http://blog.libertarian.org.au/2009/07/28/plan-to-increase-marginal-tax-by-8-5/

To square the circle we have: productivity gains (being discussed much in the NHS at the moment); improved public health investment in the short term (think of Needle/syringe programs as a classic example of spending now to save later); rationalisation of the state/federal divide so there is less double-spending on these programs; and ditching the private health rebate. Strengthening the PBAC to pre-Howard govt levels would help; greater investment in public R&D (think of the CSL development of the HPV Vaccine as an example). There are potentially large gains from people dying at home, better social care spending and more efficient aged care/health sector interaction. Better geriatric medicine in general is a good way to save – abolishing or tightening up the rules on benzodiazepines alone would have significant benefits for A&E wards, for example. Also, attacking inequalities which have large downstream effects in secondary care (e.g. improving diabetes management in poor people, to prevent their clogging up A&E with avoidable admissions) is another easy way to control costs. All these types of interventions reduce costs while improving patient care.

Also, the idea that healthcare costs should always increase or should increase at greater than the rate of economic growth is not necessarily true, but depends a lot on the way in which the growth occurs (they grow much faster in the US than here, for example); and all this ageing population stuff is a little overrated in my view.

Michael2, when I worked in a hospital I didn’t meet patients every week, so I would be sacked in your model. And yet in just 2 years I achieved:
- a computerised system for methadone dispensing which greatly reduced the risk of costly adverse events
- a direct data entry system for routine clinical visits which significantly reduced paper-based data entry costs (i.e. other administrative staff costs) and reduced the clinical staffs administrative burden
- major improvements in the ability of staff to access pathology results immediately on their computer rather than having to wait minutes or hours to view them
- a computerised system for monitoring excluded clients’ access to the clinic, with significant safety gains for all staff.

Not to mention my involvement in every aspect of public health planning, and of course all the reactive stuff I had to do every day. There is very little fat left to cut in the Australian public hospital system, and administrative staff work just as hard as clinical staff to ensure the smooth functioning of a very complex system. This administrative/clinical divide doesn’t exist in practice and we have to think a lot smarter than “no cuts to frontline staff!” if we want to contain costs and improve health in a modern hospital system.

I’m curious as to how many people, like yourself, want their favourite heroic heart/brain/kidney surgeon/nurse spending hours filling in the spreadsheets to send to government departments so that “performance can be monitored”, “clinical safety standards upheld”, “accountability” for taxpayers monies and “transparency” throughput or survival rates all can be documented and explained.

No10 is a must.

1. Organise a patient-free day (like they have pupil-free days at school).
2. Get all the hospital staff together in the car park.
3. Ask for a show of hands over who has worked with a patient in the last seven days.
4. Dismiss those who don’t put their hands up.
5. Have a vote among the core staff over which cooks, cleaners and pay staff they should invite back.
6. Ban anyone with the word facilitator or anyone who has ever used the word ‘client’ from coming withing a mile of the hospital.
7. Fine all managers 10c for every form that clinical staff have to fill in.
8. Send the bill for all alcohol-related illness to the brewers and Hotels Association.
9. Ditto for tobacco and fast food.
10. Abolish all taxpayers subsidies for private insurance companies.

Going back to the NHHRC report: the inclusion of serious proposals in the shape of the former – i.e. the clearly Scotton-influenced ‘Medicare Select’ – is encouraging. The long term stance is clearly going to be: competition, consumer choice and getting price signals into the block purchasing of health services. In many ways the report is a rejection of social democratic ideas about how to deliver healthcare. So it’s nice to see that even in the midst of the GFC you can still rely on an ALP-commissioned report into health to incorporate elements of the neoliberal agenda.

BBB

We can quickly see though that none of those things are going to be candidates for significant reform….so, it will be taxes that have to lift….which doesn’t phase me so long as the revenue is raised efficiently…

I have no problem with that broad agenda, but unless this and subsequent governments find ways to cut deeply into other expenditure programs (which I doubt they have the courage to do), the tax share of GDP is going to have to rise noticeably over time.

Let’s assume Kevin Rudd was courageous. Is there anything you’d put on the chopping block?

Most of the things that come to mind are either satisfying but don’t save a lot of money, or are on the revenue side of things anyway.

I wonder how long before he starts to define the tax share so as to exclude the medicare levy? The above was always a dumb committment to make as it is basically either a promise to underinvest in public spending or not address longer term fiscal problems. Australia’s tax share isn’t even high by developed country standards.

Simple, taxes will ultimately have to increase as a share of GDP. If Rudd wants to ignore that reality during the course of his premiership, then the task will simply fall to whomever follows him.

The last intergenerational report, which was written in the midst of a commodity boom that we now know somewhat inflated the Commonwealth’s structural revenue position, estimated that Australia faced a fiscal gap related to aging/health of between 3 and 4 per cent of GDP by 2040.

On top of that, the government wants, over time, to expand public investment in health, education and basic infrastructure.

I have no problem with that broad agenda, but unless this and subsequent governments find ways to cut deeply into other expenditure programs (which I doubt they have the courage to do), the tax share of GDP is going to have to rise noticeably over time.

Putting on my soothsayer’s hat for a minute, I reckon that within 5 to 10 years we will be facing up to having to significantly increase the rate of GST….

Perhaps I’m being pessimistic, but it almost sounds too good to be true which leads me to wonder if they’re underestimating the real costs, or banking on many people not doing annual checkups even if its free, or planning on reasonably high co-payments to discourage people or just limit the cost by having long queues (or a bit of each of the above).

I’d still say that was a very good deal. An annual checkup including full dental x-rays costs about $150 – $250 alone.

Obviously that’s going to be a harder pill to sell, given the general Australia loathing for up-front costs etc. Who knows, I’d love to be proven wrong and people to actually see and understand the value of paying a couple of hundred a year in return for proper public dental.

I’ve always thought it would make the Medicare levy a lot more palatable if it came up with your PAYG. Something to consider perhaps.

I just did a calculation on the ATO website and worked out that a 0.75% increase in my Medicare levy would work out to a max of $80. I don’t know about others, but I would gladly pay $80/year for access to a proper public dental health scheme. Hell I’d damn near beg for such a chance.

As the report pointed out, providing public dental would be cost effective, given the cost to the general health system at the moment from dental emergencies ending up in hospital, etc.

I have to say the reforms suggested are very good to this layperson’s eye. I really hope Rudd & Labor have the guts to implement them.