The Coalition’s Policy to Support Australia’s Health System is a cautious document, despite shadow health minister Peter Dutton’s promise of a “cracker of a health policy”.
Tony Abbott set the scene at the policy launch by announcing that the Liberal Party would no longer accept tobacco company donations - despite his scornful rejection of Labor’s criticisms. The Coalition’s health policy is marked by the same small-target strategy: ducking for cover in the face of attack.
Health policy has been a minefield for the Coalition in past elections, and this is policy definitely has a strong “play it safe” approach.
Threats to abolish Medicare Locals have turned into a “review” of their structure to ensure the money is being used to effectively support frontline services.
This reflects a similar decline in hostility from the Australian Medical Association toward these new primary care organisations. But promises for increased investment in the training of general practitioners – the most substantial section of the document – shows no thought on how the new structures can be used to improve services.
Similarly, Labor’s cuts to the subsidy of private health insurance will be reviewed when “fiscal circumstances allow”. Media speculation had suggested some more radical reforms.
Some private insurers have been pressing for access to GP services, which is currently illegal. Any such changes have now been ruled out, with a vague assurance from Shadow Minister for Health Peter Dutton that:
if private health insurers are willing to contribute to keeping people well, we should be willing to have that discussion.
The promises are modest – costed at $340 million over the forward estimates (the three years beyond the current budgeted year).
Unlike the previous election, there are no measures for mental or Indigenous health – despite the Coalition’s widespread criticism of the implementation of Labor policies.
Nor does prevention get a mention, other than attacks on Labor’s new “bureaucracies”, which doesn’t name but hints at the Australian Preventive Health Agency.
Two of the major challenges facing Australian health care are the (linked) growth in chronic illness and the inadequacies of our fragmented health system. Both issues are recognised in the Coalition policy.
But prevention is even ignored in the long discussion about the massive burden of diabetes. Instead, we are offered a National Diabetes Strategy, where the illness is treated as mainly a problem of general practice. And there’s no new money on offer.
The Coalition’s long-standing demand for community control of hospitals has turned into a vague promise to consult with the states and territories about increasing community involvement “where necessary”, in the existing local hospital districts.
There’s no word on the government’s freeze on increases to the Medical Benefits Schedule, which sets payment levels under Medicare.
Thrust and parry
The document is full of curious asides; it points out the failings of government policies without spelling out alternatives.
Some are fairly obvious targets. Labor’s former health minister, Nicola Roxon, is quoted at length attacking Kevin Rudd’s “cynicism” and “ludicrous way” of governing.
We are reminded of the over-promising and under-delivery of the Rudd years: the slow roll-out of GP superclinics, the failure to meet elective surgery waiting time targets, and the continuing “blame game” between Canberra and the states over health funding.
The policy has little to say on how any of this will be improved, other than by apparently continuing Labor’s changes in the formula for hospital funding.
There’s a swinging attack on Labor’s closure of the Medicare Chronic Disease Dental Scheme. But while a Coalition government will support the new arrangements, it only promises to renegotiate them when the current agreement with the states and territories expires.
If elected, Tony Abbott will be the first prime minister to have held the health portfolio. And this policy shows some signs of Abbott’s own experiences.
The ghost of Abbott past
Taxpayer subsidies of pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS) have been a major driver of health expenditures. Recent debates have focused on drug pricing and the costs of distribution through community pharmacies.
The Coalition’s policy is silent on both issues.
Instead, the document focuses on the process of adding drugs to the PBS. Under current arrangements, governments cannot add listings to the PBS without a positive recommendation from the independent Pharmaceutical Benefits Advisory Committee (PBAC).
The Coalition promises to:
restore the independence of the Pharmaceutical Benefits Advisory Committee (PBAC) and restore integrity to the PBS listing process.
The target here is the Julia Gillard government’s 2011 budgetary measure, which delayed PBS listing of drugs approved by PBAC. But, significantly, there’s nothing in the Coalition policy that would stop this happening as large ticket items would still need Cabinet approval.
If the “integrity” of PBAC is read as respect for its processes, the only threats in recent years came from John Howard’s government.
In 2001, the Howard government by-passed PBAC to subsidise the breast cancer drug Herceptin. In 2006, over health minister Abbott’s protests, Gardisil’s HPV vaccine was fast tracked onto the National Vaccine Register after very public pressure on PBAC from John Howard.
A promise to extend colorectal cancer screening is another piece of unfinished business from Abbott’s period as health minister. A national screening program was added to Coalition policy during the 2004 election campaign.
Blocked by caretaker rules from the technical advice of the health department, the scheme was poorly costed and the screening program was a shadow of what was promised. Abbott’s new policy would bring forward full implementation by 14 years.
The strongest positive directions offered by the Coalition policy document are in strengthening workforce development, in primary care, hospitals and rural and remote settings. They also continue a strong record in fostering medical research.
The next government will face hard choices about health costs, and how to improve quality and access to services. These decisions become even harder if the electorate is constantly reassured that nothing difficult or unpopular is threatened.
Parties were once prepared to take sweeping reforms to the electorate. Neither Gough Whitlam’s Medibank nor Bob Hawke’s Medicare were instant vote winners from opposition, and both fought off sustained scare campaigns from well-funded opponents.
Both major parties now prefer to slip silently into office. This cowardice has haunted the Rudd and Gillard governments. Almost every reform that offended a major interest group could be accused of breaking faith with the electorate. It may come back to bite an Abbott government.
Jim Gillespie’s latest book Making Medicare: The Politics of Universal Health Care in Australia, co-authored with Anne-Marie Boxall, will be published next month by UNSW Press.