Health may not be the winner

Friday, 19 March 2010 

One of the more heart-warming developments from the government’s current wobble, is to see conservative commentators putting their political leaning to one side and come rushing to the government’s aid. Gerard Henderson, of course, bridles at being called a conservative. Although he does think Labor has taken too much the side of the unions in its IR program, so, given it’s the most-anti union in the party’s history, maybe its not a Labor government he really wants. Anyway, a few weeks ago he had advice for Rudd. He suggested that the government stopped talking about climate change and the ETS and start focussing on health and the economy instead. Funnily enough, this was exactly the same advice of that other government well-wisher, Dennis Shanahan.

The judgement that health is a vote winner for Labor presumably comes from running a finger down the list of the parties’ strongest issues and stopping at the one on which Labor scores best. It seems as though Rudd has taken this to heart by challenging Abbott to debate health next week. Rudd clearly wants to have some issue to take Abbott up on while the climate change agenda stays in limbo, with no sign of revival now until at least June. But despite the best intentions of Gerard and Dennis, health may not be the clear-cut answer for the government it may seem.

There is something very politically useful in Labor’s health reform plan for the government, namely the anti-political attack it implies on the state governments. But what is the basis for that attack? Namely that state governments, especially Labor state governments, are seen as no longer capable of effectively running state services, or at least no better than the Liberals.

When state governments began depoliticising during the 1990s, and being about little more than public services, Labor’s natural links with the public service unions, and the way that translated into higher state spending in health and education, appeared as an advantage. However, given it was one of the reasons for the depoliticisation of state government in the first place, the erosion of Labor’s links with the unions started to work its away through. Combined with no real difference on spending priorities, Labor’s advantage has fallen away and in fact is now getting blamed for the state of public services. Having nothing to oppose doesn’t help the Liberals either, but they only have to look viable for even a few weeks before the election and suddenly they are in with a chance.

This problem of the impact of Labor’s eroding social base is being reproduced at the Federal level and suggests Labor in Canberra will have no more to offer running public services than state Labor did. An example of the political problems this can cause was on display last night on The 7.30 Report with Gillard talking about the claims in The Australian that the cost of the school buildings was blowing out. There was this interesting exchange about where some of these claims came from:

KERRY O’BRIEN: The New South Wales Teachers’ Federation talks about principals, teachers and parents being concerned about estimates blowing out and payments to builders way beyond normal construction costs. They’re the people on the ground.

Are you confident that the various audits are actually efficient themselves, are actually preventing waste, or arriving, as I said, after the horse has bolted?

JULIA GILLARD: Kerry, give me a break. The New South Wales Teachers’ Federation is in a vicious dispute with the Government because they’re anti MySchool. They don’t want the My School website, they never wanted it and, of course, they’re talking about boycotting the national tests.

Part of the issue for teachers here is the way that the MySchool website has turned the performance of school students into wholly being about the school (and teachers) rather than the socio-economic background that they came from. Even a cursory look at where the good and bad performing schools are would reveal it to be also a map of something else. This, plus the bypassing of state teacher unions that the national tests and curriculum represent, would not have been possible in the past from a Labor government, but is certainly possible now and especially led by someone as anti-union as Gillard. Yet by doing so Labor loses the backing of the unions in carrying out such public service shake-ups and, as in this case, even to the point where they will feed stories to the government’s critics.

We have been here before. The insulation saga was not even a traditional public works program but entering into homes in a low unionised industry and again the unions played a part in publicising the program’s problems. Abbott in his reply on health yesterday naturally made this direct link between the government’s running of the insulation program and its future ability to run the health system. There are similarities why the federal government could be vulnerable. Once again in health, a key part of Labor’s plan is to bypass the state health unions, as well as the state governments, and rely on the less dependable goodwill of those like the AMA who will win out at the local level.

In defending against Abbott’s linking of health to insulation, it hasn’t helped that the government still has not got control of the insulation issue. Rudd’s mea culpa was effective at knocking the dynamic out of the story but there was no follow though and it is still running. The government’s approach seemed to be to throw money at it and hope it will go away. What would have been tactically more sensible would be to have turned the debate around and go in hard on firms defying the regulation. It not only would have taken control of the story but would have made the Coalition vulnerable given Abbott’s natural resistance to regulation, especially on worker safety. It should have been the government going first and highlighting every case of shoddy installation it could find, rather than letting Abbott go around at his leisure to each new case as he did yesterday.

Labor’s defence against Abbott is to remind everyone that Abbott ‘ripped a billion out of the health system’, which, whether true or not, is perhaps not really where a government that started by insisting Howard’s ‘reckless spending must stop’ wants to end up. But anyway, in reality Abbott is not the one the federal government should be attacking, but rather its own state governments, for the reasons that may see two of them fall this weekend.

Posted by The Piping Shrike on Friday, 19 March 2010.

Filed under Tactics

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6 responses to “Health may not be the winner”

  1. Graeme on 20th March 2010 12:13 am

    Nice piece by Laura Tingle as today’s op-ed in the AFR.

    1. Both parties slave to Market research for at least a decade
    2. Anarchy prevailing in politics.

    At first these two claims seem contradictory: wouldn’t meek polldriven politics be the opposite of anarchy, a constant tacking to pick up subtle shifts in the median voters’ flatulent wind? Aimless, directionless, except that there’s a two boat race to win?

    But by anarchy she just means a normless flailing about. (If one adorned with gormless chestbeating). Not anarchy in the Kropotkin sense.

    Perhaps Laura has been supping from the Shrike’s nest?

  2. Tad Tietze on 23rd March 2010 11:34 am

    Part of Rudd’s problem is that the smoke and mirrors about the states’ failure and “ending the blame game” is so technocratic and complex that Abbott may well find big targets for his populist approach and sow doubt.

    It seems clear to me that Rudd wants more control in order to drive sharp microeconomic reform inside public hospitals so as to contain costs. This while he does nothing to challenge the source of cost overruns in the increasing power of private interests in public health, something encouraged by government subsidy of the private system among other things.

    Right-wing commentators like The Oz’s Michael Stutchbury have picked up on this from a pro-market viewpoint (i.e. “let’s throw more cash at the private system”).

    Amusingly, Rudd’s plan leaves IR to the states themselves despite stealing the money over which industrial disputes will be had!

    I’ve written about it here in my charmingly “old-Left” manner:

  3. Ricc on 23rd March 2010 11:39 am

    Great post. I suspect though the IR disputes will move to a single point – the AMA and the ANF going direct to the Feds.

    The whole Commonwealth basis for funding nursing homes grew out of this. Originally, the Catholic Church provided them out of donations but discovered after WWII that the supply of nuns and volunteers to do this was drying up. So they went to the biggest funder in town – the Feds, not the states, who had legislative responsibility for it.

    Surprisingly, the local hospitals, who were partly state funded but nowhere near as much as today – didn’t follow suit.

    So politically savvy orgs like the Catholic Church knew which pollies to butter up – the ones with the money, not necessarily those with clear constitutional responsibility.

    There is some danger that the AMA leave the states with an unfunabale bill, I suspect they will go on the front foot to Canberra for more lurks and perks.

  4. Tad Tietze on 23rd March 2010 1:29 pm

    Ricc: The clever thing about Rudd’s announcements to date is that they find a way to take on the nurses’ and salaried hospital doctors’ unions (ASMOF in most states) without taking on the AMA which is much more focused on private practitioners. I think this public/private split explains the AMA’s warm welcome of his plan.

    So there will be speed-ups for me as a salaried public specialist but no winding back of exorbitant private fees for my private colleagues. This will make the private system look more and more attractive and work against any plan to increase doctor numbers in public hospitals.

    The reality of markets is that everything follows the dollars. By cost-containing public hospitals in isolation Rudd will find cost-containment harder to achieve in the long run. He may also create an industrial flashpoint which pits him against health workers, part of the ALP base he has chosen to leave behind.

  5. The Piping Shrike on 24th March 2010 9:42 am

    I thought the article was interesting Tad and much what was said about the private sector made sense. But I didn’t recognise this alternative “rationally planned system”. Did you mean the government?

  6. Tad Tietze on 27th March 2010 4:55 pm


    But seriously, only a reinvigoration of mass civil society politics as distinct from “official” politics seems to hold the hope that rationality can be imposed on the very dysfunctional system we have right now.

    Better to raise the ideal of rational planning than admit defeat before you even start, IMHO. Otherwise you get stuck in the dominant market-bureaucratic discourse and don’t even know where to start with partial reforms.

    Obama had this problem writ large: he accepted the necessity of private corporate hegemony in health and then tried to construct reforms around that. His plan could end up being overall worse for poor and working Americans as a result.

    Maybe we need a pro single payer campaign here, too. 😉

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