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Labor's View on Health08 October 2003
Labor's Health spokeswoman Julia Gillard spoke to the National Press Club today about the challenges facing Australia in reforming its health system.
Here is a transcript of Ms Gillard's remarks:
Last week was a week of birthdays --- Medicare's and mine.
Last Wednesday, Medicare turned 20.
The first set of legislative amendments giving birth to Medicare were given Royal Assent by the Governor General of the day, Sir Ninian Stephen on October 1, 1983.
A few days earlier I celebrated my birthday ---although I have to confess to be significantly older than Medicare.
The Prime Minister surprised me by giving me a Tony Abbott as a present --- but so far I have only discovered wrapping paper and some empty boxing --- I've not found anything of substance inside.
The newspaper articles accompanying the appointment of the new Minister for Health were full of expectation about the political contest to come between the two of us.
That is to be expected.
But behind the political spectacle lies a much more serious and deeper debate.
The future of the health system is not a personal battle between politicians.
For everybody's benefit, it must be a contest or debate of ideas, values and solutions.
I want to focus on that debate today.
Real Reform Or Political Fix
In a year's time, if you can take the Prime Minister's word, we will be facing the next federal election.
We will also be celebrating Medicare's coming of age.
However, the next election will be the most crucial date for the future of Medicare and our health system.
Whenever it is, Australian voters will have a clear choice about the health system they want.
A system with a robust Medicare at its centre, revitalised and reformed by a Crean Labor Government --- a universal health system based on the values of fairness and access.
An ailing system patched up by a political fix designed to get them to the next election. A system that will not get the critical care it needs if a Howard, Costello or Abbott Government is re-elected, because they want a two a two-tiered system based on the ability to pay not need.
On election day it will be a choice between Labor's real reform or Howard and Abbott's political fix.
A Debate About Values
For Tony Abbott health has little philosophic value and is 'a 99 per cent resource allocation exercise'.
However, the debate about health in this country has been and will always be a debate about values. These values determine where the funds are allocated.
Medicare, which sits at the heart of the system --- is a great Australian institution and an expression of basic Australian values --- the most importance of which is that 'we believe in looking after each other'.
Cultural values like the 'fair go' and 'looking after each other' aren't just extras you can tack on our government, our economy or our community.
They influence every aspect of our lives. They're part of our nation's foundation stories. They form a legacy that generation after generation have handed down to us.
For me, the behaviour of our Prisoners of War in Changi exhibits the essence of this legacy and what I believe it means to be Australian.
What was it about being 'Australian' that made them fight, die and endure the privations of imprisonment?
Historian Gavan Daws said this about those who were captured and sent to places like Changi:
"...all the way down to starvation rations, to a hundred pounds of body weight and less, to the extremities of degradation - all the way to death - the prisoners of the Japanese remained inextinguishably American, Australian, British.
The Americans were the great individualists of the camps.
The British hung on to their class structure like bulldogs.
And the Australians kept trying to construct little male-bonded welfare states."
While time has moved on, and today we have moved beyond simply "male bonding" and "welfare states", we still believe in looking after each other.
But there is a warning. Just because this spirit has been so central to us for so long doesn't mean we can't lose it; that it can't be taken away.
The choice we face today in relation to health is that choice --- the choice of whether or not we as a nation want to keep looking after each other.
It is an important choice because health is central to our quality life, and we never know when or where we will need the health care system.
Back To The Future Health Policy
Sometimes when the Prime Minister is feeling relaxed and comfortable, he lets slip his real agenda.
Just two weeks ago it happened again on national television when the Prime Minister said:
"I thought that we had a very good system in the very early 1970s before there were some changes made that I don't think made it better and made it worse."
It is important to remember that he's referring to the system before Medibank --- the system that dominated the Prime Minister's cultural reference point, the 1950s.
It is important to remember that he believes the change that made it worse was Medibank.
So what was this 'very good system'?
It was a system that meant many Australian families faced the cruel choice between getting no treatment or paying to go to the doctor, and even paying to get treated in a public hospital.
It was a system where failure to pay medical bills could lead to bankruptcy.
It was a system where charity was often the basis of the provision of medical care.
It was no doubt 'a very good system' for some --- but not all Australians.
And history tells us that that is the system to which John Howard wants to return ... because he and the conservatives have form on these issues.
The History Of Health Policy
The conservative parties have always been opposed to a universal health care scheme for all Australians.
From the days of Chifley and Menzies, the clash of values between Labor and our conservative opponents about health care has been clear.
Labor was prepared to use Commonwealth leadership and funds to achieve universality and equity.
Our conservative opponents washed their hands of any leadership role preferring to do no more than subsidise private provision.
In the days of Chifley, Australia looked to Labor to lead the nation in ensuring that our national life reflected the values for which many people fought and lost their lives.
In 1946 the Australian constitution was amended to give the Federal Parliament power to legislate for:
The provision of ... pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorise any form of civil conscription)...
Labor enacted the Hospital Benefits Act 1945 which provided that the Commonwealth would pay to the States approximately 6/- per bed day provided the States abolished means testing and fees for treatment in a public ward.
However, the election of John Howard's guru, Robert Menzies in 1949 saw these important reforms wound back or dismantled.
During this time, Australia remained one of the few industrialised nations to lack a comprehensive social insurance scheme for health care.
The Menzies government sought to replace the Chifley hospital benefits scheme with a system of voluntary insurance and fees and means testing in public wards.
And even though public criticism led to some reforms in the late 60s many people who would have qualified for government support did not seek assistance because the arrangements were so complex.
The battle lines drawn by Chifley and Menzies have continued through the 1970s to today.
Labor's Medibank, pioneered by Gough Whitlam came into operation little more than 10 weeks before the Fraser Government was elected.
It had two major components --- universal national insurance for medical services and the provision of free public hospital services.
After promising to maintain it, Malcolm Fraser's government set about systematically dismantling it with the advent in May 1976 of Medibank Mark 2.
It enabled people to opt out of the national insurance system if they took out private health insurance. Further changes were made after 1977 and in April 1981 it was announced that the remnants of Medibank were to be abolished.
Commonwealth benefits were restricted to the privately insured with special provision made for pensioners, the poor and those eligible for sickness benefits.
A 30 per cent tax rebate for flat rate insurance contributions, at a cost of $600 million per year in tax expenditures, was announced.
The Fraser Government insisted that fees should be charged for all hospital inpatient and outpatient services, except for pensioners and those who the Commonwealth determined were disadvantaged.
There was no consultation with the States, and except for Queensland all States reintroduced charges, signifying the end of free hospital care and the re-emergence of the voluntary health insurance model of the Menzies era.
It took the election of the Hawke government to reinstate a universal health system with access to bulk billing general practitioners and free, universal access to public hospitals.
It will take the election of a Crean Labor Government to do it again.
The Battle Of Values Continues
Apart from the introduction of fees for public hospitals and the absence of Malcolm himself, the Howard Government's policies are déjà vu Fraser Government.
For good reason --- John Howard.
He was crucial to the dismantling under Fraser and he has led the dismantling by his own government.
He hasn't changed his views --- he has simply changed his presentation.
So the battle lines are clear --- Labor stands for a universal health system, for Medicare. Labor stands for real reform.
The Howard Government stands for the dismantling of Medicare and for a two-tier system where quality and access is determined by what you can pay. They stand for ad hoc un-co-ordinated initiatives...they stand for the political fix.
The values driving the Howard Government are the same as those that drove Menzies and Fraser. Health Minister Tony Abbott can't walk away from them without burning his Liberal membership ticket.
When the Prime Minister tells Mr Abbott to 'do whatever ever it takes to FIX Medicare' he does so with a nod and a wink --- they know the Liberal code when it comes to 'fixing' Medicare. It's code handed down from Menzies.
We know he wants Tony Abbott to 'fix' it up 'good and proper', to 'fix' it up 'once and for all' to 'fix' it so that it can never be fixed again!
This latest order from the Prime Minister follows previous orders to Mr Abbott to 'fix' Pauline Hanson and One Nation, and to 'fix' the unions ...
There is nothing he can do to the Howard Government Medicare package to make it more acceptable to Australians. It is a two-tier system --- it is not Medicare - and it is not how we look after each other.
A Health System For The 21st Century
Labor built Medicare, believes in Medicare and will save and rebuild Medicare.
Labor in government will face up to the challenge of reforming our health system to bring it into the 21st Century --- a challenge that not only involves dealing with illness and injury but prevention and the promotion of healthier lifestyles.
The health issues facing Australia have changed vastly over the past century, and meeting these challenges requires real reform not a short-term political fix.
In 1900 about 15% of children died in their first year, now less than 1% do.
100 years ago infectious diseases such as tuberculosis were a major killer --- now two thirds of people die of cancer and heart disease.
Improvements in our standard of living, prevention of infectious disease and to a lesser extent improvements in medical treatment have seen average life expectancy rise from 50 years in 1900, to close to 80 today.
Today the main health burdens we face are mental illness, chronic disease, injury and disability.
Yet the reality is, that chronic disease is not easily treated or cured. Despite our best efforts at prevention, dealing with chronic disease is costly and complex. Often treatment manages rather than cures these diseases and new advances provide only marginal improvement.
It is also clear that poverty, disadvantage and discrimination are related to worse health outcomes. This is particularly true for the health of people from Aboriginal and Torres Strait Islander backgrounds.
Each year brings improved pharmaceuticals, new pathology tests, better imaging techniques, novel uses for information technology, and advances in surgical procedures.
And Australians now expect access to the most sophisticated health care available.
All of these things lead to unmistakable conclusion that we have an enormously more complex health system than 100 years ago or even 20 years ago ---- and it is in need of significant reform.
When parents leave doctors' surgeries, with a sick child untreated because they can't afford a $40 surcharge, the system is in need of reform.
When regional towns don't have GPs, the system is in need of reform.
When the hospital system is under serious stress because there is not enough appropriate accommodation for acute frail aged people, the system is in need of reform.
When emergency departments are being swamped by people who can't afford to go to their GP, the system needs reform.
When the Government's only plan for medicines is to put their price up by 30 per cent, the system needs reform.
The Labor Approach
Labor is prepared to take on the challenge of real reform.
The most important thing a Crean Labor Government will do is to do what the Howard Government refuses to do --- establish national leadership for the Australian health system.
There has been no clearer example of a lack of leadership than the recent negotiations over the Australian Health Care Agreements.
We all know that access to our public hospitals is under pressure. Demand for emergency, inpatient and elective surgery is growing.
Everyone engaged in the health system, specialists, doctors, managers and patients --- the many people I have spoken to from Sydney to Darwin, from Adelaide to Perth from Central Coast, New South Wales to Burnie, from Charlestown to Brisbane over the past few months are all frustrated about the gaps, holes and duplications in the system caused by the separate Commonwealth and State funding streams.
They are tired of the bickering, cost shifting and blaming that currently passes for the national management of our health system.
Yet, the Prime Minister's response has been to repeatedly avoid a serious discussion with the States about options for addressing these pressing health issues.
A recent National Health Summit involving 250 medical professionals proved, showed there is an appetite for reform.
By taking the lead, we will deliver real reform and that means better health outcomes and more cost-effective health spending.
What Labor Will Do
Labor has a two-pronged approach to reform of the health system.
We will systematically address the crisis points in the system, and we will set the foundation for real reform in the long term.
Labor will build on our $1.9 billion plan, our down payment on saving Medicare, through further investments in primary and community health teams in areas of health need.
With population ageing, the increasing importance of chronic diseases and the introduction of new health care technology, GPs and our community health services will become more important.
There are significant gaps in our health services. A man on the central coast in NSW resorted to pulling his own teeth - forced to such a dramatic solution because of the decline in dental services, caused by the Howard Government's slashing of the Commonwealth dental program.
People who have long term needs as a result of chronic illness, mental illness, disability and frailty are the real experts in our health system about the gaps in service provision.
We will address these gaps by improving the integration of community based services, residential care, and acute care in hospitals.
We will explore new forms of primary and community health service delivery through teams that bring together GPs, nurses and allied health staff. This will be particularly important in areas where there is an under supply of services in outer metropolitan and rural areas.
We will ensure better links between primary and community health services with hospital and residential services in the interests of better co-ordination of care and outcomes for patients, particularly those with chronic illness, mental health, disability and frailty in community settings.
We will ensure the Pharmaceutical Benefits Scheme is sustainable and vitally needed medicines and vaccines are affordable.
In the lead up to the next election we will unveil a coordinated series of policies to revitalise our health system, including our policy on the private health insurance rebate.
The policy to flow from the current review will improve the effectiveness and efficiency of the rebate and will not undermine people's capacity to take out private health insurance.
Of course, in light of the government's scare campaign we could have decided to do nothing.
But that would be irresponsible. The existing scheme has failed on all counts. Premiums continue to rise, the numbers of people in private health insurance continues to decline and it hasn't worked to take the pressure of the public health system.
In addition, complex changes to the system will mean that those with private health insurance won't be able to choose their hospital or their doctor.
The rebate is in need of real reform. But Labor will not do anything that will add to the burden of Australian families or undermine their ability to have private health insurance.
Long Term Reform
As well as taking immediate action to revitalise our health system, Labor will lay the foundation for long-term reform.
Our aim will be to end forever the days of cost and blame shifting, of sharp and stupid edges between primary care, acute care and aged care.
And this reform will be achieved in the first term of a Crean Labor Government.
Within the first month of the election of a Labor Government, Labor will establish a National Health Reform Commission to drive the reform process.
The head of the Commission will not be a medical professional but an expert in change management. The head of the Commission will be a person agreed by the Commonwealth and State Ministers for Health.
In the first three months of a Labor Government, the National Health Reform Commission will bring together all the major players including the Commonwealth, all State and Territory Governments, the heads of major statutory authorities, a representative group of managers from major public hospitals and health services, consumers, doctors and other health professionals, health unions and the private health sector.
The summit will be less about what to do --- and more about how to do it --- that is, the development of a systematic and strategic agenda --- an 'action agenda' for reform of the health system.
Significant reforms will be in place within 12 months, overseen by the Reform Commission.
The Commission will make recommendations in areas such as:
Australia's long-term primary health care strategy
The Commission will develop the blue-print for the reform of Commonwealth and State funding arrangements.
It will also develop mechanisms for evaluation and feedback of the reform process.
The outcomes of this approach will be:
Better health outcomes, and a stronger focus on patients
At the next election, Australian voters will have a clear choice about the health system they want.
It will be a choice between a health system with the Medicare for the 21st century at its centre, a Medicare revitalised and reformed by a Crean Labor Government --- a universal health system based on the values of fairness and access.
An ailing system patched up with a political fix, by a Howard Government committed to the long-term destruction of Medicare.
A choice between Labor's real reform and Howard and Abbott's political fix.
Labor built Medicare, believes in Medicare and will save and rebuild Medicare, again. And in doing so, Labor in government will face up to the challenge of reforming our health system to bring it into the 21st Century.
Australians want to be able to have access GPs, hospitals, pharmaceuticals and other health services when they need them. They shouldn't be denied access to services on the basis of their ability to pay.
Australians want to know that their health services are responsive to their needs and provide high quality services. They want to know that services will adapt to their circumstances and be accountable to them.
Australians want to see national leadership and strategic investment in health services for the future. They want Governments to work together. They want an end to squabbling and bickering. They want solutions, not point scoring.
Australians want a universal health system because Australians --- you and I --- fundamentally believe in 'looking after each other.'
These are the reforms, these are the values that I will continue to work for, fight for and, with voters' support --- implement.
Only a vote for Labor will deliver Australians the health system they want and need.
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