Health - an awful 'debate' and meaningless 'reforms'

Some initiatives such as "hospital in the home" or community based palliative care or more money for prevention, have benefits for the whole society - but at an additional cost.

Society can be better off - but only with more health funding. However, treasury officers say that the way to save money is to close beds. Health workers cannot understand the thinking.

Now let us look at the so called health reforms that are upon us

The dual federal/state provision of hospital funding has been a problem recognised for at least forty years. The money also comes, in lesser amounts, from other sources like the health funds and private pockets. An extra amount might have to come from private pockets.

The current system is characterised by:

• Big deficits in area health services.
• A "blame game" in which each level of government blames the other for deficiencies and shortfalls.
• Cost shifting as each level of government tries to shift costs to the other level. (A Premier once told me that his job was: "To take the socks off the Commonwealth at every opportunity". Nothing about desirable social objectives. All about money.)

So opening new facilities is not going to solve the problems if we do not have enough doctors or nurses or therapists or physicists to service new facilities.

In March 2010, the prime minister, Kevin Rudd, bullied the states into accepting a package which was taken to a subsequent election by Julia Gillard - who won the election. Now Julia Gillard has changed it.

There will be no GST clawback. There will be an eventual 50% funding from the Commonwealth. There is some talk of an extra $16.5 billion - but details are sketchy. She has abandoned a Rudd promise to fund 100% of primary care in hospitals. As there is already a 43% commonwealth contribution, the new offer is not worth much.

The process started by Kevin Rudd would have had to involve reform of primary care to eventually include a greater emphasis on prevention. It would end the blame game, eliminate waste and provide a basis for dealing with rapidly rising health costs.

The health debate in Australia is awful

Real reform would come only if one level of government took over total funding responsibility. Now the promise is of 50% Commonwealth funding.