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Restoring the public health system

What must be done
By Jenny Haines

It seems likely that Labor will be elected at the next federal election, probably with a Greens balance of power in the Senate, a very desirable outcome.

This result will no doubt send the conservatives in this country into a spin. Mark Latham and the new Labor Government will cop it big time in a very similar way to the way Gough Whitlam and his government were hounded.

But Mark Latham and the new Labor government should not be deterred and those who want progressive change in the health system in this country should be prepared to support, cajole and push to achieve the necessary change.

Ninety per cent of the polled voting public, Labor Liberal or whatever, say in poll after poll that the health system must be fixed. But how?

I am going to concentrate on four major issues:

  • Funding.
  • Medicare.
  • The Pharmeceutical Benefits Scheme.
  • Aged care services.

    Funding the health-care system

    There is no doubt that the way in which the health system is funded has to change.

    Large area health services in NSW now run cash deficits of $10 million to $40 million each year and they have cut their services to the bone in previous years. Surgical waiting lists are blowing out. Emergency departments are on code red 36 per cent of the time. Two years ago it was 17 per cent of the time. Access block in public hospital wards is an everyday event. This can't go on.

    The NSW government, with a lot of justification, blames the federal government. NSW is deprived by the federal distribution formula of our fair share of taxation revenue based on population numbers. Bob Carr talks frequently about the hundreds of millions of dollars of taxpayer's money going to the other states, but unfortunately, even with Labor governments in the other states, agreement can't be reached to change the distribution.

    The federal government blames the states, conveniently forgetting the nearly $3 billion handed by the federal government to the highly inefficient private hospital/private insurance industry. There are reports that access block is now spreading into private hospital wards. Certainly the private industry is very interested in taking patients who pay, to help them make a profit and they aren't interested in those who are chronically ill, critically ill (even if they become critically ill in the private hospital) or they can't pay.


    What is to be done to restore the health system.

  • The Health Reform Alliance has put up a model for an Independent Health Commission that channels health funds directly from federal level to health services. I have some reservations about how accessible, informed and consultative this commission would be, but if such a body can stop the cost shifting and the blame shifting in health services and ensure a more equitable distribution of funds, particularly to areas of need, it is worth a try.

  • Labor must abolish the subsidy to the private hospital/private insurance industry. That $3 billion can be well spent in the public sector on reducing waiting lists, opening beds, funding the filling of vacant positions in all health professions, training and education budgets and all of the day-to-day operational costs that currently run on starvation rations just to maintain bare survival. The private hospitals can go back to being what they are – competitive services. Let their market dictate which of them profits and thrives and which of them die.

  • Labor must proceed with the establishment of GP-type services next to public hospital emergency departments. It can be done, and has been done, as a trial in the Hunter Area Health Service. Let's get on with it, and stop Health Minister Tony Abbott's childish blocking of this much needed initiative.

  • Labor must restore the Commonwealth Dental Scheme. This is a core promise and will be done. The situation in dentistry is beyond scandalous, and must and will be corrected as one of the first acts of a Labor government.

  • Labor must address the nursing shortage. A lot of the problems of the system stem from the fact that there is a desperate shortage of trained nurses. Several federal government inquiries have identified for Tony Abbott and Brendan Nelson (Federal Minister for Education) that there will be a shortage of 30,000 nurses Australia-wide between 2001 and 2006. But both Nelson and Abbott live in la la land! Brendan Nelson has provided universities with funding models that give them no choice but to close nursing schools. Abbott refuses to take specialist nursing advice by refusing to appoint a chief nursing officer at federal level. There is a long-term conservative agenda here to deprofessionalise the nursing workforce and drive down nursing costs by having a less skilled workforce. Labor policy commits an incoming Labor government to the appointment of a chief nursing officer at federal level. A Labor government will create more nurse education places for nurses by funding an additional 3125 new full-time and part-time undergraduate nursing places by 2008. A Labor government will also provide an additional $43.4 million for clinical training for undergraduate nurses so they have a smooth transition from studying at university to working in a modern hospital.


    This election is critical. If Labor does not win, Medicare is finished.

    There is a major difference between Labor and Liberal on Medicare at this election.

    You all know about Medicare Plus, one of the greatest health service cons perpetrated on the Australian people in recent times. You've seen the literature. You've seen the television advertisements that portray Medicare Plus as changes of great benefit to families, couples and singles, with all those couples nodding in the television ads and saying that sounds good, when in fact they are being asked to pay more for their health care.

    John Howard and Tony Abbott must be hoping like hell that no-one reads the fine print or actually sits down and works out mathematically what Medicare Plus means for them and their family.

    For instance — if the Government is going to cover 80 per cent of your costs for medical services outside hospital — ie the ECGs, the x-rays, the blood tests your GP sends you for, above $700, that's great, but most healthy people won't spend more than $700 a year. You have to spend $700 on your health care before you get the benefit of this great step forward by the Howard government.

    Labor is going to this election with a firm policy on Medicare, which is easily accessible on its website:

    The Pharmaceutical Benefits Scheme

    The recent debate has taught us all a lot about the PBS and we keep learning day to day. The most recent response by the American trade representatives that Mark Latham's and the Labor Opposition's changes to the sections of the Free Trade Agreement that refer to the PBS may in fact end up wrecking the agreement is very revealing. Howard has been caught out here, running messages for the American pharmaceutical industry.

    Readers who saw the recent Four Corners program on ABC Television will have seen graphically how the PBS is the system that many Americans want, because their system is so dysfunctional.

    That program showed that an unwell man with heart disease, high blood pressure and high cholesterol could easily spend $1000.00 a month on medications necessary to keep him alive. Drug companies in the US provide drugs free to some people, but only after they go to their GP, and then visit the poor old nurse (mopping up the mess after politicians and bureaucrats again!), drowning in paper work, to put in their applications each month for the continuation of their supply of drugs. What a ridiculous and humiliating process.

    With the signing of the US-Australia Free Trade Agreement, those who want affordable medicines have to fight to keep the PBS, because the American pharmaceutical companies are not going to stop until they get what they want. Note Mark Trevorrow's letter in the Sydney Morning Herald on August 13, 2004. He contracted conjunctivitis on a trip to the United States. To treat his eyes he went to a pharmacy on 90th Street in New York and paid $A96.95 for a small 5ml bottle of eyedrops. As he says, it was "a vision of ugly things to come if we can't save our pharmaceutical benefits scheme."

    Mark Latham was right to stand up to Howard over the issue of patents. But, Labor also agreed recently to the increased cost of prescriptions under the PBS and it was said at the time that this increased cost would be reviewed after the election. Labor has to be kept to that promise!

    Aged care

    The federal Australian Nursing Federation recently conducted a phone-in on aged care services. The results of that phone-in revealed widespread community concern about staffing levels and the nation's aged care services. Staff in the state branch offices of the ANF took 1000 calls in less than five hours from community members and nurses who wanted to voice their concerns. Jill Iliffe, federal secretary of the ANF said that the main concerns were:

  • Inadequate staffing levels — 86.1 per cent.
  • Inadequate standards of care — 62 per cent.
  • Poor quality food — 27.1 per cent.
  • Inadequate domestic services — 18.4 per cent.

    The current federal government has allocated millions to aged care but the industry still has huge problems. Labor policy is clear on care for the aged in our community:

    One of the biggest problems in this industry is the effects of the funding model and deregulation — unqualified, untrained aged-care workers. There must be a restoration of allocated funding for staffing costs. The National Conference of the ALP modified the party's policy to provide for minimum staffing levels in residential aged-care facilities.

    There must also be a return to the recognition of the need for qualified staff and training and education of unqualified staff to avoid errors, casualties and poor care.

    Most importantly the disparity between aged-care nurses and the public-sector nurses wages — with aged-care nurses up to 20 per cent behind public-sector nurses in some states — has to be addressed with some urgency.

    The payment of bonds that require the sale of the family home should be abolished and there should be investment insurance for those who pay any amount upfront at the time of entry to an aged-care facility.


    This election is critical for the health industry. There is a stark difference between Liberal and Labor at this election.

    We all know that Labor governments can have lovely policies and be lousy governments.

    This Labor government is going to be under enormous pressure from the conservative forces in our society, who will get their way if there is no counter-pressure from the progressive forces of our society.

    All Australians should remember that the health industry is about life and death and the quality of life more than any other. A Latham Labor government must not only be elected but it must carry out its policies.

    Based on a talk at Politics in the Pub, held at the Gaelic Club, Sydney on August 14, 2004. Other speakers were Dr Con Costa and Professor John Dwyer.

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    Created on August 27, 2004