The Elephant In The Operating Theatre


One of the most noteworthy aspects of the Rudd Government’s first year in office was its penchant — even obsession — with policy reviews. Not content with simply promising to govern better, Labor came to office in late 2007 with a surprisingly detailed policy platform. Even more surprisingly, Rudd then honoured most of his promises in government, including the headline items like abolishing AWAs, ratifying Kyoto and delivering the 2008-09 round of tax cuts in Wayne Swan’s first budget.

But many of Labor’s promises were in fact simply to establish reviews into existing policies. As the Liberals pointed out at the time, Labor announced more than a hundred different policy reviews, enquiries and committees into nearly all aspects of the Commonwealth’s activities — from visual arts in secondary schools to the future of the nation’s security.

In part, the "establish-a-review" strategy made sense. The 12 years of John Howard’s government had left the nation with a legacy of many bad laws, incoherent policies and self-defeating administrative log-jams. In some areas, like climate change, the nation had barely acknowledged the challenges facing it, while in others, like health policy and defence procurement, the current system was manifestly dysfunctional.

But there were other respects in which the review-driven policy-making of the Rudd Government seems to reflect the personality — and personality flaws — of its leader. Establishing a review or enquiry for just about everything has kept the bureaucrats busy, the academics engaged and the media releases flowing. It could also be argued (and has been) that is simply the logical consequence of electing a former top departmental bureaucrat as the Prime Minister.

But the constant flood of reports has also had its drawbacks. The most glaring is an inevitable lack of clarity. As these reports filter out to the media and the wider public, their executive summaries are sifted for significance and recommendations are divined like tea leaves for their chances of being made into law. This muddy water is further agitated by the many vested interests affected by the various potential policy changes as they vociferously lobby for special treatments and protections. This, in turn, seems to have encouraged the Rudd Government to try and split the difference between the recommendations of its hand-picked reviews and the most vocal of the opposing industry lobby groups. It is transactional politics in action, and it’s never pretty.

You can see how the review process is meant to work (and how it gets captured by political exigencies) by examining the recently launched report of the National Health and Hospitals Reform Commission.

Like Ross Garnaut’s draft report of his climate change review, this interim report is intended to survey the policy landscape and foreshadow a range of possible government actions. In this it is quite successful, presenting for instance a range of interesting ideas which include a new universal dental care program funded by an increase in the Medicare levy, nurse practitioners for the country, souped-up versions of Labor’s campaign idea of SuperGP clinics, and an option for a federal take-over of public hospital funding and management.

Even these relatively uncontroversial suggestions quickly drew the fire of the medical lobby groups, including a predictable rant from the increasingly out-of-touch AMA President Rosanna Capolingua about how the report would lead to a British style NHS system. "You lose your choice as a patient and care becomes rationed," she remarked last week, apparently unaware of the fact that for millions of Australians, unaffordable dental care means tooth decay is their reality, but they didn’t choose it.

Although politics in the doctors’ union can be every bit as vicious as in more proletarian labour associations, Capolingua’s obvious conservative affinities have led to the Government sidelining her during most serious health policy discussions — a situation that is clearly not in her members’ interests.

But, like Garnaut’s, the health report is also hamstrung by what it leaves out: most notably, the entire discussion of the public versus private delivery of health care.

Private health provision is the proverbial elephant in the health policy room, as anyone who has tried to go to doctor in the US will know. Here in Australia, our mixed system includes plenty of obvious inefficiencies, the most glaring of which is the 30 per cent private health insurance rebate. As health economist Ian McAuley has pointed out, this $4 billion subsidy to the private health insurers is a wasteful churn of taxpayer money. McAuley thinks the interim report "makes a lot of assertions but really doesn’t go into the analysis."

At its worst, the policy-by-review process simply results in bad policy — like Penny Wong’s CPRS. Labor’s long and complex implementation of climate change policy began well, with a clear and well-reasoned argument by Ross Garnaut about why Australia needs to act on greenhouse gas emissions. But several more reports and papers later — and still with no legislation on the table — Kevin Rudd now risks leaving Australia with the worst possible emissions reduction policy: a clumsy, complex and cravenly compromised system that doesn’t even seriously reduce emissions. Nor is the key Minister, Penny Wong, performing as well as many first hoped. Blaming the Greens won’t exactly help Labor get its legislation through a hostile Senate.

It’s no coincidence that Joe Hockey has had a good first weekend as shadow treasurer, simply by pointing out the glaring inconsistencies in Labor’s approach to emissions trading policy. Sometimes effective government demands something that committees and policy reviews rarely deliver: the expenditure of political capital, also known as courage.

Ben Eltham is New Matilda's National Affairs Correspondent.