Prime Minister Kevin Rudd volunteered to take the poisoned chalice Australia's public hospital system but has baulked when the time came to take a swig.
He set a deadline during the election campaign. States and territories had to improve public hospitals by mid-2009 or the Commonwealth would seize financial control of the system if voters gave the go-ahead.
''It's time for someone to put their hand up and take responsibility and if elected as prime minister in two months time, that's exactly what I intend to do, so that when it comes to health and hospitals the buck would stop with me if elected as the next prime minister of Australia,'' Rudd pledged at the time.
''A Rudd Labor government will seek to take financial control of Australia's 750 public hospitals, if state and territory governments have failed to agree to a national health and hospital reform plan by mid-2009, to eliminate the duplication and overlap which currently plagues the system.''
Fast forward. Rudd has moved into the Lodge. The deadline has arrived. The public hospital system is still plagued with problems.
Just look at the latest State of Our Public Hospitals report. In 2007-08, 31 per cent of patients waited too long for treatment in emergency departments up 1 per cent from 2006-07. The median waiting time for elective surgery was 34 days two days longer than the previous year.
But Rudd doesn't have the stomach to deliver on the election commitment at this stage.
There are many salient reasons for the Commonwealth to take control of the public hospital system. Currently, there are two levels of bureaucracy three in some states that lead to duplication and overlap. The system is riddled with inefficiencies. About $1 billion annually could be freed up for other health services if authorities cracked down on bungles in hospitals. There is also the buck passing.
The following is just one scenario. Joan is an 85-year-old patient with type 2 diabetes who needs elective surgery to remove cataracts. People with diabetes are 60 per cent more likely to develop this eye condition.
Joan missed out on effective GP care, which meant her diabetes was poorly managed. She spent 12 months on the waiting list for elective surgery to remove the cataracts. When Joan eventually had the operation, she had to spend six more months in hospital because she was too frail to manage at home but couldn't secure a bed in the nursing home. Who is to blame for her shabby treatment? GPs and aged care are federal responsibilities. States and territories run public hospitals. This causes cost shifting.
Both levels of government fund the public hospital system. The states can cry poor and the feds can squeal mismanagement.
If the Commonwealth takes over financial control of the country's 750 public hospitals, it can drive reform, overcome cost shifting and buck-passing, try to eliminate inefficiency, and target spending based on need rather than postcode.
The Rudd Government appointed the National Health and Hospitals Reform Commission to help drive change within the system and has recently received its final report. Rudd wants time to consider the document before making any radical changes. Fair enough but it also adds up to another dishonoured election commitment. The Government has already broken promises on private health insurance rebates and the Medicare safety net.
Opposition health spokesman Peter Dutton calls it ''fundamental injustice day''.
''This was the day Kevin Rudd promised to fix public hospitals and to have them fixed by June 30 or he would take them over and the Prime Minister, after 18 months, cannot claim that our 750 public hospitals have been fixed, not by any stretch of the imagination,'' Dutton said.
But Dutton was cagey when asked if the Opposition would support a federal takeover. ''We'll be ready to announce our policies at the time of the next election,'' he said. ''What I'm saying to you is that we are open to change into the future because that is what needs to take place, there does need to be change in the health sector and what form that will take, we'll put some meat on those bones into the future.''
In office, the Coalition had a poor record when it came to reforming the health system despite intense lobbying from the sector. Labor has proved more receptive to change across the spectrum from health promotion to acute care. It has invested $64 billion in public hospitals a 50 per cent increase under the new five-year Australian Health Care Agreement. It wants to improve health promotion and primary health care to prevent people from developing chronic illnesses and to better treat people with these diseases so they don't end up in hospital.
Will the Rudd Government follow through and make the tough decisions? Is it willing to really reshape the system so more effort is devoted to health promotion and disease prevention when most of the energy and money is currently invested in public hospitals? Will it take over the public hospital system?
A federal takeover makes sense and should help to tackle some of the problems in the system. States and territories have some legitimate concerns. The Commonwealth lacks experience in running public hospitals and Canberra bureaucrats may be oblivious to the needs of patients in Burnie, Cairns or Perth.
From a political standpoint, Rudd is probably reluctant to pick a fight with the states and territories in the lead-up to the election. The Government is also dominating opinion polls while the Opposition is in disarray. From a policy standpoint, the Government can ill-afford to stick with the status quo on health, given the increasing burden of chronic disease, the ageing population and rising costs of you-beaut medications and medical technology.
Danielle Cronin is Political Correspondent.