Australia's steps away from education and health equality have harmed us deeply
This is the second in my four-part January series on how our politicians have done a poor job adapting when circumstances change or policies don't work.
This week, it's education and health policies. Both suffer from flaws that had their genesis in the Howard years and which successive governments have not fixed.
When we suffer a catastrophic or chronic health onslaught, the private system is uninterested. Photo: Louie Douvis
With education, I'll start with an analogy. When I taught journalism and media law at the University of Canberra, come exam time, I always advised students that they should answer every question required of them, even if they thought they would make a complete hash of one question.
Make a rough stab at it no matter what, I told them, even if you think you would be better off concentrating on the questions you think you're good at. This is because it's far easier to get a mark of just 20 per cent for the dud question than it is to get the same extra marks for your best answer on another question – because to get the extra 20 percentage points on top of the 80 or so you might already have is near impossible.
So, too, with our schools. There is little point pouring extra money and resources into the better schools that already achieve good educational outcomes. The money and resources are better directed at the worse schools (the dud question), where improving educational outcomes (get a quick 20-point boost) is relatively easy.
The Howard government significantly increased funding to private schools to win votes, because an increasing number of aspirational parents (often with good reason) thought that sending their children to private schools was worth the sacrifice. The publicly stated reason was that private schools were not getting a "fair" share because state governments favoured public schools.
And so increasing amounts of money were being wasted in places where the money was not needed for education. The funds were spent on ancillaries.
The Gillard government tried to redress this with the "needs-based" Gonski version 1 reforms. Alas, Julia Gillard succumbed to the bellowing that no school should be worse off under the reforms. The result was an unsustainable budget blow-out. Where else will get the money to improve the lot of poor schools unless you pull back funding from the already more-than-well-off schools?
The result was that, on objective measures, Australia's education attainment fell in relation to other OECD countries. It's a damnable result that can't be put down to not enough money in the system, but rather to the money being spent in the wrong places and on the wrong things.
Giving money to "schools" is not the same as giving money to "education". If no federal government has the fortitude to address this, maybe the Commonwealth should remove itself from school education entirely and let the states do it.
Gonski version 2 perpetuates rather than fixes the problem.
Meanwhile, in the university sector, the Commonwealth is setting up for another educational step backwards by freezing funding at 2017 levels, which in effect means freezing places. It means many qualified students won't get a place given population increases.
In health, another time bomb is ticking, again with its genesis in the Howard years. The ideal behind Gough Whitlam's Medibank and its revival, after Malcolm Fraser desecrated it, via Bob Hawke and Bill Hayden's Medibank was the simple proposition that people should be treated according to clinical need, not their ability to pay.
John Howard put the scalpel into that proposition, using the same "entitlement" view of the world that the Coalition abhors elsewhere.
In education and health, Howard and his government argued and implemented the proposition that well-off people were "entitled" to whatever base level public provision is available in health and education, and then to top that up with private health and education funding to get a superior result.
That's entirely different from the reasonable view that wealthy people need not engage with public health and education but buy their own in its entirety. Howard did the opposite. He used public money to subsidise private health insurance by making it tax-deductible.
It was argued under the banner of choice. Well, choice is fine if you choose to go it alone. But the Howard vision of choice was to grab your public-sector "entitlement" and top it up with your publicly subsidised private health insurance. This was the road to great inequality.
The fact is that no matter what one's wealth, come a catastrophic or chronic health onslaught, the private sector is uninterested. It cannot and does not deliver best and continued treatment for the big items: cancer and heart disease. For those, everyone ultimately requires the public system, even Kerry Packer.
The move by Coalition governments to transform Medicare from an efficient universal system of health insurance based on clinical need to a social-security safety net coupled with a grossly inefficient system of private health insurance, however, is facing an internal contradiction.
Successive governments, including Labor, have squeezed and freezed the amount that the government under Medicare pays doctors and specialists. It has got away with squeezed GPs because people can shop for a bulk-biller.
But now, the freeze and squeeze on Medicare payments to specialists is about to dramatically affect the health system. The specialists have responded. They cop the squeezed and frozen payment for public patients, but not private patients. They can charge private patients a "gap". Private insurers usually pay hospital costs and very little if any medical costs, such as the fees charged by specialists, so they don't pay the ever increasing "gap" charged by surgeons, anesthetists and other specialists.
Imagine the horror of the soccer mum who is told that her son's painful knee injury in the public sphere is elective and will be treated some time in the next year or so, but if she draws upon her queue-jumping private insurance policy, which gives immediate and free hospital treatment, she will be charged a "gap" by the surgeon, anesthetist, intensive specialist that totals up to $10,000.
The soccer mum will wonder why she bothered with private health insurance if the gap payments make it impossible to use and she must take her son to the public system (with its attendant waiting list) anyway.
As the horror stories of gap payments permeate, more people will abandon the private system, the very thing Howard's subsidisation of the private and screwing-down of the pubic sought to reverse.
Governments need to ensure the private health system is ancillary and a helpful pressure valve to a public system that is the main game, not try to make the public system a welfare prop and require that the bulk of healthcare is provided by a private system that is demonstrably inefficient, unfair and incapable of providing for catastrophically and chronically ill Australians.