Dr Trevor Mudge, AMA Vice President; Dennis Correll, Council of the Ageing; John Kerin, The Australian, with Tony Delroy, ABC Radio 2BL

Dr Trevor Mudge will be with us, Vice President of the AMA, who's in our Adelaide studios. And Dennis Correll, who's an Executive Director of the Council on the Ageing, who is going to be joining us in our Melbourne studios tonight. But first to John Kerin in Canberra. John, good evening.

KERIN: Hi, Tony.

DELROY: Well, what a campaign it's been. It hasn't focused to a large extent on the domestic issues simply because of what's been happening. Tampa and also in Afghanistan. But let's have a look at the individual policies of the major parties. The Coalition for a start. How would you describe its approach in relation to health and this election?

KERIN: Well, Tony, I think as you were saying the domestic issues have been very much overshadowed, and you know, we really have to look hard at what these policies are. But I guess Michael Wooldridge, who is retiring on Saturday, in the Coalition's case, it's very much standing on its record. It's saying, 'you know, we've put in a record amount through the Medicare agreements with the States'. In their specific new policies this time around during the campaign, they're talking about putting in extra money for getting extra doctors, about 150 extra doctors, in rural areas and fringe areas. There's $750 million from the Budget to improve illness prevention, immunisation, so it's very much of Michael Wooldridge sort of saying, 'Look, we've done these things over the period we've been in office and, you know, we're going to continue with more of the same if we're returned', even though he won't be the Health Minister.

DELROY: It is kind of difficult with health, isn't it? Because it's almost a bottomless pool, because no matter how much you pour in you can always spend some more. It's a very expensive area, particularly with the new technologies and the new drugs coming through?

KERIN: That's true. But I think that most people would acknowledge that there is, you know, that our public hospitals are under-funded at the moment. And I think if you're looking at the policies of the two parties, Labor is the only one that actually is offering extra funding for public hospitals in terms of a new promise in this campaign.

DELROY: Now, obviously the Coalition sees one of its main positives out of the last couple of years is the restoring of the private health insurance industry. And obviously, the private hospital system being propped up with this 30 per cent rebate that its put in place. It's playing big - you know, that is a big card. And Labor is certainly saying, 'me too', on that issue.

KERIN: Yeah, I guess both parties really are now pretty much locked into the private health rebate. It's almost part of the landscape. You can't really take it away from voters who, you know, have just got that $700 or $800 off their policy.

DELROY: Yeah, still it's a very expensive option?

KERIN: That's true. And we know that you can deliver this kind of money more efficiently if you were to put it directly to the public hospital system. I guess the only party that sort of stood up on this particular question has been the Democrats who have basically said, 'Look, we should means test the rebate.' And, you know, according to them they could raise a billion dollars which they would put towards the public hospital system.

DELROY: Health and the elderly. It's a particularly pertinent issue today with a Melbourne woman running a full page ad after her elderly mother was fatally injured in an accredited aged care facility. Has the Coalition targeted much money towards health care, medical and otherwise, for older Australians?

KERIN: Well, what Bronwyn Bishop has done - there's been a bit of a care funding shootout, if you like. Labor got their policy out first and it included a capital loans program to build more beds in regions and get into the shortage. And Bronwyn Bishop responded with $200 million in care funding. But when you have an issue like that which broke today with Mary and Val Wilkinson, I don't know what either party could have done about that.

DELROY: Yeah, well, obviously the commitment of the person to basically give away their inheritance by spending it on taking out a full page advertisement to say, 'Hey, this has happened. It shouldn't happen again.' I mean it's obviously very hard for the health care system to cover every possibility, but it just goes to show the heartfelt attitude of a lot of Australians to this area?

KERIN: Yeah, I think what we're seeing - and something that Mary Wilkinson talked about today sorry, Val Wilkinson, the daughter in this case, was that the attitudes towards, you know, there were some comments today that well, it was a tragedy but, you know, she was an older person. You know, we can't sort of value people at this stage of life, less. And the attitudes towards the elderly have changed quite a bit in the last couple of years. And I think that's been brought about by the focus on what's been happening in the residential aged care sector.

DELROY: Also, I guess, baby boomers are getting older and also they're seeing their parents in a lot of these aged care facilities, and you know, that baby boomers can scream when they want to?

KERIN: That's correct. And when they, as they move into that field, it'll be a few years yet I suppose - they'll be demanding better care. It won't be a matter of, you know, both sides of politics will have to come up with solutions.

DELROY: And it's still a section of the community, John, that you really can't ignore as a politician simply because there are such large numbers?

KERIN: Yeah, that's true.

DELROY: And they all vote, or most of them do anyway. In terms of dollars, the ALP is saying, 'we're going to spend more on health'. Mr Beazley is going to restore funding to dental care, which is one issue that has been a little bit sensitive too with the aged care area.

KERIN: That's right. That was a program that the previous Labor Government ran up until 1996, which was then discontinued by the Coalition Government. I mean there's been a pressing need. We talk about waiting lists of half a million across the country when you talk about dental care for those on lower incomes and pensioners and so on. I don't think there's any doubt that that particular policy is a winner for the Labor Party.

DELROY: Can you see any other decisive differences between the two major parties on the health care issue? Obviously Labor has decided that it's going to focus its efforts on health and education and a couple of other key issues. So, you know, what are they going to do that's going to be, you know, different to how the Coalition is approaching it?

KERIN: Well, I think there are perhaps - if you look at health and aged care together, perhaps the biggest criticism of the health care groups has been that there's not enough money on either side. We had an independent arbiter say that, you know, it should be about a billion dollars. Maybe that's what's needed and maybe that they're short of ideas. But I think the two things that sets the Labor policy apart in this area is that they are spending money putting aside some money for the people who are trapped, if you like, in public hospitals. And there's about $120 million there for their care, while unveiling capital loans program for the shortage of spaces in nursing homes. And those two policies actually may have some effect on, you know, the shortage of beds and the plight of people who are basically languishing in public hospitals at the moment, who shouldn't be there.

DELROY: John, the Democrat's health policy, as we mentioned earlier, they are not so keen on the unchecked private health insurance rebate. They want to see it means tested, which obviously could have a fairly big impact. But the Democrats health policy also seems to centre around this boosting of the funding to Medicare. A lot of people are concerned that Medicare may be withering on the vine.

KERIN: Yes, that's true, in terms of what we spend on general practitioners. But I would and I know that doctors groups are very strong on saying, you know, have had this examination of the costs in general practice and are suggesting that rebates have been falling below inflation and patients are going to pay more to visit their family doctor. But there has been some movement in this area. And certainly Michael Wooldridge has put in about $750 million in paying for longer visits and special rebates for mental health, asthma and diabetes and those sorts, when you visit the doctor for those problems. Doctors to get extra payments. So it's not as if there hasn't been any movement in this area. It may be, at this stage, we need to do more.

DELROY: Indeed. John, thanks so much for joining us tonight.

KERIN: Okay.

DELROY: We really appreciate it. John Kerin there, who is The Australian's correspondent dealing in the areas of health and aged care. We're going to continue the discussion, and joining us in our Adelaide studio tonight, Dr Trevor Mudge, who is the Vice President of the AMA. Trevor, good evening.

MUDGE: Good evening, Tony, and your listeners.

DELROY: And Dennis Correll is with us as well tonight, Executive Director of the Council on the Ageing. Dennis, good evening. Dennis, are you there?

CORRELL: Yes, I am here.

DELROY: Terrific. Good evening to you.

CORRELL: Good evening.

DELROY: Dr Mudge, I might start with you. You're not particularly happy with what either side is offering in relation to health in this election campaign?

MUDGE: No, not really. We're not. I think that this represents amongst the biggest wasted opportunity you could imagine. This, as you've already intimated, is perhaps the most policy-free zone election of any that we've had. And I think although there are other reasons for that, it's really fairly appalling that both parties have been able to get away with the sort of lack of vision that they've both produced, I think, especially in health and aged care, our particular areas. But across the board, I think, this will not go down in history as one of the great ideas elections, will it?

DELROY: Certainly. Dr Mudge, looking at specific issues, the AMA in its health policy report card, says there's too much power in the hands of health insurers. Now, I mean, should the rebate system be scrapped? Or should it be altered? Or, you know, what's your view on it?

MUDGE: Well, I think that while we supported and do support the subsidising the private health system in order to take the pressure off the public health system, I think we've always said that the subsidy should have gone into usage of private health rather than in subsidy of premiums. And, after all, even though the two billion that's been put back in is quite a lot of money, it really only represents the money that successive governments have taken out of private insurance subsidies in the last 10 or 15 years. There was what was called the 'bed day' subsidy, in which the government did subsidise private health funds usage of beds. And there was the reinsurance pool, which the private health funds were able to use for the high cost members, particularly the elderly. And, of course, the statistic is that most of us use up 50 per cent of our lifetime health care expenditure in the last 12 months of our lives. Which again, as you've intimated, is a big problem being stored up by us baby boomers, who are going to get to that point sooner or later, where we want to use up that 50 per cent.

DELROY: Absolutely. Dennis Correll, what's your view on the private health insurance rebate?

CORRELL: Well, I wasn't expecting to agree with Trevor much, but when he made the comment that they would prefer to see - this is the AMA would prefer to see the money used to subsidise the usage of health, we would agree with that completely. Because at the moment we just see it being wasted going through a private health insurance system which has high administration costs, which have risen since the subsidy came in. It used to be about 10 or 11 per cent, it's gone up to about 13 or 14 per cent. And we've got an issue - John Kerin very astutely mentioned the dental care area. And, according to the Australian Institute figures, you've got about $360 million of private health insurance going to dental care and yet we can't even get the most basic government subsidy to dental care for low income people.

DELROY: Dennis, also the Coalition took quite a number of drugs off the PBS, which has affected, I guess older Australians. Is this being addressed at all in this election by either side?

CORRELL: We were very pleased to see that the Labor Party had picked up a policy - which was in our election guide - which was that there should be much tougher controls on the pharmaceutical companies and the amount that they expend on advertising and trying to get medical practitioners to use particular pharmaceuticals. That does need to be capped. It's an extraordinary amount of money that is spent on that. And effectively it comes out of the Pharmaceutical Benefits Scheme. We, for years, have accepted the line that we've got to cut some things out of the pharmaceutical scheme to make room for others. But I must say we've become very annoyed at that argument when we see such vast expenditures on trying to flog new drugs that have come onto the market. We've got the situation with this cererex

MUDGE: Well, no. If you look at the percentage they spend on advertising, that's not the big cost of pharmaceutical companies have to bear. The big cost is actually bringing the drug to the marketplace, because all of us as consumers want absolute certainty, or as close to certainty as we can get in medicine, that new drugs are safe and effective. And therefore the costs of developing a new drug has ballooned to the billions and billions. And that's really why, when they get it to market, the cost of new and effective drugs is so expensive. And the Pharmaceutical Benefits Scheme has a budget, which is going up by about 15 per cent a year. It is again another big problem. I mean the bottom line I guess - and the AMA is not supporting one political party over another at all - but the bottom line of it all is that neither party is being honest with the electorate about health. The problem with health is that, again as John Kerin and yourself alluded to, that the costs are going up all the time because of new technologies. Look, 30 years ago when I was a kid in the country, the most expensive piece of equipment for the local hospital was a chest x-ray machine. It probably cost $20,000 in today's money. Now, of course, they've got a CAT scanner and they want a PET scanner as well, and they're on the list for an MRI scanner. Now, that's about, you know, $15 million worth. And the same applies in every other area, so that as new technologies come on the market, medicine now is more about modification and improvement of lifestyle than it is about saving lives. Now, what society has to grapple with is, what forms of lifestyle modification should we as a community pay for? And what forms of medicine and lifestyle modification should individuals bear themselves? Because there isn't a country in the western world that doesn't ration health care because the demand is bottomless. They ration it either by waiting lists or by a cost signal, or a combination of both. And nowhere, in the rhetoric we've heard about health, has there been any discussions about expectations and difficulty in meeting the cost of it all. And meanwhile governments take out more and more money. By the Senate Committee Inquiry, the public hospital system needs $900 million immediately, and not 550 over four years. And here again we have a new system of announcing funding. You know, $550 million over four years. If you look at the figures it's about $2 in the first year, $5 in the second year, $10 in the third, and the other 550 is in the fourth year if of course they're still in government. So I mean it's vapour wear really, in software terms. And I don't think we, as a community, should be letting our politicians get away with it, quite honestly.

DELROY: Dennis Correll, is the accreditation for the aged care facilities good enough as it sits at the moment? It's obviously changed during the last years of Bronwyn Bishop's reign as aged care minister, is it in a position now where you're happy?

CORRELL: Well, let's say for a starters that accreditation is a good system. It needed to be brought in. It has moved the standards of the buildings up. Much higher standards are now being achieved, and will be even higher by 2008. And the standards of care are being pushed up as well. What it has done is expose the problems that have been lying in the system for some time. We're not happy with it as yet because it is a system - it was such a new system that it will take years to develop. When you look at the hospital accreditation system, that took years to settle down as well.

DELROY: I think one of the real worries is that the fact that a lot of these aged care facilities seem to be having incredible problems attracting nursing staff and qualified staff to deal with the patients who are in those.

CORRELL: A massive issue, Tony. That's to do with the amount of money that is paid in subsidy to the aged care facilities through subsidy of the government. There is an indexation formula, which is an all of government formula, which is below the sorts of salary increases that have been needed. And so in about the last 10 years salaries have been slipping behind in nursing homes and hostels, which is a real tragedy because we are losing good nursing staff.

DELROY: Yeah. Do you think we've got the kerosene baths behind us? I mean, obviously these sort of incidents are going to turn up every now and again. We hope that they don't, but they probably will. But I mean, do you think that we are, as a system operating nationally, we have a reasonable control so that, you know, people aren't being tortured in their declining years?

CORRELL: I'd say that the residential care system is now extremely aware that bad care will be detected. We have a media that are very watchful now, since the kerosene bath incident, that they will now pick up on issues. And that has been a great boom in, I must say, for residential aged care from the point of view of the consumer of care. That they know that there is more watchful care now being taken. But we've still got a long way to go. We will continue to have instances. There's 3,000 facilities across Australia. There are still problems, and we'll continue to have problems for the time being.

DELROY: Dr Mudge, the AMA has been highlighting, for quite a while, what it sees as a major problem in bulk billing and the neglect of GPs. Can you take us through some of the issues? Obviously regional doctors are very thin on the ground as well at the moment.

MUDGE: Yeah, it's one of the big problems, I think, in getting doctors to the periphery of urban centres and into the country. Is that the lack of support for Medicare rebates again the then Labor Government seven years ago commissioned what they called the 'Relative Value Study', in which the profession participated, to try to find out what the Medicare schedule of rebates for patients for doctors services really should be. It reported, just before Christmas, that their rebates were about a billion dollars a year short because of failure to index the Medicare rebate over 15 years. Now, both sides of politics have ignored that report, just like the Senate's Committee on Public Hospitals, and have continued to take money out, in real terms. That really means that doctors who are working in areas where all of their patients are disadvantaged and are finding it very difficult to pay a co-payment for the doctor's fees, are finding that they can't run their practice at a profit. And that diminishes the ability of disadvantaged patients to access health care. It means gaps. Co-payments are increasing. And until somebody does something about the underlying structural reform that Medicare rebates need - and it would only take a billion dollars. Look, it's said that this current Government has thrown away $20 billion in sweeteners in the last 12 months. Now, you know, health is the single most important issue in this election, according to every poll. And what have we got on health? We've got no vision, no policy. We've got no support for Medicare. We've got no commitment to put real new money in. All we have is rhetoric. And it's a great shame, I think.

DELROY: Trevor, the AMA has also highlighted the issue of medical indemnity. And this obviously is going to be an issue of matter of urgency for both sides of politics, simply because, you know, the level of actions in the courts and the insurance worries about doctors, I guess, could drive some of them out of the industry.

MUDGE: Well, I'm an obstetrician, Tony, and it's going to drive obstetricians out of the industry. I think that the $13 million payout that we saw publicised this week is wonderful for the poor individual injured, but it means $20,000 for every practising obstetrician in Australia. There are only 800 of us. And as these cases escalate, and the cost of future care and settlements escalates, then we aren't - that's not a cost that society is going to be able to bear because doctors have to pass on that cost to patients or they have to go out of business. And either way society is going to bear the cost. We have to do something to reduce the cost before Australia, like Florida in the US, runs out of obstetricians, because that's what happened there in 1986. It was only after that that the Government brought in a capped scheme to bring the costs down and the obstetricians back.

DELROY: Well, back to hospital care and private insurance. Victorian colleagues of the AMA have raised serious concerns about private hospitals cherry picking patients. That is, taking the patients that are more lucrative and refusing the more difficult to treat patients. And, Dennis, does the Council on the Ageing currently see this cherry picking of patients by private hospitals as a major issue?

CORRELL: A very major issue. When we most recently polled our members, we asked them what were their biggest worries in life? And the waiting lists came out top above every other issue. Other issues that people came out with were much lower down, were things like pensions. So the issue of that came up and that the AMA raised regarding to Mayne Nicholas hospitals, is a very real worry. We find also that we've got a lot of pensioner members who rely on a pension, ten and a half thousand dollars a year, are buying private health insurance because they're afraid of not getting into hospital. But yet now they've got a situation they may not even have a guarantee of getting into a private hospital. A very serious worry to older people.

DELROY: Dr Mudge, how do you see this? I realise you're in another State, but obviously it's a pretty serious issue because, I mean, this is a national private health change - private health chain, I'm sorry.

MUDGE: Yeah, look, I think the issue is very serious and it's not confined to Victoria. And, of course, you know we shouldn't be picking out one particular chain of hospitals as the villain. I mean really the villain in the piece is the amount of power that's been given to the health funds in the last five years or so since the former Labor Government - well, ten years I guess - brought in the so-called Lawrence reforms. Whereby above schedule fee payments were able to be paid by health funds if they were able to contract doctors to funds. And also contract hospitals to funds. So that because hospitals are being contracted to funds, the funds have been able to squeeze them. And in many cases the behaviour has been quite unconscious. Even the ACCC has agreed with that.

DELROY: So, essentially what you are saying…

MUDGE: It's really not a negotiation. There's not a negotiation there, and the hospitals are just starved of money. And, therefore, to look to make a profit they have to - well, they are looking to try and get into areas where they can actually make a profit rather than the areas where they don't because of the funds structure. And that means they're looking at rapid turnover surgical things. And, you know, aged care as Dennis rightly says, is going to be a problem. Those who are elderly and sick and who need a lot of care in hospitals and spend a long time in hospitals are, like obstetric patients, going to lose money for the hospitals. And it's hard to blame the hospitals for trying to turn a profit, because without a profit they can't go on operating.

DELROY: Obviously. There's a wide range of concerns in relation to these health services in this country, essentially what we're talking about tonight, you know, is there enough being done for public hospitals? Is the rebate for private health insurance the best way to spend the health dollar? Are rural/regional areas getting adequate funding? Is Medicare in crisis and desperately in need of additional money and so on? There might be an issue that you would like to raise tonight and we would love to hear from you tonight. My guests are Dr Trevor Mudge, who is the Vice President of the AMA, and also Dennis Correll, who is the Executive Director of the Council on the Ageing.

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