No cure in sight for a shameful policy vacuum

WHAT happened to the all-important health policy debate during this election campaign?

Why isn't it receiving more attention from our political leaders?

Labor's website exclaims that the reforms from its first term are the most significant since the introduction of Medicare, which is more an indictment on how little has been done since that time than a positive comment on the changes. And don't expect Julia Gillard to nominate health as her first order of business when doing the media rounds.

The Coalition has tipped a bucket of money into mental health, and is committed to funding twice as many new hospital beds as Labor. But Tony Abbott (as a former health minister) knows it is difficult for the Coalition to campaign on prioritising health given its historical neglect of the policy area. In the 1990 election the Coalition forgot to announce a health policy at all during the campaign. That failure signed the political death warrant of then opposition health spokesman and leadership aspirant, Peter Shack.

The National Press Club debate between Health Minister Nicola Roxon and the Coalition's opposition health spokesman Peter Dutton vanished without a trace. That was partly because it was held on the day Abbott and Gillard conducted their town hall question-and-answer sessions in western Sydney. Abbott's gimmick of jumping down from the stage overshadowed the substance of what was discussed anyway.

But there are other reasons health policy hasn't been put front and centre during this campaign, an unhealthy outcome to be sure.

The Labor Party is embarrassed about its watered down reforms, which are so much less impressive than those promised three years ago. And the Coalition sees little advantage in beating the drum about its alternative health policy given opinion polls consistently favour Labor as the better manager of health care.

Added to each of these reasons is the awkward situation that health reform was Kevin Rudd's pet topic, not Gillard's, and the new Prime Minister was the opposition health spokeswoman in 2004 when the disastrous Medicare Gold policy was unveiled. It's a Fawlty Towers-style case of "don't mention the war".

Meanwhile Dutton needs to focus more on holding his notionally Labor seat of Dickson in Queensland.

Abbott didn't exactly cover himself in glory when he was health minister during the Howard years. Labor's attacks that he ripped a billion dollars out of the health system are misleading, but he did break his 2004 "rolled gold" election promise on the Medicare safety net, and funding for health care under Abbott was substantially less than it has already been during Roxon's

stewardship.

So we are left with little scrutiny and discussion about what is probably the most important and vexing policy area confronting modern Australia. Whether it's the impact of an ageing population on our health system, the burden that rising rates of diabetes and obesity place on it, or the need for preventive health measures that dangerously feed into principles of nanny statism, how governments set the policy levers on health care should be the No 1 vote-changing issue at this election.

Unfortunately neither major party has a sustainable plan, which is the universal diagnosis you will receive from health care professionals when quizzing them on the party platforms. No wonder they don't want to make it a central campaign issue.

For decades economic modelling has revealed that the fiscal burden of providing quality

health care will put a massive strain on future budgets. You cannot overstate the significance of this fact. That makes it vital the

tier of government responsible for health has the capacity to inject the necessary funds into the

system. But responsibility for health policy is split between the commonwealth and the states, so we don't even have the pre-conditions in place to begin work on setting the health system up for the strain it will be under in the years ahead.

Even after Labor's reforms, that remains the case. Despite a promise to take over public hospitals, all the government has delivered in terms of ending the blame game is a switch of funding responsibility from 40 per cent federal, 60 per cent state to 60 per cent federal, 40 per cent state. It slightly improves the fiscal sustainability of health funding, but that's all.

As health minister, Abbott floated the idea of a federal takeover, and according to his book Battlelines, the federation is broken and in need of fixing. Yet now he is a political leader it is more important to him to win the election than do it with a mandate to fix health.

Labor's watered-down reforms and Abbott's capitulation on macro health reform are the ultimate examples of leadership cowardice in this election campaign.

So long as funding of health care remains split between the commonwealth and the states, reforming the sector, improving efficiencies and guaranteeing funding won't reliably happen.

Shortly after Rudd's reforms were agreed to, I interviewed the health minister on Sky News's Saturday Agenda. I asked her what she thought about a policy in NSW that allows for single-person-operated ambulances. A left-field question to be sure, but I wanted to see if she was comfortable with a policy that allowed a driver to pull up at the scene of an accident, try to get someone's heart started, load them into the ambulance solo, and hopefully -- if they haven't locked the keys in the vehicle -- start it up and drive them to the emergency ward.

The situation is so farcical it beggars belief, but that's just a micro example of what's wrong with the health system.

What was the minister's answer? Ambulances are a state responsibility, full stop, next question please. What does the opposition think? It's a disgrace. Solution? None, of course, it's a state issue: sorry, that damn NSW Labor government again.

Yes, ambulances are a state responsibility, thank you for the lesson in governance, but that's one of the problems that needs fixing. Two tiers of government running health means no one takes responsibility for the problems in

the sector. The blame game continues unabated.

If either major party had an ounce of policy credibility in this important policy area they would seek a mandate for a full federal takeover of health care. Not just regarding hospitals, which was Rudd's original commitment; a lock-stock takeover of the sector.

As a federalist generally in favour of the maintenance of states' rights, it pains me to advocate a federal takeover of such breadth. But the harsh reality is state governments don't have the guaranteed funding streams necessary to support future health care needs. Ever since the commonwealth took over income-taxing powers in World War II, states have struggled to cobble together funding for adequate service delivery. State taxes are largely regressive (poker machines, stamp duty, and so on) and damage economic growth.

A federal takeover is not without its complications, starting with ensuring the remoteness of Canberra doesn't put the health system out of touch with local needs. But one tier of government must take responsibility for ensuring the sustainability of the system, and that can't happen while health management remains split.