Perhaps it's in the fine print but certainly the headline recommendations from the Commission of Audit show no understanding of the differences between city and country circumstances where health and health services are concerned.
The proposal for a Medicare co-payment misses the point for rural and remote health - indeed blunter evaluations have been offered by some of the Alliance's correspondents! And the proposal for copayments for emergency department treatments and compulsory private health insurance would exacerbate existing disadvantages faced by the people of rural and remote areas.
People in rural and remote areas are already paying through the tax system for health care they can't access. And it would be counter-productive in health terms and unfair in 'Australian terms' to erect any additional barriers in the health sector to primary care in country or city. There is evidence from around the world that the more access people have to primary care; the healthier they are as individuals, communities and even whole societies.
Primary care is provided in many of the more remote areas by nurses, Aboriginal Health Workers, allied health professionals and others - despite there being no GP. The changes that are therefore going to work in those areas are those that recognise, increase and enhance the wonderful work undertaken by those other professionals - not fiddling with GP co-payments.
Out-of-pocket health care costs are already higher in rural and remote areas and many people make extraordinary efforts to access a GP, including paying transport costs, and the last thing they need is another barrier to access.
In aggregate, people in rural and remote areas have about $2.1 billion less access to primary care every year than people in the major cities. This disparity is despite the fact that they have poorer health and less life expectancy than those city people.
Compared with those who live in major cities, country people by necessity have to rely on public hospitals by an amount estimated at $800 million a year because they have no primary care.
The uptake of private health insurance (particularly full cover) decreases with remoteness because incomes are lower and no private facilities exist. A greater role for private health insurance would therefore be impractical in rural and remote areas.
Regardless of the current fiscal situation, rural people should not have to pay more for less access to essential public services.