It's the time of year when treasurers and finance ministers, asked about the content of the budget, reply with righteous indignation that we'll just have to wait, as though they've been asked to break the official secrets act, while their ministerial colleagues are busily leaking or even announcing large slabs of what's to come.
Why do politicians indulge in this tiresome charade? Because they want to be sure we know about the nice bits, while delaying our knowledge of the nasty bits as long as possible.
They haven't yet leaked much about what lies in store on healthcare, though what we have been told is benign. The government, which in its first budget told us healthcare spending was growing "unsustainably", is adding a lot of hugely expensive new drugs to the pharmaceutical benefits scheme.
And it seems the freeze on the rates of Medicare rebates – including bulk-billing payments to doctors – is to be eased, at a cost of $500 million over several years.
There's sure to be some bad news on health hidden in the budget but, after the success of Labor's scare campaign at last year's election, alleging the Coalition wanted to "privatise" Medicare, it's a safe bet it won't be too terrible. No one got a bigger scare than Malcolm Turnbull.
Voters have always been strongly attached to Medicare – by which they mean not having to shell out when they go to a bulk-billing GP – and Labor was trying to reawaken voters' resentment when, in its first budget, the government proposed a GP co-payment of $7 a pop.
The element of truth in Labor's scare was that, if you froze bulk-billing rebates for too long, GPs would begin to break out and start charging their own co-payments.
That's the political reason the freeze is to be eased. The Turnbull government will never again make controversial changes its opponents could characterise, however wrongly, as "privatising" Medicare.
Most of the things you could do to limit the growth in healthcare spending involve cutting the incomes of doctors, or at least restraining the rate at which they're growing.
So, whenever governments try, the doctors resort to their own scare campaign, telling their patients – the older and more pitiable the better – the government is forcing them to charge, say, $3000 for having their cataracts fixed.
Few people could afford to pay such prices – which is why, in reality, they'd never happen – but that doesn't stop old ladies taking their indignation to a slavering tabloid media or beating down the doors of their local member.
But it's a great pity to have the government running scared of making changes to Medicare. There's a lot of inefficiency in our present arrangements which, if we could reduce it, would slow the rate at which the healthcare bill is growing and so ease the burden on taxpayers, without harming patients.
Indeed, as Dr Stephen Duckett (a real doctor, not a medico), of the Grattan Institute, argues in a new report, Building better Foundations for Primary Care, a more efficient system could give some patients better care by reducing the need for them to go into hospital.
Much has changed since Medicare was first installed in the 1970s. It needs to be brought up to date without weakening its key features.
One thing that's changed is the rising average age of the population, meaning that more doctor visits are about chronic (lasting) conditions – such as diabetes, asthma or heart disease – rather than acute (temporary) problems.
So GPs need to spend more time helping their patients manage their chronic conditions (older patients will often have more than one), which requires longer but (we hope) fewer consultations.
But, as Duckett and his colleagues explain, Medicare's present system of rebated fee-for-service, acts to discourage such better assistance to chronic sufferers.
It gives GPs a financial incentive to increase the number of services provided, but also keep them short.
It would be better to pay GPs a (higher) fee for successfully managing a patient's chronic condition. But that's well down the track. First things first.
"Primary care" is the medicos' term for a patient's first point of contact with the healthcare system. It could be a hospital emergency ward or an "allied health service", but mainly it's GPs.
Health experts have long known that the key to an efficient and effective health care system is to get primary care working well. GPs get paid a lot less than specialists, but they're probably more important to ensuring good patient care.
Our primary care doesn't work well enough to be called a "system", mainly because of squabbling between federal and state governments and the absence of clear lines of responsibility.
Duckett says we need a primary care agreement between the two levels of government and the primary health networks, which should be given more resources, responsibility and accountability.
But first we need much more information about what happens in general practice, so sensible targets can be set for improved performance.
Since almost all GPs use a computer program when seeing patients, such (de-identified) information could be supplied with little additional effort or cost.
If the government is about to ease the screws on GPs' incomes to the tune of half a billion dollars, it should make this conditional on them providing the information needed.
