As the health reform debate gears up from lunchtime today, that gurgling sound in the background is the death rattle of federalism as a political philosophy of any force in Australia. A short memorial service, led by Greg Craven, will be held at a time and venue to be advised.
You still get the infrequent commentator or politician who wants to argue for competitive federalism. Jonathan Pincus continues to push that barrow. Lawrence Springborg declared in November that the LNP believed in competitive and co-operative federalism (the constitutional equivalent of country and western). But the Prime Minister’s proposal to centralise hospital funding will, in sheer dollar terms, leave a gaping hole in the venerable ideal of a federalist system.
The list of suspects for who killed federalism is long and, like Murder on the Orient Express, they all did it. John Howard and the High Court he appointed head the list, having initiated and facilitated, respectively, the greatest centralisation of power ever seen in Australia (although as Wayne Errington points out in his excellent short essay for Peter Van Onselen’s Liberals & Power, Howard’s centralism was pragmatic and driven by an activist agenda, not as an end in itself). Labor governments, particularly in NSW, have seriously damaged the state government brand through poor management and under-investment. Labor and the Coalition party machines are also responsible, serving up poor-quality MPs at state level and, in the Liberals’ case, being unable to maintain internal unity.
And ultimately the commitment of both sides of politics to economic reform and reducing costs for business has inevitably led to the push to harmonise regulatory and taxation frameworks across the country.
Those few remaining federalists holed up in backwoods shacks with rifles and canned food can’t look to Tony Abbott, either. In his book Battlelines, the only area where Abbott seriously departs from John Howard is on federalism — and he thinks Howard didn’t go far enough. Then again, Abbott has the commendable trait of changing his mind regularly on fundamental issues, so he may yet turn out to be a determined states’ rightist.
Don’t get your hopes up for “health reform” — and the term should be used very loosely — yielding major health benefits or even the sort of dynamic economic benefits that, as Andrew Podger has noted, should flow from eliminating or reducing multiple government funders of health programs. No one has clean hands in this process. If you were sickened by the sight of big polluters coming in for their chop on the CPRS, wait til you see state governments lining up to insist they need more funding. Victoria has already done it, insisting there be no actual reform, just more money for it. And the health sector, led by the doctor’s union, will mobilise to grab a share of any extra funding that may be going.
Nor is Kevin Rudd coming to this process with honest intentions, given the health debate is the outcome of his political strategy to damage the Howard Government while in Opposition and he appears determined to manufacturer a showdown with unpopular state governments on an issue where the public is convinced they’ve been poorly served locally. To this end, the more the states scream blue murder, the better for Rudd.
And Tony Abbott appears to have changed his mind on health centralisation and, having championed it when Health Minister, now seems set to oppose the Government’s proposals, regardless of what they actually are — apparently there has been an entire turnover of public servants in the past two years, and all the ones who effectively ran Abbott’s programs when he was Minister for Health have been supplanted by bungling Labor incompetents. This means any good policy that might accidentally emerge from the scrum of rentseekers, vested interests and politicians on the make will be opposed in the Senate, bringing that lunatic Steve Fielding into play.
You’ve seen all the tricks and scams before during the ETS debate — the threats and pleas, the dodgy “independent modelling”, the self-interest disguised as the public interest, all run through a compliant media. Only this time all the participants pretend that they’re deeply concerned about Australians’ health and wellbeing.
Hey Bernard, did you write this before the health policy was revealed?
It read to me, having listened very carefully, that the funding and management models for this health reform should prevent a number of the concerns you raise.
By paying 60% of each procedure, it stops the misallocation of funds. And by funding on the basis of population and regional need, not a trickle down directive from on high (at state level) that assumes one size fits all, it will also call a halt to unnecessary spending in one place while others miss out.
Overall, I found the policy initiatives and rationale seemed quite sensible and was articulated well.
Whack! That’s the sound of the PM hitting the Health Reform ball out of the park!
I think the model for Health into the future addresses the issue of the agendas of the self-interested by stating that there will be transparent scrutiny of every ‘interest group’ in the health spectrum. We, also, as the consumers on the ground, will be able to feed into the system our assessment of it all whenever we use it and feel that need to make some comment. It appeared from the PM’s speech that there will be a Health Ombudsman position created to handle complaints and that will make sure that there is no empire building, or distortions being fed in by powerful self-interest gruops such as Big Pharma, Doctors, the Health bureaurocrats. If we, the people, identify it, we can let someone know now. This also may come about by complaining to our local MP, or via the Internet. I’m sure the gov. will facilitate all possibilities with the aim of transparency and effectiveness.
That is, if the Party of ‘No Way, Jose’ passes the legislation.
Didn’t Abbott want to change funding to Hospitals from the States (via GST or whatever) to the Federal govt when he was Minister for Health! Watch him backpeddle now. Mr, ‘I won’t support anything you put up’ attitude? Where are all those who criticized Rudd when he was in Opposition and disagreed with Howard – politicians should work together blah blah? Gone to water now!
What the NSW govt has been doing re Health is nothing short of a disgrace – I’ll be glad to hear more about this and investigate it some more, but in essence, I think it’s a good idea. Example of NSW idiotic shambles – announced that Registered nurses in hospitals would be decreased, and replaced with those of lesser education? In a world of continuing updates in health practices and technology, you’d think we’d require nurses at least to the Registered stage. Another idiotic fact, is those nurses who graduated at a NSW University(via Tasmanian course on NSW campus) will not be able to get jobs? Why allow them to study etc if no job opportunities – how can they gain experience without a job? On top of all this, too many nurses are working long hours with short hours in between shifts, sometimes no break at all! Tell me why NSW would defend these disgraceful practices? No money? Bankrupt perhaps?
The Minister didn’t even know!
I’m certainly not criticising those who work in hospitals etc. My mate has had some serious surgery as a pensioner, and the treatment was awesome(sorry about the food??). I was most impressed, particularly with his triple heart bypass and total knee replacement ops- lovely people too!
No Bernard, don’t agree. I listened today and thought it was all pretty cleverly constructed. I like the idea of local flexibility and the transparency of service delivery. If this same transparency were to spread to private practices we would be half way home. Further, if this all works I would think it would encourage cooperative federalism rather than discourage it.
DAVIDK – I think health is too important for anyone to play with it. Peoples’ lives depend on it, and every State seemse to have its problems – maybe not as bad as NSW, but?
Mind you, in fairness, they’ve been done out of lots of money via the unfairness of GST division, perhaps up to $1 billion+ per yr since 2000 – can do a lot with $10 billion!
Perhaps this would take care of that anomoly.
I think people just want an efficient, caring system that works well when their loved ones are ill – shouldn’t be too much to ask should it? I also think that needing a knee replacement or hysterectomy shouldn’t be classified as “elective surgery”? Having a nose job is(as long as it’s not required due to car accident, assault etc?)or boobs made bigger or smaller(as long as….cancer or something?) This was done by some beaurecrat who thought it was a good way of making the numbers more palatable – those in agony weren’t impressed. My mate had to wait 6 wks for an endoscopy when he could’ve had bowel cancer(didn’t pheew!) but that’s just ridiculous – some wait 14 wks apparently?