One Nation, guns and the Queensland question: what does it all mean for the 2019 federal election?



File 20190328 139371 1uycvcc.jpg?ixlib=rb 1.1
Pauline Hanson claims the Al Jazeera undercover “sting”, which has grabbed international headlines, was a media “stitch-up”.
AAP/Dan Peled

Chris Salisbury, The University of Queensland

Of all the controversies to conceivably bring Pauline Hanson undone, private discussions about gun law amendments wasn’t an obvious candidate.

Yet her recorded comments about the 1996 Port Arthur massacre and subsequent gun law reforms are potentially destructive for her One Nation party. Only potentially, though; Hanson’s supporters have long shown a propensity to forgive or shrug off her party’s outlandish or shocking assertions.




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Already, Hanson and party colleagues have shifted blame for the Al Jazeera “sting” to a media “stitch-up” and, they claimed, foreign political interference by an “Islamist media organisation”.

Presumably some Hanson adherents will find that plausible – the party has made anti-Muslim rhetoric part of its regular platform. Other One Nation supporters might now question the principles the party claims to stand for.

Why guns policy?

Why would One Nation seemingly risk whatever political capital it possesses by flirting with changes to gun controls and seeking assistance (if not funding) from gun lobby groups?

The party’s nativist policy positions on refugees, immigration and foreign investment are well known and readily detailed on its website. Until now, gun law amendment has sat well behind these. One Nation’s listed policies on firearms regulations include increasing penalties for gun-related crime and “streamlining” weapon licensing requirements. Not exactly controversial stuff.

But it is important to remember that the party first emerged in the wake of the Port Arthur shootings and rural resistance to the Howard government’s gun ownership reforms. Hanson and her candidates campaigned in the party’s early years on relaxing John Howard’s laws. They also benefited politically from a mainly regional backlash against these – and against Howard’s National Party partners.




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Recently highlighted connections between Australian gun lobby groups and minor parties, including One Nation and Katter’s Australian Party, bring the backdrop to this policy agenda into sharper relief.

One Nation’s original and more recent platform caters to disaffected, largely non-metropolitan constituents who feel the party’s anti-immigration, anti-foreign business and anti-government intervention policies “speak for them”.

In its recent incarnation, One Nation has tried – and found ready accomplices in sections of the media – to “mainstream” its appeal and some of its positions. It’s been observed that the party’s Senate members have regularly supported the Coalition government’s legislative agenda during this term, on matters ranging from the reintroduction of the Australian Building and Construction Commission (ABCC) to reduced welfare spending.

The party’s suite of published policies covers matters of concern to many Australians, such as power prices, transport infrastructure, water supply and jobs creation.

In this respect, it was perhaps not so surprising that Liberal MPs should describe the party as “more responsible” than its earlier manifestation. Even former prime minister Tony Abbott, Hanson’s one-time political nemesis, endorsed One Nation owing to its “constructive” relationship with the government in parliament.

But this normalisation fails to mask the party’s extreme stances or inconsistent policy positions – even between its own members. One Nation adheres to curious policies decrying United Nations infringement on our sovereignty, as well as questionable claims about evidence-based climate policy.

Then there is the attention-seeking behaviour: Hanson wearing a burqa in the Senate chamber; or Queensland Senate candidate Steve Dickson suggesting the Safe Schools program involved teachers instructing students in masturbation techniques; or New South Wales upper house candidate Mark Latham proposing Indigenous welfare recipients undergo DNA testing. Stunts like these place One Nation firmly on the political fringe – though not without fellow dwellers. Notoriously, Coalition senators scrambled to backtrack on supporting Hanson’s Senate motion decreeing that “it’s OK to be white”.

Stunts such as Pauline Hanson wearing a burqa in the Senate place One Nation on the political fringe.
AAP/Mick Tsikas

This latest party engagement in seeking out overseas gun lobby assistance highlights another inconsistency, given Hanson’s vote in the Senate supporting new restrictions on foreign donations.

The Queensland question

Considering this, why do One Nation’s policies seemingly still appeal to significant numbers of voters, particularly in Queensland? Traces of an entrenched conservative political culture thumbing its nose at “the establishment” partly explain the party’s appeal in Queensland (and perhaps some of Peter Dutton’s ill-judged, racially charged comments as immigration minister).

It’s a culture underpinned by a history of less diverse migrant influence than other parts of the country and arguably a more wary, paternalistic past regarding Indigenous and minority communities.

Another reason is the accentuated city-country divide in Australia’s most decentralised mainland state. Here, some agrarian-themed party policies – such as for dam building or vegetation management – directly pander to regional voters. As a minor party not in government, though, One Nation has limited opportunity to carry these through, beyond aiming to wield balance-of-power influence in the Senate.

More telling is One Nation’s claimed inheritance of an old National Party constituency. It is one that feels “left behind” – a sentiment the Shooters, Fishers and Farmers Party successfully tapped into in the NSW election.

As in the past, the Nationals will seek to differentiate themselves from their Coalition partners and marginalise One Nation and other far-right parties ahead of the 2019 federal election.

But that’s no easy feat in Queensland. Since the Liberal and National parties merged in the state to form the LNP in 2008, there has been no distinct outward National Party. Some rural and regional voters in Queensland have felt unrepresented to a certain extent, and their grievances have placed many in a resurgent One Nation camp.

The party’s identification with aggrieved outer-urban and regional conservative interests keeps its voters’ preferences an issue. Again, this is especially so in Queensland, where several LNP MPs hold seats in such areas on tight margins.

But following this week’s revelations, and particularly in the wake of the Christchurch shootings, the preference issue will bedevil the Coalition in this state and elsewhere.




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The prime minister’s latest announcement directing the Liberal Party’s state branches to preference Labor ahead of One Nation sends a needed message, but not unequivocally. It apparently leaves Liberals free to place One Nation ahead of the Greens or others, and is ambiguous on how this will apply to all LNP MPs in Queensland, or possibly influence Nationals MPs elsewhere.

But the clamouring of Queensland’s Nationals-aligned MPs for new coal-fired power stations – mirroring One Nation policy – indicates their likely preference leanings in favour of the minor party (and presumably leaves the Greens last of all).

The recorded actions and comments of Hanson and her party colleagues could bring a political reckoning for One Nation at the coming federal election. Voters will soon judge if the party warrants their electoral support and decide if this new controversy is a bridge too far.

For its part, the Coalition is treading a line between getting its hands burned over preference “deals”, as happened at Western Australia’s last election, or doing as John Howard (ultimately) did and jettisoning One Nation preferences altogether.The Conversation

Chris Salisbury, Research Associate, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Coalition’s record on social policy: big on promises, short on follow-through


Anja Hilkemeijer, University of Tasmania; Amy Maguire, University of Newcastle; Katharine Gelber, The University of Queensland, and Peter Whiteford, Crawford School of Public Policy, Australian National University

This article is part of a series examining the Coalition government’s record on key issues while in power and what Labor is promising if it wins the 2019 federal election.


Religious freedom

Anja Hilkemeijer, Law Lecturer, University of Tasmania; and Amy Maguire, Associate Professor, University of Newcastle Law School

In December 2017, joyous scenes accompanied the long-awaited enactment of marriage equality in Australia. This joy was soon replaced by outrage, however, when the community learned of the extent to which religious schools may legally discriminate against students and staff on the basis of their gender identity or sexual orientation.

In response, Prime Minister Scott Morrison announced last October that parliament would swiftly act to disallow religious schools to expel students on the basis of their sexuality.




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However, action on removing the special exemptions in the Sex Discrimination Act 1984 (SDA) for religious schools quickly stalled. Following a number of private members’ bills, a range of amendments and two Senate inquiries, it became clear the Coalition government wanted religious schools to retain some special exemptions.

In a Senate committee report in February, Coalition senators insisted the matter of religious school exemptions from the SDA be referred to the Australian Law Reform Commission.

To date, no referral has been made. And given the few parliament sitting days scheduled before the federal election, it appears this issue will fall to the next parliament to resolve.

The Coalition has also announced a number of initiatives to boost protections of religious freedom following the release of the long-awaited Ruddock Religious Freedom Review in December.




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Contrary to the panel’s recommendation, Morrison said the government would appoint a religious freedom commissioner to the Australian Human Rights Commission. He also said he wanted to pass a Religious Discrimination Act before the next federal election, but the government has not provided any details on what form such a statute might take.

While the Liberal Party’s election policies have yet to be released, it is safe to assume the Coalition would seek to implement all the proposals announced in response to the Ruddock report if re-elected.

What about Labor?

If Labor wins the May election, it will feel pressure to follow through on removing exemptions for religious schools in the SDA, as it has committed to doing.

Labor has also indicated it supports enacting a federal law to prohibit discrimination on the basis of religious beliefs, but it needs to see the details of such a proposal before committing to it.


Freedom of speech

Katharine Gelber, Professor of Politics and Public Policy, The University of Queensland

Freedom of speech has become a prominent topic in public debate in recent years. One trigger was the 2017 marriage equality survey. During the campaign, the Australian Christian Lobby argued that marriage equality would “take away” people’s right to free speech and former Prime Minister Tony Abbott insisted that a “no” vote was essential, “if you’re worried about religious freedom and freedom of speech”.

A second trigger was the 2017 parliamentary inquiry into freedom of speech, which raised the question of whether the wording of the racial vilification provision in federal law (Section 18C) should be changed, and whether the procedures under which complaints are dealt with by the Australian Human Rights Commission should be altered. Subsequent attempts to change the text of Section 18C were unsuccessful.




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What has received far less media attention, though, are the multiple ways in which the Coalition has undermined free speech while in government. The Coalition appears to be a friend of free speech only when it suits them.

The list includes extensive laws that restrict free speech far more than is necessary for legitimate national security purposes.

These include counter-terrorism laws prohibiting the unauthorised disclosure of information that does not have a public interest exemption. Another new law ostensibly designed to prevent foreign interference in Australian affairs exposes journalists and charities to risk of prosecution.

In addition, the Coalition included secrecy provisions in the 2015 Border Force Act intended to prevent people who work in offshore detention centres from disclosing information. The legislation was so draconian, the UN special rapporteur on the human rights of migrants cancelled a planned visit to Australia in September 2015 on the grounds it would prevent him from doing his work. Eventually, in the face of a High Court challenge in 2017, the government removed the provisions.

What about Labor?

Labor’s position on free speech is less clearly stated. On the one hand, it has a record of support for national security laws that restrict free speech. However, Labor takes a different stance from the Coalition on anti-vilification laws, which it defends as narrow, valid restrictions that prevent racism, bigotry and discrimination.

Perhaps the biggest shift in public discourse around free speech has been the degree to which politicians from One Nation, Katter’s Australian Party and the United Australia Party, as well as some from the Coalition, have been emboldened to promote harmful stereotypes of migrants, asylum seekers, LBGTQI and other marginalised groups.

Indeed, in some quarters, political rhetoric has become so caustic that it has separated informed public debate from evidence and reasoning, and undermined core democratic institutions.

If Labor wins the election, its biggest challenge will be to provide the leadership to shift public discourse away from this and facilitate a political culture that embraces diversity and provides free speech to as many people as possible.


Social security and welfare

Peter Whiteford, Professor, Crawford School of Public Policy, Australian National University

Social security and welfare remains the largest component of government spending. In the latest budget released by the Coalition government, spending is projected to increase from A$180 billion in 2019-20 to just over A$200 billion in 2022-23. This represents a slight fall, however, from 36.0% of total spending to 35.8%.

Compared to previous budgets, there are no major proposed cutbacks in assistance. The Coalition government has attempted to slash funding for social security and welfare in its past six budgets, with little success.

There are some welcome initiatives set out in the budget, including a commitment of A$328 million over four years to the National Plan to Reduce Violence Against Women and Their Children, and a commitment of A$527.9 million over five years to establish the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.




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But the budget also extended the government’s Cashless Debit Card trials, which have courted controversy. The Australian Council of Social Service has argued the card curtails people’s freedoms and hasn’t resulted in any positive effects. This followed an Australian National Audit Office report, which concluded that the card had major flaws and it was difficult to see where social harm had been reduced due to a “lack of robustness in data collection.”

The Coalition government has attempted to play up its social security and welfare successes in recent years, pointing to the fact that the proportion of the working-age population receiving income support is at its lowest level since the early 1980s.

But this appears to be the result of fewer people applying for benefits rather than people moving off benefits more rapidly, as has been claimed. It also reflects a somewhat stronger labour market in recent years and changes introduced to the Parenting Payment Single and Disability Support Pension programs under the Rudd/Gillard governments.

What about Labor?

Whoever wins the next election will face pressure to further increase welfare and social security spending as the National Disability Insurance Scheme ramps up and the Aged Care Royal Commission releases its findings. The recent report by the Parliamentary Budget Office projects that real spending on aged care will increase by around A$16 billion over the next decade as a result of Australia’s rapidly ageing population.

Newstart, the main payment for unemployed Australians, is also increasingly being seen as inadequate. It has slipped relative to pensions and wages each year because it is indexed to the slower-growing consumer price index.

Labor has promised that, if elected, it will use a “root and branch review” to look at lifting the rate of the Newstart unemployment benefit. However, it is not just Newstart that is inadequate, but support for single parents and families with children, which has been cut by both major parties over the last 15 years.The Conversation

Anja Hilkemeijer, Lecturer in Law, University of Tasmania; Amy Maguire, Associate professor, University of Newcastle; Katharine Gelber, Professor of Politics and Public Policy, The University of Queensland, and Peter Whiteford, Professor, Crawford School of Public Policy, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Dog whistles, regional visas and wage theft – immigration policy is again an election issue


Jock Collins, University of Technology Sydney

This article is part of a series examining the Coalition government’s record on key issues while in power and what Labor is promising if it wins the 2019 federal election.


Immigration policy will be a major issue in the 2019 federal election. We know this because immigration has featured significantly at every Australian election since the 2001 “children overboard” election.

David Marr and Marian Wilkinson argued in their 2003 book, Dark Victory, that willingness to play the race card in relation to boat people was a decisive factor in John Howard’s election victory. For Tony Abbott, “Stop the boats” was a major campaign theme when the Coalition won back government in the 2013 election. The current prime minister, Scott Morrison, rose to prominence as Abbott’s unyielding immigration minister who stopped the boats.




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While the events of Christchurch may have cramped the opportunity for the Coalition to run hard on fear, promising to be tough on borders and tough on (Muslim) terrorism, the dog-whistle politics on the issue of refugees and asylum seekers will be there for those wanting to hear it.

For Labor these policy issues have been difficult. It was Kevin Rudd who as PM declared that those arriving by boat would never be settled in Australia, irrespective of the validity of their claims for protection under the UN Refugee Convention. Labor supported efforts to get children out of detention on Manus Island, but doesn’t want to give the conservatives too much space to convincingly advance a “Labor weak on border security” line.

Humanitarian intake is growing

The Coalition governments of Abbott, Turnbull and Morrison have in fact increased Australia’s annual humanitarian intake significantly. The number has risen from just over 13,750 to more than 18,000 – though the government has not loudly broadcast this fact.

In addition, Abbott in 2015 announced a one-off intake of 12,000 Syrian conflict refugees. Most of them arrived in 2017, effectively doubling the annual refugee intake in that year.

Australia – and the refugees – coped well, demonstrating the nation’s capacity to significantly increase refugee intakes. Our research with newly arrived Syrian, Iraqi and Afghan refugee families suggests they are settling well in Australia, receiving a warm welcome from locals in the cities and regional centres. Employment and family reunification are their key worries.




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Labor’s shadow immigration minister, Shayne Neumann, has flagged a new temporary sponsored visa for the parents of migrants. Unlike the current visa, it does not have a cap and it might assist refugees to get their parents to Australia.

Labor has announced it will increase the annual humanitarian intake of refugees to 27,000 by 2025. It will also abolish Temporary Protection Visas (TPVs). These visas provide boat arrivals who are found to be refugees the right to stay for only three years with work and study rights and access to Centrelink payments. As Labor argues, this places them “in a permanent state of limbo”.

The Coalition parties have not announced their policy intentions in relation to humanitarian intakes or the rights of asylum seekers, including those who arrived by boat.

At a time when Home Affairs Minister Peter Dutton scans the horizon for new boat arrivals, record number of asylum seekers are arriving by plane under tourist visas. In 2013-14, there were 18,718 asylum applications, including 9,072 boat arrivals. This had increased to 27,931 asylum applications, with no boat arrivals, by 2017-18.


Department of Home Affairs

Each year the Australia government sets the permanent immigration targets. Until recently this was set at 190,00. In practice just 162,000 immigrants have been admitted over the past year or so.

A token cut and 2 new visas

In this context Prime Minister Morrison’s announcement that the permanent immigration target will be cut to 160,000 is really no change in immigration policy. There is nothing to see here if you dismiss the need to be loudly anti-immigration in the current populist political climate.




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The announcement is linked to congestion-busting in the major cities of Sydney and Melbourne. It is accompanied by the introduction of two new visa pathways – the Skilled Work Regional (Provisional) Visa and the Skilled Employer Sponsored Regional (Provisional) Visa – for skilled migrants to live and work in regional areas for five years.

These visas offer the carrot of permanent residency at the end of three years to attract new immigrants to regional Australia. In addition, the budget announced that scholarships to the tune of $94 million over four years would be available to domestic and international students who study there.




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Temporary migrants exploited

Most immigration policy debates centre on permanent immigration intakes, particularly of humanitarian immigrants and asylum seekers. Yet annual temporary migrant intakes – international students, working holidaymakers and temporary skilled workers – are three times greater than the permanent intake. Over 800,000 temporary migrants were in Australia in June 2018.

One key policy issue is the exploitation of temporary migrant workers. The Turnbull government abolished the 457 temporary skilled migration visa because of increasing reports of abuse and exploitation by employers.

One recent survey of 4,332 temporary migrant workers found “increasing evidence of widespread exploitation of temporary migrant workers, including wage theft”. Half of all temporary migrant workers may be underpaid. About one in three international students and backpackers earned $12 an hour or less – about half the minimum wage.

This issue goes not just to the ethics of maintaining a temporary migration program largely premised on migrant worker exploitation. It also resonates with Labor’s campaign for a living wage and the restoration of penalty rates for workers in response to the low rate of real wage growth in Australia, which constrains consumer demand.




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The 2019-20 federal budget allocated extra funding to the Fair Work Ombudsman to bolster enforcement action against employers who exploit vulnerable workers and announced the National Labour Hire Registration Scheme to target rogue operators in the labour hire industry. However, the research suggests wage theft is widespread in the small business sector, a key target for tax relief in the budget. It is an area of immigration policy that requires considerably more resources and punch.The Conversation

Jock Collins, Professor of Social Economics, UTS Business School, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cutting cancer costs is a worthy policy, but we need to try to prevent it too


Terry Slevin, Australian National University and Simone Pettigrew, Curtin University

Removing the financial worries from Australians diagnosed with cancer is bound to be a popular move.

The Opposition’s A$2.3 billion cancer care plan – announced in Bill Shorten’s budget reply speech on Thursday night – aims to ensure cancer treatment costs for scans, specialists and drugs are bulk billed or subsidised under the Pharmaceutical Benefits Scheme (PBS). It would be a hard heart indeed that did not welcome such a move.

Maybe even better than avoiding the out-of-pocket costs of treatment is preventing future cases of cancer. Around one-third of all cancers are preventable by not smoking, staying at a healthy weight, eating healthy food, being physically active, minimising alcohol consumption, and avoiding excessive sun exposure.

But apart from a small commitment to tobacco control in the 2019 budget, neither the government or opposition has made even the vaguest commitment to, or investment in, cancer prevention.




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So far we have heard virtually nothing from either party on efforts to tackle obesity, promote healthy eating, encourage more physical activity, reduce alcohol consumption, promote sun protection, or boost efforts to increase participation in cancer screening and vaccination programs.

The government currently spends around A$2 billion a year on “public health”, which includes monitoring, regulation, as well as prevention and vaccination. This amounts to less than 2% of the nation’s total health expenditure of A$170 billion. That is about half of what we spend on patient transport.

A boost to 5% – or closer to A$8.5 billion – could make enormous strides in better prevention programs, driven by high-quality research.

Poor track record

When it comes to investment in disease prevention, the story is not strong for the Coalition.

The Rudd Labor government established the Australian National Preventive Health Agency (ANPHA) in 2009, with funding of around A$60 million a year. The agency ran national programs focusing on tobacco, alcohol, healthy eating and reducing alcohol consumption.

But the new Abbott government axed the agency in 2014, after drafting legislation to expunge it from the books.




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From 2008 to 2014, the National Partnership Agreement on Preventive Health (NPAPH) funded programs in Australia tackling unhealthy eating, physical inactivity, drinking too much, and smoking, via a funding pool of A$872 million.

Programs such as Live Lighter and Foodcents, for example, provided evidenced-based and practical help for people to live healthy lives. Other programs improved the availability of nutritious foods, and ensured walking and cycling were safe and viable components of transport planning.

In 2012, the then Labor government committed to the continuation of the NPAPH to 2018, but it was axed by the Abbott government in the 2014 federal budget.

Prevention programs aim to make it easier for people to make healthy choices, such as being physically active and eating a nutritious diet.
Annie Spratt

This took hundreds of millions of dollars otherwise committed to prevention efforts out of the federal budget calculations.

All of these discontinued efforts were likely to have had a major effect on reducing future generations of Australians from hearing those awful words: you have cancer.

Like any human endeavour that aims for big changes in systems and behaviours, stopping and starting the programs that lead these changes diminishes the prospect of success.

So why is it hard to get governments to invest in prevention?

Strong and influential industries consistently lobby governments to protect their commercial interests. That’s what happens in a market economy democracy. The alcohol, processed food and even tobacco industries continue to exercise an influential voice in the halls of power.

Unsurprisingly, industry aggressively opposes higher taxes on these products (“sin taxes”) and programs discouraging their use.




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It is common to hear politicians tell stories of individuals, “real people” who benefit from a new treatment or access to new life-saving medical care or drugs. We all connect with these heart-warming stories and they illustrate the importance of the public funding investment.

Such stories are harder to tell in prevention. How do we find the 64-year-old enjoying his granddaughter’s first day at school, largely because he did not die of a smoking-related disease in his 50s because tobacco control efforts in his youth meant he did not take up smoking?

To tell of our success, we revert to dry and dusty but impressive statistics, with one estimate of 500,000 premature deaths prevented over the past 20 years.

Effective prevention policies, such as putting a minimum floor price on alcohol, work to reduce alcohol-related harm. But making it more difficult to reduce the price of alcohol is politically unpopular.

Reforms such as expanding smoke-free areas are taken for granted now, but were opposed when first introduced.

Tobacco control measures are now accepted and welcomed, but that wasn’t always so.
Patrick Brinksma

Finally, the benefits of prevention often take many years, even decades, to arrive. Political timeframes are often linked to election cycles of three or four years.

A long-term view is vital. Each dollar invested in skin cancer prevention, for example, returns about A$2.20 in cost saving in avoiding cost of treating the disease. But there are decades between reducing kids’ sun exposure and avoiding treatment when those kids reach their 50s and 60s.

As the election campaign unfolds, let’s hope both aspiring Australian governments continue to show a genuine interest in the health of Australians and commit to preventing disease. Is 5% of the health budget too much to ask for that?The Conversation

Terry Slevin, Adjunct Professor, School of Psychology, Curtin University and College of Health and Medicine, Australian National University and Simone Pettigrew, Professor, School of Psychology, Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Labor’s cancer package would cut the cost of care, but beware of unintended side effects



File 20190408 2909 1dbbi9k.jpg?ixlib=rb 1.1
The median out-of-pocket expenses for breast cancer treatment is A$4,192.
ESB Professional/Shutterstock

Kees Van Gool, University of Technology Sydney and Jane Hall, University of Technology Sydney

Labor’s big-ticket election promise is a A$2.3 billion package to provide free medical scans and specialist consultations for cancer patients, plus automatic listing of new cancer therapies on the Pharmaceutical Benefits Scheme (PBS) once they’re recommended by the nation’s expert advisory panel.

One in two Australians will be diagnosed with cancer by the age of 85, and around 145,000 new diagnoses are made each year. So most of us have a close relative or friend who will be affected by the policy.

But there are some important policy considerations a Shorten government would need to plan for to ensure the package provides optimal care, improves patient outcomes, and does actually reduce out-of-pocket costs.




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What’s the problem with cancer care?

New therapies for cancer are rapidly evolving, and are often extremely expensive. Seeking treatment involves navigating a complex array of public and private providers across multiple health care sectors, often leaving patients with high out-of-pocket costs.

These costs are highly dependent on which providers the patients choose (and the fees they charge), the level of private insurance cover, and the volume of services used.

A recent Queensland study found the median out-of-pocket expenses for a breast cancer patient, for example, was A$4,192.

It’s possible but very time-consuming for patients to “shop around” to reduce costs. But this is an unreasonable burden to place on patients.

The Labor proposal provides an opportunity to develop a comprehensive cancer control program that encompasses prevention, early diagnosis, treatment and follow-up – at a reasonable cost.




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Better care for cancer patients

Cancer treatment is well researched; there are clear evidence-based guidelines that establish clinical pathways for the best treatment.

Nevertheless, there is substantial variation in treatments given to cancer patients. This difference cannot always be explained by their clinical conditions, and sometimes the care is not evidence-based.

It’s important that the proposed reforms do not just fund more care, but support more of the best care.

The approach that has shown promise in other countries is known as “bundled payments”.

Under bundled payments, a series of health care services – that can span over time and across multiple health care sectors and providers – are bundled together for funding purposes. This gives providers or institutions greater flexibility in how they spend money delivering care to the patient.

There is a danger that bundling can provide incentives to skimp on care, because the provider receives the same amount of funding no matter how much care is provided. But this can be addressed by monitoring the quality of care and the patients’ outcomes.

Ensuring the financial benefits flow to patients

Australian governments have made several attempts to provide better safety nets that cushion patients from extra charges.

Study after study shows that, in these circumstances, providers are likely to raise their fees. So while patients get some financial benefit, the doctors benefit also.

Under current Medicare rules, the Australian government does not and cannot determine doctors’ fees. It can only determine the amount of the Medicare benefit.

In general practice, most consultations are bulk-billed implying that the fee the doctor charges is equivalent to the Medicare benefit.

Only 31% of specialist consultations are bulk-billed, leaving more patients with an out-of-pocket payment.




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What can government do to encourage cancer care providers to bulk-bill?

Labor has announced they will add a bulk-billing incentive payment, as occurs in primary care. Specialists will receive an additional payment if they bulk-bill a cancer-related service.

This will not guarantee that every patient will not incur any out-of-pocket costs – although it should increase the likelihood that they will. Indeed, the Labor target is that 80% of patients will be bulk-billed.

However, previous research has shown that while the GP bulk-billing incentive led to a reduction in costs for those eligible (concession card holders), it also increased costs for those not eligible.

Careful monitoring is required to ensure the volume of services – and their fees for non-cancer patients – do not go up.

Not all cancer care is based on the best available evidence.
Napocska/Shutterstock

A further unprecedented complication is that for some services, it will be necessary to differentiate Medicare payments on the basis of the patient’s cancer status.

To guarantee patients face no out-of-pocket costs would require more radical reform. Again, the bundled payment system could be a vehicle for such reforms whereby payments are conditional on all the patient’s service providers agreeing to deliver care with no additional fee to the patient.

Depending on whether a patient is privately insured, the bundled payment could be financed by private health funds and Medicare.

Of course, it’s not yet clear that bundled payment schemes can be directly applied to the Australian setting.

The Labor cancer package requires careful and rigorous research effort to inform and guide the policy development.

A new vision for Medicare

Medicare is now 35 years old. It was built on fee-for-service payment, and focused on short, acute episodes of illness.

Now it’s time to move to new funding mechanisms that provide better care for complex, ongoing conditions, at a cost patients and the country can be sure represent efficient use of resources.




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Cancer is a good place to start and it could indeed be the most significant reform of Medicare so far.

Imagine a health system where every Australian was assured of optimal care, no matter what their illness or economic circumstances. That is a health system worth paying taxes for.The Conversation

Kees Van Gool, Health economist, University of Technology Sydney and Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How has education policy changed under the Coalition government?



File 20190408 2912 10gjzew.jpg?ixlib=rb 1.1
The Coalition made some major promises in the 2016 election. Has it delivered?
from shutterstock.com

Glenn C. Savage, University of Western Australia; Susan Irvine, Queensland University of Technology, and Tim Pitman, Curtin University

This article is part of a series examining the Coalition government’s record on key issues while in power and what Labor is promising if it wins the 2019 federal election.


School’s policy and funding

Glenn C. Savage, Senior Lecturer in Education Policy and Sociology of Education, University of Western Australia

The Coalition’s approach to schooling policy since the 2016 election has primarily focused on its Quality Schools agenda. This centres on increased funding (A$307.7 billion in total school recurrent funding from 2018 to 2029). It also attempts to steer national reform in areas such as teaching, curriculum, assessment and the use of evidence.

The Coalition wants to steer reform in teaching, curriculum, assessment and the use of evidence.
from shutterstock.com

The government’s policies are strongly informed by the 2018 Review to Achieve Educational Excellence in Australian Schools (aka Gonski 2.0) which examined how record levels of federal funding could be better tied to evidence-based practices.

The review’s recommendations are central to the National School Reform Agreement. This ties federal funding from 2019-2023 to a number of new national reform initiatives, which include:

  • changes to the Australian Curriculum through the development of “learning progressions”. These describe the common development pathway along which students typically progress in their learning, regardless of age or year level
  • developing an online assessment tool to help teachers monitor student progress
  • reforms to improve the consistency and sharing of data
  • a review of senior secondary pathways to work, further education and training
  • establishing a national evidence institute to undertake research on “what works” to improve schooling outcomes
  • developing a national strategy to support teacher workforce planning.

While the Coalition sees the agreement as heralding a positive new reform era, deals done with states to get it over the line are far from ideal, especially in the fraught area of school funding.

The agreement ensures that by 2023, private schools will receive 100% of the recommended amount under the Schooling Resource Standard (SRS) funding model, whereas most government schools will be stuck at 95%.

The states share a great deal of the blame. But it’s not a good look for a federal government promoting a commitment to needs-based funding.

What about Labor?

A Labor government would change some elements of the national reform conversation. But the extent to which it would radically shift the current trajectory is debatable.

Labor has promised further school funding increases and flagged other reforms such as universal access to early childhood education for three and four year olds, tougher requirements for entry into teaching degrees, and the creation of a National Principals’ Academy to provide leadership training.

But Labor also shares a great deal in common with the Coalition.

Both preference a strong federal role in schooling. Both support (at least in theory) the principles of the SRS, and there is significant alignment between parties when it comes to reforms in the National School Reform Agreement.

Labor has also been promoting the idea of a national evidence institute for some time and many reforms in the school reform agreement build directly on those established by Labor as part of its “education revolution” agenda from 2007-2013.

While the parties will draw dividing lines to make a choice between them look stark, they have more in common than they would like to admit.




Read more:
What the next government needs to do to tackle unfairness in school funding


Higher education

Tim Pitman, Senior Research Fellow, Curtin University

Since the last federal election, the Coalition has been mostly dealing with the fallout from their ambitious policy agenda conceived under Tony Abbott, as laid out in the 2014 Higher Education Reform Bill. The chief aims of this policy were to:

  • cut higher education funding by 20%
  • increase subsidies to private providers
  • deregulate tuition fees.
The Coalition started their new government with no clear pathway to enact their vision for higher education.
from shutterstock.com

The reforms were voted down by the Senate in late 2014 and again in early 2015.
This meant the government had no clear pathway to enact their vision for higher education and fewer options for reducing higher education expenditure. One way to do the latter would be to increase the maximum student fee payable.

Another option would be to freeze increases to the amount the Commonwealth subsidised the universities to teach students, so in future years it would spend less, in real terms, on higher education. The government took this option in 2017, saving an estimated A$2.2 billion. Research funding also took a hit.

The government further announced it would introduce performance-based higher education funding, though it is still not clear how, exactly, performance will be defined.

Labor says if it is elected, it will end the freeze on increases to the Commonwealth student subsidies. Labor will also conduct an inquiry into post-secondary education, with one aim being to repriotise the importance of vocational education, so it sits alongside, not beneath, higher education.

Labor heads are also promising a A$300 million University Future Fund to fast-track funding for high priority research and teaching projects.

For both the Coalition and Labor, regional Australia is shaping up as a key battleground and this is already being reflected in higher education policy. In February 2018, the Coalition announced it was funding 22 regional study hubs across regional Australia to provide

study spaces, video conferencing, computing facilities and internet access, as well as academic support for students studying via distance at partner universities.

In November 2018, it followed with a further A$135 million in additional support for regional universities affected by their freeze on funding.

In response, Labor has upped the ante on the regional hubs, saying it will not only maintain support for the study hubs but will fund mentoring and pathways programs in the communities that have the hubs. It will also commit an additional A$174 million for equity and pathways funding to support students from areas with low graduation rates, many of which are in regional Australia.




Read more:
Australia should start planning for universal tertiary education


Early childhood

Susan Irvine, Associate Professor, School of Early Childhood and Inclusive Education, Queensland University of Technology

There are some recurring and predictable storylines in early childhood education election policies in Australia. At the last election, the Coalition’s main storyline was affordability.

Its central platform was the Jobs for Families Package – a controversial bill that promised a simplified and more generous fee subsidy to help parents cover the rising cost of education and care.

The Coalition introduced a subsidy for early childhood education, but the means test has some vulnerable children missing out.
from shutterstock.com

It was controversial because it tied children’s access to early education with their parents’ participation in the paid workforce. To get the subsidy, families had to meet a new work activity test. Children whose families did not meet this test had their hours of early education cut in half.

A drawn-out battle in the Senate saw the bill eventually pass with some hard-fought amendments to support more equitable access for children and families experiencing disadvantage.

On the whole, the childcare subsidy has been a positive change for most Australian families. However, there is evidence that the continuing focus on parent work participation means some of our children in low-income families – who research shows will benefit the most from access to high quality early education – are missing out.

The Coalition’s other 2016 election commitment was funding for universal preschool education, focusing on four year olds in the year prior to school. However, this has been doled out on an annual basis. The result being no security for children, families and service providers.

In the 2019 budget, the government committed funding for universal preschool for all Australian children only until the end of 2020.




Read more:
Don’t be fooled, billions for schools in budget 2019 aren’t new. And what happened to the national evidence institute?


This is one of two key differences between the Coalition and Labor’s early childhood policies. Labor has committed to secure and sustainable funding for universal preschool. It has also committed to expanding access to three year olds, providing two years of early education prior to school entry.

The other key difference relates to broader investment in the early years workforce. The single most important factor influencing quality and children’s outcomes are the teachers and educators working with children. Australia urgently needs a new Early Years Workforce Strategy. The Coalition allowed the previous strategy to lapse and has remained silent on matters relating to pay and conditions.

Labor has announced a commitment to investment in the workforce, including funding to train more educators and teachers, and, has previously pledged support for professional wages for professional work.The Conversation

Glenn C. Savage, Senior Lecturer in Education Policy and Sociology of Education, University of Western Australia; Susan Irvine, Associate Professor, School of Early Childhood and Inclusive Education, Queensland University of Technology, and Tim Pitman, Senior Research Fellow, Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Frydenberg is wrong to support Ivanka and Donald Trump on the World Bank. It’d be better to let it die


Mark Crosby, Monash University

Treasurer Josh Frydenberg has offered support to Donald Trump’s pick for the World Bank Presidency.

David Malpass is currently Under Secretary of the United States Treasury with responsibility for International Affairs, and his previous experience includes being chief economist at Bear Stearns prior to their collapse.

Our Treasurers support is wrong headed.

No matter what the strengths of David Malpass, the next World Bank President should not be American.

After World War Two the victors designed many of our global institutions, including the World Bank, and the International Monetary Fund. Major global institutions were headquartered in Europe or the United States, and there was an agreement that the World Bank President would be a US citizen, while the IMF would be headed by a European.

This cosy arrangement was fine for most of the 20th century, but is at odds with our 21st century world.

Trump’s unspoken ultimatum

It has been suggested that Trump would follow his usual negotiating tactics and withdraw support from the World Bank if the next chief is not American, which is presumably why some countries including Australia are likely to support Malpass.

The search for the US nomination was headed by Steven Mnuchin and Ivanka Trump, with Invanka Trump herself mentioned as a possible nomination.

Malpass may be a better candidate than the President’s daughter, but I doubt it.

Malpass has been a critic of World Bank lending to China and at Bear Stearns he ignored warning signs of crisis in 2007.

But it’s not so much Malpass’ dubious credibility that is the problem, but the idea that the President should always be American.

The American might not be the best candidate

Important global institutions should be led by the best candidate. The views and expertise of emerging market candidates, particularly from larger economies such as China, India, Brazil, Nigeria and Indonesia should be taken more seriously.

In recent years the IMF would have been much better led by a non-European. The decision to bail out French and German banks at the expense of the Greek economy in 2012 was a poor decision made by the French head of the IMF.

The IMF rightly supported restructuring of banks and financial markets after the Asian Financial Crisis in 1997, but did not push for the same for European or US banks after 2008.

So what if Australia and other middle powers did not support Malpass’ nomination?

Better off withoug the World Bank?

A US withdrawal from the World Bank would probably see its demise. But so what?

The World Bank has become relatively toothless.

Last year China lent more money to emerging market economies than the World Bank.

And this is the point. China needs to be brought into the World Bank and other institutions more fully, not sidelined.




Read more:
A Trump-aligned World Bank may be bad for climate action and trade, but good for Chinese ambitions


Problems with governance and other issues with China’s Belt and Road initiative would be much better handled by a multilateral agency, whether that is a properly renewed World Bank or a new institution.The Conversation

Mark Crosby, Professor, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Tim Wilson’s ‘retirement tax’ website doesn’t have a privacy policy. So how is he using the data?


Andre Oboler, La Trobe University

A growing debate over Labor’s policy to end cash rebates for excess franking credits has led to calls for the chair of parliament’s economics committee, Liberal MP Tim Wilson, to resign.

Labor has accused Wilson of using a parliamentary inquiry into the policy to spearhead a partisan campaign against it.

Part of the controversy revolves around a website Wilson is promoting – stoptheretirementtax.com – that initially required people who wanted to register to attend public hearings for the inquiry to agree to put their name to a petition against the policy. Wilson described this as a “mistake” that has since been fixed.

But there’s another issue with the website that’s worth taking a look at: if it complies with privacy law.

Political parties are exempt from the usual privacy rules, so we need to know if stoptheretirementtax.com is a Liberal party website or government website. The answer has implications for whether privacy law may have been breached, and if the data collected can be used for political campaigning in the upcoming federal election.




Read more:
Australia should strengthen its privacy laws and remove exemptions for politicians


A party or parliamentary website?

Stoptheretirementtax.com was registered anonymously on October 31. While it’s a requirement of website registration for owners to be publicly listed, in this case a domain privacy service was used to hide those details.

By mid-November the site was being shared by a financial services company with their clients, who said that Wilson had sent the website details to them. In several tweets promoting the inquiry in November, Wilson didn’t mention the site.

The site was promoted publicly in January, when Wilson tweeted six times that people should use it to register for hearings in Queensland and New South Wales.

In these tweets, Wilson identified himself as both the Liberal MP for Goldstein and the Chair of the Economics Committee.

By contrast, stoptheretirementtax.com doesn’t mention Wilson’s electorate or political party. The bottom of the site has the Australian coat of arms with the words “Chair of the House Economics Committee”. Wilson’s parliamentary contact details appear alongside a statement that reads:

Authorised by Tim Wilson MP, Chair of the Standing Committee on Economics.

The confusion around whether stoptheretirementtax.com is an official government website begins with the website’s domain name. It’s based on a slogan coined by Wilson Asset Management, a financial services company that is actively campaigning against Labor’s policy on franking credits. The site also uses a photograph the company has used in their campaign, and Wilson has said Wilson Asset Management were consulted in the site’s development.

Then there is the text, which reads:

At the next election your financial security will be on the ballot … Labor are attacking your full tax refund. After the election they want to scrap refundable franking credits. That will hit your security in retirement and risk pushing many vulnerable retirees below the poverty line.




Read more:
The Australian public cares about privacy: do politicians?


What data is being collected?

Stoptheretirementtax.com is collecting personal information. Visitors who wish to send a submission to the inquiry or register to attend public hearings are required to provide their name, email address, mailing address and phone number.

Visitors who want to send a submission to the standing committee on economics are offered a box with pre-filled text. A small note reads: “feel free to edit, or write your own”. A second box invites visitors to share their story.

Design features such as the colouring of the text could be seen to discourage editing of the first box while directing people to the second, meaning many people who submit a response will likely end up including the pre-filled text in their submission.

When registering for the public hearings, users are offered two check boxes (pre-checked), which state:

I want to be registered for the petition against the retirement tax

I want to be contacted on future activities to stop the retirement tax.

Until Sunday, it was impossible to register for a hearing without also signing the petition. Tim Wilson has said this was an “error”. The required check box for hearings and the design of the submission boxes may in fact be a dark pattern – a use of design feature to manipulate users into making the decision the site owner wants.

The site contains no privacy policy or indication of who the data is shared with or how it will be used.

On Monday, a page for the inquiry was added to the Australian Parliament’s website describing itself as the “the official page of the committee”. It states that submissions to the inquiry can be made via the Parliament’s submission system or by email. It also explains that “pre-registration is not required to participate” in the hearings.

A matter of privacy

Australian privacy is largely regulated by the Privacy Act and the Australian Privacy Principles it contains. Registered political parties are exempt, but stoptheretirementtax.com does not appear to come from a registered political party.

To assert it is campaign material from a registered political party at this stage would raise electoral law issues. The Commonwealth Electoral Act requires that registered political parties identify themselves in the authorisation statement on their political materials. Stoptheretirementtax.com has no such authorisation.

The Privacy Act does apply to government agencies, including ministers, departments and people:

holding or performing the duties of an appointment… made… by a Minister.

The Chair of a Standing Committee is “appointed by the prime minister”, making them an agency subject to the Australian Privacy Principles.

The Australian Privacy Principles requirements for government agencies include:

  • being open and transparent about how personal information is managed, including having a privacy policy
  • explaining why they are collecting, holding, using or disclosing personal information
  • only collecting personal information if it is reasonably necessary or directly related to one of their function or activities
  • only collect personal information by lawful and fair means
  • disclosing who else the personal information would usually be shared with

A failure to comply with the Australian Privacy Principles may put personal information at risk and can attract the attention of the Information Commissioner, who regulates privacy.

What about parliamentary privilege?

The Australian Law Reform Commission noted in 2008 that:

Ministers engaging in their official capacity are bound by the Privacy Act, while MPs engaging in political acts and practices are not.

A Committee Chair would likely be similarly bound only while acting in that capacity.

Some of the time, while acting in their capacity, they may be effectively exempt from the Privacy Act due to parliamentary privilege.

Section 16(2) of the Parliamentary Privileges Act reasserts a right of immunity going back to the Bill of Rights of 1688. It covers:

all words spoken and acts done in the course of, or for purposes of or incidental to, the transacting of the business of a House or of a committee.

That doesn’t mean the principles don’t apply, just that enforcing corrective action may be beyond the reach of the courts. Parliament has its own processes that could still be used to address concerns.

The usual rules, enforceable by the courts, may still apply in circumstances where a committee chair is acting in that capacity, but outside the business of the committee.

Advocacy activities, like running a petition or soliciting contact details for political action may not be something “for the purpose” or “incidental” to the business of a committee. In fact, publishing an overtly political website may itself step outside the protection – as it is the committee and its parliamentary work, not the activities of the chair per se, that attract the privilege.




Read more:
Australians’ trust in politicians and democracy hits an all-time low: new research


Reaching a resolution

The best resolution would be for Tim Wilson to take down the site (particularly in light of the new official site), pass to the Committee Secretariat any information they require (such as submissions), then delete all personal information he has collected through the stoptheretirementtax.com website.

A full disclosure of who data may have been shared with, where it was held and how it was secured would also help. If data has been disclosed to anyone other than the Parliamentary Committee, those who have been impacted should be informed. The Information Commissioner should be consulted for guidance and assistance.

The broader lesson is that privacy must be taken seriously. The Australian Privacy Principles are designed to ensure transparency and accountability. The lack of a privacy policy on the website should have served as a warning.The Conversation

Andre Oboler, Senior Lecturer, Master of Cyber-Security Program (Law), La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Shorten pledges $500 million for UNHCR in border protection policy


Michelle Grattan, University of Canberra

Bill Shorten has promised Labor will commit $500 million over five years to the United Nations High Commissioner for Refugees in a policy designed simultaneously to reassure voters and satisfy the party on the politically sensitive issue of border protection.

This was among proposed new measures on asylum seeker policy the opposition leader announced to the ALP national conference on Monday morning, preempting a debate later in the day, to ensure internal party differences were minimised.

He said the $500 million would directly improve orderly regional processing and resettlement in the region and countries closer to where refugees originally came from. The funding would “speed up legitimate settlement pathways – it will deny people smugglers a product to sell”.

Portraying Labor as tough on borders, but humanitarian on refugees, Shorten said that if he became prime minister, he would take immediate advice from the chief of the Australian Defence Force, the Home Affairs Department, ASIO and other agencies about Australia’s state of preparedness to disrupt people smuggling operations before people departed.

Labor would triple the number of Australian Federal Police working overseas to stop people smugglers and prevent people even contemplating getting on boats.

An ALP government would expand the existing community sponsored refugee program from the current number of 1,000 to 5,000.

“This means state and local governments, community organisations, businesses and unions and faith-based institutions will be able to sponsor humanitarian entrants into Australia and support the economic and social integration of refugees into communities,” Shorten said.

He said the expansion would be in addition to Australia’s existing humanitarian intake, so a Labor government would take more refugees overall as part of its migration mix.

Shorten reaffirmed Labor’s commitment to turnbacks and offshore processing, saying “it is not a crime to want to come to this country. But it is a crime to exploit vulnerable people to put them in dangerous and unsafe vessels and have them drown at sea”.

“We cannot, we must not, and we will not permit the reopening of their
trade in human desperation and the drownings and the irreplaceable loss of life that it brings.”

This required pursuing regional resettlement, turning back boats when it was safe to do so and maintaining offshore processing.

“But also … we understand that keeping our borders secure, and keeping people smugglers out of business should and never has meant leaving women and children to languish for years and years in indefinite detention in sub-standard facilities and unacceptable conditions”

“It has never meant allowing peoples’ mental and physical health to deteriorate whilst under direct or indirect Australian care. It has never meant fighting every step of the way against medical advice which says that more needs to be done to treat people”

“I believe that Australia can meet our international humanitarian and legal responsibilities without compromising our national security for a commitment to strong border protection,” Shorten said.

A Labor government would take up New Zealand’s offer to resettle refugees from Manus and Nauru by immediately negotiating an agreement on similar terms to the current deal with the United States.

In a counter attack against the Coalition, which is running hard on the ALP being soft on borders, Shorten accused the government of “telling lies about Labor” and thereby “doing the dirty work of the people smugglers.

“The Liberals are acting as spruikers for the criminal syndicates. Every time they get up and say that there will be a change in terms of border security, they are signalling criminal syndicates to try their hand again.

“They should be ashamed, they know what they do and they still do it.”The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Morrison’s health handout is bad policy (but might be good politics)



File 20181213 110249 1y7kc3t.jpg?ixlib=rb 1.1
The funding proposal is no fix for Australia’s health system but it could take some political pressure off the Coalition in the lead up to the 2019 federal election.
OnE studio/Shutterstock

Stephen Duckett, Grattan Institute

The A$1.25 billion Community Health and Hospitals Program Prime Minister Scott Morrison announced this week should be awarded a big policy fail.

The move sets back Commonwealth-state relations by decades – and it’s unclear exactly how much money will actually be provided.

Rather than being based on any coherent policy direction, it appears designed to shore up support in marginal electorates.

Bad for Commonwealth-state relations

One of the complicating factors in providing health care to Australians is the fact that the Commonwealth and states each have leadership roles in different parts of the system: the Commonwealth for primary care; and the states for public hospitals.

Health professionals yearn for the Holy Grail of a single level of government being responsible for all aspects of a patient’s care. That quest has proved illusory. But recent policy direction has at least sought to clarify the roles of the two levels of government.




Read more:
Public hospital blame game – here’s how we got into this funding mess


For the past five years, the states have been acknowledged as the “system managers” of the public hospital system. A rational, formula-driven funding framework has been created.

Under this framework, the Commonwealth shares the cost of growth in public hospital activity with the states. This exposes the Commonwealth directly to growing costs of technology-driven needs and giving it an incentive to work with the states to meet needs in the most efficient way.

This framework means there is one level of government to whom all public hospitals are accountable: the state. And it means voters can hold their state government accountable for hospital planning and management.

The new Morrison proposal tramples all over this policy rationality in the interests of electoral expediency. It replaces state-based planning with submission-based funding, which will enable a politician with a whiteboard in Canberra to override state priorities in favour of projects which have the greatest electoral appeal in targeted marginal seats.

It makes accountability for the overall system more confusing, and it assumes Canberra knows best.

It is a federalism fail.

An opaque policy

Labor ran a devastating campaign in the July federal by-elections, especially in the Queensland seat of Longman, which involved calculating and publicising precisely how much worse off the local hospital was under the Liberal health policy – where the Commonwealth funds 45% of hospital growth – compared with Labor’s 50% sharing policy.

In the Longman case, Labor asserted there was a A$2.9 million cut to Caboolture Hospital based on the decisions taken in the 2014 Abbott/Hockey “slash and burn” budget.

Scott Morrison’s new cash splash is no doubt designed to overcome this political weakness for the Coalition.




Read more:
Why scare campaigns like ‘Mediscare’ work – even if voters hate them


However, unlike Labor’s funding, which is ongoing, it’s unclear whether the extra largess the Coalition is offering will continue beyond the budget “forward estimates” (that is, the next four years). It’s unclear how much will be devoured from existing Commonwealth funding agreements, such as the dental agreement, which are coming to an end.

The Commonwealth has responsibility for most aspects of policy to address social determinants of health, particularly employment and income policies. Rational health policy would recognise the importance of considering these issues and balancing the health benefits of, for example, lifting the Newstart allowance, against funding for specific health initiatives. There is no hint this has happened with this announcement.

New handouts under the Morrison package will be portrayed as being for specific areas of “high political need”. But the reality is funding will eventually be swept into the Grants Commission allocation process and redirected according to the Grants Commission formula.

This may restore some rationality into the health handout, albeit with a lag of a few years. But the actual level of funding to be allocated to specific areas will be shrouded in Grants Commission opacity. Insiders will be able to follow the money, but voters will be kept in dismal ignorance about how much they will benefit in the long-term – after the gloss of a local funding handout has worn off.

This policy is a transparency fail.

Politics versus policy

The Community Health and Hospitals Program lists four feel-good, worthy funding targets:

  • specialist hospital services such as cancer treatment, rural health and hospital infrastructure
  • drug and alcohol treatment
  • preventive health, primary care and chronic disease management, and
  • mental health.



Read more:
Morrison government promises $1.25 billion for health care


Everyone has a potential place in this funding Nirvana. Lobby your local MP, and your local hospital or community health program might be the lucky health policy lottery winner!

Provided voters don’t see this as a cynical political exercise – and that is a big risk in an electorate which already ranks politicians low on the trustworthiness scale – then the new policy could be smart politics. We won’t know until the votes in next year’s federal election are counted.

In the meantime, given the drubbing the Liberals received in last month’s Victorian state election, the biggest challenge for the Morrison Government might be deciding which electorates are now marginal and worth shoring up.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.