Roy Morgan’s first face-to-face poll of the Rudd era shows Labor with a predictably bloated two-party lead of 60.5-39.5. Read all about it here.
Reflections on the Miracle of Democracy at Work in the Greatest Nation on Earth
Morgan: 60.5-39.5
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561 Comments
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Gus, it’s a bit of sport, kind of like bear baiting web 2.0 style really.
Basil if its sport its something akin to Australia playing England at cricket and Glen sure as hell isn’t Australia
On le savait!
La Brette.
Apres….. l’evenement
Gus, shhhhh, he doesn’t know that, he thinks he is Bradman.
Any relation to face?
er, i didn’t read william’s posts calling for a ceasefire. terribly sorry.
He must be outside ,playing…
I keep saying that the tax cuts are not a good idea.
http://news.ninemsn.com.au/article.aspx?id=65346
Regret to inform.
MIA.
Grave Fears.
Say, scaper…
…
…
Would you try my 274, in that case?
303 CW, No, la Brette wrote her Quarterly essay (from which this extract is taken) before the election, not after. See the following, published October 31:
http://www.theage.com.au/news/opinion/judith-brett/2007/10/31/1193618929372.html
Crikey Whitey
Rudd said he would govern for all the people including the non tax payers and I believe if there is tax reciepts that are to be returned as to speak, I would look at investing in infrastructure or reducing consumption tax or excise to halt inflation.
A bold move I know.
Scaper, agree, perhaps a good place to start would be taxes and excise on fuel, which has a dramatic effect on the cost of goods used by everyone. Couple this with a dramatic boost in research funding into alternative sources of non-polluting transportation energy so as to eventually move away from hydrocarbons. I really hope that Swanny decides to reduce the wedge tax cuts they were forced into, the vast majority of people polled would rather see better services.
Don’t see too many ads trumpeting the Australian Government these days, perhaps we can channel that disgraceful waste of money in reducing waiting lists in hospitals.
The Finnigans @ 275,
The Libs should pay for it?
Que?
Ummmm … refer the newspapers of 25/11 for news on who won the election ???!
Basil @ 313,
It would need a lot more money than Howard spent on ads to make any difference to the hospital system.
This elective surgery idea of Roxon’s is an absolute stunt – a complete joke.
Dyno, wasn’t the figure something approaching half a billion, I realise that won’t fix it but it would be a good start.
Giving money to the hospital system is not a bad idea per se (though earmarking it for elective surgery will just about ensure that nothing useful happens). You’ve also got to fix the rotten system that is completely bloated with administrators who don’t actually do anything to help patients!
The fact that Roxon’s very first act is such a silly one fills me with dread – not that I think she’s dumb (she probably isn’t), not that the idea itself is going to cause damage (it’s going to do nothing at all expect pad out a few administrative budgets), but she has sent a pretty clear early signal that playing political games is one of her top priorities.
Crikey re 274 and 310 is Labor’s Low Tax First Home Saver Accounts – Larger Deposits And Higher National Savings what you are alluding to?
http://www.alp.org.au/media/1107/mshou040.php
Roxon is a moron. Fancy not propping up the local hospital at PI. OK it’s not a state hospital but for christ sake it’s the only hospital the Island has.
For the sake of $2.5 million all the locals and tens of thousands of tourists could have had somewhere to go if they fell ill. Instead she plays petty politics. The hospital is located in the seat of Flinders which is a staunch Liberal seat. Of course the local member is shadow minister Greg Hunt.
Imagine the goodwill she would have generated if she’d saved the place. Instead she simply couldn’t give a stuff.
If Roxon had a commitment to health care and equity she would have moved to ensure the local residents had a hospital. Now they have to travel 40 minutes to either Wonthaggi or Inverloch. God help anyone in real strife.
She is a disgrace and a hack who only won preselection to her seat because of affirmative action. It shows.
Rant over.
Here’s an entertaining video of “Nelson’s” Battle of Trafalgar.
Should lighten the mood on a slow Sunday arvo.
http://www.abc.net.au/default.htm
“You’ve also got to fix the rotten system that is completely bloated with administrators who don’t actually do anything to help patients!”
this is a bit of a myth. while i don’t doubt some dead weight can be trimmed, hospital systems are biased towards having a high ratio of administrators to other staff positions. secondly a lot of people perform admin/oversight roles and medical roles as well. there aren’t thousands of champagne sipping managers just sitting around somewhere. earmarking money for elective surgery means you can actually pay surgeons, nurses and ot staff to actually perform the surgery. it means that hospitals will have more resources to spend elsewhere until the big infrastructure reforms get rolling.
health service provision is something where overspending can lead to adverse outcomes for patients as easily as underspending. the fact that they aren’t just throwing money around straight off the bat gives me hope that they’ll take advice and put in place a serious, overall strategy to fix things, instead of the piecemeal cherry picking we had from the old regime.
Thanks Scorpio 320, indeed a mood lightener. Oh well, as the bear has not appeared for his daily baiting, I am off to do something productive.
Sceptic @ 319
Why should the Labor Party start handing out public money to keep a private hospital afloat for the use of a bunch of superannuated Liberal voters?
If the demand for a hospital in that area were that great surely it would not be going broke? If it was just bad management which sent it broke then surely one of the larger private hospital operators would have gladly annexed it, got it running efficiently and made a packet off it?
Funny how the PI hospital was not on the verge of closing until just after the Howard government lost office. Why did we not hear about this hospital until after the election and why was Nelson so quick to make some mileage out of it by saying it was a test of how the Labor Party will run health?
Rant over
323
TurningWorm
The local lib member promised to bail out the hospital during the campaign – they did 5/8 of bugger all in the 3 years preceding the 2007 election but that’s neither here nor there. Now if it was in a Tasmanian marginal seat it might have received more attention from the rat and the mad monk but even then only in the last 6 months.
Question: what’s going to happen now to the Mersey Hospital? Will the Federal Government still be running it? It sure didn’t save the previous member for Braddon LOL
316 Basil-Sadly $600M would just keep the public hospital I work in afloat for twelve months. Spread over 700 public hospitals throughout Australia, it is a pittance.
317 Dyno and 321 Gam-The public hospital system is basically one huge administration with patient care a bit of a sideline. The best way to cover up underfunding is by overmanaging. Read “Hippocratic Oaths” by Tallis for a great view from trenches. for There are now more administrators than patients. The earmarked money for waiting lists is a shallow, populist vote-grabber which will do nothing to reform the system.
319 Sceptic- I believe I have precedence on referring to Roxon as a moron.
And to all of you, if Roxon doesn’t sack that disgraceful cow Jane Halton, it is sending a sign that she is going to take a politically expedient and morally bankrupt approach to her portfolio.
Diogenes wrote: “The public hospital system is basically one huge administration with patient care a bit of a sideline. The best way to cover up underfunding is by overmanaging. Read “Hippocratic Oaths” by Tallis for a great view from trenches. for There are now more administrators than patients. The earmarked money for waiting lists is a shallow, populist vote-grabber which will do nothing to reform the system.”
do you have any supporting evidence for that? i’d like to see it before i change my mind. the best stats i can find put expenditure on admin and r&d at 5.4% of total expenditure in 2001-2002 as opposed to around 20% for doctors’ services. my suspicion is that, like a lot of other services, the previous govt. simply refused to collect statistics it knew it wouldn’t like. this is why an actual infrastructure/organisational roll out will take time. it would be madness to just jump in and start sacking people left and right without getting a full picture of what’s going on.
why would roxon need to grab votes? it’s barely been 3 weeks since they won, let’s not get carried away here. if it was a cynical vote grabbing exercise, like cherry picking a hospital in a marginal electorate, would she be doing it now? why not closer to the election where there isn’t a chance for people to figure out it won’t work? this extra money might not fix the main problem (this will take years) but it will actually help people who have been waiting YEARS for help. and in the short term it will free up desperately needed money for other things for hospitals. if you remain unconvinced, i doubt you can be convinced, which is fair enough i suppose.
Steve K
I’m sure lots of Liberal candidates made lots of promises to their communities during the campaign as part of the Liberal party’s ‘All Politics Is Local’ campaign strategy.
My point was the hospital played a dirty game to try and force the new government into giving it a handout and the Liberal leader thought he would score a few points from the sidelines as well. That is not how this country works anymore.
Acknowledge, Acknowledge
311 apres
312
scaper…
318
Ed@Bennelong
Am in enemy encampment. Contact soonest.
Any news of G?
Over.
Ten Four.
327 gam- The waiting list money was announced as during the election campaign as a vote-grabber using the logic “everyone hears about long waiting lists, if we say we are going to spend money to reduce them, that’s just gotta be popular”. She is running with it now because she promised to do so in the election.
The people who have been waiting years are mostly NOT on the waiting lists. The public hospitals have manipulated the figures by stopping patients from even being seen in outpatients so they do NOT appear on the waiting lists. I know an orthopaedic surgeon who has 500 patients waiting to get in and see him in outpatients, but only 30 on his surgical waiting list.
In my state, five years ago there were the following levels of admin above me
1. Director of Surgery
2. CEO Hospital
3. CEO Health Department
4. Minister Health
Now there are
1. Director of Surgery
2. General Manager Hospital
3. Acute Service Director, Area
4. CEO, Area
5. Director of Systems, Health Department
6. CEO, Health Department
7. Minister Health
The book I mentioned has the figures for the UK on admin to patients. In our state, the figures are not released but I have seen internal figures which confirm an enormous number of staff not involved in patient care. I will get back to you with them when I can dig them up.
Basil
I’m getting the structure organised and I’ve made my play.
These sites will explain.
http://blogs.theaustralian.news.com.au/meganomics/index.php/theaustralian/comments/pendulum_of_a_kind
http://blogs.news.com.au/news/blogocracy/index.php/news/comments/weekend_talkback27/P20/
Gam @ 327
To my very great suprise, I am able to comment on the public health service in WA from the viewpoint of a recent emergency patient. I have nothing but praise for the way the staff – the paramedics, doctors, nurses and after-care support staff – responded to my situation and that of the other patients in similar circumstances to mine. The system is obviously short of funds and there is a lot of competition for beds. But the people in the system did a great job for me in what was a dire situation. I feel i’m in safe hands, am treated with dignity, and that I will be given the best care by some very hard-working and well-organised professionals.
332 blindoptimist- Your experience is actually the most common. The more serious your condition, the better care you get in public hospitals. The hard thing is to give that standard of care to patients with a lower priority. Doctors, nurses and allied-health staff want everyone to get that standard of care. The administrators and politicians don’t because it would be more expensive.
Diogenes 333 and elsewhere – Isn’t one of the problems of the public health sector that hospitals double up as nursing homes and that the nursing home sector has been run down by the Howard Govt or at least, has not kept up with needs or is this another myth?
Diogenes, I guess the resource allocation decisions are made according to a set of priorities – I would imagine these include clinical urgency as well as all the direct and indirect costs of facitilies and staff. There is also a public interest in spending as much as needs to be spent, but not more. It is largely public money that is spent on heath care, afterall, and everyone has an interest in getting the best outcomes for the money that is committed.
But in a way it doesn’t make sense to say administrators and politicians are to blame for one set of results (the poor ones) but that they are not responsible for others (the good ones). The system is clearly not monolithic. In WA, some parts – cardiac care, for example, work very very well. But others do not. So the task really is to find out how come? And then to find ways to apply the results. This should be the object of reform of the public health system.
334
neophyte Says:
December 16th, 2007 at 7:10 pm
“Diogenes 333 and elsewhere – Isn’t one of the problems of the public health sector that hospitals double up as nursing homes and that the nursing home sector has been run down by the Howard Govt or at least, has not kept up with needs or is this another myth?”
This is a fair comment, from my very limited observations…
334 neophyte- There is some truth in public hospitals becoming de facto nursing homes but I think that only 5% of patients in hospital at any time are waiting for a nursing home bed. These patients actually don’t use many resources as they just lie there with a bit of nursing input and not much else so it’s a bit of an urban myth that it’s a bit problem.
335 blindoptimist- “But in a way it doesn’t make sense to say administrators and politicians are to blame for one set of results (the poor ones) but that they are not responsible for others (the good ones).” I could argue that most of the good outcomes are when administrators are not involved which mainly happens in urgent situations, and that when administrators get involved it all turns to sh*t, but I won’t because it’s only 90% true.
Onyer Blindoptimist @332
Majority do, overall the system isn’t as bad as the MSM would make it out to be.
But it does have problems, which are systemic ones, and will always be with us, very common across all OECD countries with public funded health systems. They aren’t unique to federated governance styles like ours either. Canada with its Province/Commonwealth system has the same problems, same issues, same difficulty in providing world-class service with limited resources. Some of those resources are outside of government or its administrators control.
As for admin, I do beg to differ with Diogenes though, partly because its just not as simple as blaming administrators and/or politicians.
The Liberal Party has always stood for fully privatised health system on the Americanised model. Public hospitals in the USA are bottom-grade service for bottom-grade people (although they vary a lot in quality across different states) Americans accept this as part of their own cultural landscape. You get what you pay for. And if you can’t afford it, well *tough*, do without. Almost all other OECD countries have major public-funded systems with much smaller private sectors if they have any at all.
Things like waiting-list blow-outs are a constant problem right across the OECD (minus the USA) They have annual OECD-Health Directorate global projects on public hospital waiting-list management, amongst other things.
Over the 11.5 years of the Howard govt, the privatisation of health care proceeded apace as a standard policy platform, one part of this was to divert health spending into private hospitals. Another part was to withdraw funding from the AHCAs and force the States into a situation where they would be held fully responsible/accountable for delivering the service to the poor.
Around 2% of GDP which should have gone to the States/Territories was withdrawn after the GST came in. This is all wrapped up in terms like vertical fiscal imbalance, and horizontal fiscal equalisation.
Different States tried different experiments to cope with the CW funding shortfall, some tried increasing privatisation, floating ideas like a flat-fee of $100 for all presenting to emergency departments, some sold off hospital wings to the private sector, or ‘co-located’ services like sharing food, cleaning, nursing, path lab, X-ray services etc, some tried service-contracts with private hospitals to undertake public patients on a sessional fee basis etc.
Others tried to amalgamate hospitals into regional health service areas, and make them *compete* for annual funding, so some got more than others, depending on internal politics, who can scream the loudest, or who has the best gift of the gab in the annual scramble for funding.
Victoria for some time back in the 90s, set heavy financial penalties on individual hospitals who couldn’t reach state-set performance targets for cost-cutting, like on patient length-of-stay. The hospital was forced to kick patients out early, or use hospital-in-the-home alternatives or face funding cuts. This often led to increases in “unplanned readmissions” and “unplanned returns to theatre”, and post-surgical infection rates with reduced post-op care, rehab, and physio.
SA did something silly in the other way, but only briefly. They accidentally set a “perverse incentive”. In recognition that patients with co-morbid diabetes needed more nursing care, longer lengths of in-patient care, path & diagnostics etc, more than non-diabetic health patients. SA health allowed an extra $500 per patient with co-morbid diabetes.
Almost immediately, 3 major tertiary teaching hospitals started diagnosing co-morbid diabetes in every other patient *chuckle*. When I saw the monthly SA stats, a few phone calls to South Oz along the lines of “How come SA suddenly recording 5 times the national average of diabetics?” hehehehe…
In short though, States were starved deliberately of CW funding, and of very large sums, thats why infrastructure, not just health and education has deteriorated.
They have had little choice but to cut services, or raise their own taxes, fees etc, and local government was badly hit in some areas, along with welfare services, disability services and public housing.
Different States have tried different tricks or experiments to cope with the shortfall in different ways. Some more imaginative than others, some more successfully than others, dependent on their own economy and capacity, and possibly just luck, I guess.
Thats why local councils havent got 2c to repair the roads, and families of 5 die. Then along comes Howard/Costello every election time to regional pork-barrell in targetted regions.
I may be a very ‘lone voice’, but to me I’m surprised the States have been able to deliver as much as they have, and its no wonder so many are in debt.
338
Rain Says:
The real question is, which country has a better system. I can’t think of any.
Thanks Rain for the holistic view of 338. I’ve copied it to my desktop so as to remember and maintain the rage.
“Diogenes 333 and elsewhere – Isn’t one of the problems of the public health sector that hospitals double up as nursing homes and that the nursing home sector has been run down by the Howard Govt or at least, has not kept up with needs or is this another myth?”
This is a fair comment, from my very limited observations…
_________________________________________________________________
Not true, though States have often let that myth circulate.
Aged care has always been federal responsibility, though there are historical state funded ones and other private or semi-private services around.
While there are national needs-based guidelines and formulae for allocation of aged care services and beds, Howard/Costello did unbalance it, to a degree, by region/electorate, some got plenty, some got bugger all.
The other issue is they are two different systems of care, and transition between the two systems can reach bottlenecks in different times and places.
One of my colleagues once used the analogy of “wheels”… Hospitals are spinning fast, with hundreds of thousands in-and-out on an average of 3-day stays. High through-put.
Aged care homes have an average of 3-year stays with long-term care and so are spinning slowly, with low throughput.
If you have one wheel spinning very fast and another spinning very slowly, what happens when you put them together? CRUNCH. You need a “clutch” or gearing system
Sometimes called sub-acute or step-down care in health systems.
Hospitals want to discharge fast, “revolving doors”, aged care homes need more time to get beds and care organised. Often with old people, for example with strokes, the families need several days or even weeks to come to terms with the situation, and make arrangements. Sometimes a combination of care-at-home packages might be appropriate, but this takes time to organise.
hospitals get pissed off, as in “we need that friggin bed *now*, for the next emergency, we got em piled up downstairs!” So its all the friggin Commonwealth’s fault for not making enough aged care beds available.. and the media takes it up and you get the picture?
341 Rain-I agree with almost everything you say. When I used the term “politician” I was referring to State and Federal. The bottom line is that hospitals are underfunded for what the public has come to expect from them. There are only three honest ways to fix this.
1. Increase funding (ie raise taxes)
2. Reduce publics expectations (a la USA)
3. Increase efficiency (which is fairly limited in what it can do and difficult)
The health systems have hugely expanded their bureaucracy to help do 3. but have found it almost impossible to do so and so now the bureaucrats mainly manage each other. I honestly cannot remember a good initiative from any of our Health Ministers which has worked in ten years.
Excellent. Let’s ensure there are no hospitals to service towns that have a large Liberal voting population. That’ll teach them won’t it!
Excellent point. Let’s only keep hospitals open if they make money, regardless whether there are adequate facilities to service the country area. In fact let’s extend the principal to all metropolitan areas. Hospital should be money making ventures and not a facility to treat sick and frail people.
Don’t really see your point. The fact is the hospital is on the verge of closing now. A re-elected Howard government would have faced the same problem.
Because the ALP said that with hospitals they would end the blame game. Instead Roxon is blaming the local authority and is referring the matter to James Merlino (the state minister), Merlino says it is a matter for the federal government, and in the meantime local residents (some of whom who probably vote labor) lose their only local hospital.
Rant over.
Beautifully argued at #323 though.
Those of you who want to indulge your loathing for the Murdoch press will enjoy this piece by Paul Kelly:
http://www.theaustralian.news.com.au/story/0,25197,22926587-5013871,00.html
In it he makes clear that it was the obnoxious drunken News Ltd hack and Costello toady Glen Milne who, by leaking the McLachlan letter in the hope of bringing on a Costello leadership challange in 2006, ensured that in fact Howard would stay on and lead the Libs to disaster, thus inadvertantly destroying Costello’s hopes of the prime ministership. Poetic justice for all: Howard defeated, Costello thwarted, Milne exposed as a meddling incompetent grub.
Diogenes, my brother in law mentioned to me that 90% of health care money is spent on patients who live less than 3 months.
He is not a doctor, but is no fool. is this based on a semblance of fact or just a wild exageration?
345 Fulvio- There is no way that is true. Most Medicare payments are for GP visits and minor operations. Most PBS scripts are for long-term illnesses (esp for cholesterol and high blood pressure). So for most Federal funding that is not true. In public hospitals, almost everyone lives more than 3 months after discharge and very few die in hospital. Of the sickest who require intensive (or expensive) care, 75% of them live more than 3 months. Most administrators complain (tongue in cheek) that the problem is that medicine is now so good at looking after our sickest and most chronic patients that they refuse to die and so cost them money! Certainly there are huge amounts spent on some patients with cancer with a poor prognosis on some intensive care patients but they are the minority.
Overall, I’ll go with wild exaggeration.
Fulvio @ 345 “..my brother in law mentioned to me that 90% of health care money is spent on patients who live less than 3 months…”
The amount is an exaggeration, but is one of the issues plaguing health economists, ie: spending on “the last year of life” (not last 3 months). Also wrapped up in public expectations, better life expectancy, better technology etc, we all want access to it, and for free.
The top 3 main cost-drivers of health expenditure are:
- new technology (including pathology/diagnostics, eg MRI, and medications on PBS subsidy)
- rapidly increasing complex chronic diseases in all population groups
(diabetes, CV disease)
- last year of life
I’m currently working on 5-10 year economic models for diabetes and musculoskeletal diseases like arthritis, comparing the cost of public health prevention programs, versus the likely impact of life-long medications, GP and specialist, and allied health services, and regular hospitalisations. Diabetics are freaking expensive bludgers, and prevention by making those fat arses get off their butts, will save the taxpayer a lot of money in the future.
This isn’t as good as Glenn Milne revealing that Downer had a chat with Howard late last year and said words to the effect – all the issues are now favouring Labor, the voters aren’t buying economic management, and national security anymore. Downer pleaded with Howard to come up with a new big issue to take attention away from Labor, but Howard simply replied “We have done everything we wanted to do.”
In other words, over the last 12 – 18 months leading up to the election Howard had completely run out of any ideas of how to make the country better. He had absolutely no intention of doing anything new, he just wanted to stay P.M. for a) the sake of staying P.M. and b) because it meant he could stop Costello from becoming P.M.!
This act alone should change the way historians treat the Howard legacy. At the end he didn’t care what happened to the country, or his political party. He just wanted to stay P.M. to stop others from assuming the job.
Thank dog the Australian voting public put him out of his misery.
Diogenes and Rain, thanks for the perspective.
Sceptic @ 343
How is Nicola Roxon playing the blame game by blaming the local authority?
By local authority I am guessing you mean the board that runs the hospital?
The private hospital?
Is it wrong to blame a private entity for not being able to run itself at a profit or to at least fund it’s own activities? If this private entity was running at a profit would they be offering a share to the federal government?
Has Nicola Roxon not held meetings with the hospital to organise moving the patients to alternative, even public facilities?
But I’m sure you are right, if not for affirmative action we would be having someone of the calibre of Tony Abbott sorting this situation out good and proper.
OK, OK. One more whack back then we’ll call it square OK?
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