts of our economy let alone health care. 

This has all been as part of a partnership between the Guild and the Australian government, as the Guild strives to help it secure a viable and sustainable medicines and health system. 

Being a pharmacist is not, as Spartacus claims, a licence to print money. It’s disappointing that he has dug up the mantra of some ill-informed commentators of the ‘60s, and if he bothered to check the data, he would see that community pharmacists’ average annual wage is anything but excessive – and for it they work extended hours and on weekends because that is when many patients need their pharmacist.  

During the height of the COVID-19 pandemic in 2020, it was pharmacies that kept their doors open and were there for their patients when they needed help, care and reassurance the most.   

All the while the Guild never called for any lockdown – but worked tirelessly to ensure our members were kept abreast with their obligations and other updates from health authorities to keep their patients safe and for access to care to continue.   

This is all an inconvenient truth for the likes of Spartacus.  

One of his most absurd claims is: “When questions come up of foreign doctors and pharmacists, what is the general reply? No ticket, no start.” If only he was aware from the most basic online search which would show that the Guild is very actively seeking to expand the Skilled Occupation List to include pharmacists for overseas skilled migration due to very concerning and dire shortages across the country. We are doing this to open the way for foreign-trained pharmacists to seek employment in Australia. Oops, zero out of 10 on that one, Spartacus. 

He also says the Guild went ‘nutso’ when the supermarkets wanted to go into the pharmacy business. Yes, we did and still do oppose moves by supermarkets to open pharmacies primarily on the basis that there would be vastly decreased access for patients, particularly in regional, rural and remote areas.  Supermarkets that are owned by publicly listed companies answer to shareholders first and foremost.  If Spartacus wants to know ‘Who benefits from healthcare?’ it certainly isn’t in the aisles of supermarkets whose high-profit drivers are potentially deadly tobacco products. 

Pharmacists on the other hand as owners of their practices answer to their patients and are accountable to their registration board.   

Community pharmacies, on the other hand, are very accessible. In capital cities, 97 per cent of people have access to at least one pharmacy within a 2.5 kilometre radius, while in the rest of Australia 66 per cent of people are within 2.5 kilometres of a pharmacy. 

So, Who really benefits from health care? All Australians do. 

Anthony Tassone is Victorian Branch President and a National Councillor of the Pharmacy Guild of Australia 

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