Prime Minister Tony Abbott has rejected a proposal by doctors to exempt pensioners from a $7 GP fee, but has left open the possibility of negotiating over whether children's visits were charged.
Speaking to reporters in Melbourne on Thursday, Mr Abbott said pensioners already paid about $7 for prescriptions subsidised by the government under the Pharmaceutical Benefits Scheme.
"I don't think it's unreasonable for a comparable amount to be paid for visits to the GP," he said.
Asked whether he would consider exempting children from the fee, Mr Abbott said sometimes people had to pay for something "to appreciate what you're getting" but that the government was talking to cross-bench senators about the proposed legislation.
His comments coincided with the release of an Australian Medical Association proposal on Thursday that would exempt children under 16 and concession card holders from paying a GP fee.
A GP fee would not apply to certain Medicare items including chronic disease management plans, mental health treatment items and residential aged-care visits under the AMA's proposal.
The AMA proposed a $6.15 payment for other patients. It rejected the government's planned $5 cut to Medicare rebates, which was designed to encourage doctors to charge the $7 fee.
The doctors' association also wants the government to defer fees for pathology and imaging for at least two years to work through details.
Under the government's proposal, announced in the budget, all patients would pay a $7 fee, but concession card holders and children would be bulk-billed after paying the fee 10 times in a year.
Federal Health Minister Peter Dutton rejected the AMA proposal, saying it would deliver "a windfall to doctors by wiping out 97 per cent of the government's estimated savings".
He said he believed most Australians supported a modest GP fee which was needed to ensure the sustainability of the healthcare system into the future.
"I thank the AMA for their honesty in publicly and privately supporting a co-payment in principle," he said.
Labor, the Greens and the Palmer United Party also rejected the AMA plan on Thursday.
The Coalition needs the support of at least one of these parties to pass legislation in the Senate.
Opposition Leader Bill Shorten said Labor would not support a Medicare fee in any form, while Greens Senator Richard Di Natale said "no amount of tinkering or adjustments can save this dog of a policy".
Palmer United Party leader Clive Palmer said his party would not support the AMA plan. "It's a dead duck," he said.
Health, welfare and community groups also rejected the plan.
"A co-payment would erect a barrier to primary health care for many thousands of families and individuals who would not qualify for concessions," Consumers Health Forum chief executive Adam Stankevicius said.
Terry Barnes, a former Howard government adviser who placed the issue of fees for GP visits on the political agenda in a submission to the Commission of Audit, said the AMA plan was "a deliberate cash grab for GPs under the guise of fairness to vulnerable patients".
"My original $6 co-payment plan is fairer than both the government's and the AMA's and should be revisited. It better balances savings and fairness," he said.
While the government estimates its own proposal would generate savings of more than $3.5 billion over four years, the health department estimates the AMA proposal would produce savings to the budget of just $66 million over the same period. The department estimates doctors would be $580 million better off over four years by charging the fee to non-concessional patients who are currently bulk-billed.