Election 2022: sports rorts, car porks and many snouts in the trough

No matter which party wins tomorrow’s Australian federal election or who holds the balance of power, there are three generation-defining issues facing the country: climate change, debt and healthcare. All three rank the highest in voters’ concerns, and detailed answers to all three have been tacitly avoided by the two major parties during this election campaign.

When it comes to health – whether that is primary care, hospital care, aged care, disability care or preventative health – the problems are stark and the answers are not easy, but they need to be confronted. The Coalition boasts of its record funding for Medicare and its response to the Aged Care Royal Commission, while the ALP conjures up urgent care clinics, voluntary patient enrolment and ensuring our elderly are properly fed. The Greens want to add dental care to the mix, and even though there is a very noticeable number of trained doctors standing for parliament, most are running on platforms concerned with climate change or political integrity rather than fixing the health system.

Hospitals didn’t really get a look in, despite ambulance ramping and bed blocking at an all-time crisis point in every state and territory in the country. The peak medical bodies are now showing white hot anger and are demanding that the next health minister sit down with them and acknowledge the crisis, calling for an urgent hospital summit. The Sydney Morning Herald and The Age health reporter Dana Daniel gave a pretty good overview of where everyone is at with acute care, and it ain’t pretty no matter which way your politics lie.

In primary care, the ALP made a vague stab at a new policy with its $1 billion package last Saturday, promising $250m each year over three years to begin the move to VPE and providing a new funding model for patients with chronic illnesses to be cared for through team care arrangements with their general practice. Labor also promised $220m for a fund for practices to buy equipment, including IT for telehealth and wound care supplies. Outgoing health minister Greg Hunt immediately dubbed this a slush fund, and while he is absolutely right, it’s also a bit hypocritical coming from the party behind sports rorts and car porking.

Rural GP Paul Mara drew attention to the paradox of organisations like the RACGP, which at its practice owners’ conference in Hobart last weekend was arguing on one hand that GPs needed to drop bulk billing and start charging patients more, while on the other rubbing its hands with glee at the thought of all of this lovely moolah potentially on offer. “The RACGP is walking astride a barb wire fence, with one hand on a Liberal type copayment and the other in Labor’s trough,” Dr Mara said. Quite.

So is health and aged care funding just an intractable problem that will never be fixed? Are we doomed to suffer crisis after crisis in all areas of healthcare policy, our hospitals blocked, our ambulances ramped, our GPs burned out, our nurses under-paid and our elderly under-fed? It seems so, with no one willing to put concrete proposals on the table to enable real structural reform. We in the health IT industry think we have part of the solution, but without any money – or more importantly, political will – we still seem to be going nowhere.

We asked readers just last month if they thought the parties had dropped the ball on healthcare policy in this election campaign. A cool 97 per cent of you said yes. It’s hard to see how that has changed over the last few weeks.

So while we wait to see the fate of our political leaders, we plod on regardless. There’s been a little bit of other news this week: New Zealand released its budget and decided to fund some interesting data and digital infrastructure projects, but it too has found healthcare funding an intractable problem and has decided instead to completely upend the whole district health board system.

In Australia, some action is happening for aged care software vendors to begin the process (again) of getting aged care more digitised, but at the same time the federal Department of Health is insisting on going ahead with its highly controversial plans to cap the money it pays to support the electronic prescribing system. It is certainly not taking a backward step in the face of intense industry lobbying, as this story shows.

Next week, when all the dust of the election campaign settles, we can hopefully return to more mundane pursuits in the digital health sector. There’s still a lot of positive change going on in our industry, if only we could get our hands on some of that moolah. Once more unto the breach, dear friends, once more.

That brings us to our poll for the week:

Is adequate funding for health and aged care an intractable problem that will never be fixed?

Vote here or leave your comments below.

Last week, we asked: Will the JP2060 Phase 4 health knowledge management system proposal work?

Most readers seemed positive, with just over two-thirds saying yes. Some of those who said no had an interesting argument or two. Here’s what you said.

Comments  

0 # Kate McDonald 2022-05-27 14:28
Last week, before the Australian election, we asked: Is adequate funding for health and aged care an intractable problem that will never be fixed? Two thirds agreed: 62 per cent said yes, 38 per cent said no.

We also asked: If yes, why? If not, what do you think can be done? Here’s what you said:

- Technological ‘em advances, advances in drug and other developments and societal expectations means we will never be able to afford all expectations. However, there are many changes that can improve health funding including addressing the siloing impact of Commonwaelth versus state funding and delineated responsibilitie s. It will never allow for seamless or patient centric care.

- Vote libs out

- Many boomers do not want to end up a vegetable in aged care. Real choices to VAD must be made available. Let people have choices and the costs would be reduced.

- There is not a bottomless pit of money, we need to focus on prevention, reducing lifestyle risks and then, when intervention is needed, delivering healthcare in new, more effective and efficient ways.

- There are not enough carers to look after the residents
- These areas have been politicized. Therefore there is no long term commitment to addressing the complex multi layered issues. Lots of talk, minimal action/ funding boosts and not well thought out. Just throw a pot of money in the direction of where the most votes are perceived, like giving out a few hundred dollars to individuals as a vote sweetener.

- Plus there is the need for efficient and effective oversite and management of fiscal and service management at the coal face and the significant reluctance to employ and pay appropriately for the necessary skill sets to achieve this.

- Inability of Commonwealth and State Governments to reach consensus on the form that health reform should take especially around blended payment system to manage complex and chronic diseases. Move away from fee for service for managing chronic diseases.

- Prof Ric Marshall stated that “health costs are like elastic”. I believe whilst the majority of a population assume free health care, this will continue. Health Fund membership is essential. Aged Care is very complex, both care modelling and financial - wise. I believe the elastic is even longer.

- Review and realign priorities for funding

- Don't conflate health with medical care. There are many low cost (but difficult, socially and politically) ways of improving health. If governments were clever they would not attack the problems head on but governments are not often clever enough, they just think they are.

- Many of the expensive aged care problems are the result of a person's earlier health and medical problems so a focus on health would pay off two ways in the long term.

- Won’t approach parity until focus shifts to prevention , primary care and personal responsibility from illness focused “specialist “ intervened expensive model.

- Because those with wealth and high incomes have been able to convince enough politicians and voters that taxation is bad and a bigger public sector is a problem. But taxes are the price we pay for a civilized and fair society, and services like health and aged care need to be provided on the basis on need not how much income someone has. This requires a rethinking of how we raise funding for health and ageing. There may be more support for higher funding if there was more use of levies like the Medicare levy to fund better health, ageing and disability services.
Politics defines amount but depends on standard care willing to fund and pay taxes for.

- Too many governments only ever see as far as the next election. To provide proper services requires proper funding and that means taxes.
- Never a vote winner ...

- Numbers of patients and cost of care will continue to rise as population continues to grow and people live longer. More advanced care options may save more lives but the technology and drug cost will continue to escalate.

- stop talking - fix Aged care (it's embarassing).

- At this point any genuine attempt to fix it would be good

- Health is a black hole. There are always new treatments, medications, tests and procedures being developed. People live longer with more chronic diseases that require long term therapy. We have medicalised old age and no one is willing to discuss at what point do we say ENOUGH!

- 1. The State/ Territory and Federal divide in funding will always limit the capacity for real system level thinking and change.
2. The small business aspect of GP care and the influence of that on (predominantly publicly funded) acute care services ensures that different incentives and drivers are embedded and will ensure that a collective vision and system change will not occur.
3. The frankly ridiculous funding and staffing level discrepancy for our Aged Care services will continue to ensure that our elderly are not cared for as they should be.
4. The dreadful stories we hear of the emergency centre call centre workers - who know that there are no ambulances available and are not "allowed" to tell people. And those poor people waiting with their loved ones as they die... waiting for an ambulance that is not coming
5. And the lack of (knowledge of and availability of) widespread alternatives for after hours/ emergency health care, that will redirect people from ED's
Are just a few of my (clearly somewhat depressed) thoughts....

- Given that Labour is now the predominate Govt across most States perhaps its time to stop the blame game between the Fed and State Govts. They had the opportunity in the Rudd years and failed to deliver. If they fail to do so this time they will find that a Teal like structure might be their nemesis as well. With a primary vote in the low 30's they have 3 years to make real and sustainable change. A true democracy is not a two party model.

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