Policy not politics will fix our hospitals

The health debate in this year's federal election will be conducted on two fronts.

One is the precinct of the 'policy wonks', the other the preoccupation of aspiring parliamentarians. The former muses about structural reforms to the health system, the latter agonises over measures to reduce health costs and broaden service options. The savvy political performers will blend the two and appeal to a vision that alleviates hip-pocket pressures.

Since the last federal poll health has been very much on the back burner at the national level. It has not drawn the same degree of public debate that was the case prior to the 2004 election.

Both John Howard and Kevin Rudd have deliberately adopted more reflective stances to the recent emergency department horrors besetting major metropolitan hospitals.

This is more a product of the sensitivity of the political ownership of the problem than it is an indication of a 'new politics' in the health debate. Where hospital crises can be contained to administrative bungles rather than a lack of political oversight or investment, the more political leaders can adopt a statesmen-like persona and keep at bay the rising pent up public frustration.

But despite this political management, the health debate is squarely about the system's capacity to meet demand. The ageing of the population has exacerbated the inadequate size and range of the health workforce.

Into this environment come the major political parties seeking to lure votes without sending alarmist signals on how they will handle this complex issue.

Both parties recognise the dysfunction in governance between the Commonwealth and the states. Numerous reports indicate that savings of around $2 billion can be achieved from the eradication of bureaucratic duplication. Only Labor has suggested a potential radical change to the current governance arrangements. Labor will give the Commonwealth full responsibility for public hospitals in three years if the state government performances fail to adequately improve the situation. The Coalition has embarked on a different direct management model with the Mersey hospital in Tasmania. It is billed as a test case and may be the fore runner for other Commonwealth run public hospitals.

Neither party can enter a federal election campaign without offering a way through the public hospital blockade. The usual antidote is money.

One glaring problem for public hospitals is the preponderance of elderly patients needing aftercare. Labor has already announced that it will open 2000 aged care beds to ease the burden on public hospitals. The Coalition has yet to counter, but has the potential to expand the current aged care homes program. However, both sides will miss the point if they restrict changes to the aged care homes scheme.

The underlying inequities in health care particularly for the mentally ill and those with chronic conditions will struggle to gain 'oxygen'. The Realpolitik of health care will dominate. There are more well than sick voters! Both sides of the political spectrum will seek to appeal to the majority of voters who fortunately don't struggle to get to work from ill health or face a debilitating disease that changes life's prospects forever.

Although the pragmatic political aspirant will probably win out, it is incumbent on the rest of us to raise a voice for those who no longer can or are too tired from trying.

Eureka Street

4 Oct 2007