Peter Dutton does not really believe in Medicare. He is more interested in Trump-type culture wars than the health of Australians.

He matched the $8.5 billion the Australian Government pledged for Medicare, not because he cared about the health of Australians but because it was a way to neutralise government Medicare policy.

He refuses to come up with a credible health policy.

It is the same Dutton-type approach on health as it is on China. Change your mind and your policy if it is politically advantageous.

In the lead-up to the last election Peter Dutton was beating the anti-China drum as hard as he could. Now he tells us that, “the relationship with China will be much stronger than it is under the Albanese Government”. He doesn’t really believe that, but he changed his mind about China because it was politically advantageous. The Liberal Party organisation told him that at the last election, in the top 15 seats by Chinese ancestry, the swing against the Liberal Party was 6.6% compared with only 3.7% in other seats. Five seats will be in play at the next election because of the “Chinese vote”: Reid, Aston, Chisholm, Tangney and Bennelong.

But back to Medicare.

The Liberal Party does not believe in universal healthcare. It believes with a passion that the private sector is better and more efficient in healthcare. But that is just not true. Medicare administrative costs are about 3% of total revenue. In private health insurance, administrative costs are more than double that. The major PHI companies also make very large profits and pay high executive salaries at the expense of contributors.

The Liberal Party undermines Medicare by stealth. It introduced a government subsidy for PHI to weaken Medicare. That subsidy to prop up PHI is now costing about $11 billion per annum. The Liberal Party regards Medicare as a safety net and not a universal health system.

The National Party cares even less about health in the bush where health is much worse and services are poor. It cares more about miners than farmers.

The Liberal Party believes that individuals should take more responsibility for healthcare. Consequently, we see the scaling back of bulk billing and increases in gap payments.

Dutton’s record as health minister tells us the real story and what he really thinks about Medicare.

A survey of doctors for the Australian Doctors magazine ranked Dutton as the worst health minister in 35 years. He was so embarrassing that he had to be shifted out of health and into home affairs. His performance in that portfolio was not regarded as a great success either, so he had to be shifted again, to defence.

But let’s look at his record in health.

He had to withdraw his $7 co-payment when he was minister. This increased co-payment was designed to force more payment by individuals, rich and poor.

Dutton opposed the plain packaging of cigarettes. He called it a “bridge too far”. But we know that plain packaging of tobacco has contributed greatly to improving the health of Australians. Long-term smokers die 10 years earlier than non-smokers and tobacco remains the leading cause of preventable death and disability.

He abolished the National Health Prevention Agency. We spend much less on health prevention than most other OECD countries, but we know from experience that the benefits of prevention are huge.

Even though we have made substantial progress on reducing smoking, we have made little progress in other areas.

• Obesity is rife. It is estimated that 50% of young Australians, aged between 5 and 24 years will be obese by 2050.
• Health labelling of food is unsatisfactory. Reform invariably encounters lobbying by the food and beverage industries.
• Little progress has been made in reducing sugar content in food and drinks. The National Party prefers to support sugar producers in northern NSW and Queensland.
• The promotion of junk food like McDonald’s is not curbed. Little attempt has been made to reduce serious health deterioration as a result and the consumption of fast foods- cakes, chips, chocolate and sugary drinks.
• We learned from the COVID epidemic that we were inadequately prepared and the great personal and public cost that was incurred.

A National Health Prevention Agency would have assisted in focusing on all these major preventable health problems. But Dutton decided he was not interested in health prevention and abolished the agency.

He also abolished Health Workforce Australia. We now see the consequences of that in the shortage of nurses and doctors.

But a much bigger problem is the need for reform of the health workforce structure and work practices. Multi-skilling, teamwork and flexible training are key micro-reform issues. That has been clear for decades.

An example of restrictive practices and workforce inefficiency is in obstetrics and midwifery. In Australia, less than 10% of normal births are managed by midwives. In the Netherlands, it is more than 70% and, in the UK, more than 50%. Obstetricians don’t want to concede territory.

Health is Australia’s largest industry, at about 10% of GDP. There are about 700,000 health professionals. The number is increasing by about 4% a year. The healthcare and social assistance industries represent more than 14% of Australia’s total workforce.

About 70% of every health dollar of expenditure is in labour costs. Workforce reform therefor cannot exclude such a large area of expenditure. It is more important than any other workforce issue. Health workforce reform will not be easy, but it is essential.

We have employment silos everywhere, with inadequate connections, junior doctors, specialists, clinicians, nurses, allied staff, managers, colleges, universities, pharmacists and ambulance officers. There is extremely poor human resources and people management skills across the workforce. There is a lack of co-ordination between workforce issues, service delivery, finance and infrastructure.

As the Australian Institute of Health and Welfare recently described the problem, “Health workforce reforms are essential for addressing future workforce demand and for building a more resilient, responsive and patient-centred healthcare system".

Our minimal progress in preventive health care and modernising our 19th century health workforce structure can be laid at the door of Dutton who abolished the two key agencies that could have led critical change in both these areas.

Dutton has left an awful legacy from his time as health minister. In his heart, he does not believe in Medicare as a universal health system. He is more interested in Trump-type culture wars than healthcare.

For more on Dutton, P& I recommends:

https://publish.pearlsandirritations.com/why-dutton-has-begun-flying-in-the-face-of-the-china-hawks/