Welcome to part 14 of Croakey’s election series. I don’t know yet if it’s the final instalment – depends if any other Croakey contributors are fired up to fire off an election piece before V-Day…
Below, Paul Smith, political editor of Australian Doctor, gives us a rather pessimistic overview of both major parties’ health policies, while health economist Professor Gavin Mooney explains why at least one of the parties’ health policies got him excited.
A bleak future, whoever wins
Paul Smith writes:
In truth there has been no grand health policy from either Labor or the Coalition since the 2004 Medicare Gold fiasco. This time around it’s been a lot of GP super clinics, cash for mental health (genuinely a good thing) and dull bickering riddled with rubbish sound-bites which is meant to pass for genuine political debate.
It’s worth pointing out the few topics that seem to have become off limits.
No discussion on the role and function of private health insurance rebates now we have mainstream political consensus on a policy that not even the National Health and Hospital Reform Commission was allowed to question. The last time I looked there was still a huge amount of cash going into it.
And Indigenous health, along with dental and aged care, seems over the last four weeks to have become lost in the respective parties’ calculations on what wins votes in the key marginals.
It is also noticeable that the structural reforms – “the biggest shake up since Medicare” or even “more important” than Medicare – have rated barely a mention by the Labor Party.
Perhaps it is because the topic is to the wider world of little interest, perhaps because the reforms as they stand are a dog’s breakfast, perhaps because they are not fit for the alleged purpose of that brave promise of ending the blame game.
The feeling I get is that Labor could secure votes by pledging to rip up the Rudd-states agreement and starting again – but the votes would have been limited, restricted mainly to health policy wonks who read the Croakey blog.
If Labor is successful on Saturday night, the real tragedy is that it’s too late for a restart. The politics won’t allow it – unless Victoria’s non co-operation can bring down the whole thing.
No reform was ever going to be close to perfect but we now face in the coming years the prospect of the politicians pretending to make a pig’s ear into something approximating a silk glove.
If the Coalition was offering an alternative – or at least some commitment to look at the reform commission’s report – then the future would not feel so bleak.
But there isn’t one. Tony Abbott – both now and as Federal Health Minister – is the self-professed incremental conservative.
There are merits in that view when it protects what works and it is worth reminding ourselves there is a lot that works in the Australian health system.
But without improving service integration, fixing the system disconnects in areas like aged care and mental health and chronic disease management, without sorting out governance and accountability, the future is going to be both expensive for the government and its taxpayers and painful for those poor buggers caught in the silos.
Our expectation of what politicians offer is now so low that it has become the argument for not expecting any better.
The parties clearly believe that somewhere out there is a constituency that is convinced by this stuff – the mythical “ordinary Australians”. At the one moment when politicians should be showing the best of themselves – some kind of vision for what they can achieve – there is something literally dispiriting when they can fall far short and still be confident they will be getting our vote.
What’s this? A policy that’s actually about the community’s health?
Professor Gavin Mooney writes:
Prior to this request for comments on the parties’ health policies at this election, I had not looked in any depth at the Greens’ health statements.
What I had intended was to write about the similarities between the Coalition and the ALP policies, especially on issues of (largely missing) principle and I’d have tied this into what comes through from Citizens’ Juries. These tend to be equity, especially with respect to Aboriginal health, prevention (but not victim blaming), community support especially for the mentally ill, primary care and not – yes NOT! – investing yet more in hospital beds.
I then would have wanted to say: it is time to listen to the citizens’ voice; time to recognise that citizens have principles they want health services based on; and argued for much more focus on keeping people out of hospital rather than just rolling out the intellectually dead but expensive mantra of “more beds good; too few bad”.
And I would have argued that the main parties are failing the nation in first being captured by the special interest groups in health care especially the AMA; second not seemingly being interested in hearing the citizens’ voice; third being devoid of guiding principles to underpin their health policies; and lastly relying on ‘experts’ who seem all too ready to blame the victim, especially with respect to life style problems rather than blasting the perpetrators – the booze, fag and fast food industries. (Do these public health mafia ever talk to obese people or ask smokers why they smoke?)
And then I looked at the Greens’ policy!
It ain’t perfect but it is good on many fronts. On principles, for example, the Greens state “individual health outcomes are influenced by the inter-relationship of biological, social, economic and environmental factors”.
They are big on community support in mental health; and on equity, wanting to “alleviate social disadvantage” and to “deliver accessible, culturally appropriate and community controlled health services” to Aboriginal people.
They push for people participation both “individually and collectively [collectively – now that really is great!] in the planning and implementation of their health care”; and they want “to plan now for changing disease patterns arising from climate change”. And on prevention, they want to tackle the villains on the supply side and tax their advertising budgets – oh I could drool!
But it gets better! What gets me really excited by the Greens policy is that I can see nothing in their policy – nowt, absolutely zilch, damn all, SBA – on more hospital beds!!
Where on earth did all of this common sense on health policy come from? The Greens must have some rather unusual experts to advise them. But another thought. Maybe just maybe they are listening to the critically informed voices of the community – and I am not talking silly focus groups here – through Citizens’ Juries.
But nah – no political party at this moribund election could possibly be doing anything as radical and risky as that. Silly me.
To see the previous posts in the Croakey election series: