But why does he leave\u00a0private health insurers untouched?<\/p>\n
http:\/\/www.afr.com\/p\/business\/healthcare2-0\/the_audit_missed_healthcare_costs_pDVkJjKdrNlkAWzF1vuFGP<\/p>\n
PUBLISHED: 07 MAY 2014 02:38:00<\/span>\u00a0| UPDATED: 07 MAY 2014 05:38:26<\/span><\/span><\/div>\n There\u2019s a well-worn joke about a lost traveller standing at a crossroads and asking a grizzled old Irishman for directions. \u201cTo be sure,\u201d the Irishman replies. \u201cI wouldn\u2019t start from here.\u201d<\/p>\n Prime Minister Tony Abbott, Treasurer Joe Hockey and Finance Minister Mathias Cormann established the National Commission of Audit to give directions on more sensible, structured and sustainable Commonwealth and federal-funded programs and services. But if the commission\u2019s report is the starting point to a better healthcare future, like the Irishman I wouldn\u2019t start from here either.<\/p>\n Overall, an unavoidable impression is that the commission, headed by then-Business Council of Australia chairman Tony Shepherd, didn\u2019t fully grasp Australia\u2019s complex, often economically irrational, and, above all, highly political healthcare infrastructure. Rather than do much original policy thinking, it sought largely to put its own stamp on policy debates already under way, including Medicare co-payments; widening the roles of private health insurance and health professionals other than doctors in primary care; and improving federal-state and public-private co-ordination of effort.<\/p>\n The commission\u2019s narrative attempts to connect the dots between various elements of the Australian healthcare picture \u2013 public and private, federal and state, and acute, primary and preventive care. In doing so, however, it misses the reality that\u00a0the Australian healthcare system is not a system at all. Instead, there\u2019s a tangle of loose and fractious associations of providers, funders and consumers, all competing aggressively for resources and\u00a0dominance, all believing they know best and those wearing white clinical coats,\u00a0typified by the Australian Medical Association and Pharmacy Guild of Australia, bully anyone who opposes their\u00a0agendas<\/p>\n <\/p>\n In its naivete, the commission recommended that Health Minister Peter Dutton should \u201cidentify a framework that brings together all aspects of the health system \u2013 public and private, hospital and community-based \u2013 to support the organisation and delivery of healthcare in a way that tightly focuses on individuals\u201d. Sounds easy, but the problem is Dutton, as minister, is not the supreme controller of an ordered system but herder-in-chief of a multitude of feral, rent-seeking cats, including the states and territories and their ravenous public hospitals. Dutton may have the Commonwealth\u2019s immense political and funding leverage, but like King Canute, he cannot command the tempest of interests.<\/p>\n In 2008-10, former prime minister Kevin Rudd sought to do exactly what the Commission of Audit recommended, by way of his National Health and Hospitals Reform Commission. Rudd\u2019s raising health reform expectations so high, coupled with his subsequent failure to deliver, is a major reason why he is a former prime minister. Abbott and Dutton are very mindful of his hubristic lesson.<\/p>\n Indeed, a political fact of life is that there is a broad national consensus that Medicare, as a universal public health insurance scheme, is reasonably fair and effective. As the overheated debate about a modest $6 co-payment on bulk-billed GP services shows, the slightest proposed adjustments to Medicare\u2019s fabric bring outraged howls not only from healthcare ayatollahs, but from voters fearing change to a beloved institution. Even incremental Medicare reform requires considerable political courage.<\/p>\n Dutton, Abbott and Hockey bravely have flagged Medicare and wider health structural reform as a high priority for their government. But such structural reform must be measured and gradual, delicately balancing entrenched Australian notions of a fair go with the philosophical and economic goal of encouraging individuals to take greater personal responsibility for their own healthcare consumption and choices. As the Abbott government now knows, it is tough enough selling economically self-evident concepts, like modestly increasing pay-as-you-go in Medicare and the Pharmaceutical Benefits Scheme, in the teeth of ferocious opposition.<\/p>\n <\/p>\n This is why the commission\u2019s showstopper recommendation, that higher income earners be compelled to take out private health insurance in place of Medicare, will gather dust. Most Australians see private health insurance as complementing Medicare, not replacing it. Labor and the Greens haven\u2019t hesitated to demonise the commission as Americanising Australian healthcare, and no sane government will go there.<\/p>\n There are, however, some gems in the report. Besides supporting Medicare co-payments (although proposing a ridiculously high $15 figure and inadequate protections for the less well-off), the commission\u2019s recommendations on partially risk-rated health insurance for unhealthy voluntary behaviours such as smoking; taming the health bureaucracy beast; revamping the Pharmaceutical Benefits Scheme; and breaking the Pharmacy Guild\u2019s ownership and location cartels, are timely and welcome. But on health policy generally, the report falls short. Nevertheless, and as did John Howard and Peter Costello in 1996, on budget night Abbott, Dutton, Hockey and Cormann will declare that what they announce isn\u2019t half as bad as the commission of audit\u2019s more radical recommendations. That\u2019s the basic truth of this exercise: it gives political and policy cover to a new government striving to sell a difficult, inherited fiscal repair task to a bruised, wary and sceptical public.<\/p>\n Terry Barnes runs consultancy Cormorant Policy Advice, and wrote the Australian Centre for Health Research\u2019s proposal to reintroduce co-payments on bulk-billed general practitioner services<\/p>\n Visit\u00a0afr.com\/healthcare2-0<\/a>\u00a0for more health coverage.<\/p>\n<\/div>\n The Australian Financial Review<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":" But why does he leave\u00a0private health insurers untouched? http:\/\/www.afr.com\/p\/business\/healthcare2-0\/the_audit_missed_healthcare_costs_pDVkJjKdrNlkAWzF1vuFGP The audit missed healthcare costs PUBLISHED: 07 MAY 2014 02:38:00\u00a0| UPDATED: 07 MAY 2014 05:38:26 TERRY BARNES There\u2019s a well-worn joke about a lost traveller standing at a crossroads and asking a grizzled old Irishman for directions. \u201cTo be sure,\u201d the Irishman replies. \u201cI wouldn\u2019t start … Continue reading Terry Barnes on Commission of Audit<\/span> HEALTHCARE SHOULD FOCUS ON INDIVIDUALS<\/h2>\n
AMERICANISING OUR HEALTHCARE SYSTEM<\/h2>\n