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Wise and shiny politicians: are they likely to make sound structural reforms to our health system in this Budget?

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Living in New South Wales is a blessing.

We have vibrant country towns and a spectacular harbour in our capital city. New South Wales’ politicians from both sides of the fence are, however, proving to be less than squeaky clean, way way less, in fact. The term ‘honest politician’ will certainly be entrenched as an oxymoron here for decades to come.

Selective amnesia is so rife that one must wonder if Parliament House should have a dementia wing.

Surely it is time our society set down some ground rules for those seeking to enter politics, such as holding a meaningful job independent of political parties or unions for 10 or more years, and having a demonstrated tolerance of Aussies of all ilks and persuasions through broad community involvement.

Yet, these sheltered party hacks who represent us determine the very nature and quality of the health system in which we work, and through whom our loved ones are treated.

Is Medicare, which even blind Freddy must admit is deeply flawed by its negatively skewed indexation formula, about to see major change in this year’s Budget?

Our publicly beloved “universal” insurance system is certainly unlikely to receive a funding lifeline or structural makeover from the Coalition. Continued freezing or negative  indexation of rebates must bring the current system sliding down, so that bulk billing enables, at best, three-minute medicine and, at worst, lack of access to care for the most needy in society.

What bean counting politicians hate about fee-for-service is its uncapped fiscal outcomes. They would prefer greater control of expenditure through the clubs of capitation or salaried care, even though the evidence shows they give a poorer bang for the public buck.

Such attacks on funding are very short-sighted approaches, because already funding is inadequate for primary care to provide the high quality preventive services essential to curtailing the huge and accelerating spend on tertiary care.

If our system is to reap major efficiencies, it needs to empower preventive care by supporting GPs to lead better funded multifaceted primary care teams.

There also needs to be a sensible and ongoing educated community debate about end of life care. Far too often, bucket loads of dollars are simply wasted on the futile prolongation of lives devoid of quality. Always a messy topic, and full of emotion and extreme views, it never the less must happen, and end of life directives must become the norm, not the exception.

Being pragmatic, what do I expect from the Budget? Will rural health get a leg up? Will private insurers be given a green light to insure for GP care? Will taxation rise? Will structural reform be put in place to empower high quality preventive care? And will end of life care rate a mention? Will disability pensions be harder to access? Will you be smiling on budget night?

No, No, Yes, No, No, Yes, No.