By opting for a $5 cut to the Medicare rebate, instead of a straight $7 co-payment, Mr Abbott is making doctors do his dirty work.

Doctors will not be arguing that medical fees structures do not need to be re-evaluated as already they are faced with significant challenges to continue bulk-billing arrangements in many circumstances.

They will, however, be upset the government has effectively passed the buck by suggesting a reduction in the Medicare rebate of $5 is “optional”.

Already underpaid by world standards, doctors will have little choice.

On a positive note is the government’s decision to ensure bulk billing continues for children and many categories of people on welfare payments.

But it’s a wonder it took the government so long to make such a concession, given its previous proposal had little sector support, little chance of being passed through the senate and almost total opposition in the community.

Clearly, Mr Abbott’s government is using the few remaining weeks of 2015 as an opportunity to clean up a messy year.

The government has largely failed to implement many of its key budget measures, in part due to a disjointed senate but also due to its own dysfunction and reluctance to move away from its ideological position.

The changes to medical services will be much more palatable for the senate, and for the Australian population.

It will still see, according to the Prime Minister, the same level of savings on the budget bottom line.

What it does, however, is open up a debate about the future steps that can now be made to change existing Medicare arrangements.

It is not a stretch to suggest that should these latest changes be supported, it will only open the gates for further erosion of the principles of universal health care in Australia.

We have a system that is not perfect. However, it stands as one of the best in the world for ensuring all our people can access the care we know and expect.

Any change in this area should always be debated fully and openly by the Parliament.