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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

CoAG: health reform « Previous | |Next »
April 19, 2010

Today is crunch time to address the rapidly rising costs and inefficiencies in the fractured healthcare system at CoAG in Canberra. The common ground is that the system does need more money now rather than in 2014, and the commonwealth's contribution has gone down and down and down over the last decade. But extra funding does not necessarily mean higher quality health care.

MoirAhospitals.jpg

Will the states accept the Commonwealth's bribes or sweetners and sign up to a limited public hospital program? Or will they---WA, Victoria and possibly NSW --- continue to resist signing over a portion of their GST, even though they tacitly agree that a single funder of health is best? That would begin to end the cost-shifting and finger-pointing that bedevils the current split system.

Or will they refuse to cut a deal and go out on a limb, even though the states have little hope of funding or supplying on their own the 21st-century system that we will need to deal with chronic illnesses and an ageing population over the next decade. And the states know it.

What we have, as Ian Hickie observes in the National Times is that:

The big dollars have been allocated to public hospitals and purchasing of elective surgery from the private sector. The real service commitments, particularly the guarantee that you will be treated within four hours of presenting to an emergency department, are clearly focused on improving the acute care sector only.

Nor are the states pushing for the rapid introduction of e-health despite the cost savings, or addressing the perverse incentives such as fee-for-service associated with bulk-billing in which clinicians are rewarded by the number of transactions rather than health outcomes.

Unsurprisingly, the states have been more interested in extra cash rather than addressing the underinvestment in prevention, early intervention and alternative care settings, particularly for older people. Lowering obesity rates, particularly among young people and those on lower income, or dental care do not seem to be very high on any real health priorities list. Nor is mental health.

Tony Abbott has little to say apart from it being another example of Rudd's smoke and mirrors. Peter Dutton, the Coalition's shadow health spokesperson, has nothing to say, as usual. No doubt they will oppose.

Update
The talks move very slowly---"inch by inch"--- by all accounts. Everybody has stayed on message about CoAG being constructive and everybody being willing to negotiate. NSW Premier Kristina Keneally has agreed to hand back 30 per cent of its GST to Canberra to help fund Kevin Rudd's hospital reforms.The commonwealth's claw back of GST to fund health care is the key sticking point, or bone of contention for Victoria and Western Australia. That issue has yet to be discussed at CoAG. Will it be debated tomorrow?

The Commonwealth continues to throw money around --this time it is $1.2 billion to help meet the emergency department and elective surgery targets set up under the Rudd's reforms. They are not talking about reducing the number of patients coming into hospitals through good primary care as David Burchell observes:

Unravel the righteous words about the importance of primary and community care, and it becomes clear that nothing much is about to change there, either. There are no specific proposals about nurturing "wellness", or better treating the epidemic of breast cancers, or dealing with mental health more effectively. Nor is there any evident revision of the received view that treats old age as if it were a form of illness, so that the elderly are condemned to spending their autumn years under the cold fluorescent lighting of hospital waiting rooms.The federal proposals won't make the business of hospitals easier, by keeping people out of them. They won't make the system fairer in any discernible way; nor, so far we can be told, will they work to restrain overall costs.

CoAG has yet to begin to seriously discuss health reform. What we have on display this time is more political posturing and positioning for upcoming elections.

Update 2
So it cost the Commonwealth $5 billion in incentives (including $1.2 billion to help meet the emergency department and elective surgery; $800 million for improved mental health services and 1300 extra hospital beds) to get the states on board plus a partnership with the states, with each contributing to a joint pool to fund hospital reform.

So the Commonwealth had to back down on directly funding the local hospital networks as the states are still involved in controlling the money. That state involvement through a joint funding arrangement to deliver hospital funding reform does mean the continuation of centralised and bureaucratic approach rather than giving the hospital networks the ability through direct funding to deliver locally crafted services according to the needs of the population.

| Posted by Gary Sauer-Thompson at 7:29 AM | | Comments (25)
Comments

Comments

The politics of health is just a squabble for money in the short-term. Despite their rhetoric the states are not really concerned about putting health on a sustainable footing in the long term.

Here's a laugh. In Murdoch's Australian Christopher Pearson reckons the current squabble over health (ie., over hospital funding) reform has "increased the likelihood Tony Abbott will snatch an upset victory at the next election."

Pearson is on another planet. His reason for the claim is that:

It's plain that John Brumby and Kristina Keneally have concluded a second Rudd government is by no means inevitable and nor is it necessarily in their best interests.

On what basis is this 'plain'?

Apparently, the chariot wheels are wobbling on Rudd's Health Plan A, in the absence of any quick-fix alternative theme, his case for re-election is looking threadbare. Pearson also reckons that Rudd's health reforms are a cack-handed attempt to sell a health policy that Labor colleagues say is illogical, hastily confected and bizarre.

Pearson doesn't know that much about health policy as he gives no reasons for increased commonwealth funding being "illogical, hastily confected and bizarre" and he makes no reference to the policy inquires over the last couple of years.

He doesn't need to, does he? He can see through the appearances of politics (theatre, stage management) to the essence-- the likelihood that Tony Abbott will snatch an upset victory at the next election.

What fool would ascribe credibility to a rapscallion like the non-Pearson?
I know...
No, listening to it on radio, it does seem some are right about it coming together as another piece of evolving psycho drama/ street theatre leading into an election- apparently they've realised there is still a bit of Howard's Horde left and because it's an election year they will spend it on lagging social infrastructure rather than defence, which, juxtapositionally, is always announced first thing back FROM an election.

Lenore Taylor in the National Times says that:

Having agreed to every health-related aspect of Rudd's proposed health and hospitals reform, COAG was deadlocked last night because of mutual mistrust over money.If it eventually founders on this point voters will have every right to judge their elected representatives harshly.

Where we are at the moment with Victoria and Western Australian is that health reform that everyone agrees is needed will not founder over whose name is on the stream of money that funds it.

John Dwyer in The Australian says that the participants in the Council of Australian Governments meeting are locked in a divisive battle over the funding of our public hospitals, not health system reform. It is hospital care that is the centrepiece of Kevin Rudd's plan.

Health reform means a shift away from our hospital-centric system to one driven by the need to focus on a patient-centred healthcare system.This means primary care reform that allows stressed hospitals to have fewer patients.

The model favoured by many primary care specialists features one-stop-shops where doctors, nurses, allied health professionals and dentists work as teams to provide a full range of services to enrolled patients. Medicare funding of the team - not just the team's doctors - would be essential. To date no such promise has been forthcoming.

No one at CoAG is talking about changing our hospital-sickness-centric system to one that emphasises the prevention of illness or its early detection and treatment.

Paul,
Pearson has no idea what he is talking about. He's dreaming. Keneally has agreed that NSW hand back 30 per cent of its GST to Canberra to help fund Rudd's hospital reforms. Why would NSW wait for Abbott and the Coalition ? He has no policies re health.

The best interpretation of Brumby's resistance to Rudd's health reforms is that he is fighting against the march of power to the centre in our federal system. Even though the Brumby Government provided much of the policy grunt for the Rudd Opposition, Brumby is fighting the erosion of the power of the states in Australian federalism. Having control over the GST is a totemic issue.

The commentary is pretty poor on this--its all politics and no health.Thus Niki Savva in Dr Kevin's healthcare at Unleashed misreads what is going on. She says that Rudd's

original plan had two inbuilt self destruct buttons - the snatching of 30 per cent of the GST revenue from the states, and the prospect of a referendum if they did not agree to it.The first was bound to raise the suspicions of the States and incite rebellion, and the second force the States - and the opposition - to mount a 'no' campaign, and ensure the referendum headed for glorious defeat.

And our glorious Kevin, in all likelihood, envisaged himself standing tall amid the wreckage, saying he had done everything humanly possible to fix health but had been thwarted by wilful State Premiers and Tony Abbott, none of whom had any regard at all for the national interest. Then off he would race to the election and referendum.

She adds that this would be the blame game all over again. The one he promised before the election that he would end. And what about the buck that he said would stop with him.

Savva, who was one of the senior correspondents in the Canberra Press Gallery and Costello's press secretary, makes no mention of the necessity of the states and commonwealth having to work together on the funding because the state's budget's would be torpedoed by rising health costs over the next 20 years. That means no referendum as it is in everybody's interest to sort out the funding of health services within a federal framework.

As cold blooded and evil looking a reptile (Savva) as ever I've seen.
Last week one of the ABC current affairs show had the cheek to include her with another right wing spinner, the equally sinister David Penberthy, no doubt as "balance", under ABC management's eccentric notion of what it entails.
The subject matter included health and refugees, so why was the discussion limited to two right wingers?

5 billion eh. Might put the broadband on the backburner.

Les,
Tanner must be rather unhappy with all the spending. Tax the miners with a resource tax to help reduce the budget deficit? Increase the Medicare levy? Pressure the Coalition to pass the private health insurance legislation in the Senate.

Pity about the GST clawback. It opens the door to even more clawback by the commonwealth --eg., for education. The Western Australian Premier Colin Barnett refused to move on states' rights he wasn't willing to give up control of a third of his state's GST to the commonwealth to fund health. He is prepared to hand over the equivalent in dollar terms.

It is more money for the public hospital system, which desperately need more resources, but it does nothing to reduce the increasing demand for hospital services. It is not a shift to a single funder of health, nor is it health system reform.

Will Abbott and the Coalition block this in the Senate?

Gary,
It is what Rudd is good at. A word based solution.

Time will tell if it translates to outcomes.

In A maculate conception Katherine Murphy says:

this smells like status quo for the health system dressed up with a great deal more money and some medium-term efficiencies, including more transparency, which might prevent some of the money disappearing down an enormous sinkhole. If we believe some of the current problems with Australia's health system stem from split responsibilities between Canberra and the states, nothing has changed: the package agreed yesterday preserves that hoary old divide.

She says that the problem with maintaining divided responsibilities is the task of achieving genuine far-reaching reform remains that much harder when the table is crowded with competing interests.

The Commonwealth has stepped in and taken responsibility for growth in the health system to prevent it's slow decline. That is a big plus

Gary,

Do you think they should block it?

Les,
If the Coalition tried to block the hospital funding reform legislation it would place itself offside with a majority of the Australian population, who are in favour of the Commonwealth taking greater control of the hospital system.

It's not a tactic to persuade the electoral middle ground to switch their vote to the Coalition. They will snipe from the sidelines and link it to the budget deficit since health is not their preferred territory to fight on.

Gary,

There has been some early poll figures that point to that but I wonder if the strategy of the Rudd government basing their election campaign on "We want good change" "They want to keep people in waiting rooms" is the best way when they have been seen to have not lived up to expectations now.

Is this what we are going to get for all issues "They want your kids to be dumb" They want more boats to come" " They want more crime".
If that is the intention it shows the lack of ability.

How did I miss the cartoon?
"Dr" Rudd again, the cartoonists seem to have settled on him as a medical person.
Sort of "Flying High" set in a hospital ward.

Paul,
the initial upload of the Moir cartoon got screwed up. I failed to check the post as it was a case of post and run because I was buying and trying to set up a new computer. I only noticed that some of the code was missing this morning.

For pete's sake Gary, if that's the case, no harm done; another gem and better for the unexpected surprise.

I can't beleive it!
Today's 'tiser has a cartoon on the coag health talks. Have a look at what emergency surgery our hero has been up to this time, only who or what is the actual patient and what's the actual condition being treated?

Paul,
nothing online at AdelaideNow. I could only find this article by Greg Kelton

Gary, you have the wit not to buy the actual paper, whereas I've been getting it delivered lately, on the basis of a cut-price offer.
The centre page cartoonist is not usually brilliant, but this time he depicts a haemorraghing patient , "health system",
as the surgeon, elbow deep in gore, tosses an offending organ,"WA", over his shoulder,
as an underling warns the monitor "senate" has gone dead, to signal the onset of "complications".
The centre sheet btw is dominated by a piece from one Amber Petty, lamenting on the pivotal contemporary issue of women's fatal attraction to "bad men";
"loved too well, not too often..."
Egghh!

The conflicts are not really about health. Or rather, health is an example of the states are responsible of the big gap between revenue-raising capacity and spending responsibility in the developed world.

The states in our federal system account for 43 per cent of government spending, yet they collect only 15 per cent of tax. Hence the fight about the buckets of money.

That imbalance is one of the core reasons why some say that the states' days are numbered

Good heavens, Peter Stock, could you imagine the panic up the big end of town if state governments were again a force in locales and actually acting in the interests of same?
Not for nothing have they had their wings clipped.