Federalism at risk?

Probably as a result of their focus on endless dissections of federal Labor’s leadership woes, most bloggers seem to have overlooked a potentially very significant centralist gambit by Howard government Health Minister Tony Abbott in today’s Oz. The Mad Monk, it seems, is agitating for a hostile federal takeover of Australia’s public hospital system:

One option the Podger Review could consider is giving the commonwealth more say in the actual running of public hospitals commensurate with the funding it provides. …

And once the commonwealth Government is engaged in any particular area of responsibility, how can it avoid the demand to provide leadership?

But what arguments does Abbott muster in support of this mooted Commonwealth power grab?

First, that State ALP governments have failed to fulfil a role as “laboratories for policy innovation“, instead being merely “de facto members of the federal Opposition“. The evidence for this proposition? A claim that “18 per cent of the NSW Health Minister’s and 15 per cent of the Victorian Health Minister’s press releases were attacks on the commonwealth Government“!!! What does he expect them to do? Pump out puff pieces lauding the Monk as the world’s greatest health minister? Federal and State governments have been slagging each other ever since federation, irrespective of their respective political colours.

Abbott’s article takes an even more bizarre, almost surreal, twist in contrasting State Labor governments’ alleged lack of policy innovation with the records of past conservative Premiers:

[W]ithout a vigorous federal system, premiers such as Nick Greiner, Jeff Kennett, Richard Court and Joh Bjelke-Petersen would have been unable to pioneer policies that became best practice around the country.

Joh’s government was certainly well known for policy innovations, as the Fitzgerald Royal Commission detailed, but few apart from Tony Soprano or Chopper Read would be likely to see them as representing “best practice”. Nor could Jeff Kennett’s reform of Melbourne’s public transport system, although at least Jeffrey was just inept rather than corrupt.

Perhaps the most disturbing aspect of Abbott’s article (apparently an edited version of a speech to a credulous audience of Young Liberals) is the breathtakingly cynical way he pays lip service to the critical importance of federalism as a political and constitutional concept, and then proceeds to rob it of all substantive content:

“Power divided is power controlled” is an important conservative principle. It would be quite wrong for a successful democracy such as Australia to tamper with its fundamental constitutional order.

It would be equally wrong for the commonwealth Government not to use the mechanisms provided for in the Constitution, such as agreements with the states and conditional grants under section 96 of the Constitution, to secure the best possible outcomes for the Australian people.

This is dangerous nonsense. One of the more disgraceful aspects of a century of High Court constitutional jurisprudence lies in its radically centralist interpretation of the section 96 grants power, not to mention an equally egregious approach to the treaties aspects of the external affairs power (section 51(29)). For at least the last twenty years, as a result of the accumulated weight of High Court decisions, there have been no effective constitutional constraints on any federal government using those two powers unilaterally to completely abolish federalism in all practical senses if it so wished.

The only constraints to unrestrained centralism have been political ones, not least the fact that the Liberal Party has always professed to uphold federalism as one of its central tenets. It has certainly been a principle often honoured in the breach, but until now it would have been difficult to argue convincingly that a significant commitment to federalism didn’t exist in the Liberal Party. Other political constraints have included the fact that federal governments of either persuasion have seldom controlled the Senate, and that there have almost always been at least a couple of State governments of the same political colour as their power-hungry federal colleagues. Neither of those constraints now apply to the Howard government, and if Abbott is allowed to get away with redefining federalism out of existence, the last inhibition against excessive central power will have disappeared.

I’m almost tempted to hope that the Libs win the forthcoming WA state election, so that there’s at least one State Liberal party branch with the resources and incentive to fight effectively against any Howard/Abbott federal power grab. It isn’t obvious (to me at least) that a Barnett Liberal government would be worse than (or even noticeably different from) Geoff Gallop’s colourless Labor administration.

I’m not arguing that reform isn’t sorely needed in relation to hospitals or health care more generally. Cost and blame-shifting by state and territory governments are practices that badly need addressing. But they have existed for a long time, and previous conservative party Premiers have been among their most enthusiastic exponents. Perhaps Abbott’s threats are best seen as merely a rhetorical waving of the big stick to get the Premiers and Chief Ministers to the negotiating table and talking seriously about meaningful health care reform. I certainly hope that’s all it is. Federalism is a far more important aspect of Australia’s liberal democratic constitutional order than many people seem to appreciate; every bit as important as separation of powers or the rule of law in guarding against tyranny and oppression. That’s why I’m puzzled that Abbott’s article hasn’t attracted more attention.

About Ken Parish

Ken Parish is a legal academic, with research areas in public law (constitutional and administrative law), civil procedure and teaching & learning theory and practice. He has been a legal academic for almost 20 years. Before that he ran a legal practice in Darwin for 15 years and was a Member of the NT Legislative Assembly for almost 4 years in the early 1990s.
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Homer Paxton
Homer Paxton
2022 years ago

Ken, firstly it is good to have you back.

howard has always been a centralist even in his first innings as Opposition leader so I am somewhat mystified at your apparent surprise.

I am not surprised at Abbott’s useless arguments for such a proposal. He has always been over-rated.
If Gilly is as good as other bloggers allege then she has been given a political gift.

Having control of the Senate from July will not be all beer and skittles.

Rafe
2022 years ago

This play appears to be totally inconsistent with the intended division of powers and responsibilities between the central and state governments. Of course that principle may be contested but it makes a lot of sense as a part of an agenda to keep power dispersed and under control.
Many of the problems in health at the state level arise from excessive political input which results in strange reflex actions so the Government can appear to be in control (and caring) while in fact doing little or nothing to address the real issues. Ramp this process up to the Federal level and the whole hospital system nationwide can be thrown into chaos at one swoop. At least it has to be done state by state at present!

Dave Ricardo
Dave Ricardo
2022 years ago

Relax, Ken, this was just Abbott taking an ideological crap, just like he did with abortion shortly after the election. No doubt it was very relieving for him, and the stench for the rest of us is overpowering, but nothing will come of it.

Howard is just too conservative to destroy our fundamental political institutions in this way. Abbott, still a right wing student agitator at heart, likes to let off these little bombs, ho, ho, ho. And he likes to play the provocateur, like heaping praise on Joh. For a man pushing 50 who wants to be PM, Abbott is very immature.

But as you say, it will stop the moment there is a state Liberal government, and that may be in a few weeks. Once that happens, all this talk about hostile Canberra takeovers from Abbott (and Brendan Nelson, for that matter), will cease forthwith.

As for the specific case of hospitals, that must be one of the most empty threats in the history of the Australian federation. Like, John Howard is going to want to cop the heat for hospital waiting lists. Yeah, right.

Ken Parish
Ken Parish
2022 years ago

Dave

You may be right, but I’m not convinced that most voters would automatically blame Howard for hospital waiting lists just because he began using section 96 grant conditions to run hospitals like an invisible puppet master, any more than voters know who to believe is responsible for problems with secondary or tertiary education at the moment. The States would certainly keep blaming the feds just as they do now, while the feds would continue to claim hospitals are a state responsibility and that they have plenty of GST money to fix any problems. Voters would still not know who to believe.

Peter Kemp
Peter Kemp
2022 years ago

Section 96 says that the Commonwealth ”…may grant financial assistance to any state on such terms and conditions as the Parliament thinks fit”

Section 99 seems to preclude the Feds punishing NSW or Victoria: ” The Cth should not, by any law or regulation of trade, commerce, or revenue, give preference to one state…..”

States can, if in unison reject Cth deals for more control and do the usual blame game, but I agree with Dave R, Johnny needs blame for long waiting lists like he needs a hole in the head.

I think this all could be another example of Chris Shiel’s defined ”conspicuous indignation” exercises.

Nevertheless thanks for the subject matter KP, I will check out some case law and see if there is anything in the Cth taking control where legislation does not purport to ”cover the field” (ie allows state legislation to co-exist where it doesn’t conflict)

Geoff Honnor
Geoff Honnor
2022 years ago

Happy New Year Ken – welcome back.

Abbott has been running this line for a while – Howard closed him down when he floated it last year. The Podger Review (referred to in the article) is being undertaken by Andrew Podger for the office of PM & cabinet. You’d almost conclude that the Health Minister might be miffed that he’s being shut out.

Julia Gillard’s health platform in the last election (which was the John Dwyer Healthcare Reform platform) incorporated this element as well.

Ken Parish
Ken Parish
2022 years ago

I’m also not sure that equating Abbott’s latest outburst with his earlier and self-indulgent abortion utterances is necessarily valid. This is a statement in Abbott’s own area of ministerial responsibility, in an area where reform is undeniably needed.

Hospital and health care costs and inefficiencies are a major aspect of projected future budget blowouts discussed in the Intergenerational Report. Although these costs will emerge over the next 20 years and more, we certainly need to begin addressing the issues now.

I’m sure the ALP agrees; hence Julia Gillard’s pre-election promise to convene a Health Care Summit. I was critical at the time of the lack of any concrete detail in Gillard’s policy statement, but not of the need for major policy reform. The difference now is that Abbott seems to think he can afford to act unilaterally and coercively rather than consultatively with the states and territories (or other stakeholders). The Coalition’s forthcoming control of the Senate and federal ALP disarray mean that, in the short term at least, he probably can.

For those reasons, I’m not prepared to simply write off Abbott’s gambit as his merely “taking an ideological crap”.

Dave Ricardo
Dave Ricardo
2022 years ago

Ken, I was talking about Abbott’s general preparedness to entertain the trashing of federal institutions (at least while Labor is the party of the state governments).

As for the hospirals, while I don’t think that Johnny Howard would want to take on the headaches of running the hospitals (the waiting lists, the patient deaths, the negotiations with the surgeons -what a nightmare!), that doesn’t mean that rationalisation of responsibilities between the Feds and the states isn’t a good idea. But to work that will require co-operation between the parties, not the Feds moving in like the SS Death Heads invading Poland.

Vee
Vee
2022 years ago

Federal government takes over health.

Federal government should take over Telstra
Rail
Ports
Post office
All infrastructure

Oh wait a minute – isn’t that exactly what they don’t want to do yet by advocating taking over one lot, they’re making a good case for taking over the others. At the very least Telstra which is what the public wants.

Just in case some don’t get it, I was being cynical and overbearing on the infrastructure quips. Except for Telstra which we have an opportunity to save.

Ken Parish
Ken Parish
2022 years ago

Peter

Constitution section 99 (preference/discrimination) has repeatedly been held by the High Court not to constrain the Commonwealth’s grants power in section 96. See especially Victoria v Commonwealth (Federal Roads case) (1926) 38 CLR 399 and Deputy Commissioner of Taxation (NSW) v WR Moran Pty Ltd (1939) 61 CLR 735. In the latter case, Latham CJ said:

“Further, the case of Victoria v. The Commonwealth (the Roads Case) is conclusive against the defendant upon this point. It was there held, by a court of seven justices, that the Federal Aid Roads Act 1926 was a valid enactment, “being plainly warranted by the provisions of sec. 96 of the Constitution, and not affected by those of sec. 99 or any other provisions of the Constitution” …

Sec. 96 is a means provided by the Constitution which enables the Commonwealth Parliament, when it thinks proper, to adjust inequalities between States which may arise from the application of uniform non-discriminating Federal laws to States which vary in development and wealth. Discrimination is prohibited in laws with respect to taxation (sec. 51 (ii.). Bounties must be uniform (sec. 51 (iii.)). Laws or regulations of trade, commerce or revenue must not give preference to one State or part thereof over another State or part thereof (sec. 99). But these “equal” laws may produce very unequal results in different parts of Australia. A uniform law may confer benefits upon some States, but it may so operate as to amount to what is called “a Federal disability” in other States. Sec. 96 provides means for adjusting such inequalities in accordance with the judgment of Parliament. That section is not limited by any prohibition of discrimination. There is no general prohibition in the Constitution of some vague thing called “discrimination.” There are the specific prohibitions or restrictions to which I have referred. The word “discrimination” is sometimes so used as to imply an element of injustice. But discrimination may be just or unjust. A wise differentiation based upon relevant circumstances is a necessary element in national policy. The remedy for any abuse of the power conferred by sec. 96 is political and not legal in character.”

There may conceivably be (so far unexplored) constitutional limits on the extent and manner in which section 96 grants may be discriminatory/preferential between states, but in general terms section 99 does NOT constrain section 96. It’s certainly true in theory that the States could always reject section 96 grants if the Commonwealth’s terms and conditions were unacceptable to them, but in an area as important and politically sensitive as hospitals and health care a real and sustained refusal (as opposed to bellicose posturing to the gallery) is unlikely.

Homer Paxton
Homer Paxton
2022 years ago

Ken,
the major reason for health costs rising is the price of prescription drugs.

Peter Kemp
Peter Kemp
2022 years ago

Ken, a much later case, Qld Electricity Commission v Cth (1985) 159 CLR 192 was an industrial relations spat where the Feds specifically enacted the Conciliation and Arbritration (Electricity Industry) Act 1985 which was to apply to the dispute in question.

The QEC submitted that the Act was discriminatory against a state ie Qld. It was held that the Act was invalid as it subjected a State government agency to special burdens or disabilities–”-it discriminates against the State of Qld ….” (Mason J at 220-1)

Given that each State or territory has different departments and modes of delivering hospital services, it looks to me that if the feds enact legislation state by state (to take control) they could succumb to this precedent, if they enact blanket legislation covering all states and territories it may have enough holes in it to attract the precedent again.

You may well be correct that s99 does not preclude s96 based on the earlier cases you mentioned, but my read, so far, is that if the feds want to take over it could well be a legislative nightmare and end up in the HCA with the 1985 case (and others I am still looking for) above as a basis for challenge.

Even if successful, if the feds want to acquire all the assets, they have to pay a fair price (s51xxx1) and I don’t think Peter Costello would like the multi-billion dollar bill for this.

I therefore don’t think Abbott is looking at major legislation to exert Fed control, I think he is posturing and will stick with negotiated conditions to federal money as per the status quo.

Ken Parish
Ken Parish
2022 years ago

Peter

The 1985 SEQEB case had nothing to do with Commonwealth grants under section 96. The Commonwealth purported to impose a special (and discriminatory) dispute resolution mechanism. No Commonwealth revenue grant was involved. The Commonwealth law was held to run foul of the so-called Melbourne Corporation doctrine, an implied prohibition which the High Court has read into the Constitution prohibiting the Commonwealth from discriminating against a state or states (in the sense of imposing burdens on a state or states that don’t apply to ordinary citizens) and from legislating in such a way as to impair the states from functioning as independent sovereign entities.

The SEQEB case says nothing at all about whether and to what extent the Commonwealth may discriminate against a state or states in the terms and conditions it offers attached to section 96 grants i.e. the SEQEB case in no way overrules or even affects the principles set out in the Federal Roads or Moran cases. That is partly because section 96 grants can only be made to states and not to ordinary citizens, corporations etc (because of the terms of secion 96 itself). Hence by definition it isn’t possible for such a grant to infringe the Melbourne Corporation principle: only states can receive them, so they can’t receive them on terms less favourable than those applying to ordinary citizens or corporations.

As for your mention of Constitution section 51(31) (acquisition of property on just terms), neither Abbott nor anyone else has suggested that the Commonwealth might act to acquire title/property rights to state hospitals. You are quite correct that the Commonwealth would have to pay just terms to the states if it wanted to do this, and it would almost certainly lack constitutional power to acquire them anyway. But it doesn’t need to acquire property rights. It can simply impose terms and conditions on Commonwealth grants that spell out in nauseating detail how the states must run their hospitals if they wish to keep receiving Commonwealth money. That’s exactly what happens with universities: the campuses remain state assets, but almost every aspect of how universities actually function is governed by Commonwealth rules. You don’t need to own something to be able to control it.

Peter Kemp
Peter Kemp
2022 years ago

The best analogy I can think of where the States and feds had joint ”covering the field” and the feds wanted total control was over Aboriginal affairs, this was done only by referendum altering the constitution in 1967.

I submit that for Abbott to get control of State hospitals, the same will apply, ie forget it Mr Abbott.

Ken Parish
Ken Parish
2022 years ago

Peter

I don’t know how I can explain it to you any more clearly. The Commonwealth needed constitutional power to legislate in relation to Aboriginal affairs, because (a) it wanted to be able to legislatively override unwilling states like Queensland quite directly to give Aboriginal people equal rights (not just by imposing financial pressure through threatening to withhold grants); and (b) until 1967 the Constitution expressly excluded Aboriginal people from the “people of any race” for whom section 51(27) then authorised the Commonwealth to make laws. Hence the need for a referendum. Even before 1967, the Commonwealth could have imposed any terms and conditions it liked on grants made to the states for aborigines. It needed no additional constitutional power to do so: if the states didn’t want to observe the terms and conditions then they didn’t get the money.

As I said, there is no constitutional impediment on the Commonwealth imposing whatever terms and conditions it likes on grants it offers the states for hospitals (or any other purpose whatever) under Constitution section 96. If the states don’t agree to the terms, they don’t get the money. Thus it was, for example, with Howard’s gun buyback scheme in the wake of the Port Arthur massacre. The Commonwealth had no direct legislative power at all in relation to guns, but was able to coerce all the states and territories into agreeing (some very reluctantly) to implement the scheme by threatening to discriminate drastically against non-cooperating states in the provision of section 96 grants.

Peter Kemp
Peter Kemp
2022 years ago

Ken, the Cth can impose conditions under s96, we agree on that. The question then is what are the limits on conditions under s96.

What would be crucial would be whether the feds enacted legislation to cover the field which I argue they would have to do to get control of hospitals. If so, the States would have heaps of ways to test the legislation, it is not only a question of grants, its a question of grants PLUS legislation to get total control, another ballgame entirely, consistent with my legislation argument of QEC.

(Precedent in one area of the law does not automatically exclude its application in another area, consistency being the key.)

The precedent, of the QEC case could be more relevant as it applies to legislation not grants.

In the light of Cth legislation in NSW v Cth (The Hospital Benefits Case)1983 151 CLR 302 demonstrates my point that the federal minister who imposed a further condition under s73b of the Act that registered organisations not pay monthly levies imposed by the State acts was overturned ie. Fed legislation was held not to cover the field. So if the feds enact legislation that doesn’t cover the field they cannot exercise complete control.

Where the states have an asset and the feds purport to cover the field and did in fact gain complete control, then I would argue that the States have a powerful argument to be compensated as they move out of the field.

I don’t think the feds will enact legislation to cover the field, as to do so implies a takeover which must be compensated for. The grant itself with a condition to take control without legislation, seems to me to be impossible, but if so emminently challengeable.

Apart from the case of Aboriginals and the relevant constitutional changes there, I can’t think of any ”fields” of joint responsibility that the feds have taken over [excepting Heritage/ Littoral law,Franklin Dam etc. (External affairs powers)] without compensation for assets.

Peter Kemp
Peter Kemp
2022 years ago

Ken, the Cth can impose conditions under s96, we agree on that. The question then is what are the limits on conditions under s96.

What would be crucial would be whether the feds enacted legislation to cover the field which I argue they would have to do to get control of hospitals. If so, the States would have heaps of ways to test the legislation, it is not only a question of grants, its a question of grants PLUS legislation to get total control, another ballgame entirely, consistent with my legislation argument of QEC.

(Precedent in one area of the law does not automatically exclude its application in another area, consistency being the key.)

The precedent, of the QEC case could be more relevant as it applies to legislation not grants.

In the light of Cth legislation in NSW v Cth (The Hospital Benefits Case)1983 151 CLR 302 demonstrates my point that the federal minister who imposed a further condition under s73b of the Act that registered organisations not pay monthly levies imposed by the State acts was overturned ie. Fed legislation was held not to cover the field. So if the feds enact legislation that doesn’t cover the field they cannot exercise complete control.

Where the states have an asset and the feds purport to cover the field and did in fact gain complete control, then I would argue that the States have a powerful argument to be compensated as they move out of the field.

I don’t think the feds will enact legislation to cover the field, as to do so implies a takeover which must be compensated for. The grant itself with a condition to take control without legislation, seems to me to be impossible, but if so emminently challengeable.

Apart from the case of Aboriginals and the relevant constitutional changes there, I can’t think of any ”fields” of joint responsibility that the feds have taken over [excepting Heritage/ Littoral law,Franklin Dam etc. (External affairs powers)] without compensation for assets.

Peter Kemp
Peter Kemp
2022 years ago

Sorry for the doubling up, my ISP quit momentarily.

Peter Kemp
Peter Kemp
2022 years ago

s96 cannot be applied therefore in isolation if a state succeeded in making a case that the concurrent legislation that went with a grant, (or a grant alone that had a condition of total control) attempted to take control without fair compensation.

Total control would equal possession, possession implies ownership, such ownership without fair compensation is against the constitution.

Ken Parish
Ken Parish
2022 years ago

Peter

You seem to be misunderstanding me. Law is in many respects an art rather than a science i.e. there is more than one possible answer in many situations, and none may be definitively correct. But that doesn’t mean law is completely indeterminate. The scope of Constitution section 96, for example, is quite settled law. One may reasonably argue that the High Court was less than faithful to the basic principles underpinning the Constitution (in this case federalism) in the way it has interpreted section 96 over the last century, and that’s exactly what I DO argue. But in all practical senses it’s an argument that was decided long ago, whether you or I like it or not (and I don’t). The Commonwealth can make grants under section 96 on whatever terms and conditions it likes. End of story. Settled law. It isn’t a matter for opinion or argument. It has nothing to do with “covering the field” or acquisition of property or any of the other points you’ve made.

What I’ve been trying to achieve in our discussion is not to exchange opinions on debatable though uncertain propositions (pleasurable though that would be in areas where there’s scope for it), but to convey a clear explanation of what the law actually IS (whether we like it or not). It seems I’ve failed. I guess it must be my own lack of skill with language and logic. Mea culpa. I have nothing more to say.

Peter Kemp
Peter Kemp
2022 years ago

Ken, I agree with much of what you say but we must agree to disagree on ”Cth can make grants on whatever terms and conditions it likes” IF at the same time it ties the grant to acquisition of property without just compensation. Such unjust acquisition is settled law, but I won’t quote the cases, it is a matter of argument on the individual facts in a court. Inconsistency between State and federal law has everything to do with covering the field as a legal test, again arguable on the facts.

Your focus solely on s96 to the exclusion of the rest of the Constitution and case law in a novel (and hypothetical) case is erroneous. Sorry, but I must vehemently disagree that you say my argument cannot ever be acknowledged.

Francis Xavier Holden
2022 years ago

Whitlam bypassed the states to set up community health services with direct funding when states were being recalcitrant. Didn’t take too long before they were flicked back to the states after a bit of posturing on both sides.

Abbott is just posturing before the young libs prior to the Health reform business gets underway. The states know that the easiest way to stop any nonsense is just to say to the Feds. Yeah sure here’s the hospitals and health services – you want ’em you have ’em.

Peter Kemp
Peter Kemp
2022 years ago

Agree FXH, I think Whitlam did the same with local councils but I don’t know where that has gone since.

Rafe
2022 years ago

On the topic of the community health services set up by Whitlam funding, is there any write-up of the subsequent decline of the services (as appears to be the case in NSW)?

Jim
Jim
2022 years ago

Ken,
Welcome back!
I suspect that Abbott’s motivation is twofold ; frustration at the continual blame (for a supposed lack of funding) heaped on the Feds by the state government providers and a belief that reform of the sector is long overdue and can only be carried out by the coalition.
There’s an elephant in the room that’s ignored by most participants in the health debate – IR reform.As a former IR Minister Abbott would no doubt be accutely aware of the “sacred cow” status enjoyed by the health sector when it comes to productivity/efficiency improvements as trade-offs for wage increases.
The public hospital sector sets the benchmark for the largest single cost stream in health care delivery – wages. Wage increases in the public hospital sector over recent years have been high by comparison with other industries (nothing wrong with that per se except that state governments have been unable to obtain any real efficiency dividend).
This isn’t due (despite what the vested interests say about health being “different”) to there being no obvious efficiencies/qualitative improvements to be made – it’s about lack of political will to get a better deal for patients and taxpayers.
If Abbott thinks that the Feds can deliver a system which is more efficient, less wasteful and more accountable and are prepared to pay the price politically,then we should at least be willing to listen.

Rafe
2022 years ago

Taking up Jim’s point, it is possible that the windfall of GST funds to the states has been mostly passed on to wages for teachers and nurses at least in NSW, without efficiency or productivity gains.
The Hogan report on residential care for the aged identified over-regulation as a major problem for productivity and innovation. Of course that is not a case for handing the sector over to the commonwealth.

Jim
Jim
2022 years ago

Rafe,
The residential and community aged care programs ARE federally funded and regulated and a good example of my argument. Generally speaking,the aged care sector has demonstrated significant innovation (certainly more so than the accute sector) in service delivery because it’s had to. Funding levels in aged care are far less than in the accute private or public sectors – by a huge factor and there’s no state government to bail providers out.
Annual funding increases have (with the exception of last year’s pre-election sweetener)generally been less than CPI and certainly less than wages growth.
Resident fees are capped by regulation so income is 100% controlled by government.
I’m not suggesting that this is ideal – far from it – just that the sector doesn’t attract the same level of political/community support as health so this stringency doesn’t come at a political cost to government.
Hence, reform is easier.

Francis Xavier Holden
2022 years ago

jim – the problem is that health is “different”. Despite pretty good wages and conditions there are shortages of nurses in the workforce here and worldwide. Anaesthetists are almost impossible to obtain in rural areas (and without them no surgery can be performed) and increasing like super models won’t get out of bed for less than $.5m per annum or many who don’t want to work more than 4 days a week with no nights. The increasing feminisation of the medical workforce has an important and lasting effect. The women, and increasingly younger men, are not willing to work heroic hours or even “normal” hours. Why bother when you can earn from $100,000 – $200,000 doing 3 or 4 days a week. This trend wont change.

If by IR reform you mean structural workforce reform to bring in say, Nurse Anaesthetists like in the USA and define more non nursing duties to lower paid carers or end the strangle hold that the Colleges have on medical training and workforce issues then yes we need this deep structural reform.

But then Abbott is already publically on record as saying he isnt on about this sort of major change to the system. It takes hard work, skill, and thinking and sustained effort against articulate and powerful interests with lot of unknown and negative externalities, and not just tough macho boys beer talk. And we all know that he and his mates prefer the macho beer talk to real work.

Nic White
2022 years ago

“It isn’t obvious (to me at least) that a Barnett Liberal government would be worse than (or even noticeably different from) Geoff Gallop’s colourless Labor administration.”

Keep an eye on myself and Robert Corr’s blogs for election coverage and you might decide otherwise.

Homer Paxton
Homer Paxton
2022 years ago

howard wouldn’t just take over Health or education. It would be slow.

first of all you would need changes to the GST legislation if the States didn’t do some of the most expensive services.

Jim
Jim
2022 years ago

Francis,
The shortage of nurses (worlwide) is obviously the prime factor driving wages up in the health and aged care sectors.
You and I agree on the need for real structural reform as well.
It’s the mindset I’d like to see change and it must soon given the horrendous cost implications. We have to accept as consumers that health care delivery has to be subject to the same challenges to the status quo as other industries.
If what Abbot is proposing removes a layer or two of bureaucracy , makes accountability more transparent and delivers more “bang” for the buck , I’m happy to hear him out.

James
James
2022 years ago

Quick example of a possible productivity improvement in health:

I spent 10 months in hospital after a serious accident. Every day in hospital, a registered nurse (RN) or an enrolled nurse (EN) would help me get out of bed, get showered, etc. I understand the length of training involved for these two types of nurses is three years and one year, respectively. They were always flat-out and often contract nurses had to be hired to fill the shift.

When I finally went home, personal carers were trained to do the same job in two days.

When I discussed this situation with the nurses on the ward they agreed that it would be fantastic to have some sort of low-level carer to help out with the simple jobs, but they agreed the union would never wear it. The problem continues to this day.

Francis Xavier Holden
2022 years ago

jim – one of the biggest and easiest to fix issues is physical infrastructure. Easiest as in all that is needed is $. It also has the benefit of some job creation in the building industry.

As you would know in aged residential care most nursing homes are now too small to be able to provide efficient staffing almost no matter what staffing profile could be used. Even buildings less than 10 years old are suffering from design influencing care and flexibility.

The Acute sector suffers considerably from inflexible building structures unsuited to introducing effiencies, due to small <$12m, injections of fragmented capital injections.

The savings from a layer or two of bureaucracy being removed whilst playing well in a populist fashion result in very little savings and given the amount of accountability and reporting that the pollies and the public now require might even possibly cost money.

The really big issue is how to get Aged Care, Acute Care and GPs and other Primary Care working effectively together to deliver good health outcomes. That is we need more “system in the system”.

As James has pointed out above good, effective and efficient health outcomes are often provided by non health professionals keeping people out of expensive care by providing meals, companionship, monitoring and physical help ranging from help with showering, dressing to mowing lawns walking pets and house cleaning.

Any reasoned analysis of how to improve the australian health care system from any side of politics always comes up with a model that incorporates what is essentially a version of regionalisation and some abilty to pool funds from Medicare, PBS, Aged and Acute plus capital. This requires not a takeover by the Feds or the states but cooperation between the two, (plus local government and “private” medicine – although in truth there is very little true private health care) and structures to take the politics, emotion, shroud waving and special interests out of health resource allocation making.