A sense of mission required for the (eventual) post-Covid nation

Jan 19, 2022
Pharmacy
There is an opportunity to renew health services after the disruptions and diversions of the pandemic. (Image: Unsplash)

We need a statesman to recognise the opportunity to renew health services after the disruptions of the pandemic. This is the second of two articles.

There will always be some politicians who will see healthcare as mere costs on the system, without appreciating that investing in, and maintaining a healthy population is an investment that pays real dividends. Healthcare, moreover, is a naturally increasing part of the economy, giving that the population is ageing; costs are more easily restrained by providing quality services efficiently than by rationing health-giving services that considerably improve the quality of life.

For those whose approach is also touched with an undue emphasis on the public-private divide, public health expenditure is often considered a bad thing simply because it involves public servants — implicitly a drain on expenditure — rather than can-do capitalists , whose every action creates jobs and investment.

The statesman, rather than the drudge, will recognise the opportunity that is being created in the course of renewing health services after the disruptions and diversions of the pandemic. It provides new opportunities to consider the problems as a whole, rather than, as so often happens in practical administration, as bit that can be dealt with only piecemeal, and usually with no great strategy.

It provides new opportunities for Commonwealth-state agreements about responsibilities, that allocate responsibility and accountability rather than feeding the blame game. It allows a new focus on developing, maintaining, providing continuous education for, and properly paying an enormous workforce of up to 750,000 Australians, including 100,000 doctors and 20,000 dentists, 300,000 nurses and midwives, and 150,000 allied health practitioners.

It also involves a chance for a careful and measured look at the development of better IT and telecommunications, including increased opportunity not only for providing healthcare in remote locations, but “tele-health” consultations for patients with chronic conditions, or mostly needing pharmacy scripts or regular pathology checks.

That also provides fresh opportunities to find savings and efficiencies in payments for pharmaceutical dispensing and drugs.  In a new environment focused on quality outcomes and better bang for the buck,  rather than mere cost-cutting, service reduction and the substitution of “personal responsibility” for general health insurance, it may well be possible to deliver better outcomes at a lower price.

But it does involve some sense of mission — some vision and some commitment — rather than a mere intention to restore things to the way they used to be. That sort of approach can produce, at best, only incremental change at the margins, and, as has been repeatedly shown, outcomes as much influenced by the promotion of the vested interests of providers rather than the public interest. The Australian Financial Review, for example, has suggested that the great shortage of RAT testing kits was primarily a consequence of the deep opposition to using such kits from professional pathologists. This was not, of course, framed as being motivated by their vested interest in a lab-based business model.

The irony of ‘punishing’ no-vax Novak

I have no strong feelings about men’s tennis (though I much enjoy women’s tennis) but I am a serious devotee of irony, not least that emanating from Scott Morrison, who even by American and Pentecostal standards is a notable irony-free zone. The past week has seen deep indignation at the arrival in Australia — with a valid visa — of Novak Djokovic, for the Australian men’s tennis championships, which he has frequently won in the past. Novak has been openly resistant to vaccination, and is said to have suffered from the Covid, which may or may not confer some immunity, but only a fraction of that conveyed by vaccine.

By the usual standards, or the Rules to which Morrison expressed such attachment, international visitors are not allowed unless they have been vaccinated. Yet the Australian Tennis Federation, on some jag of its own, tried to create some exceptions,  which Djokovic said he complied with, and was thus given a visa. Unluckily for those who were attempting to enforce the “rules are rules, unless you are a friend of the minister” rule, Border Force handled the inquisition of Djokovic with characteristic ham-fistedness and lack of honour or proper process, and Djokovic’s visa was upheld. The government promptly announced that the minister for immigration would consider deporting him on “character” grounds though the minister stayed his hand for deep thought.

On Friday Djokovic’s visa was cancelled by the Immigration Minister.

The rationale for the vax rule is, of course, that Novak should not be exposing his fellow competitors, or game officials, to the risk of exposure to the dread coronavirus. On a matter such as this, the dotty views of Novak about choice, or the dangers of vaccination must step aside to the requires of the general health of the many.

While not hectoring Djokovic, thus providing leadership on the Australian Way and Morrison was attempting to cajole premiers, and the public into the idea that people with coronavirus need not isolate nor do anything much to avoid spreading the bug if they were largely symptom-free. This was so as to keep the engine of the economy turning over, as well as keeping nurses, teachers, shop workers and truckies able to carry on. Adherence to earlier rules — designed to reduce the risk of transmission — was said to be reducing the daily workforce by 10 per cent, and, were schools to be closed, would bring that to 15 per cent.

A person testing positive to coronavirus, whether by RATs test (if you can find one) or PCR-test (if they will let you do one) is highly contagious, whether or not she is showing symptoms. Morrison, and those of his advisers who put the health of the economy ahead of the health of Australians, are judging that most of those they infect will develop mild symptoms only, or none at all. That may be so, but the latest variant, Omicron, is likely to infect many more people than the Delta or earlier variations. Thus the “small percentage” of serious symptoms — some life-threatening — may well exceed the Delta tally.

All in all, I should think that the average tennis groupie is safer from Djokovic than from her next-door neighbour, or, for that matter, Border Force.

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