Opinion: Corrosive, centralised elitist power

That policy vacuum has to a great extent been filled by think tanks, consultants (particularly accounting firms) and industry associations. One or two of the think tanks are independent and produce reports with the eye on the national interest. The Grattan Institute and the Australia Institute are good examples. But too many are self-interested or produce recommendations that the government wants to hear.

It now seems that the Public Service is being treated with more respect. It will, however, take some time to restore it to the engine of policy ideas and recommendations that it was last century.

The corrosion of Public Service policy repair, maintenance, and scrutiny over the past 25 years had resulted in a slow collapse in in public health, public education, and welfare.

It has been highlighted this month by the Royal Commission into Robodebt and the Grattan Institute report on Medicare.

As power gets centralised, those who exercise it become increasingly isolated. They do not know what it is like to be unemployed; unable to afford a medical or dental appointment; or to mix with children from less fortunate backgrounds at school. They do not even know other people who have had those experiences.

And they pursue policies that increase the isolation. They have no empathy or understanding.

The Robodebt is a classic example. People who have been on welfare or know a lot of other people on welfare know that benefits are calculated weekly, fortnightly or monthly, not annually. So having no income for two months preceded and followed by employment for the rest of the year (usually on a meagre wage) does not preclude you from receiving the benefit or require its repayment.

A more empowered Public Service would have pointed that out fearlessly and the whole expensive fiasco been avoided.

On Medicare, the Grattan Institute report recommends a top-to-tail revamp. It is not just about money. It argues that the 40-year-old system is no longer fit for purpose. An ageing population means more people are presenting to GPs with complex multiple conditions.

That is true. But it is also about money. If you have been in the position of not being able to afford to fill a prescription or know people like that, you would not forever increase the prescription co-payment.

Nothing illustrates better the way centralised, unempathetic power has eroded public health than the increases in those co-payments.

When Labor introduced the Pharmaceutical Benefits Scheme in 1946 all medicines were free. They were distributed according to need, not money.

The Menzies Coalition introduced the first co-payment in 1960 and it has been rising ever since. It is now $42.50, more than the cost of many drugs. The scheme now has been eroded from a universal scheme to a user-pays-everything-nearly-all-the-time scheme.

If the Menzies 50c co-payment in 1960 had gone up by the inflation rate it would now be between $7.50 and $8, not the $42.50 imposed by increasingly out-of-touch policy makers.

It is the same for GPs and specialists. Forty years ago, when Medicare began, the idea was that everyone would get free treatment – a universal scheme. Now, patients pay on average between $45 and $50 per GP visit and massive sums plucked out of the air for specialists.

Medicare is still a universal scheme insofar as you will not be left for dead at the emergency department door. But treatment is increasingly based on capacity to pay, not medical need. Health Minister Mark Butler has a task ahead of him to reverse this trend.

Those in power need to understand what it is like to have an extremely painful hip and no prospect of paying for a new one and every prospect of waiting for more than a year to get one free in a public hospital.

They need to understand what it is like to never being able to afford dental treatment.

On the education front, the change of government might see more effort going to public schools because of the lived experience of those driving the policy. Albanese went to a non-elite Catholic School and Education Minister Jason Clare went to Cabramatta Public School and Canley Vale High School.

That contrasts with the 80 percent of Abbott-Turnbull-Morrison frontbench who went to private schools – and generated elitist, unempathetic policies accordingly.

Only with less centralised, elitist power can health, education and welfare (and, indeed, tax policy) in Australia be fixed. The Robodebt Royal Commission is doing an excellent job of pointing that out.

This article first appeared in The Canberra Times and other Australian media on 13 December 2022.
www.crispinhull.com.au