In part 15 of Croakey’s election series, Robert Wells, director of the Menzies Centre for Health Policy at the ANU, is reflecting what appears to be a widespread sentiment. That is, in this election, we are largely facing “least worst” choices when it comes to health policy.
It almost beggars belief when you think we’ve had almost three years of endless reports and consultations. It’s not as if our political leaders haven’t been told, ad nauseum, about what is needed to create a fairer and more sustainable health care system.
Robert Wells writes:
Comparing the two major parties’ health policies is a bit like comparing two of the most infamous motor cars ever produced: a Leyland P76 (Labor) with an east German Trebi (Coalition).
For those of more tender years, the P76 was big and clunky, poorly assembled and sent the manufacturer broke. The Trebi was a cheap peoples’ car that was notoriously unreliable, underpowered and dangerous to its occupants.
The problem Labor has is that it is largely running out the Rudd model: big and flashy, expensive to run and full of rattles with fittings that are likely to fall off. The key design fault in the Labor plan is the generous and effectively untied commitment to the hospital sector through to 2020. There is the added burden of local hospital networks, confused accountability between these networks, the states and the Commonwealth and a parallel largely undefined primary health care network (Medicare Locals).
Labor has some real gems of reform, particularly the move to more eHealth (eg rebates for electronic transactions). More flexible funding approaches, as proposed for the diabetes management measure and support for practices nurses, could pave the way for further initiatives to support care for people with chronic conditions rather than a slavish adherence to fee for service.
Disappointingly, Labor has fallen short on further support for mental health, promising some modest expansions of existing programs and to make mental health a priority for a second term.
The Coalition on the other hand has gone for a minimalist approach with very little recognition of the changes in health need and delivery that are required for the 21st century.
Like Labor, they have a heavy emphasis on hospitals, much less accountability and a proliferation of local hospital boards to add to already confused accountability. The centrepiece of their primary care strategy is an increase in Medicare rebates for longer consultations, which will increase doctors’ income without reducing patient costs.
The Coalition’s mental health commitments have been welcomed by the sector as a good start.
Neither side has a policy that will tackle the increasing burden of out of pocket costs for consumers. This is a growing problem and the Australian Bureau of statistics estimates that in the past year around 1 million Australian over 15 failed to see a GP because they could not afford it. The Coalition could exacerbate this problem by looking to achieve a billion dollars in savings on the Pharmaceutical Benefits Scheme, which can be achieved by either increasing copayments, or more likely, restricting the list of subsidised medications.
Neither side has a credible solution to the ‘blame game’ (ie the constant bickering between Commonwealth and states over who pays for what). In fact both have solutions that will magnify the ‘blame game’ with hundreds of new local networks and boards to add to the accountability melee.
Neither side has an effective strategy to reduce Australia’s over-reliance on expensive and risky hospital care as the alternative to more effective arrangements for primary and community care.
To see the previous posts in the Croakey election series: