Health policy in the WA state election: it’s unfair!

How to change things? We need as a minimum political leadership in health. We probably need higher taxes to pay for better health care in the public sector - and most of us would willingly pay more for a better health care system. That system needs to be driven by the preferences of the people and the people’s voices then used to drown out those of the AMA.

In WA ideally we need to hand the state health services over to the Commonwealth. It really is silly to have a health care system for a population of less than 2 million. We do not have the political leadership or enough good managers to run state based systems well.

But that is long term. Within the WA state health services one of the biggest mistakes made in recent years has been has been the setting up of "area health services" in geographical regions around the state. To succeed, such a system requires lots of high quality managers. We simply do not have them. What has happened - and it was totally predictable - is that instead of taking power from the centre and distributing it to the periphery (which was the theory) in practice it has led to yet greater power resting in Perth.

What is needed is explicit centralisation of management but married to a very clear system of decentralisation of preferences for health care priorities, in essence local citizens’ juries. There is no reason why management and the question of preferences must take place at the same level. The former can be centralised while the latter should be regionalised.

What of the minor parties’ health policies in this election? As we vote on Saturday, there is an argument that says well, let’s make whoever is the major party in the new parliament more accountable. That is best achieved by trying to ensure a hung parliament, giving more power to the small parties and independents. It is also the case that they are likely to be more answerable to the electorate. Indeed the Greens state in their health policy that “health and funding priorities should be decided by ongoing public participation processes at all levels”.

The politicians from the major parties are out of touch with the wishes of the WA population. The Citizens’ Juries wanted more equity geographically, more for Aboriginal health and more public health and prevention. What the ALP and the Coalition offer are more expensive hospital beds and greater inequities.

In WA we need a state-wide Citizens’ Health Convention, plus local conventions as well, where a random selection of ordinary people, suitably briefed by experts and given time to reflect, can decide the basic principles (such as with respect to equity) on which any future government is to run our health services. It is not hard to achieve. It is truly democratic. It is not too late for the major parties to endorse such a proposition.