Last week Kevin Rudd promised that if state governments didn't "fix" their public hospitals, he would take them over. In response, the Prime Minister said that his plan to "fix" health was better because the Coalition would spend more money than would Labor.
The reality is that any politicians who think they can fix Australia's health system are fooling themselves -- and the electorate. Health will never be "fixed". What we expect from our health system will always be more than it can deliver. As soon as a higher standard of service is achieved, we become accustomed to that standard and we demand yet further improvements.
If the waiting time for a hip replacement in a public hospital is reduced from, say, six months to six weeks, could we then say the system has been fixed? Likewise, if every patient in an emergency ward was treated within 30 minutes rather than being left on a trolley for three hours, would we declare ourselves satisfied?
It's no consolation to someone who has waited years for elective surgery -- but there's a reason they have to wait so long. There are others with more pressing needs.
By world standards, Australia has a good health system. People in need of medical attention usually receive what they require. Inadequate or inappropriate care is the exception rather than the rule. In most cases, a person's income does not determine the quality of treatment they receive. The idea that the nation's health system is on the verge of collapse is simply wrong.
The widespread belief that the health system is about hospitals and nothing but hospitals is convenient. But it is far from reality. Australia's 755 public hospitals account for only one quarter of the country's $90 billion annual spending on health.
Often when politicians talk about "health", they are actually talking only about hospitals. And hospitals are much easier to "fix" than the health system as a whole. Even if the system may never be fixed, at the very least it could be improved by introducing measures that encouraged individuals to take greater responsibility for their own health outcomes.
At the moment, governments continue to insist on health policies that treat all people the same regardless of how differently people care for their own well-being. The attraction of administrative and financial solutions is obvious when it is compared with the difficulty of dealing with philosophical issues such as the extent to which people should be advantaged for maintaining a healthy lifestyle or penalised for doing the reverse.
While it's true that Canberra and the states play the blame game when it comes to health, it's not obvious how a federal takeover of hospitals would help the situation. The states would no longer be able to complain that they don't have enough money, and the Commonwealth couldn't claim that the states were wasting the money they had. And this would be a good thing. But in place of this old dispute, there would arise new turf wars between different federal departments and between the hospitals themselves.
"National priorities" for health sound nice in theory, but before any Labor premiers hand over the running of their public hospitals to Kevin Rudd, they should consider the consequences. At present Victoria's 143 public hospitals compete only against each other for State Government funding. But if funding is controlled by Canberra, the state's public hospitals would not only have to compete against Victorian hospitals, but also against the other 612 public hospitals throughout the rest of Australia.
The national priorities of the Federal Government would replace the regional priorities of the State Government. Any federal government, regardless of whether it is Liberal or Labor, could quite reasonably conclude that the requirements of Victoria's public hospitals were not as great as those of, say, the Northern Territory.
While to some extent the differing needs of different communities around the country are already taken account of through existing federal and state funding formulas, the flow of financial resources from Victoria and NSW to the other states will be exacerbated if hospitals are operated nationally.
There's every chance that the Rudd plan could result in a cut to funding for Victorian public hospitals, or at the very least funding increases at a lesser rate than at present. This is one of the reasons why when some months ago Tony Abbott suggested something similar to Labor's proposal, the Prime Minister quickly shelved the idea.
How John Brumby explains the benefits of Rudd's plan remains to be seen. Victorians might be less keen on the ALP's promise to "fix" hospitals once they know the real price of the solution.
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