Now is the time for the type of action on health policy which is usually blocked by the AMA and other special interest groups, says health policy analyst Jennifer Doggett, who has some advice for the independents who are now in government-making negotiations
Jennifer Doggett writes:
It’s strange times indeed when the 31 445 citizens of outback Queensland who voted for Bob Katter have more capacity to influence health policy decisions than the members of the AMA.
Independents in Parliament spend much of their professional lives being irrelevant on the national stage, with nothing more politically taxing to do than judge the Victoria sponge competition at their local agricultural show.
However, occasionally they get cast into the spotlight of political relevancy and are given the challenge of delivering the next government and thus profoundly affecting Australia’s future.
Perhaps more importantly for their political futures, they need also to simultaneously secure some largesse for the constituents who put them there in the first place.
It’s a delicate balancing act, even for a politician.
They are seen as incompetent if they don’t negotiate some substantial hand-outs for their local areas but cannot afford to come across as too obviously rapacious by disadvantaging the rest of the country to shore up their own electoral support.
Their window of opportunity is typically small. They have to grab whatever is on offer quickly as delayed negotiations can risk damaging their averred commitment to securing a stable government.
This requires a good sense of what is both politically and practically possible to deliver.
Regardless of their apparent position of strength, they cannot overplay their hand. It’s important to remember that, regardless of the increased green vote, the vast majority of Australians still supported one of the two major parties.
This places limits on the extent to which either party can go to secure the support of independents with only a fraction of the popular vote.
The best outcome for both sides in the negotiating process is to find issues which the major parties would actually like to deliver on, but have failed to do so due to pressure from powerful interest groups.
This is where, if the independents are smart, they can achieve real gains for both their local communities and the country as a whole.
Under the guise of negotiating pressure, the majors can afford to annoy the special interest groups whose support they required in the lead up to the election.
This can give them the freedom to pursue strategies that were seen as too politically risky this time last week.
It can also help Ministers loosen the purse strings for programs for which they previously have been denied funding by the party bean-counters.
Encouragingly, health services are an issue mentioned by all the independents as a priority for their local areas, along with essential infrastructure services, such as broadband, which will also play a role in health care delivery.
If they casting around for ideas to put on the negotiating table, the following issues are all ones which would not only benefit rural communities in the short term but would create a health system more able to respond to the needs of all Australians into the future:
- a Health Service Charter – we pay lip service to a universal public health system but the reality is that many Australians are denied equal access to care due to location, cost, cultural and other issues. A Health Service Charter would set out minimum service standards for ALL Australians and provide an ongoing opportunity to call governments to account if they fail to deliver.
- strengthened primary care services – many of the health problems in rural areas can be addressed through providing more comprehensive primary care services. Labor has gone some way towards achieving this aim but these gains need to be consolidated and an agreement secured from the Coalition to reverse the decision to divert primary care infrastructure funding to increased Medicare rebates.
- a public dental service – it can be done. It just needs adequate funding and the political will to annoy some dentists who fear that a public program will undermine the profitability of private dentistry.
- health workforce reform – this is a key issue for rural health care which struggles to attract professionals from the city but which is prevented from adopting innovative workforce strategies due to rentseeking practices from the AMA and other specialist groups.
- Independent Medicare-funded midwifery. From rural towns without a doctor to Indigenous communities where women want the choice of birthing in country, this issue is important to rural and remote communities across Australia (and to many urban Australian women as well).
Realistically, not all the health needs of rural Australia can be met through the horse-trading that will take place over the next few days.
However, there is a real possibility that if they play their cards right, the Independents could make substantial gains for the future health of both their local constituents and the Australian community as a whole.