Ten months ago I wrote about the opportunities the pandemic provided to tackle the many problems of our health ‘system’. I have watched with dismay as those opportunities have been frittered away, first by the Federal Government and more recently by the federal Labor Party.
Immediate response to Covid
The initial response was promising. Money was spent where it was most needed to invest in the future, from support for the unemployed to increased childcare. An income one could survive on; that allowed many to eat properly and afford their medicines. Important groups missed out, regarded by an elitist Government as not important enough to deserve help, from the arts and entertainment industry to the many overseas workers and students who had for years contributed to Australia through taxes, spending, and employment. Refugees and asylum seekers didn’t count and never have.
But the Federal Government finally accepted that when one is investing in the future a budget deficit is not a bad thing, as countless OECD countries have been doing for years. ‘All in it together’ was the dishonest catchcry. However, once it was seen that the economy was going to return to growth, all that was forgotten.
New investments in the future have included vaccinations for all, including asylum seekers. Sadly this decision was based on the reality that Covid-19 among the poor could negatively affect even the wealthy. A more equitable approach to health care in general was not considered. The other investments in the future seem to be in supporting the expansion of the dying fossil fuel industry and feathering the nests of the wealthy with inequitable tax cuts.
At the same time there is a withdrawal of financial support from those most likely to immediately spend any money they have on essentials. One and a half million Australians have been returned to a poverty level income. Those who were unemployed pre-pandemic have no chance. Poverty is their lot for years to come.
Supposedly this move will encourage these people to ‘get a job’ at a time when there are multiple applicants for almost every job. What does a single mother with kids aged 10 and 13 do? Go fruit picking and leave them at home 200 kilometres away?
Poverty makes people sicker, physically and mentally. Sometimes it kills. Poor people die younger than middle income people, and much younger than wealthy people. Forcing people into poverty is not healthy.
Ideas for the Future
In the book of essays Upturn: a better normal after COVID-19, numerous writers have covered a range of topics on this subject. Only one was on the topic of health and that was directed more to developing new ways of providing health care in the context of the new ‘normal’ and of preparing for a further pandemic. None directly tackled the effects of, or the solutions to, income and wealth inequalities.
Thus, if one talks about increased employment, better work conditions, improved job security, higher wages, more increased female employment, more equitable access to childcare, less fossil fuel extraction, less air and water pollution, better education, more secure housing, stronger communities, and the many other issues raised, one is talking about health. These are the social determinants of health, the factors that determine the conditions in which people are born, grow, live, work and age. Income and wealth inequalities affect all of these factors, and are affected by them.
Investing in Health ‘System’ Reform
So what of reform of the health system? Substantial changes are required to move on from a disconnected maze of health services towards an integrated system that is patient- rather than provider-centred. That requires investment. The Federal Government has indicated it has no interest in substantial reform. Health care is generally adequate if one has the money, so the government believes that little change is needed.
One might hope Labor would be keen to invest in constructive change especially as for the first time for decades we are in an environment where budget deficits are acceptable. But in a leaked email reported in The Age, the Labor’s Deputy Leader Richard Marles is quoted as saying: “As Anthony (Albanese) has made clear, all policy proposals should consider options to minimise the fiscal impact and/or be fully offset by savings within respective portfolios.”
That appears to be an instruction not to bother even with proposals that are an investment in the future. That sets huge limitations on significant reform of our health care.
Income and Wealth Inequity: The Tax System
Ideas abound as to how we can work towards a more equitable and therefore healthier society. Tax policy can look at the disparities related to the share of the pie enjoyed by the wealthy. It appears to be off the agenda for the Labor Party, which passed inequitable tax cuts soon after losing the last election.
Income and Wealth Inequity: Lifting The Floor
To tackle what Frank Stilwell calls the floor (basic wage, welfare, unemployment payments etc) three ideas stand out.
First, we could aim for full employment as in the 1950s. Investing in large private industry construction projects may be useful, especially if not directed to further extraction of fossil fuels and destruction of our planet. But ongoing secure, properly paid employment is required. Many private enterprises have little interest in job security, fair work conditions, or quality service as is well illustrated by the fiascos of poorly regulated residential aged care, security services, publicly supported privately run vocational training, and others. We could aim to expand our public services to cover so many of these areas, providing secure and properly paid work and getting a much more reliable level of service.
Second, we could consider a Job Guarantee as proposed by Bill Mitchell (see webinar). The proposal envisages a basic wage job opportunity unconditionally provided to anyone who wants to work, and recognition that a job would include the raising of children and other tasks that are not currently valued financially. Practical issues abound but apart from income security, this aims to eliminate the demeaning, distressing, disempowering effect of a punitive Centrelink.
Third, we could consider a Basic Income Guarantee about which I and others have written before. Such an income should be sufficient to live humanely i.e. not a Newstart level but at least at pension level.
Variations on these ideas, including combinations of them and of an Unemployment Insurance scheme, require consideration by leaders who are not locked into archaic neoliberal theories and ideological elitism.
We briefly invested in our citizens and our future through JobSeeker and JobKeeper. We need that to continue but that requires courageous, visionary, and politically astute leaders. As a realistic optimist, I live in hope.