Labor's health and policy reform compromise

With a federal election just over a year away and the government in the political 'death zone,' Labor's health reforms appear increasingly compromised.

Two meltdowns in state health systems emerged last week. Tasmania has hallmarks of being our very own Greece. The minority Labor administration has foregone revenue with extreme Green anti-job policies. No longer able to fund their health system, they have come sniffing to Canberra for a bailout and been rewarded.

Queensland's finances are even more dire according to the Costello Report; at the heart of it Queensland Health, growing at 11% a year. Added to that, Queensland Health is 9% more wasteful than the rest of Australia, including an extraordinary 7000 people in head office alone.

These revelations show that despite all the magnificent rhetoric, real front line health reform simply hasn't eventuated. Regional cancer centres have been dropped into marginal Labor communities. Millions have been ploughed into superclinics; many are taj mahals in country towns built close to functioning general practices. A perfectly functioning GP afterhours arrangement has been completely uprooted, with the replacement call centre simply cost-shifting work into stretched public hospital emergencies.

Australia has three classic tensions in its health system; the state-federal divide, public-private and hospital-community health. Having eight Labor governments in 2008 was an ideal opportunity to broker the first divide but the once-in-a-generation party alignment was passed-up by Kevin Rudd.

Second, Labor genuinely dislikes private health, so managing that piece of the puzzle is also beyond them. Compare that stance with Dutch and German left of centre political parties who countenanced compulsory national private health insurance models.

That leaves this federal government clinging to the last chance saloon of delivering primary health care reform. First states refused to add their community health services to the mix. Then attacks on doctor groups put much of that sector offside. Former Minister Nicola Roxon's failed attack on the ophthalmologists is case in point. That means the once mighty Labor health and hospital reforms are now restricted to a litter of new and enlarged authorities.

Medicare Locals is just the beginning of that trend towards a health uber-bureaucracy. There is the $118million health performance authority, the $92million hospital pricing authority, the $133million Preventive Health Agency, the $125million Health Workforce body, the $26million Aged Care financing authority, $15million for the Aged Care reform council, $12million for the Medicare Locals network, $32million for a mental health commission and the $38million born, dumped and spawned again Administrator and Funding body.

With modern Labor, for every ten bureaucracies they establish or enlarge, an eleventh is thrown in with steak knives. Problem is, nothing is ever free.

In fact, it takes quite an effort to invest a quarter of a billion dollars into non-service providing bureaucracy, but the Gillard administration is determined to show it can be done.

Kevin Rudd never spent a cent of the $120billion national stimulus package on health care. Tanja Plibersek cites the $5billion Health and Hospital fund, but that was born entirely from the Howard Costello surplus. That fund is now effectively committed, with not a single Labor dollar added in the five years since establishment. Now, to increase the odds of a 2012/13 surplus, the Government is on a 'go-slow' with only eight of the 63 projects from 2010 having a signed contract.

Nothing focusses the mind like running out of money. With a predecessor's surplus to spend, the last five years of federal health reform has been a combination of bigger bureaucracies and leaving the real challenges to underfunded but well-meaning Medicare Local staff. It appears virtually every health challenge Kevin Rudd inherited in 2007 will be passed on to Australia's next administration in 2013.