The opportunities of the new Australian Parliament
The composition of the new Federal Parliament provides excellent opportunities for the development of a health policy for Australia.
This is because the many points of view that need to be reconciled to achieve a comprehensive and inclusive policy will be represented in the new parliamentary configuration. While this may at first sight seem clumsy and inefficient, it is a process critical to developing a policy that will guide health service provision and financing on behalf of the community. As the Canadian commentator John Ralston Saul has written, the price of democracy is inefficient conversations – lots of them – that allow for all voices to be heard.
There is a further reason to be pleased that in the new arrangements a more cautious, inclusive and conversational approach will be applied to the development of a national health policy. It is that all too often, insufficient consideration is given to the unintended side effects of what appear to be bright new policy initiatives.
Amartya Sen, a Nobel Prize winning Indian philosopher and economist, refers to this omission as one of the more common cardinal errors of social policy makers. If asked, all the players may be able to provide more insights than one thinking alone.
Simply having many players at the policy table does not, of course, guarantee freedom from this error. As the Chilcot Report on the United Kingdom’s involvement in the recent Iraq war points out, a ‘coalition of the willing’ failed to question in depth what the consequences of war would be in the longer term. It was as though the policy stopped halfway.
The unintended side effects of the (good) policy to fund clinical psychologists to assist with the management of patients with mental health problems via general practice – workforce redistribution and budget over-runs – are examples of side effects that may have been anticipated if more ‘thought experiments’ – thinking through what might follow – had been conducted prior to implementation.
By what process might this policy be developed?
First, parliamentary leadership is required. A policy development oversight group that is genuinely multi-partisan should be established. This is not a matter of setting up yet another expert committee or commission of advice. The politicians need to lead. How the group wishes to proceed is, of course, entirely up to them.
Second, it is critical that high on the group’s agenda be a discussion about what Australia may reasonably expect from its health services, private and public, hospital and community, curative and preventive. There must be limits: what are they? How far do we wish to go in ensuring equity of access? How far in privatising the costs of health care? This is a special problem for patients who have serious and continuing complex problems, as my colleagues and I and many others have documented. Chronic illness is a fast track to poverty at present.
There are many topics to be discussed – which underlines my argument in favour of an inclusive conversation, auspiced by the Parliament, to begin. Attitudes vary in relation to prevention, and in the last Parliament a national agency for prevention was abolished. Is that what we want to do, or the best we can do?
And what are our expectations of research as a society? We know what experts and academics expect, but there are other voices as well that need to be heard, including those of some who have values espoused by science (and some who don’t).
Finally, there are ways of doing policy development well. From my personal perspective, I place a high premium on the contribution that solid data can make to the process. But my experience with policy development leaves me in no doubt that the ‘voice’ of data is but one voice. For a policy to work, data elegance is not enough. There must be buy-in from those whose lives and livelihoods are affected by it.
The new parliamentary structure requires a more humble and inclusive approach to policy formation. Nowhere is this of more value than in working out where we as a nation are going with health and health care.