“MAKING QUALITY COUNT”
WEDNESDAY 10 SEPTEMBER, 2014
NOVOTEL BRIGHTON LE SANDS, SYDNEY
Newspeak/Doublethink: The Contribution of Eric Blair to Public Debate on Australian Health Policy in 2014
I would like to acknowledge and pay respect to the traditional owners of the land on which we meet – the Gadigal people of the Eora Nation.
Our health system is facing its greatest challenge in 40 years.
For the past five months the public has been drawn to the debate on how we fund health services in Australia. This is not a new debate. 40 years ago the country was enthralled in an idea called Medibank. The name was different the issues were the same.
The Medibank legislation was historic for the Parliament and for the country. It was the first Joint Sitting of Parliament under s59 of the Constitution following a double dissolution – the deadlock provision for resolving disputes between the Upper and Lower House. There has not been another.
More importantly it fundamentally transformed the way we think about health care in Australia. It set the framework for Bob Hawke and Neal Blewett to introduce Medicare a decade later.
Bill Hayden made the case for Medibank:
“The intention of the programme is to provide health services in the same way as education. A social utility available as a right to every Australian. Not a commodity to be purchased or as a privilege for a few.”
A year earlier, the Henderson Poverty Inquiry told the government 15 per cent of the population had no health cover, and a larger proportion of the population had inadequate insurance to protect them in the event of serious illness or injury.
The Coalition vowed to destroy it – and they did. Labor vowed to restore it – and we did – a decade later.
We have fought hard for Medicare and will continue to do so. The provision of Universal health Care is a core Labor value.
It is why we will oppose the current changes with every fibre of our being.
In Government, Labor fought for a more rational funding system of our health and hospital system based on efficient pricing, sustainable funding, and equalising the burden of cost increases across State and Federal budgets. The Government has torn up the agreement ripping over $55 billion from health and hospital funding.
Labor understands the role of primary care as the best and most effective part of our health system. We doubled the number of doctors and nurses, expanded bulk billing, invested in rural and regional health care, in indigenous health and closing the gap. We established Medicare Locals to help coordinate primary care on a regional basis.
The Government is withdrawing money from primary care through its ill-conceived GP Tax and changes to the PBS safety-net, and throwing the coordination of primary care services into mayhem by scrapping the Medicare Locals and starting all over.
- a two-tiered health system
- a retreat from fairness
- a more fragmented, costly and complex system
Doublethink and Thought Crime
When the great English writer George Orwell (Eric Blair) published his dystopian novel 1984, he could never have imagined the impact it would have on the language of politics.
The words Big Brother, Newspeak, Thought-Crime and Doublethink attached themselves to the way we speak and think about politics. These were the proto-memes for a pre-social media generation. They became shorthand to describe a dark, cynical approach to government and the beguiling power of political language.
It was 65 years ago but the deep impression of Orwellian language remains relevant today.
In 1984 Orwell described the phenomena of Doublethink as:
“…… the power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them.”
Doublethink was on display last week when Assistant Health Minister for Health, Fiona Nash visited the Aboriginal Health Service in Bunbury Western Australia. I have no doubt that Minister Nash was genuine in her attempts to consult on measures to close the gap in indigenous health outcomes, but to use the Bunbury AMS as a site to advocate the merits of a GP Tax beggars belief.
Indigenous life expectancy is five to seven years less than non-Indigenous Australians. They are 2.5 times more likely to be hospitalised for preventable conditions, and have higher rates of death due to injury, digestive system disease, kidney diseases, maternal, neonatal and congenital conditions and certain infectious and parasitic diseases.
What work does a price signal have to do except close doors on Indigenous patients.
In Orwell’s 1984, the architects of Newspeak removed antonyms from language – there was no use in a society without dissent.
Newspeak was at work when the Health Minister set out to start a national conversation about “modernising” and “strengthening” Medicare. I cannot be so kind to the Health Minister, as his Assistant Minister. His aim is not to strengthen Medicare – at least not as we know it.
The Minister’s blueprint, which was set out in the national Commission of Audit, was to shrink Medicare to a safety-net welfare system.
In a defiant moment in Orwell’s novel the anti-hero, Winston Smith proclaims –
“There are Truths and Un-truths, and if you cling to the truth, even against the whole world, you were not mad ….”
Some truths about our health system
Amid the apocalyptic claims of unsustainability and busted seams, we are compelled to speak some simple truths about the system and where we need to go.
(i) A good health system that needs improvements
The first point to make is that we have a good health system by most recognised measures. Yes, it needs improving but when you compare the percentage of GDP spent on health with other comparable nations, we do very well. At around nine per cent of GDP, we sit alongside Sweden, Norway Ireland and the UK, below New Zealand, Canada and France, and around half that of the United States.
Using the US as the benchmark, we continue to outperform when it comes to life expectancy and most equity indicators.
(ii) Gaps to be closed
Notwithstanding this success, there remains a significant gap between the health and welfare of Indigenous Australians and Australians living in outer-regional, rural and remote areas.
While we argue about the future threat of a two-tier system, people in regional and rural Australia can rightly argue that we already have one – the gap between the city and the country. Between Indigenous and non-Indigenous.
- Life expectancy is lower by up to 7 years.
- Diet and nutrition is poorer.
- Chronic disease rates are higher, especially for diabetes and heart disease.
- Rates of accident, injury and substance abuse are higher.
- Access to care is more expensive and distances more vast.
- Education and disease prevention is harder and more expensive.
- Practices, clinics and programs are also more expensive to run and logistically harder to attract clinicians.
- There is an urgency here that I, as the Shadow Assistant Minister responsible for Rural and Regional health, feely acutely.
This must be a policy priority.
(iii) Spending in perspective
We have been told by the Minister for Health that ten years ago we were spending $8 billion on Medicare and today we are spending around $20 billion.
In that time, spending on the Pharmaceutical Benefits Scheme has jumped from $5 billion to $9 billion.
The raw numbers are correct. But just as the housing, food, wages has inflated in that time, the far more honest figure to use is the proportion of government spending.
Ten years ago, the cost of Medicare was 4.8 per cent, and today it is about 4.6 per cent – almost identical, if not slightly less.
The PBS cost 3.2 per cent ten years ago, but today costs only 2.3 per cent – less as a proportion of government spending.
We have choices, not a crisis.
(iv) When countries get older and wealthier
The health budget is a sign of a country and community that has its priorities right. It is about spending choices. A wealthy country should spend a proportion of its increased wealth on health and wellbeing – otherwise what is the point?
The fact that we are spending more of our national income on health is a good thing. It says we have more money to spend on health today than we did a decade ago – we do.
And as we get wealthier as a nation we live longer and have more health issues to spend money on – and they do.
These are signs of the success of a country not of its failures.
(v) GP Tax is a solution in search of a problem
The next point I want to make is this: the GP Tax is flawed at every turn. It is a solution to nothing (except maybe the gnawing disappointment of equity).
More fundamentally – it is built on very shaky foundations, claiming a price signal is crucial to stop over-servicing in health system.
The Commission of Audit exclaimed with incredulity that Australians could not be so sick that they need to visit their GP 11 times a year. And indeed they are not. They looked at the wrong column.
In fact the number is half that but this is the basis of a cornerstone of their health policy upon.
Though even if this data had been correct – as AMA President Brian Professor Owler has said – it would actually be better for the health of the average Australian if they did see their GP 11 times a year, rather than the current trend of about 5 or 6 times.
It is designed to reduce access, and it will.
According to the NSW Bureau of Health Information about 15 per cent of patients are already avoiding accessing health care, filling a script or deferring treatment because of the financial cost.
This accords with the experience of local health professionals. In my own region, the Director of the Illawarra Shoalhaven Medicare Local, Dr McCartney has confirmed that even more patients are already avoiding seeing their GP and getting vital tests for fear of paying the GP Tax.
People do not go to the doctor because they’re bored and want to read six-month old copies of Women’s Weekly.
They go because they are sick. They go because they need to advice and support of a qualified medical practitioner.
The country does not save money when people don’t see their doctor because they just can’t afford it.
It certainly saves no money when you design a policy that diverts people from the most efficient part of the health system to the most expensive part – emergency wards and hospitals.
It is a Regressive Tax
It will cost consumers over $3.4 billion. This is money coming out of primary care that should be being invested in it.
The worst part of it is that those who can afford it the least or need health care the most are those who pay the highest cost.
When Orwell said:
“….there are some ideas so absurd that only an intellectual could believe them….”
He was unkind to intellectuals but he may have had policies like this in mind.
The values that will underpin our Health Policy
People seeking an early indication of what we will do when next in Government should look to what we have done in the past.
The values of equity. An understanding of the importance of access, regional and sectoral solutions, working with the health workforce and with the States and Territories, not against them.
You can be certain that Health Policy will play a central role in the 2016 election. Labor will ensure this.
Concluding remarks: “It’s a wonderful thing, the destruction of words”
In the course of my address this morning, I have had recourse to the writings of Orwell. This has been no folly.
I am deeply determined to expose the Orwellian language which litters the public debate in this area. The Governments program is laced with language which says one thing and does another. It must be exposed.
I am also acutely aware of the importance of political language in delivering on the things we care about.
For it is political language which is the engine that will turn sound policy into a lived reality. What we say – and how we say it – matters.
By equal force, political language can be the destroyer of things we hold dear. You don’t strengthen something by dismantling it. You turn the values that drive equality on their head.