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My interview Razor Sharp 18 February
Me interviewed by Sharon Firebrace on Razor Sharp on Tuesday 18 February. (0)

My interview Razor Sharp 11 February 2014
Me interviewed by Sharon Firebrace on Razor Sharp this morning. The Royal Commission, car industry and age of entitlement get a lot of the coverage. (0)

Razor Sharp 4 February 2014
Me on 4 February 2014 on Razor Sharp with Sharon Firebrace. (0)

Time for a House Un-Australian Activities Committee?
Tony Abbott thinks the Australian Broadcasting Corporation is Un-Australian. I am looking forward to his government setting up the House Un-Australian Activities Committee. (1)

Make Gina Rinehart work for her dole

Sick kids and paying upfront


Save Medicare

Demonstrate in defence of Medicare at Sydney Town Hall 1 pm Saturday 4 January (0)

Me on Razor Sharp this morning
Me interviewed by Sharon Firebrace this morning for Razor Sharp. It happens every Tuesday. (0)

I am not surprised
I think we are being unfair to this Abbott ‘no surprises’ Government. I am not surprised. (0)

Send Barnaby to Indonesia
It is a pity that Barnaby Joyce, a man of tact, diplomacy, nuance and subtlety, isn’t going to Indonesia to fix things up. I know I am disappointed that Barnaby is missing out on this great opportunity, and I am sure the Indonesians feel the same way. [Sarcasm alert.] (0)



Health care: reform or revolution?

Health care reform across the world is built on a lie – the lie that the market can satisfy human need. 

As John Lister puts it in the UK weekly Socialist Worker in a discussion of his book Health Policy Reform: Driving the Wrong Way:

[The capitalist system] places the priority on profit rather than human health, perpetuates extremes of inequality between and within countries, and gives preference to the operation of market forces rather than planning and redistribution of wealth.

As Lister points out nearly 85 percent of the world’s population has just 11 percent of healthcare money spent on it.  Those people suffer 93 percent of the burden of the world’s diseases.

Lister’s conclusion is that neo-liberalism, not need, drives health care reform. Proposed reforms in Australia just prove the point

The National Health and Hospital Reform Commission has just presented its final report to Labor Prime Minister Kevin Rudd. 

A Healthier Future For All Australians: The Final Report makes a number of recommendations which essentially continue the ongoing privatisation of healthcare in Australia and the increasing use of price signals to reduce demand.  

The recommendations suggest moving some responsibilities and funding to the Commonwealth Government from State Governments.

This may save some duplication costs but will do nothing to address public hospital waiting lists, beds disappearing and less GPs with more patients.

Here is how  Robert Wells in ‘Can COAG deliver on health? History suggests not’ in Crikey describes the main changes:

The key areas for reform include:

  • A greater focus on prevention and primary care, including the Commonwealth assuming full funding for these services.
  • Greater clarity of responsibilities between the levels of government in relation to health services generally and hospitals in particular.
  • Specific measures in relation to chronic disease, mental health, aged care and indigenous health; and
  • Getting action on eHealth-electronic patient records.

These aims appear admirable but market solutions like the ongoing private/public split and the proposal for a Medicare Select scheme to operate in competition with current private health schemes don’t address the issues of delivery on the ground.

Neither does shifting the funding from State to Commonwealth Governments as the Report recommends .

Using a market model to address Aboriginal health won’t close the 17 year gap in mortality rates.

Propping up health insurers, specialists and private hospitals in Australia won’t close this gap. 

The number of hospital beds is now 38 percent less than in 1981. A market model won’t bring back those beds. It will exacerbate further losses.

Indeed Rudd is already talking about doing more with less in health care.  That shows his true intent.

Less nurses, less beds, less doctors, less hospitals but more costs for patients- is that what he means by more with less?

 The problem is not the funding arrangements but the market model for health care.

And one word of warning about the push for preventative action – this might benefit select groups of capitalists and actually be more costly to society over time because of its inappropriate focus on profits.

 The Commission’s recommendations do nothing to address the two tier system – one gold plated system for the well off and one queue infested and costly system for the rest of us.

As John wrote in Health care for all: time for a national system:

…when it comes to health, the market is a failure and doesn’t need carrots and sticks. It needs abolishing.

Why should medical treatment depend on what’s in your wallet?

I have an alternative.  Abolish the private health insurance rebate.  Establish a National Health System which is funded through progressive taxation. Make all medical and hospital services free.  Put doctors on a wage.

Increase public spending on health services to ensure there are no waiting lists. Soak the rich till the pips squeak to pay for this.

You only have to look at the US to see that model is a failure. 50 million people there are without health coverage. This disgrace is in the richest country in the world.

Canada for example moved away from that model to  a medicare approach in the 80s and the results have been a significant improvement in health outcomes for the whole population and a decrease in health costs overall – much less than the US system.

Estimates are that the move to greater Commonwealth responsibility and funding will cost around $5 bn per year and that initial capital costs will be in the order of $7 billion over four years. 

In  addition the report recommends a Denticare free dental scheme for all which will cost $3.6 billion and be funded by increasing the Medicare levy by 0.75 per cent.  Already the Dental Association has claimed this will do nothing to address the delays for the 650,000 Australians waiting for public dental care.

So all up, if we take the Denticare scheme into account, the total cost will around $10 billion a year. This sounds a lot.

It is one third of the cost of the tax cuts to the rich Labor implemented from 1 July.

It is about one fifth of what Rudd has spent on the stimulus package. It is less than a third of what he proposes to spend on jet fighters.  

It is what the tax system gives to the holders of capital (overwhelmingly the ruling elite) in capital gains tax concessions.

A wealth tax and/or inheritance tax would easily raise this amount.  So too would increasing the company tax rate and marginal tax rates on those earning more than $120,000 (double the average wage.)

Why single out the rich for paying for health care for all?

It is true that we as individuals benefit from ‘free’ health care.  But we need to keep our ‘individuality’ in perspective.

We are wage slaves for capital. A healthy workforce is a more productive workforce.  And it is that extra benefit – the value we as fit and healthy workers create which the bosses then expropriate – that should be the basis for funding any increased health expenditure.

So the Rudd Government will try to get us to pay for their market based solutions.  Workers shouldn’t pay for health care under capitalism, and they definitely shouldn’t pay for a system that cannot work properly.

The last word belongs to John Lister. He says:

 Nowhere is there any evidence that market-style ­reforms can improve efficiency, cut costs, or do anything but compound existing inequalities in access to healthcare.

However, the dominance of neo-liberal ideology and the plentiful supply of servile academics means that these baseless policies have become the mainstream agenda of the “health policy reform industry”.

My conclusion is that health policy reformers are “driving the wrong way”, asking the wrong questions, and getting the wrong answers.

An alternative is possible — one which begins with the progressive concepts of cooperation, solidarity and planning, and aims to build inclusive, comprehensive and accountable systems based on the collective sharing of risk.

This is the good old socialist principle: “From each according to their ability — to each according to their needs.”

 Exactly. Let’s tax the rich to pay for universal health care as part of a move to a just and equitable society.



Comment from THR
Time July 29, 2009 at 1:20 am

Excellent post. I had some troubles with the formatting, though.

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