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September 30, 2004

Medicare Gold?

I saw most of Mark Latham's ALP campaign launch in Brisbane on ABC television last night. The visuals were very good: they were minimalist, mostly Conservative blue, with the emphasis clearly on the message of 'Taking the Pressure off Families.' Stunning and effective imagery.

It did the job for tipping the balance of the campaign towards the ALP. It now looks as if the question is: just how many seats will the Coalition lose? To what extent can Howard limit the damage? Can they hang on? Or has the rot set in?

The Canberra Press Galley are saying Medicare Gold is a part of an ALP strike into John Howard's heartland, and an admission that Latham must penetrate the grey vote to win. Will Medicare Gold shift the older Australians in the marginals who are rusted onto Howard towards the ALP? I don't think so. Neither does Ken Parish. Will the older Australians give up their private health insurance, leave the private health insurance pool, and cause a reduction private health insurance premiums? I reckon they will keep private their health insurance.

Though I was impressed with visuals I was not impressed with the rhetoric of Latham's speech around the "Howard is waging war on Medicare. I want to build a fortress around it" meme. Consider this part of the speech:

"When he first led the Liberal Party [John Howard] said that he wanted to "take a scalpel to Medicare"...Well, that's what this election is all about. It's a referendum on the future of Medicare.

Do we want the Coalition to take us further down the American road of privatised health - a two tier system? Do we want to give John Howard another chance to put his scalpel into Medicare? Or do we want a Labor Government with a plan to save Medicare? Just one tier. One world-class health care system for all Australians.

We set up this system, we're proud of it and we're going to bring it back to its full health. Labor believes in Medicare. It's good public policy. But it also says something special about who we are, about the things that make us uniquely Australian. It says that in our country, if you get sick then someone will care for you. It says that the Australian people look out for each other. That we help our mates and those in need."

John Howard is wandering around inside Medicare with buckets cash. That is hardly taking a scalpel to it. John Quiggin is not impressed by that. He says that Howard is:

"...hampered by the fact that, for all but the last six months or so of his 30 years in public life, he's opposed Medicare and done his best to destroy it. He was Treasurer in the Fraser government which actually did destroy the first version, introduced by Whitlam".

Historically accurate. But no credence is given to Howard judging that it is politically necessary for him to accept Medicare and not destroy it.

Latham's rhetoric is very misleading. He says that Medicare has been one of the great ding-dong battles of Australian public life---a battle of principle on health policy. Presumably he means public v private. Labor is investing in public health care whilst the Coalition pursues the privatisation of health - a system based on private insurance and private care.

Oh? does not the ALP supports the 30% rebate for private health insurance, private hospitals and private doctors who are not bulkbilling.

I realize that speeches are for the party faithful who want to celebrate, feel proud, adore their heroes, and get misty eyed about their future together. But what a conservative understanding of Medicare the ALP has: it is all about hospitals, tick and flick bulkbilling and doctors. Nothing about primary health care, or the services provided by allied health, or keeping people from needing to go to the hospitals in the first place.

What was innovative was the Commonwealth picking up the tab (hospital costs) of Australians over 75, plus guarantee them immediate access to hospital treatment. Historic healthcare reform says Chris Sheil over at Back Pages, without saying why. He goes onto predict an ALP victory, barring an unforseeen left of field event.

But Latham doesn't care whether the hospital is privately owned or state run. So he is providing support to private health care. Ssh. Don't let on that the party faithful has sold its principles on public health long ago.

But that doesn't matter cos it's the images on television that matter.

Posted by Gary Sauer-Thompson at September 30, 2004 07:55 PM

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I spelled out some of the reasons why it is a historic change in the thread Gary - but surely blind Freddie can see that one level of government taking complete responsibility for aged care is somewhat new in Australian history!

As for public versus private, what difference does it make? Where's your head? Soviet Union? We're not all as last-century ideologically driven at Back Pages as you rusted-on true believers over here at Public Opinion.

(and while I'm here, my name is not 'Sheils')

Posted by: cs at September 30, 2004 09:11 PM

your name has been changed from Sheils to Sheil.Apologies for that mistake.

I'm glad the historic moment has been spelt out. The commonwealth taking complete responsibility for the hospital care of Australians over 75's is innovative.The ALP is to be applauded for its initiative.

I can't help but notice that you do illustrate my argument in the post:--that the ALP reduces Medicare to hospitals, doctors bulkbilling etc.

Re-read what you have written:

"..but surely blind Freddie can see that one level of government taking complete responsibility for aged care is somewhat new in Australian history!"

Aged care has been reduced to hospital care.

Aged care is more than hospital care. It is also primary care; it is being cared for at home with appropriate medical services; it is having a variety of good quality residential facilities etc etc.

My point was that the ALP has developed a fortress mentality around Medicare and it has a shrunken conception of it.

Why so? It has some clever people, takes good policy advice and still has a touch of vision.

A suggestion. I would point the finger directly at the big boys who control the party;it is the girls who have the more innovative policy ideas but the conservative boys squash them because they lack political courage.

But you know the ALP better than I do.

On the other issue you raise about my head being in the Soviet Union etc etc I have no problem with paying my doctor for services rendered, going to a private hospital or taking out private health insurance.

So I guess the issue is that you reckon the 30% tax rebate for private health insurance is a good idea whilst I don't.

Funny thing politics. The ALP politico types loathe Howard and detest his policies but they end up supporting a lot of his legislation and going along with many of the policies he has implemented. So little roll back, so little roll back.

As I said in the post: there is a big gap between rhetoric and reality with the ALP. Now that--what you see is not what you get-- is a good ole nineteenth century idea.

Posted by: Gary Sauer-Thompson at September 30, 2004 11:28 PM

"..but surely blind Freddie can see that one level of government taking complete responsibility for aged care is somewhat new in Australian history!"

Aged care has been reduced to hospital care.

You missed the point Gary - the commonwealth already has almost all responsibility for the other arms of aged care - this completes the loop, and that's why it is so exciting for policy wonks like me. There are untold policy and service benefits in this, all of which are fantastic, but most of which are also too arcane and/or complex to discuss a week out from a general election.

As the ALP, I'm no apologist - work out your own story.

(thanks re name)

Posted by: cs at September 30, 2004 11:40 PM

But I have my own story re the ALP. It is a retro 1970s one:the conservative, duller male heavies from the right stiffle the innovative bright women from the left whilst the others either play with plasticine or learn to sit down with the toddlers.

Posted by: Gary Sauer-Thompson at October 1, 2004 12:19 AM

Medicare Gold was an innovative (depending on who you talk to) and well thought out political move. Rather than bamboozle as Howard has done, they went for one well-planned king hit and I think it landed. Whether it will dismantle, time will tell.

It worked for my mum and dad who can't afford private insurance and are too proud to let me pay it for them and yes it got me thinking that Latham might just make it. If they also announce a Nursing Home policy as is rumoured...it may be the thin edge of a wedge which differentiates the two at least on something.

What other alternative do we have?

Posted by: saint at October 1, 2004 05:15 AM

I agree that Medicare Gold cuts through the fog and spin and that it appeals to older Australians without private health insurance. I have my doubts whether it removes the need for seniors to retain their private health insurance.

It is kinda like mainstreaming the current policy towards veterans. It is good policy, especially if it brings partnerships between public and private hospitals and cooperation between the states and commonwealth.

However, mainstreaming depends on resources to deliver.

Is there the capacity to create extra private and public beds? I presume that there is spare capacity in the private health system,as there is none in the public system.

How are the staff shortages (doctors and nurses) going to be overcome?

Who misses out from the prioritising of elderly Australians in accessing our hospitals?

Will the doctors in the private hospitals go along with a cap on their fees?

Is there going to be a large transfer of public patients into private hospitals?

It is not clear to me how Medicare Gold addresses the structural problem between the long stay older patient in public hospitals (bed blockers) and the aged care problem.

Posted by: Gary Sauer-Thompson at October 1, 2004 08:29 AM

don't the over 75's already have free health care? - that's why we have medicare, isn't it? those (75 and under) that choose to pay for private health services are welcome to do so, but i don't see why the government should pay for or subsidise either individuals or the industry..

surely the money is better spent providing adequare public health care for seniors?

Posted by: kez at October 1, 2004 06:32 PM

Perhaps Chris can explain why my 32yr old cousin will have to wait a year for a public hospital operation on his knee, but his 83 yr old grandfather wouldn't.(not that he requires one) Why should age prioritise hospital care? If anything my long retired father, would happily give up a place at the front of the queue for his working age grandson.

Posted by: observa at October 1, 2004 08:24 PM

Gary, I think the private sector have indicated that there is capacity as far as bed. As far as doctors, specialists, nurses, I think someone has to bite the bullet and get rid of the artificial monopoly created by the medical colleges and/or look at recognizing overseas qualifications.
Nurses, especially in aged or nursing home care, will be a tougher nut to crack.
But they are not insurmountable problems and probably ones you would like to tackle in government, not in an election campaign.

I agree the structural problem hasn't been addressed and I am not sure that today's announcement by Labor of interest free loans etc is a good response. Haven't had time to absorb it all.

Observa - no one over 75 or not has to wait for crisis care now, nor will they need to do so in the future. I think this policy is aimed at those on waiting lists for 'elective' and non life threatening surgery eg hip replacement. If you removed the backlog (which comprises mostly of the elderly and which I believe actually represents about a month of work max all up across all hospitals), and use the excess capacity in the private sector to get elderly people treated as the need arises, it should free up the queues for everyone u75 to some extent..yes one does need to see the assumptions and model and details but even at top of the head level, it could work. Devil is always in the detail I guess. And health policy is a real spaghetti and meatballs nightmare.

Posted by: saint at October 1, 2004 09:09 PM

I concur with your sentiments about the trade restrictions on doctors and the shortages of nurses. The current practice is to poach this skilled labour from other countries rather rthan put the reources into the education system with fully funded university places.

I reckon the ALP is being a bit coy on what it will cost to deliver the provision of universal benefit to anyone over 75 to go at no cost to a private hosipital of their choice.

That's what Medicare Gold boils down. to in the absence of a masssive funding increase for our public hospitals, does it not?

The ALP's $3 billion may well be $3 billion too low according to Paul Goss, a former health commissioner under Labor and the Coalition, in the Australian Financial Review yesterday.

How does this square with the ease the squeeze tax burden on the aspirational suburban middle class?

Are we going to see the over 75/s being obliged to go down to the local employment agency to get a part-time job?

Posted by: Gary Sauer-Thompson at October 2, 2004 12:48 PM

It's good politics in the context of the campaign, where a message needs to be simple and clearly understood.

Rationalisations with the states systems and the private systems will occur.

I agree that the health insurance rebate is a waste of funding better spent on our public hospitals.

However, maybe they've taken a leaf from Howard's GST book, and realized it'll be easier to sell this in government than from opposition (as Howard did with the GST).

I don't know that it's all that noble but the precedent has been set.

I wouldn't write off the women just yet. From what I saw of Gillard and Lundy in TV debates, they've got quite a bit to offer and are unlikely to get steamrollered on everything.

Posted by: Don Wigan at October 2, 2004 06:20 PM

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