Dr Trevor Kerr – who provides regular comment on Croakey posts – has written in, wondering whether there is any point to providing online comment about health policy issues.
Of course there is (but I would say that, wouldn’t I) – if you see some value in open and engaged debate. I often pick up new and interesting takes on issues from Croakey comments myself. But I do agree with Kerr’s point below that fragmentation of public debate is a potential downside of the online publishing revolution.
“Lesley Russell, Menzies Centre for Health Policy, has written at least two recent articles and spoken for one radio talk on the Government’s planned reforms of health care. They are at The Australian (‘Costly US scheme should be lesson’) and at the USSC website (‘Health policy expert, Lesley Russell, blogs about Obama’s speech on healthcare reform’ and ‘Lesley Russell, Geoff Garrett & John R. Graham analyse Obama’s address to Congress on healthcare reform’).
Each of the three publications includes a space at the bottom for comment.
What is the point of asking for commentary in a public domain without there being a clear plan that describes how the commentary will be used and what it hopes to achieve?
The internet is a powerful and enabling tool, but it comes with the hazard of diffusing opinion that ought to be harnessed for the public good. On the other hand, recent events surrounding the debate in the US over health care reforms should warn of the power of the older, tried and true methods of coalescing vocal opinion. Any unexplored weakness in expressions of reforms by governments are likely to be sought out and magnified into rowdy divisions that have been fuelled by emotional reactions to pressure on trigger points. Sloppy recommendations bearing on end-of-life decisions can easily be tipped to create furore, confected or real. Emotional reactions then become tools for thosewanting to consolidate opinion along ideological divides.
The public good requires structures in the policy and administration of health care that allow informed comment and action by consumers. Witness
the arguments in Australia that have arisen for return to local boards of government for local hospitals. Further, structures should prevent industrial and professional cartels from feathering their own nests.
The ideal “public” option may be, in lay eyes, to be much more like some agencies in the private, not-for-profit sector. That is, highly skilled and selfless professionals delivering a high standard of compassionate care without the explicit promise of high personal financial rewards. The real “public” option is, however, perceived to be bloated by managerialism that soaks up new dollars before there is any appreciable
improvement in actual care for patients.
The picture is even further obscured and obfuscated by the activities of numerous health policy units and gurus across the nation, each of them competing with the others for kudos and grant money, without any obvious coordination for the public good.
The public face of the public option needs a few people who can become as recognisable and camera-ready as the best of the front-line PR people who educate the public about the tobacco, beer, junk food, mining and pharmaceutical industries.
If consumer experiences and opinions are worth anything at all in the context of the development of health care policy, then they ought to be gathered and redacted by as few central agencies as possible. The Letters columns of newspapers are as likely to be biased toward ‘the industries’ as not. Comment boxes at the ends of on-line article are, almost always, black holes.
There is a looming tragedy in the health care debate. It will be a reflection of the worst that xenophobes have thrown at the Obama administration. When it becomes more apparent that the Rudd government cannot deliver more for the same, or less, cost, questions will arise about the “worthiness” of those who cannot afford to pay for expensive treatments. It will be seen as entirely rational, in policy terms, and palatable, for ordinary voters, to reject fringe dwellers as ‘unworthy’ to receive the benefit of hard-earned dollars from tax-payers.”
• Trevor Kerr is a retired medical microbiologist, now working part-time for a community health service