How the health overhaul became a big stink over tax
IT’S not just that Health Minister, Nicola Roxon has acknowledged that taxes may need to increase to fund Labor’s health policy in the longer-run. Or, that Treasurer Wayne Swan has admitted a full federal take-over of the nation’s 764 public hospitals could yet be pursued.
Such frankness should be welcomed in our political leaders. It’s just that in both cases, the comments underscore the fact that in complex reforms, there is many a slip `twixt policy cup and delivery lip.
Put another way, there is a huge distance and many hurdles between Kevin Rudd’s radical health reform promise, and the tangle of changes needed to make things better for patients. Those ``slips’’ are already apparent.
Like the fact that the states will have to agree to hand back somewhere in the ball-park of $90 billion from their sacred GST river of gold. WA and Victoria have flagged major resistance and both SA and Tasmania could yet baulk if the voters opt for change in state polls.
Then there’s the Australian Senate. The closeted red chamber pilloried by Paul Keating as ``unrepresentative swill’’ is already twitching in anticipation of another chance to frustrate the will of the people’s house. The Opposition wants nothing of K Rudd’s 60 per cent federal take-over and will use its senators to that end. The cross benches too are always eager to block the elected government.
That paragon of rigour and consistency, Steve Fielding, elected on 1.88 per cent of the primary vote in 2004 (what did that wafer-thin mandate have to do with the current government’s program anyway?) has indicated he is unfavourably inclined. True to form, he issued a rejection before reading the policy detail - unless he is a speed reader which, by his own admission, he is not.
Ironically, one of Fielding’s more famous malapropisms, that he was ``torn between two places and a hard rock,’’ actually now applies rather well to Kevin Rudd’s current dilemma.
The health reform plan, and therefore Mr Rudd’s own plight, are floating between a set of probably unbridgeable positions. Some of that is the Government’s fault and some is not. The fact that the massive plan has been dropped like a depth charge into the febrile atmosphere of a federal election year is significant because it has not only changed the sense of what is possible, it has also raised suspicions that the announcement is not so much an attempt at a health policy as it is an attempt at a re-election strategy. Hence there is a tension between the merits of the plan versus the motives behind it.
This kind of cynicism, which is running hot in the media at present, is regrettable because it has obscured a proper assessment of a policy which clearly has merit. Yet the Government can hardly complain because not only has it dictated the timing of the announcement but, on such matters, it has form. After all, the policy is late by about 8 months against the promised deadline for its release of mid-2009. Several state elections are further complications - two of them underway right now in SA and Tasmania, and another due in Victoria at the end of the year.
These factors were all known knowns (to borrow from Rumsfeld) and have made sober consideration and acceptance of the policy less, not more likely. Going by the signals coming from the states, there seems no chance of all of them coming on board by the deadline of April 11, the date of the next Council of Australian Governments meeting.
Victoria’s Labor Government believes it already runs Australia’s best system which is decentralised with local boards, and already uses activity based funding. So it is struggling to see where the new deal makes things better for Victorians. The state’s Health Minister, Daniel Andrews says there is no new money for the state for four years.
WA’s Liberal government remains hostile and is unlikely to warm to anything that will make it easier for federal Labor. This may not have been such a problem had the policy been dropped out last year and safely away from the federal poll. As one observer said, Premier Colin Barnett will probably run interference for Mr Abbott just as Labor states did for Kevin Rudd before the 2007 election.
Perhaps most telling though is that on his first full day of selling the plan, Kevin Rudd, the man who won on a platform of cooperative federalism, began lashing the states and warning openly that they would fight hard to protect their patches. His unmistakable message? `I stand for the public interest, they stand for their own interests.’ Hardly conciliatory.
Mr Rudd’s defenders rightly point out that he had always promised a referendum if the states proved uncooperative so he is just doing what he said he’d do. True enough, but taking more than two years to tumble out the policy and less than two days to start wedging the states, smacks of being just a little too inclined to the fight over the result. Besides, if it is good enough for him to take the time to get it right, as he likes to say, it is unreasonable to deny them time to consider the detail and the implications.
Even if the states can be wrangled into some kind of acceptance, the Senate looks set to frustrate enabling legislation slated for this year. All of which adds up to no material progress and the prospect of the partial take-over plan forming the spine of the 2010 re-election campaign. Yet even here there are traps.
Some in Labor are already drawing parallels with the emissions trading scheme debacle likening the sheer complexity and glacial pace of the health reform to the ETS and to known shortcomings in the PM’s communications skills. The early signs suggest these fears may be well placed.
Kevin Rudd clearly wants to go with a back to basics health and education agenda in 2010. He is half-way there. Education has emerged as a genuine strength although that’s more down to the high-achieving Julia Gillard than the PM.
On health, the extra money pumped in has been substantial including billions on new cancer wards and a whopping 50 per cent increase in the Commonwealth’s end of the current 5 year healthcare funding agreement with the states. But the main game of fixing the public hospitals as promised in 2007, remains unfulfilled. Kevin Rudd has left it very late to kick that argument off but its one he must now win.
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