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Plibersek vs Dutton: the post-debate analysis

Plibersek went first and started out talking hard cash. The figures tumbled out of her mouth like an accountant with Tourette’s. Thousands, millions, billions, multi-billions on a myriad of different programs and policies set up under the Labor government. I struggled keeping track amid the confusion – but it ended with the biggest ever number I’ve heard used in a health debate.   Apparently the federal government was saving $100 billion in private health insurance rebates. That is the GPD of a small African country. It turns out that the savings were over 40 years – at the limits of our lifetimes – but it is a number with a lot of zeros nevertheless for those impressed by such things. She boasted of the government’s achievements in health reform – begun under her new-old boss Kevin Rudd. And then she mentioned a “next phase”. Some may question if we’ve actually quite got through “this phase” yet. But the “next phase” when it comes will focus on primary care and prevention. Her audience was left to fill in the blanks of what that means.

Dutton’s opener was about the importance of Indigenous health – which was good if a little leftfield. But there was a problem. The Liberal’s recently unveiled health policy apparently only mentions Indigenous health once – so after talking about our national shame over mortality rates in Indigenous communities, he had to move on. Moving on meant moving to firmer ground – i.e. super clinics, the looming disaster of e-health and the patient controlled electronic health record (PCEHR), before eventually ending up in a relatively unvisited land of the health system – at least for most viewers at home – the PBAC listing process. Dutton declared the government had bastardised the system, delaying life-saving medications recommend by experts for PBS listing simply in order to save cash.

Plibersek denied  this immediately. Dutton kept going. But he was caught short when the health minister asked him to name names – specifically the name of one drug delayed by the government which has been causing so much heartache. Dutton floundered and started mumbling about not having the drug names with him as though somebody had asked him something ridiculous like doing differential calculus in his head. You could tell it was a political hit by the smile spreading across Plibersek’s face. One announcement Dutton made last week – to some GP joy – was grants for GP practices in rural and remote areas. It was about $50 million to expand teaching infrastructure. He mentioned that today. But added the small print. Practices will have to cough up their own cash too. “They will have skin in the game,” Dutton said. It sounded like a 50-50 split in skin.  Then there was a question that would have raised the blood pressure of many GPs still smarting from the MBS rebate freeze.

Plibersek was asked about rising gap fees faced by patients with life-threatening and chronic diseases. The index freeze itself, the restrictions on the safety net, means testing on private health insurance – these had been the federal government’s idea the journalist said. She added that 30,000 bankruptcies a year linked to health costs.  At least Abbott as health minister had raised Medicare rebates. “Why vote Labor if you have mounting health costs?”  This was Plibersek’s response: “The best chance of a decent health system is under Labor. We introduced Medicare twice because the Liberal government destroyed it the first time. Bulk-billing rates are at historic highs now…[any regular reader of Australian Doctor can fill in this bit themselves].   She added: “When we talk about out-of-pocket expenses I’ve interrogated the data. It is surprising to see that included in a lot of that data are things like band aids, condoms, complementary medicines, vitamins and so on. People make a choice to use those things. I have no difficulty with that. But people can go to a GP and a public hospital for free..”  Dutton: “I don’t think people have gone into bankruptcy buying complementary medicines.”

Dutton was again asked about Medicare Locals and his pledge to review them. Was he prepared to cull a couple of them completely if necessary? Yes, seemed the answer.   “There are some Medicare Locals doing some amazing work around the country. But there are others who have been failing their local communities. That is on the advice of the Medicare Local people themselves. Part of the problem was – not the Medicare Local but that the government did not know what they are doing.. They threw money at Medicare Locals and now tell us what your function will be. So some of them have done well with that money and others have not.”  Plibersek accused Dutton on doing a U-turn on his previous infamous pledge before the AMA faithful to get rid of them all together. Her own reasons why he had been “forced to retreat” were a little odd. She claimed it was because communities around the country were saying that they “value their Medicare Locals, value the after-hours GP services that they are delivering, the mental health services they are delivering, the way they are identifying gaps in health services and filling those gaps”.  Is that true? Where is evidence for that? And on after hours GP services – Medicare Locals are not actually delivering them. They are delivered by GPs. Have been for years apparently so not sure whether the alleged public gratitude is a little misplaced.

What else was there in this one hour show? A vision of the future health system – the reason for tuning in save some hideous political cock-up like Tony Abbott v Nicola Roxon circa 2007?  Not really.

It’s worth pointing out that Dutton will say no to any tax on alcohol to deal with problem drinking. Doesn’t want excessive regulation apparently. And Plibersek mentioned the importance of the primary health care home – i.e. tying patients closer to regular GPs or GP practices.  It was a passing mention. It has not entered the minds of the public yet, but perhaps it is a thought Plibersek sees as central to her “next phase” reform.   There must be more to come. It is another ten days till polling day!