Registered Nurse and Sydney Socialist Party member Ger Hughes looks at Labor’s healthcare reforms and outlines a socialist solution to the crisis in healthcare.
The Australian public health system is in crisis. Common occurrences are long surgical waiting lists, run down infrastructure, low staff morale and overcrowded emergency departments and wards.
The condition that the Australian public health system finds itself in has been caused by decades of under-investment and neglect by successive State and Federal governments. This has been combined with the promotion of private healthcare as an alternative to the public system.
Earlier this year former Prime Minister Kevin Rudd and Health Minister Nicola Roxon spent a considerable amount of time visiting hospital wards and health centres around the country. They were drumming up support for their proposed healthcare reforms. These visits were no more than a cynical public relations exercise rather than an effort to find out what was at the root of the problems within the health sector.
Even before the reforms were officially announced there appeared to be disagreement within the Labor Party ranks. Nicola Roxon indicated that she wanted tax increases to fund the reforms but the Labor State Premiers, led by Victoria’s John Brumby, were demanding more health dollars from the federal pot.
When the reforms were announced they were broadly welcomed by those in the health sector as a sign that the Labor Government was at least putting some thought in to health policy. But if you look beyond the rhetoric there is next to nothing in these reforms to address the serious problems facing the sector.
Much was made by the federal government of the plan to take over 60% of the funding of public hospitals and 100% of the funding of non-hospital public health services. The major source of this funding was to be derived from the dedication of one third of GST revenue which was to be set aside for healthcare. What was not so publically announced was the fact that there was to be no new funding for health until 2014 at the earliest!
Starved of money
Dr. John Deeble, who is a co-architect of Medicare, has declared this arrangement as completely inadequate stating that “the growth in funding is extremely slow and the public health service has been starved of money”.
Immediately following the announcement of the reforms there began a fierce round of horse trading with all the State Premiers angling for individual deals to secure their support for the reforms. So far, all of the State Premiers except for the West Australian Liberal Premier Colin Barnett have signed up to the deal.
The language of the proposed reforms talks about “retaking control of services from bureaucracies and handing it back to local hospital networks”. Doctors, nurses and others in health have been calling for this for decades, the detail of how these changes will be implemented and funded is sketchy to say the least. How, or if, they will work in practice remains to be seen.
The question of who controls healthcare is crucial. Decisions about what services should and shouldn’t be provided must not be made by those with financial incentives but by democratically elected representatives of the staff, patients and the community as a whole. Only in this way would decisions reflect genuine needs.
The proposed local hospital networks are to be comprised of 1 to 4 hospitals in urban areas with more in rural areas. The Labor reform plan is very short on details such as how planning will occur for tertiary services such as oncology or cardiac surgery. Strategic planning of these types of services is essential to ensure that they are delivered in the best possible way.
Labor’s reforms outline no strategic plan and are totally bereft of detail. In New South Wales (NSW) for example the proposed changes to local hospital networks will push the administration of the hospitals back to a structure which existed up until 2005. This will create 25 bureaucracies where currently only 8 exist. Effectively what this means is that the much needed funding that the health sector requires will be funnelled off to unnecessary layers of bureaucracy.
Contained within the plan for the federal government to provide 60% of hospital funding are restrictive conditions which the hospital networks must adhere to. These involve prescriptive standards on waiting list times, nosocomial (hospital acquired) infections and medical errors to name but a few.
These standards are punitive and promote practice which has at its core the achievement of these targets rather than concentrating on providing the best care possible. An example of the punitive nature of these targets is seen when we look at the waiting list issue.
Surgical waiting lists are sometimes adversely affected by the fact that there is often difficulty securing a bed for the patient following their surgery. These beds are often already occupied by other patients causing the surgeries to be postponed thus lengthening the waiting lists.
Beds are often occupied by people who need care but do not need to be in a hospital bed. This occurs because of a critical lack of sub-acute, rehabilitation and aged care beds. The provision of these types of beds is already the responsibility of the federal government and until the provision of this type of bed is improved the setting of targets is pointless.
Lack of proper planning
Australians use their public hospital more than Europeans and at double the rate that Canadians do. This can be attributed to the lack of access to GP and primary healthcare services. Many people with complex and chronic conditions end up in the hospital system when they could receive more appropriate treatment in a community setting.
The document released by the federal government ‘A National Health and Hospitals Network for Australia’ has the audacity to recognise this fact but offers no solution to the problem. It is irresponsible to signal the need for such fundamental reforms without indicating how that reform is to be achieved.
Best practice for the treatment of chronic and complex patients involves the use of a range of integrated services which would include nurse practitioners, physiotherapists, occupational therapists, psychologists along with other allied health and complementary therapists. The government has not said that these types of services will be included in the funding model.
The absence of these services from the non-hospital public health service serves as an illustration of the disparity between public and privately insured patients. The private health care multi-nationals in conjunction with government policy have created an image among the public that in order to receive good health care you need to have private health care insurance.
With regard to the proliferation of private insurance in healthcare the reality is that if a person requires urgent care they normally receive it very quickly in the public system. However those with non-urgent conditions are increasingly choosing not wait and are using the private system to access care in a more timely fashion.
This leads to the development of a two tiered health care system where those with the ability to pay can improve their health outcomes purely due to their ability to pay. Some areas of health care such as mental health and dentistry have been completely ignored by the proposed reforms.
The reforms are entirely too hospital focused at the expense of a primary health care approach. Whatever way they are approached the reforms do nothing to address the root cause of the problems in the Australian health system, that is that it is grossly underfunded and has been for many years. Any reform of the service must first address this neglect before any real change can be expected.
A real solution
So what is the solution to the problems of the Australian public health service? Firstly we must recognise that the system is sick and needs to be treated. The system is more sick if you are Aboriginal, homeless, mentally ill, a refugee without Medicare or if you are simply elderly and poor.
The public healthcare system is staffed by dedicated individuals who work tirelessly to provide the best service they can to the people they come in contact with. Their ability to provide that service is stymied by the chronic underfunding and degrading of the service by governments both state and federal.
Healthcare should be a right not a commodity to be traded for profit. Healthcare, wherever it is accessed, should be free at the point of contact. Private healthcare has at its epicentre the pursuit of profit first and foremost. As a result the private healthcare industry cherry picks the areas of activity it becomes involved in. Private healthcare does not as a rule get involved in long term chronic illness preferring to concentrate on the short term complication free areas that can be time limited and produce the most profit most quickly.
The private healthcare industry should be absorbed into the public system creating a single tier system which is fair and equitable. We need a massive boost to healthcare funding. The focus should be on primary healthcare with an emphasis on preventative healthcare.
The pharmaceutical industry produces enormous profits for the multi-national corporations that operate them. Most of their profits come from governments who pay inflated prices for products. This industry should be taken into public ownership and under democratic control and made to work for outcomes rather than profits.
These are not ideological notions. These policies and more would be achievable if the health system was run on a not for profit basis. The Socialist Party supports the establishment of a properly funded, comprehensive and equitable public health system which is free at the point of contact and run for the benefit of the end users.
Labor’s healthcare reforms do not provide for such a service. Rather, they will deepen the crisis in healthcare and further increase the divide between rich and poor by driving more and more people into the hands of the private health insurance profiteers.
If we really want to provide decent healthcare to all we have to not only campaign for real reforms in the here and now but we need to extend that fight to one for a complete change in the way society is run – the fight for a socialist world where people’s health needs are put before profit.
The Socialist Party says:
– End and reverse privatisation in the health sector
– Medical advice, treatment, investigations, management, administration, cleaning, catering and all other health services should not be run for profit
– For all hospital services and buildings to be under public ownership
– Rebuild the health system as a publicly funded service free at the point of use
– The health sector should be run and planned by democratic committees that include representatives of health professionals and the local community. The health system should be run and planned nationally by health workers and a government that puts people’s needs before private profit.
– Nationalise the pharmaceutical and medical supply industries under workers and community control and management. Integrate these services into a democratically controlled health system. Plan their resources to provide needed treatments.
– Fight for a socialist world to end poverty and inequality – the biggest killers and causes of ill-health