Taking responsibility

The staged walkout by the state and territory leaders at the recent heads of government meeting was calculated to keep unrest simmering in the health services until the next federal poll. Dissatisfaction with health care changes votes. Blaming a seemingly ‘mean-spirited’ Commonwealth shifts the political risk and  provides cover to reduce health budgets, while directing community ire towards Canberra.

Labor leaders like to champion their commitment to health care. More often than not the voters seem to agree. The Prime Minister knows this and has raised the stakes for Labor. By forcing the states to carry more of the funding for hospital services John Howard is challenging Labor to match their political rhetoric with money. Little wonder the Labor leaders are attempting to turn the tactic on its head. For them this is a massive Commonwealth cut to public hospitals and reveals a hidden Coalition agenda to erode the benefits of Medicare. It started with the Commonwealth’s push to raise fees for drugs and medications, followed quickly by a GP package where more patient charges are envisaged. It is now compounded with a deliberate attempt by the Commonwealth to ‘turn the tap off’ in paying for a free public hospital system. Access to essential care is increasingly determined by ability to pay rather than need.

Political ideologies aside, the funding dispute reveals a deeper divide. The shared government responsibilities for health are not evenly matched. Although the states are correct to cite the almost $1 billion reduction from the Commonwealth, their protest is somewhat limp. They have gained nearly $7 billion from stamp duties last year alone. Their capacity to make up the health shortfall seems obvious. Yet they insist that their economies cannot keep pace with the demand for services, the costs of medical technology and the ageing of the population.

The risk management of the health system is increasingly out of balance. The Commonwealth has responsibility for the viability of Medicare. This includes subsidies for medical services and listed pharmaceuticals. The states and territories are responsible for delivering the part of the insurance benefit that gives free access to public hospitals. Although the promise of insurance exists for all, the capacity of the public hospital system to meet demand and evenly distribute benefits is stretched.

Last year up to 60 per cent of people with a diagnosed mental disorder did not receive an appropriate service. Nearly 2000 public hospital patients should have been admitted to a nursing home. Up to 6000 disabled patients were waiting for appropriate accommodation in the community. Emergency departments remained clogged and ambulances were forced to bypass inner city for outer metropolitan hospitals. People were discharged earlier than ever before, with less home support, while Indigenous people suffered the worst health conditions of all Australians.

In a nation increasingly shaped by commercial mind-sets, these are not impressive performance indicators. Governments at all levels baulk at setting realistic targets to reduce the rates of heart disease, cancer, mental illness, arthritis, diabetes and other chronic conditions. They readily instigate onerous tests for the unemployed and disabled but shrink from any tangible assessment of their own performances.

To reduce the debate to blame and cost-shifting is to belittle the importance of health. An effective Medicare system requires sustainable investment from public and private sources, and a wholehearted commitment to universal access. Political parties must appreciate that Australians regard health
care as too fragile to be toyed with for electoral gain.

Other countries have taken the leap to modernise their universal health insurance systems to improve access to hospital and primary medical care services. Both Canada and the United Kingdom have recommitted to the goals we hold dear in our Medicare system. The Canadians have even claimed that health care is a moral enterprise.

Australia should follow the lead and reclaim health as a social good. This means ensuring that all Australians receive the same level of access to essential care is firstly a community responsibility. This sense of solidarity reflects our regard for each other.

If the Commonwealth, states and territories need to better rationalise sharing the cost burden of health care then so be it. There is nothing wrong with seeking greater efficiency from government spending. But these steps must not be used as a smokescreen for governments to withdraw from their responsibilities. It is counter-productive to shrink the involvement of government when at the same time an ageing population requires innovation and investment to keep pace with the burden of disease too many Australians face on their own.

It is time for government leaders to stage a ‘walk in’ and recommit the country’s resources for the health of everyone.  

Francis Sullivan is the Chief Executive Officer of Catholic Health Australia.

 

 

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