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Health debate heats up -

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The state of the health system is a concern for all Australians but it's an issue that is
traditionally catapulted into the headlines in the lead-up to an election. This year has been no
different, with the Howard government announcing a radical takeover of a hospital in a marginal
seat and with particular emphasis on the public hospital system and basic medical care. To talk to
their vision for the next term of government Kerry O'Brien speaks with Health Minister Tony Abbott,
and Labor's alternative minister Nicola Roxon.


KERRY O'BRIEN: And in the wake of last week's acknowledgement by Mr Howard that he'd step down as
Prime Minister sometime during the next term if he wins his fifth straight election, there's a
notable strategic Coalition shift away from selling the leader to selling the team.

The Prime Minister and his Cabinet colleagues are suddenly keen to stress that, person for person,
the Government ministers outshine their Labor counterparts. We've taken that as a cue to stage some
more of our occasional debates on the big issues of this election.

As today's parliamentary debate again reminds us, health will be a key issue this time, with
particular emphasis on the public hospital system and basic medical care.

To talk to their vision for the next term of government I'm joined now in our Canberra studio by
Health Minister Tony Abbott, and Labor's alternative minister Nicola Roxon.

Tony Abbott, you've written for an upcoming magazine article that, quote, "on any fair judgment
Australia has excellent health systems." Do you include public hospitals under that banner of
excellence and to the extent that the Commonwealth can, what plan do you have to improve the public
health systems over the next three years?

TONY ABBOTT, HEALTH MINISTER: Our public hospital systems could do better, Kerry, but they aren't
bad by world standards. It's not up to the Federal Government to run public hospitals. Our public
servants would be just as effective as state public servants at running public hospitals. What I
want to see come out of the next health care agreements though is a funding system which is about
funding better health services, it's not just an arrangement between governments funding big

KERRY O'BRIEN: But how do you do that?

TONY ABBOTT: For instance you could fund the public hospital system on a case mix basis. That would
force them to focus on services rather than on global budgets and it would mean that you would be
getting what you paid for in a way the Commonwealth can't be sure now.

KERRY O'BRIEN: So when you're talking about excellence, and I know that's a broadbander, but when
you talk about excellence, how do you set that against the queues for emergency care and surgery
that have been around for yonks and complaints about lack of adequate follow up care?

TONY ABBOTT: Well these are problems and they're problems that the State Governments should be
addressing. I'm not proposing to solve all their problems for them because I don't believe that
that's the Federal Government's role. But I do want the next health care agreements to, if you
like, back seat drive the hospitals into a better position than they are now and I think if we
focus on funding services, rather than just shovel the enormous pot of money into the State's
coffers, we're more likely to get good services delivered to patients.

KERRY O'BRIEN: Nicola Roxon, what are the key planks for Labor, that a Labor government would rely
on to improve Australia's public hospitals if you're elected?

NICOLA ROXON, SHADOW HEALTH MINISTER: Well Labor's already announced a $2 billion health and
hospital reform plan. We do believe that we can make our health system even better and I'm
surprised to hear Tony say that he has this interest in the health care agreements because several
months ago he refused to start negotiations with the States about these sorts of changes, in fact
seemed to have clocked off, if you like, as Health Minister. I think we do need to have serious
negotiations with the States about how we reform our health care system, both hospitals and
front-line community care and our $2 billion that we've put on the table is going to be directed
towards dealing with issues like preventable hospital admissions, pressure on our emergency
departments, how we treat older people in a more appropriate way, preferably out of hospitals and
in more appropriate settings for them. These sorts of things are really huge future challenges for
the health system and my concern is that Tony seems to have lost interest in pursuing these big
issues at a time when we really need to be retooling and re-equiping our health system for the
challenges of the future.

KERRY O'BRIEN: But you would have the same constraints, the same constitutional constraints as Tony
Abbott in terms of what the Commonwealth can do against what the States deliver in frontline care.
Now you've talked about Health and Hospitals Reform Commission, but what's that going to do?

NICOLA ROXON: Well, we've already said and put $2 billion on the table to kickstart this reform.
We've made clear that we're prepared to put extra money in the system when the Howard Government
has taken it out. We will establish a reform commission because we think there are long-term
changes in our system and the sharing of responsibilities between the Commonwealth and the States
that could be improved and we could make every health dollar go a lot further in providing better
services for the community.

KERRY O'BRIEN: But I suppose what I'm asking is -

NICOLA ROXON: We're not afraid of that reform which I think the Government has lost a bit of
appetite for but actually the health challenges of the next generation need us to be prepared to
look at those things.

KERRY O'BRIEN: But what's the stick and the carrot - the stick with that commission? Why would that
commission get any better result out of the States than any Federal Government has got out of them
in the past?

NICOLA ROXON: Well the stick in that we've made very clear, and Kevin Rudd has said that the buck
will stop with him when it comes to his commitment to these reforms. The stick is that if we cannot
get sign-on from the States to actually be part of a needed reform process, we will ask the
community, we'll seek a mandate from the people, to take over financial control of the hospitals.
Now we won't do that without talking to the community because it would be a big change and we would
want to make sure that that is endorsed but we'll only do it if cooperation is not successful.

KERRY O'BRIEN: Now you're not impressed by that at all, are you Tony Abbott?

TONY ABBOTT: Well it's not a hard plan.

KERRY O'BRIEN: You've likened this commission to the British National Health System.

TONY ABBOTT: It's just another talkfest. It's just another talkfest. Now, you know, there's
somebody for everyone in the Rudd plan but it ends up being really nothing to anyone. First of all
you've got this big talkfest, then we're going to have two years of cooperative federalism. If and
when that doesn't work we're going to have the ultimate act of uncooperative federalism, namely a
Commonwealth takeover. But there is nothing specific here. It's basically a 'trust me' policy,
elect me and I'll make it up as I go along. Now I think the Australian public deserve a lot better
than that.


NICOLA ROXON: I think that's a ridiculous position. We are setting out a plan for the future, not
just for the next 10 weeks as the Howard Government seems to be doing whether it's for the Mersey
Hospital or one-off initiatives. This is a national plan for the next 10 years and we need to do it
carefully and we intend to make it work.

KERRY O'BRIEN: Tony Abbott, when you talk about sort of, this kind of ad hoc thing or talkfest,
it's only a couple of weeks ago or a few weeks ago that the Prime Minister announced the bailout of
the Mersey Hospital in Tasmania which you've since dressed up as testing a new community managed
model that could become the model for a wider introduction.

TONY ABBOTT: I haven't since dressed it up, that's always what it was, Kerry.

KERRY O'BRIEN: Well I have to say in the first couple of days I remember in our interview you said
you painted this as something that could be a massive shift but then a day later you said it wasn't
for a wider application.

TONY ABBOTT: Well no, it is a new model and a better model, I think for running public hospitals
and I would like to think that if and when this is operating, and operating well, the States might
adopt it because certainly a community board, a local hospital board that is responsive to local
patients and local clinicians is going to manage these hospitals better by and large than a giant
faceless bureaucracy. And the problem with Kevin Rudd's plan, if indeed it can be called plan, it's
all so vague and all so contingent, is that substituting Commonwealth public servants for State
public servants is not actually going to help.

KERRY O'BRIEN: Nicola Roxon is that a new path to consider, the idea of State-run hospitals
remaining as State-run hospitals but managed by the local community?

NICOLA ROXON: I think all sorts of options are possible but I think that was a fairly noble effort
by Tony to rewrite history when he's been absolutely all over the place about what this Mersey
Hospital takeover means, he's been all over the place about whether he thinks it's a good idea for
the Federal Government to take over State-run hospitals. We've set out a comprehensive national
plan which is part of a whole strategy. It's not just about one hospital in one electorate in one
marginal seat that the Government wants to win and I think that the public will embrace a
government, or an Opposition that wants to be a government, planning for the future, looking
long-term, not just at these one off solutions which aren't necessarily going to be successful.

KERRY O'BRIEN: Tony - yes, sorry, go on.

TONY ABBOTT: Nicola can't give us any of the real details. I mean, that's the whole problem. It's a
trust me strategy. She talks about the $2 billion public hospital fund but even since it was
announced it's already being raided for things like GP clinics. Now I mean it's a pre-election
health slush fund and even if it was all going for public hospitals, $2 billion over four years,
$500 million a year, it works out at about $700,000 per public hospital. It's not going to solve
too many problems.

KERRY O'BRIEN: By the same token it's not that long ago that you were floating the idea of the
Commonwealth taking over the States and only having one level of hospital management. What happened
to that?

TONY ABBOTT: Well what's happened is that I have moved on because I have discovered more about just
how difficult it is for any group of public servants to try to run things on a giant top-down
basis. It's not which level of government runs the public hospital systems which count, it's 'Are
they well run?' and I reckon this model that we are putting in place at the Mersey offers a lot of
potential for better-run public hospitals, whether in the end it's the Commonwealth or the States
which are ultimately taking responsibility.

KERRY O'BRIEN: Nicola Roxon, I can imagine that some people might find the idea of a federal
takeover of public hospitals a rather attractive proposition but it sounds on what Labor has said
so far that it would be, that they wouldn't want to be holding their breath waiting for a
referendum that would change the constitution and allow that, that's so, isn't it?

NICOLA ROXON: This is in the hands of the States to some extent. We've made clear that we are going
to demand changes, that we are going to demand better services for the community and we're prepared
to put money on the table at the Commonwealth level to help make that happen. But if for some
reason the States are not prepared to negotiate with us or don't want to pull up their socks, or
drag their feet, then we are prepared to ask the community for endorsement of a proposal for us to
take over funding for hospitals. We can't be clearer than that. It's not our preference. Our
preference is to get better outcomes through cooperation and we haven't seen for the last 11 years
what might be able to be achieved if you had a government that was prepared to work with the States
and Territories. Because Tony's Government, his Government has taken $1 billion out of hospital
funding and that of course puts pressure on the sorts of services that can be delivered. We think
that working with the States, we'll be able to deliver better outcomes. But we're not going to sit
around and just wait month in or year in, year out. If it doesn't happen we will go to the people
asking for their approval.

KERRY O'BRIEN: Sorry, Tony Abbott with the time that's left I'd like to focus on medical care from

TONY ABBOTT: Sure, Kerry, but she still hasn't explained how they're going to pay for this takeover
and what changes will have to be made to the GST arrangements.

KERRY O'BRIEN: Well we'll leave that here -

TONY ABBOTT: But it is a pretty big question, Kerry.

KERRY O'BRIEN: Alright, it will mean sacrificing time on doctors, but how do you respond to that?
Tony Abbott says you still haven't explained where your funding is going to go and he says $2
billion over four years is simply not much money at all.

NICOLA ROXON: This is $2 billion of new money that is being put on the table, that has been funded
from a range of savings which we have already announced. The Howard Government in contrast has not
been prepared to find any new money.

TONY ABBOTT: And what about the GST?

NICOLA ROXON: It hasn't actually made any commitments about what it's putting into the health care
agreement in the future and the Minister's gone off on smoko, won't actually talk to the States
about negotiations at all. So it's a bit rich for him to ask for the financial sorts of details
that he is not prepared to give from Government.

KERRY O'BRIEN: We are going to have to leave that issue there. Tony Abbott are you fundamentally
satisfied with the service offered by general practitioners and specialist doctors and the fees
charged and in terms of available service with the exception of some rural centres, and are you
satisfied that there are enough new doctors in the pipeline to solve the doctor shortage over the
next few years?

TONY ABBOTT: I'm not saying that the system is perfect but I think it is a good system and yes,
from time to time people do get hit with fees, sometimes quite high fees, and that's why the Howard
Government's safety net is so important. Last year it stood to benefit 1.5 million Australians to
the tune of some $260 million and Nicola still can't explain what Labor is going to do with that
safety net. At the last election they promised to abolish it and they still haven't made up their
mind what they're going to do at this election.

KERRY O'BRIEN: Brief response?

NICOLA ROXON: Well what's interesting is the safety net has become a necessary part of our health
sector because of the pressures that have come on working families to pay for health care, for
dental care and for other services. One in three Australians now report that they don't go to the
doctor or dentist because of cost and Mr Abbott shouldn't be proud of the fact that this is needed.
That so many people are under pressure for cost.

TONY ABBOTT: If it's necessary, Nicola, you're going to have to keep it, aren't you?

NICOLA ROXON: Well I know that Tony doesn't like to be kept in suspense for anything but we will
announce our policies in the lead up to the election when it's the right time for us, not for Tony.

KERRY O'BRIEN: Very quickly, Nicola Roxon, what would your super clinics of GPs and other health
professionals achieve that isn't available now? That comes in under the $2 billion umbrella as I
understand it, about $200 million of it.

NICOLA ROXON: This is a really important investment in frontline care for the community. We've been
told by many, many people, health professionals and others, particularly in rural communities that
we are actually not able to provide services because infrastructure is expensive, young doctors are
now finishing university with high fees that they have to repay. They won't buy into practices that
they're not sure if they can sell. If we can actually put in money for infrastructure where young
doctors can be trained, where they can work with other health professionals, where we can really
attract investment in areas that are under-serviced by Commonwealth-funded program, we know this
will make a real difference.

KERRY O'BRIEN: Tony Abbott you've had your criticisms of that as well. What's wrong with that?

TONY ABBOTT: Well look, we are doing much of this but the problem with Nicola's scheme is that it
looks for all the world like the Government setting up private practices in competition with the
private profession and I think there are certain serious problems there.

NICOLA ROXON: Well that's not what's proposed because local professionals and local communities
will bid to run these services. It is the Government paying for infrastructure which is needed and
the Government has a failed program of its own, the Rural Medical Infrastructure Fund, which has
been underspent by millions of dollars already recognising that this sort of proposal can work but
this is a much more significant approach for us and a much more significant investment of funds.

KERRY O'BRIEN: Tony Abbott, if these new super clinics take some of the pressure off the public
hospital system, surely that's a positive?

TONY ABBOTT: But you are assuming that these things don't already exist and they do. I mean there
are now dozens and dozens of really outstanding general practices that are more like massive
primary health care centres. They've got GPs, they've got practice nurses, they've got part-time
visiting specialist, they've got a pharmacy onsite, they've got diagnostics on site. They have
allied health professionals.

NICOLA ROXON: And what's wrong with funding them in areas where they don't exist?

TONY ABBOTT: Because they're operating on a fee-for-service basis under Medicare and you get what
you pay for. And the problem with this bureaucratic scheme that Nicola's come up with is that it's
just extending the public hospital problems to our primary health care centre which is certainly
not the way to go.

NICOLA ROXON: Well that's just wrong, that is not what our proposal is. That's just not - wrong,
our proposal is to have fee-for-service in exactly the way Tony described. We're just going to make
sure that it gets into those communities that don't currently have access to those types of

TONY ABBOTT: You explicitly talked about salaried doctors in these clinics - salaried doctors paid
for by the Government.

NICOLA ROXON: We've explicitly ruled them out as you know.

KERRY O'BRIEN: I have to explicitly end the debate right now. But there's clearly time for at least
one more of these during the campaign proper. Tony Abbott, Nicola Roxon, thanks for joining us