Update: The debate is being live streamed here.

Update: Roxon is very impressive, across the detail. The thing is that health is a very complex policy area, and Labor *does* have an integrated approach. But that means not everything can be done at once. The Coalition’s approach is to cherry pick bits of health for headlines, and in response to the pressure of particular interest groups. The question is whether this trumps a very well thought out policy framework which seeks to get the settings right first, while putting in place the building blocks for a holistic approach to patient care.

There is, imho, a lot more difference on health than the “parties are the same” narrative would have us believe.

Update: You should be able to get a good sense of what was debated through looking at the Tweets using the #npc hashtag. It was actually a useful policy encounter, with Dutton performing somewhat better than may have been anticipated, but with Roxon demonstrating her great command of policy detail and the ALP’s integrated plan for health. To some degree, the interchange would have been improved by sharper questioning from the journos in the audience – for instance, there are many unanswered questions on how the Coalition’s local hospital boards would actually work, but he wasn’t pressed on this, or on the very reactionary move to cut funding for e health.

Elsewhere: Mark at The Drumroll on the Ministers’ debates.

That’s continued to be the case over the last week with everyone parsing all the vicissitudes of Kevin Rudd’s political downfall, welcoming our first female PM, and frantically speculating about polls, the elections, and what she might do.

Tony Abbott has now seized the chance to come out with some positive policy, after a very long stretch of time when the Labor government was eating itself, and his fitness for office completely escaped scrutiny.

On the back of the resignation of Professor John Mendoza as Chair of the Rudd government’s National Advisory Council on Mental Health on the 10th of June, Abbott has now announced he’ll fund much of Mendoza’s program. (While we’re on social policy, he’s also declared that Indigenous disadvantage can only be ended if people take any job they can find.)

Mental health is a very important area, and it’s something that has touched me personally. I think that’s the case for more Australians than always care to admit it. But the Coalition’s announcement is not the panacea it may seem to be on first glance.

Abbott is trying to reinforce the contrast he’s been making since his Climate Change plan between his “direct action” approach and complex Labor reforms.

So, to pay for the mental health dollars, a host of Labor health programs bite the dust.

Health policy specialist Professor Stephen Leeder correctly warns that the Coalition cuts would make a nonsense of the overall health reform package.

We’re not just getting, in other words, a piece of the picture Labor didn’t pay, but the evisceration of health reform.

Abbott’s approach as Health Minister was to prop up the private sector and blame the states for everything that went wrong for public patients, while presiding over a continued shortage of medical staff and a near disappearance of bulk billing.

So he won’t be terribly bothered that this announcement kills the National Health and Hospitals Network, without explicitly saying so.

But that’s what’s happening, and that’s the context in which his announcement should be evaluated.

Elsewhere: Reaction at Croakey, Bernard Keane in Crikey.

But he cautions:

The first thing to mention about these polls is what they don’t measure. As a result of them being in the field on Thursday night in the case of Galaxy and both Thursday and Friday nights in the case of Nielsen – they wont be measuring a proper voting intention, but instead measuring an initial public reaction. We’ll have to wait for a week or so for the phrase “Prime Minister Gillard” to sink into the public brainspace before we can start to get a confident grip on the voting intention fallout.

As a result, don’t be surprised to see quite a large variation in polling results over the next polling cycle.

Of great interest also is the fact that a majority of Galaxy respondents believe that the ALP made a bad decision forced by panic, with a larger majority believing that Julia Gillard shared responsibility with Kevin Rudd for decisions of the Government.

I still don’t think that the ALP has made a persuasive case for the manner and speed with which Kevin Rudd was removed as PM. Interviews with Nicola Roxon and Chris Bowen on successive nights on Lateline show this. People can recite the verities of the Westminster system all they like, but the reality of presidential campaigns in modern Australian politics is that electors feel they are choosing between candidates for PM as well as parties. There’s a lot of evidence that there is real hurt and shock at the way in which Kevin Rudd met his political Waterloo in the electorate, a sentiment acknowledged by Julia Gillard herself.

Retrospectively validating the decision through the evidence of two polls must be tempting for Labor figures, but I’d return to my earlier point about polls representing a snapshot of static public opinion. And my argument about the dangers of staking everything, including the weighty matter of who should lead our country, on the next poll.

The leadership change may have brought those voters Possum characterises as “skeptical partisans and ordinarily soft voters back into the fold”. But the underlying reasons why those voters left Labor haven’t gone away. The rhetoric from Gillard and others in the ALP holds out inconsistent hopes – for a ‘tougher’ or a more humane line on asylum seekers and “border security”, for an end to a divisive tax debate and for mining companies paying a fair share of taxation, for action on climate change and for a deferral on an ETS until there is “consensus”.

At this stage, disillusioned voters can take their pick as to whether they believe Gillard will move government policy on the great issues of the day in their preferred direction. But not everyone can have what they want, and these circles simply can’t be squared so as to render disparate voting groups simultaneously happy for very long. The government must act, and must decide, and which way those decisions go will be the true test of Julia Gillard as Prime Minister in the lead up to an imminent election.

NB: Previous discussion of the Labor leadership challenge on LP is here.

Elsewhere: Mumble, What The People Want.

Elsewhere: Guy Rundle:

Gillard’s wave of support derived from becoming the first female PM, and Labor at that, will not long survive a rightward turn on asylum seekers, and other ‘necessary’ manouevres.

Update: Newspoll is out, showing a small increase in the 2PP to 53-48, but a rise of 7 points in the Labor primary vote, largely at the expense of The Greens.

Dennis Shanahan proclaims that only he and “hard heads” know how to interpret polls, but Peter Brent thinks not.

Elsewhere, Graham Young details the latest National Forum qualitative polling on Julia Gillard.

Update: [by Kim] Essential Research has Labor on 54-46 2PP. Bernard Keane points out that the sample is a rolling one, so it shows that Kevin Rudd was already pulling Labor’s primary vote up and attracting voters back from The Greens.

You know the script.

I’m not sure that we can be that definitive in either predicting no outcome or in assessing the subsequent politics.

Aside from funding incentives, a lot of the cards are still in the Commonwealth’s hand.

I’ve been most impressed with Kristina Keneally’s strategy throughout the manoeuvring around health. Her advocacy of what is essentially a single funder model, a pooled fund into which both the Commonwealth and states contribute, with the states hypothecating GST revenue rather than the Commonwealth clawing it back, seems to me to represent a compromise which comes very close to the original intention. And her presentation of the arguments has been assured.

She has an end in mind, and a path to that end.

By contrast, John Brumby’s intransigence seems to me to have a limited shelf life. A range of health experts have queried his claims about the superiority of Victorian hospitals, and in any case, the plan largely mirrors the Victorian system. Part of Victoria’s advantage is that its population is more concentrated over a smaller geographic space, allowing it to avoid the problems of coordination that states like Queensland, WA and NSW confront. He should also realise that his position is unsustainable in the longer term.

Brumby has to face his own electors, and deal breaking might get you so far with the admirers parochial tub thumping, but if there is no deal, Kevin Rudd will be lining him up as a duck in a row alongside Tony Abbott as an obstructionist. If he really wants a federal campaign, including a referendum, which would see him aligned with the naysayers on health (because that’s how it will be played), that’s his choice, but it seems to me to be poor political thinking.

I’m also not so sure that the conventional wisdom on the health referendum is right. Tim Dunlop argues it’s not. And it’s being reported that the referendum bills have already been drafted. So it’s quite possible to envisage a lose-win strategy for Federal Labor emerging out of a COAG defeat. But I think the forces for agreement have been underestimated.

NB: Previous discussion on LP here.

Update: The ABC is reporting that every premier bar Colin Barnett has signed up to the Rudd plan, including the cession of 30% of the GST to the Commonwealth. Barnett is negotiating one on one with Rudd. I think it’s a safe bet to say NSW’s strategy changed the game.

Update: More from The ABC. As I said in comments, I suspect Colin Barnett will come on board after one on one negotiations for “special arrangements” for WA.

Tim Dunlop has a great piece at The Drum [h/t Lefty E], arguing that:

Such a negative response to those issues points to a deeper problem in Mr Abbott’s general approach. It is no secret that — to some extent as result of his own hubris — the PM is not well-liked amongst the media that covers him. Thus, Mr Abbott’s aggressive, mocking approach to Mr Rudd has played well to that audience. Mr Abbott has, understandably, revelled in it.

What he should take away from today’s debate, though, is it is not the media he has to impress. What he has to realise, is that if he is really going to cut through and win the trust of the voters — rather than merely consolidate his so-called base — he is going to have to do more than dispense good one-liners on a beach somewhere wrapped in red cling film.

That nails it, I think. Throughout this term, the Liberals have mistaken public support for the adulation of the commentariat, and much of the ‘media narrative’ reflects nothing more than the navel gazing of the opposition/journosphere. It shouldn’t come as any surprise that constant carping, arrogance and rudeness are turnoffs with voters, how ever much op/ed writers want to cheer on the ‘pugilistic’ Direct Action Man and his supposed mad debating skillz.

Trevor Cook is also on song, starting by recording his amusement at the somersaults and permutations the press gallery have executed to explain away The Worm, and going on to characterise Abbott’s style aptly:

The fact is that Rudd was better prepared and better disciplined. His messages were better targeted (let’s fix the problem) and he never got flustered. Abbott appeared to have nothing to say, except a few lame one liners about Rudd. Rudd looked relaxed and on-song, Abbott looked like he was forcing it, working too hard for a laugh (they all back-fired) and waiting for the moment to throw his killer punch (never happened).

Abbott’s so-called great debating skills amount to nothing more than a sneer and a shout from a schoolyard bully. We saw it with Nicola Roxon and Bernie Banton in the last election campaign, and he tried to do it today but it just didn’t come off. Like all bullies, Abbott is just bluster.

This debate revealed, again, the main flaw of Abbott’s make-up as a politician – he lacks policy substance. He has none of the grasp of Rudd, Howard, Keating or Hawke. He just hasn’t spent much time wrestling with ideas and issues. Policy development can’t be done in a surf contest or a bike marathon. That’s why he can come up with a crazy idea like the parental leave scheme which taxes business to pay the salaries of people on $150,000. He just doesn’t ‘get’ what his party stands for.

Please add any interesting links in comments, and I’ll add them later on.

Elsewhere: Bernard Keane at The Stump, Ben Eltham in New Matilda.

Update: The Drum wraps the opinions of health policy experts on the debate.

Update: Croakey, with more health policy experts finding the debate underwhelming. I’m not sure all those in the thick of the policy debate really understand political communication. The point of an exercise like this is not to convey every aspect of the detail, or respond to any conceivable operational or technical question. Indeed, if Rudd had gone into policy wonk mode, as Abbott perhaps expected him to (forgetting the ‘Kevin from Queensland’ style from 2007), it would have been a disaster. This debate was about politics, and also about explaining the basics of the plan to the public in terms which resonate. That’s an absolutely basic step in securing wide support for any complex reform, as the negative experience of the ETS should demonstrate. I think some of the wonks need to get outside the wonksphere a bit.

Update: John Quiggin predicts Tony Abbott will be the new Lara Bingle.

The idea first came to attention in the National Health and Hospitals Reform Commission’s final report, which proposed that such individuals “have the option of enrolling with a single primary health care service to strengthen the continuity, coordination and range of multidisciplinary care available to meet their health needs and deliver optimal outcomes.”

In a nutshell, the idea is that these kinds of patients aren’t being looked after properly by the current fee-for-service payment structure for GP’s, and that their care isn’t being properly integrated when they see multiple health care providers. So if we encourage GP’s to take on these kinds of patients, be the primary coordinator for their health care services (like the family doctor used to do), and provide the appropriate level of care, they will be better managed.

The report also recommends a bunch of other changes to support the enrolment model:

To support this, we propose that

• there will be grant funding to support multidisciplinary services and care coordination for that service tied to levels of enrolment of young families and people with chronic and complex conditions;

• there will be payments to reward good performance in outcomes, including quality and timeliness of care, for the enrolled population; and
• over the longer term, payments will be developed that bundle the cost of packages of primary health care over a course of care or period of time, supplementing fee-based payments for episodic care.

The current implementation appears some way from this, offering a flat fee of $100 to doctors for enrolments, leading to the concern that doctors seeking to maximise their financial return will simply enrol as many relatively low-needs patients (such as healthy toddlers) and leave the more time-consuming and costly patients even worse off than before.

However, in the report, and in the reportage in the news, I can’t see any discussion of what this kind of proposal would mean for patients, and why they would participate. What’s being “enrolled” with a GP going to do for you if you’ve got diabetes or a heart condition (or Crohn’s disease)? Why are people with such conditions going to multiple GP’s in the first place?

Of course, there’s another approach to changing care incentives – get rid of fee-for-service entirely and make doctors salaried employees of a government body. Anybody want to bet on the odds of that ever happening?

The majority report from the Labor Senators is careful to quote several comments from Peter Costello in his second reading speech back in 1996 and the explanatory memorandum in order to demonstrate that its stated purpose was to provide an incentive only to higher income earners. However, the grounds for defending the levy have shifted, reflecting over a decade of Howard era support for the private health industry. We’re now told that it would have a catastrophic impact on health funds. These concerns are largely dispelled by evidence from health policy experts and health economists cited in the report. There’s scepticism that the much heralded exodus from private health will actually take place, for two reasons – that the life time cover provisions are likely to provide the stronger disincentive, and that those who actually value private health won’t leave. In addition, the best estimate is that the costs to the public sector would be around 1.6% of inpatient expenditure, an increase relatively easy to absorb.

In effect, no one is disagreeing that the policy measures in place represent a subsidy to private insurers – of massive proportions. Using figures from the Productivity Commission and other sources, the report discloses that the 30% rebate alone cost $980 million in 2006-7, dwarfing the value of tax concessions available to primary producers – $192 million – and mining – $130 million and even surpassing the dizzy heights of assistance to the manufacturing industry – valued at $963 million. Yet the financial press, all the commentators and economists routinely decry such “industry assistance” as “business welfare” (with reason). Somehow the specious argument that the private health industry provides a public good isn’t held to anything like the same standard of rigorous assessment, though that case is made in this report by Greens Senator Rachel Siewert in her dissent.

Given that the evidence from independent experts suggests that the arguments of the industry and the opposition are gross exaggerations, it seems undeniable that the bill should be passed as a matter of equity. It will be interesting to see what Senators Xenophon and Fielding think.