Of all the lotteries of life, dealing with a lifelong disability must be among the most difficult. An Australian suffers a permanent disabling spinal injury about once every 30 minutes. Many of these injuries will require full-time care for the rest of that person’s life.
And yet, as the Productivity Commission report handed down this week makes clear, the life prospects for many Australians with a disability can be grim indeed. Worse, the result is almost always enduring disadvantage, both for those disabled, and for their families, loved-ones and carers. You can’t state it any more bluntly than the Commission does when it writes, "people with disabilities and their carers are among the most disadvantaged groups in Australian society".
Perhaps the most iniquitous aspect of disability care in Australia is how unfair it is. The level of care that people can access varies widely according to completely arbitrary factors. Where you live and how you acquired your disability can mean the difference between some level of care and almost none at all. If you suffer a crippling injury in a motor vehicle accident, for instance, there is needs-based care available, provided through no-fault insurance schemes run by several of the states. But other types of disability, or the same disability caused by a different circumstance, have no such cover.
The Commission quotes Assistant Treasurer Bill Shorten, who has been campaigning on this issue for some time, explaining how unfair the current arrangements are:
"It has been said to me that the best thing to do for someone who has fallen off the roof of their home and suffered a spinal injury, is to bundle them into the car and drive it into the nearest lamppost. Yet people injured in accidents … are the comparatively lucky ones."
The reason people injured in accidents are, as Shorten says, comparatively lucky, is that other types of disability have no insurance at all. Disabilities caused by medical conditions, by genetic fluke or acquired in the womb are not covered. For the families of many of these people, there is no financial assistance available to them of any kind. A recent Australian Bureau of Statistics survey found that levels of unmet need extended to hundreds of thousands of Australians. And the unmet need extends across many different types of required care, accomodation and human services.
The Commision quotes the ABS as estimating "almost 42,000 primary carers who had indicated a need for more assistance with respite alone". Most of this unmet need is of course met by family and loved-ones. The economic and social cost to Australia is vast.
In addition to the unmet need, the chronic under-funding and the lottery of state-by-state provision, the Commission also identifies some of the more typical problems governments always face with service delivery, such as a lack of clear responsibilities, a fragmented approach, failures to intervene early, and a lack of clear planning for the future.
In summary, the current arrangement are a blight on Australian society. If we measure our social progress by the care and provision we make for the most vulnerable and needy, then Australia’s current system of disability care is nothing less than an indictment.
In place of the current state-based, ad hoc arrangements, the Commission recommends a comprehensive, universal, national insurance system, akin to Medicare. Two schemes are proposed. The first, a National Disability Insurance Scheme, will "provide insurance cover for all Australians in the event of significant disability". A parallel insurance scheme, called the National Injury Insurance Scheme, will build on existing motor vehicle accident insurance, in order to extend cover to "cover the lifetime care and support needs of people who acquire a catastrophic injury from an accident."
Together, the two schemes will be the key components of a broader policy to improve the coverage and level of care of Australia’s disability services nationally. The Commission argues the main function of the new policy should be "to fund long-term high quality care and support," with other important roles including "providing referrals, quality assurance and diffusion of best practice".
To roll all this out will take years and cost billions. The Commission has taken a conservative approach to its timetable, arguing that the scheme will require extensive consultation and negotiation in order to make it through the minefield of federal-state relations. As a result, it will not come to fruition until 2018-19. Western Australian premier Colin Barnett has already taken a shot at the proposal, telling reporters: "I am getting a little tired of schemes coming out of Canberra to take over areas of state administration only to find that they invariably fail".
The extra cost will be about $6.5 billion annually. The Commission argues the Commonwealth should simply find that money in the budget, or, failing that, introduce a Medicare-style national levy. Even if some of the states don’t agree to sign up, the Commission still thinks Canberra should go ahead, such are the advantages for the nation in terms of productivity gains and social inclusion. No doubt the details will be hashed out in many meetings with quarrelsome state premiers in the years to come.
But let’s take a step back and examine the bigger picture. This will be the largest expansion of the Australian welfare state in decades. It really is a milestone for the way our society provides for its least fortunate. And, at least at the moment, it seems as though the package has won cautiously bipartisan backing, most importantly from a newly relaxed Tony Abbott back from his European holiday.
In time, these reforms will come to be seen as the single most important social policy reforms of the Gillard government. Pair them up with the carbon tax and the increase to the base rate of the pension, and the long-term reform record of this Labor government begins to look rather more substantial than it has so far been given credit for. Of course, much work is yet to be done. But Gillard, Shorten and the entire government must be commended for signing up to this scheme. Credit must also go to the Productivity Commission, whose monumental report is testament to years of detailed, rigorous policy development, and to the disablity sector itself, whose tireless lobbying has finally borne policy fruit.
It has been a long time coming, and it’s still along way away, but the eventual passage of a national disability insurance sheme in this country means that Australians with a disability — and their families and carers — can finally look forward to a future where lives can be lived with a measure of dignity.
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