Inanimate objects can generate much passion. What matters is how they are used not the objects. A knife is great for cutting food but can be used to kill. Is a knife good or   bad? It is neither and both.

The Medicare system generates passion. The passing of its “father” Professor John Deeble at age 87 has rekindled questions about whether it has been a good or bad thing. Like the knife, it is neither and both.

OK, let me get off the fence. But first, let’s get back to basics.

When introduced in 1984, Medicare was to be a basic insurance system. The rationale was that a percentage of Australians were unable to access healthcare services due to being unable to afford insurance. A universal government funded insurance system would solve this.

To that end it has been a success. Australians regardless of income have access to services. However, like in the UK, that access can still be blocked due to waiting lines. The difference between the US and UK systems is not that people get better access to care, but they miss out for different reasons. Australia with a dual public and private system and has avoided the extremes of these other two nations.

Medicare is popular with Australians and has bipartisan political support. It is here to stay. However, a 1984 model car may need some servicing to make it roadworthy in 2018 and abject refusal to do so would not be seen as smart.

The biggest problem with Medicare is not what it is, but what it has become and how its success is measured. As a basic system it was never intended to cover all discretionary health wants yet mission creep has occurred.

With over 30c in every dollar nominally spent on health soaked up by bureaucracy, it cannot be argued that we don’t spend enough. Yet the appalling Mediscare campaign of 2016 means any improvements in efficiency are off the agenda for another two electoral cycles.

Affordable and free are not synonyms. Most insurance systems have an excess paid by the insured. This means that most of the expense is covered. It also discourages minor claims. Nobody regards this as “unfair”.

Yet the marker of success of Medicare is that there is no excess. An excess paid by the patient coupled with insurance picking up the balance has been specifically banned.

Somehow free and affordable have become synonyms. The notion that if seeing a GP is not free to the user at point of service, it is unaffordable is fundamentally false.

Somehow GP, not specialist, bulk billing rates have become all that matters. The concept that there is no middle ground between free and unaffordable has become ingrained.  This is the problem. And it has not been resisted.

In the mid 1990’s when I joined the AMA GP council as a then “bulk billing GP” I was seen as a curiosity in a group implacably opposed to Medicare.  One co-councillor asked “Did I manage patients?”

Fast forward to 2014 and the AMA led the charge against a co-payment. The Abbott proposal was not perfect but once an “excess” was introduced it would be much simpler to increase it. It is worth remembering that the same government which introduced Medicare also introduced a co-payment for PBS prescriptions! And the world kept turning.

Sadly, GP’s have allowed the Medicare system to divide them. In the 80’s the “entrepreneurial doctors” were the bad guys followed by the “bulk billing GPs in the 90’s” and then the corporate GPs. This was not driven by government but by us.

In reality, GPs collectively have done their best regardless of circumstances.

The problems facing GPs are not due to the Medicare system per se, but poor representation. Contrast our leadership with the Pharmacy Guild. With its new President there is hope, for the first time, that the College will actually argue for the interests of GPs.

Medicare is a success in defraying the main expense of healthcare for Australians and by world standards a good system. The problems we have as GPs reflect poor leadership and arguably our own acquiescence. There are solutions. It is up to us.

A version of this article first appeared here.