Nothing of substance has occurred in health reform this week. The PM has announced a position he will take in future negotiations with the states. That’s all.
Those negotiations may or may not be productive. A referendum may or may not be held, may or may not pass.
But no health reform was undertaken this week. No sick or debilitated person is better off as a result of Government action this week.
What did surface this week, though, was evidence of a troubling, and I fear chronic, disease in modern democracies – “announceabilititis”.
This is a disease of the mind. It infects the brains of politicians and their advisers. It leads previously intelligent people to mistake announcements – and media coverage in particular – for concrete program reform and outcomes. They come to equate clever government with good government.
Possibly the worst and most widespread outbreak of the disease has been in NSW for the past decade. It now appears we have the disease well and truly established in Canberra. It even infected, it was reported, the national security white paper process.
Confusing effective voter perception management with leadership is a fundamental danger in democracies.
There is the risk that success is defined, not in terms of persuasion and carriage of the majority around hard decisions, but merely as re-election and control of office. It’s hard to find a politician or political staffer who is willing to take the risk (but possible renown?) of a one term reformer. In the back of their mind is, ultimately, length of time in power
How has “announceabilititis” impacted on health reform this week? In this area of reform we have a complex challenge – the Government has, apparently, only just realized this. Much of the complexity is not intellectual, it is political. Real change involves electoral risk – that is how modern politicians and their advisers define ‘complex’.
Announceabilititis has resulted in a major announcement of a mere intention to negotiate a new health funding framework. The condition has been reinforced by multiple sound bites and column coverage in the media, so the sufferers now feel they have achieved something.
There is no doubt that creating a single funding source and accountability (actually creating it, not just announcing it) is needed for health reform. But let’s look at some of the ‘undiscussables’ in this area that announceabilititis helps politicians avoid, some of the political risk areas of real health reform. In no order of priority:
- Inadequate funding of university medical places, and unwillingness to breach medical professional barricades to use nurse practitioners, to boost primary care
- Unwillingness to use private hospitals and private support services to hospitals to cut costs and boost beds
- The challenge in too many hospitals of getting doctors to work with each other, let alone administrators, to ensure a reasonable, shared stewardship of limited resources across the whole patient population
- The need to allow bond payments – adequate payments from the capital gains of baby boomers – across residential aged care to boost investment in facilities, and the opportunity to introduce hospital-to-home transition care for older patients through aged care services, releasing beds held by ‘bed blockers’
- The need for states to get serious about the alcohol fueled pressure on accident and emergency departments through tougher approaches to closing hours, delinquent alcohol outlets and anti-social behavior
- The need to introduce co-payments for visits to hospital, just as we make co-payments for GP visits and for aged care
- The need to get citizens to be taking responsibility for their health, and for their insistence on access to the latest and best technology, by taking out health insurance (and probably before they get cable TV)
Unfortunately, we may have the very people we turned to at the last election to deal with health reform, struck down with a debilitating condition that does not allow them to differentiate when they are achieving change and when they are simply ‘spinning’. For all our sakes, let’s hope they are seeking the treatment they need.
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