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Minister sets the agenda on medical issues for upcoming election; do we need a health summit?

PETER JEPPERSON: The proposal from a number of Liberal States for a national health summit has been met with a harsh reaction from the Federal Health Minister, Mr Brian Howe. Nevertheless, the New South Wales Health Minister plans to go ahead with the meeting on 9 February, and it will be attended by at least one Labor State Government, Western Australia - that's, of course, if Premier Carmen Lawrence and her team can pull off an election victory three days earlier.

Well, Mr Howe joins us on the phone now. Well, why wouldn't a summit be a productive thing?

BRIAN HOWE: Well, there's a process for resolving differences between the States and that's via a Health Ministers' conference. We had two of those last year and we've got one scheduled I think for April in the New Year, so that what Mr Phillips is suggesting is basically a bit of a gimmick and I think that arises from the fact that he's decided to become very political in his approach to the Medicare negotiations and wrap that up with, clearly, a defence of the Fightback policy.

PETER JEPPERSON: Of course he might say you're being political. Look - summit, conference, meeting, I mean, what does it matter? Surely the best thing is to get together and try and resolve these differences?

BRIAN HOWE: Well, I think we had that opportunity in October, and the New South Wales and Victorian Health Ministers spent the day talking about ideology and failed to talk about money at all. Now they're arguing about the fact that they don't seem to get a fair share. When they had an opportunity to talk about that, that's not what they wanted to talk about. No, look, I'm all in favour of meetings and conferences, but the reality is that the Victorian Government and the New South Wales Government seem to be absolutely determined to overturn the offer that the Commonwealth has made to the States which would provide certainty for funding for public hospitals over the next five years. It's worth more than $4 billion a year, and it essentially underwrites the public sector.

Now, in New South Wales, of course, Ron Phillips is defending a situation where he has a very, very high cost structure, so even though New South Wales would get a third of the funds, the cost structure of their hospital system suffers from the doctors' dispute in 1984. It's a very, very high cost structure.

PETER JEPPERSON: But it's not just New South Wales. I mean, Carmen Lawrence said that her Government will be represented if she wins the election in Western Australia. Is that an embarrassment to you?

BRIAN HOWE: Well, obviously Western Australia are now in the context of an election campaign and I don't want to really particularly go into State issues over there. As far as the Commonwealth is concerned, the place where we'll decide our policy with the States will be at Health Ministers' conferences. Now, if we're going to have a broader conference, well, let's invite everybody and let's, for example, invite the Nurses Federation in Australia. They have very, very clear views about health policy. Let's invite the Consumer Health Forum and all of the groups that represent consumers around Australia. I mean, it's a nonsense. If you want to organise a serious, broadly-based conference you don't do it in a few weeks. That would take months to organise.

On the other hand, if you've got serious proposals that can be considered by bureaucrats and ultimately by Ministers, there's a process to do that. The reality is that Ron Phillips, and I think to some extent Marie Tehan, have essentially, rather than seeking to negotiate the Medicare agreement, sought to grandstand and politic. And I think it's got to be seen in that light and they particularly have to be put under some scrutiny in terms of their attitudes to not only our offer but to Fightback policies. After all, what Fightback represents is a cut - it's not an increase - but a cut of $1.3 billion a year in hospital funding grants. For New South Wales that means $450 million less; for Victoria it means something like $350 million less. Now, if we want to get into that kind of discussion let's get into it, and let's hear what Mr Phillips and what Mrs Tehan think about the Fightback alternative that is clearly before the voters and being advocated by Dr Hewson.

PETER JEPPERSON: Some might say that a summit would be a good place to do that, but look, let's try and read between the lines. One might think that what's really going on here is who is running health policy in this country. Now, is it you? Is it the States? Is it a co-operative arrangement? What's going on?

BRIAN HOWE: Well, I think it's essentially, has to be a co-operative arrangement because the responsibility is shared between the Commonwealth and the States. We spend a very large amount of money in health, at a Commonwealth level. We not only contribute about 40 per cent, or a little more, to the costs of the hospital system, but we pay for the Pharmaceutical Benefits Scheme and we also pay for the cost of the Medical Benefit Schedule, that is for visits to GPs around Australia where the Commonwealth bears the cost of the rebates. So we are responsible, I suppose in a broader sense, for health within this country.

PETER JEPPERSON: Yes, you're responsible, but one can't help getting the feeling that the States are not happy, they really don't want to be part of what you're doing, particularly Victoria and New South Wales. One has a feeling that the system just isn't working at the moment. Who's responsible?

BRIAN HOWE: I think that Victoria and New South Wales are seeking to go in a different direction, and essentially they're pursuing the path of privatisation. And what they want to do is to substitute subsidies for private insurance for public dollars going into public hospitals around Australia .... a choice.

PETER JEPPERSON: Why are they wrong then?

BRIAN HOWE: And the people are going to have to decide about that.

PETER JEPPERSON: Well, why is that approach wrong?

BRIAN HOWE: Well, it means that there would be a lot less money coming via the Commonwealth, and I think what New South Wales are basically saying, and Victoria, is that they want more money from the Commonwealth, plus they want the Commonwealth to underwrite the subsidies for private insurance. Now, the difficulty with that is that essentially it would mean that ultimately people would finish up paying a lot more for health and we'd see the costs of health blow out and the security of people's, the certainty people would have in relation to health care would, in fact, go. And I think that's a very poor deal indeed.

PETER JEPPERSON: This, of course, is a Federal election year. How important do you think health policy will be in the Federal election?

BRIAN HOWE: Well, I think it's one of the three or four principal issues. It's certainly a very good example of the emphasis in Fightback on cutting back on the public sector. After all, a bit over a billion dollars off health, that's a very large amount of money. And if hospitals are hurting for money, one would have thought it's a very strange way to go about it to, in fact, be cutting back.

But, of course, the shift towards private is essentially about looking after the vested interests that support the Liberal Party. It's about the private insurance funds, and it's about looking after the AMA. So the AMA would dictate the price structure; the health insurance funds would have to pay what the AMA dictated - and that was made very clear the other day in an exchange between one of the health insurance funds and the AMA. And, ultimately, people out there are going to finish up paying more, out of pocket, every time they go to a doctor, and they're going to find the costs are going up. And when they go to a hospital they won't be clear what they're going to finish up paying. Under Medicare, of course, people can elect to be a public patient in a public hospital, and they can come out of that hospital without having a bill at all.

PETER JEPPERSON: Looking to the election, and I realise it's not your decision, but when would you like an election - early or late?

BRIAN HOWE: Look, I think we're at the stage now we're obviously we're going to be involved in contentious political debate, and it's important that people have the opportunity to participate in that debate, to talk the issues through.

PETER JEPPERSON: So a later election is the preferred option for you?

BRIAN HOWE: Well, I think it's really a matter for the Prime Minister. I think if we all start getting into trying to pick when the Prime Minister elects to call an election, well, I think we'll have a funny situation. So I don't want to do that. And I think all I am saying is that there is now quite an intense political debate under way. When the Prime Minister returns from holidays, no doubt the temperature will rise even further.

PETER JEPPERSON: Yes, it certainly will. Will the West Australian election be a relief to get out of the road for you?

BRIAN HOWE: Well, I think that we've known the Western Australian election was coming at about the time it's being held. And we'll just have to see. I don't think there's any great correlation between what happens in Western Australia in the State election and what will happen federally.

PETER JEPPERSON: Do you feel nervous about facing the voters this year?

BRIAN HOWE: No. I think that we've got a very clear choice. And I've got a great deal of confidence in the intelligence of voters. I think they'll look at industrial relations and they'll see, well, we've had a decade of industrial peace, why would we want all that conflict. They'd look at taxation policy, and I think would be rather concerned about not just a goods and services tax but one at 15 per cent. I mean, that's a pretty massive impost. I think they would certainly count the cost of a massive cut in the public sector. And then I happen to think health is one of the other issues that will be of great concern to people. We've had 10 years of stable health policy, the first time probably in our history, in which health costs have been under control and we have haven't had any great crises or problems in the health system that can't be resolved. So I would have thought in those four areas there are clear differences and a very good basis on which for us to campaign successfully.

PETER JEPPERSON: Yesterday on the program the Federal President of the Liberal Party, Professor Goldsworthy, called for a new, tougher approach by a Federal Government. He promised that that would be delivered by a Liberal Government if it's elected, and he blamed the Labor Party for, in a sense, not being tough enough and for getting us into the economic mess. What's your response to all that? I mean, have you been tough enough? Have you failed to respond to the need for change?

BRIAN HOWE: Well, I'm not quite sure what he means and, of course, there's always the question of tough for whom? I mean, I think the Liberal Party has always wanted to be very, very tough on wages policy because it doesn't represent the interests, essentially, of wage earners. It's always wanted to be pretty tough in terms of public spending because it knows that the bulk of public spending goes to those at the bottom of the pile. I mean, I don't think that the Liberal Party being tough necessarily impresses anyone. If you're talking about the Labor Party's record in terms of economic management, it's been a record in which we have made a lot of decisions that have been difficult decisions, and I don't think anyone has ever suggested of our Government that it was a weak government.

PETER JEPPERSON: Do you see yourself as the party of compassion?

BRIAN HOWE: Well, I think the record stands for itself. If you look at the level of social security payments and the other forms of protection for low income people in Australia, of course the Labor Party has an outstanding record, whether it's the Family Allowance Supplement, whether it's Austudy, whether it's the development of Medicare, the opening up of places for university students, the great opportunities for training and for tertiary education for those that haven't had a great academic background at school. I mean, all of those opportunities do represent, I think, a significant achievement for a labor government in the best traditions.

PETER JEPPERSON: All right then, well, we'll see what the voters think later this year. Mr Howe, thanks for your time today.

BRIAN HOWE: Thank you.

PETER JEPPERSON: That's Brian Howe, the Federal Health Minister.