KEVIN RUDD and Tony Abbott have locked horns over healthcare reform. But for all the fuss over the detail, the prime minister and opposition leader pretty much agree on the point of the exercise: ending the “blame game” between federal and state governments.
Mr Rudd says that under his plan the federal government will “end the blame game, eliminate waste and shoulder the burden of funding to meet rapidly rising health costs.” Mr Abbott counters that the PM’s plan is “basically going to make a bad situation worse. It’s not going to end the blame game.”
The experts agree with the politicians. “Lack of clarity of accountability and definition of responsibilities creates the environment for a blame game, as each government is able to blame the other for shortcomings attributed to each other’s programs,” say the academics, doctors, economists and former ministers on the National Health and Hospitals Reform Commission. And all indications are that the public agrees with the experts.
Condemned by politicians, experts and the public alike, is there a good word to be found for continuing the blame game in healthcare and other areas where the responsibilities of Canberra and state capitals overlap? Apparently not in Australian policy debates today, bouncing as they mostly do between utilitarian cost–benefit analyses on one side and political race-calling on the other.
But step into debates that stretch back to the writing of the federal constitution of the United States and you will find plenty of reasons to worry about the “buck” stopping in one place (which, in our case, will usually be Canberra for as long as it collects so much more revenue than state capitals do).
Advocates of rationalising federal–state relations claim it stops each level of government from blaming the other for its own shortcomings. For instance, voters will be in no doubt who is responsible for how they long they wait in a hospital emergency room or for elective surgery. A federal government that keeps them waiting will be punished at the next federal election.
But will they? It’s just as likely that federal governments will tell voters in, say, Victoria, that Queenslanders are waiting even longer for treatment or surgery than they are, and so it is only fair that hospital funding flows north. It could even be true, for all most Victorians know of Queensland emergency rooms and elective surgery waiting lists (at least outside the artillery of statistics Canberra will no doubt wheel in behind such a claim).
Those Victorians who suspect the reason is poor management of Queensland hospitals will have only a single vote, cast every three years, to express their view of the federal government’s performance not only in health, but also in education, taxation, family payments, foreign affairs and all the many other things it tends to.
For what today’s federal–state rationalists dismiss as a “blame game,” yesterday’s framers of the US constitution saw as a “double security” for free people. As one framer, James Madison, wrote in 1788, “the power surrendered by the people is first divided between two distinct governments, and then the portion allotted to each, subdivided among distinct and separate departments. Hence a double security arises to the rights of the people. The different governments will control each other; at the same time that each will be controlled by itself.”
In other words, voters, as well as parliaments and the courts, will keep federal and state governments honest, but not as honest as when they are joined in the effort by another tier of government.
Take the prime minister’s proposal to have the federal government pay 60 per cent, rising to 100 per cent over time, of the “efficient price” of every public hospital service. “An independent umpire,” Rudd explains, “at arm’s length from governments, will set the efficient national price – taking into account factors such as remoteness and complexity of patients’ needs.”
“Remote” will also describe the chances of ordinary Australians contesting these prices – which, given the heroic assumption that Canberra bureaucrats will be able to identify, let alone quantify, all the factors that make up the true cost of a hospital service, are bound to contain anomalies.
Individuals and groups will effectively have one federal member of parliament, instead of one federal and one state MP, to raise their concerns with. And that federal MP can kick off a brand new blame game, by referring them on to the edicts of the worthy but still unelected experts who will make up the prime minister’s “independent umpire.”
So the blame game might not stop, though the players and their relative strengths certainly will, and in ways that make politicians less not more accountable – the opposite of what federal–state rationalists say their reforms will achieve.
Today, healthcare, schools, skills and workforce development, disability services, housing and other areas of policy overlaps are dealt with through intergovernmental agreements. Although the ambit claims and walk-outs that often accompany agreement negotiations trouble the policy purist, they do have the virtue of pitting eight state and territory ministers, and eight state and territory bureaucracies, against one federal minister and one federal bureaucracy, as well as against one another.
A nationalised public hospital system will pit individuals and groups against one mighty federal government. State governments might back ordinary Australians with rhetoric, but they will have less incentive and fewer bureaucratic resources (after all, a much-touted benefit of nationalisation is the rationalisation of eight state and territory health bureaucracies) to take up the fight.
Although the case for a federal rather than national or “unitary” approach to policy is often narrowed to the issue of states’ rights, there are many good reasons to push policy-making downwards. According to a report for the Council for the Australian Federation by researchers Glenn Withers (now chief executive of Universities Australia) and Anne Twomey, these include customisation (policies and services can be tailored to account for differences in climate, geography, demography, culture, resources and industry), creativity (states need to be innovative and to experiment in order to compete with other jurisdictions) and choice (people can move from one state to another if they prefer the latter’s policies).
And there are other good reasons to push policy-making upwards. These include redistribution (federal governments can move money between states to make sure all Australians receive minimum levels of basic services), best practice (successful policy and service innovations can be adopted everywhere, sooner) and scale (some investments, such as a national broadband network, are too large for a single state).
The blame game is what happens when we let policy-making go in both directions at the same time, and leave elected federal and state politicians to wrestle each other to a compromise. A government, political party or interest group will always be able to commission an economist to pick holes in that compromise and come up with a more “efficient” and “effective” system for running hospitals, schools, disability services and so on.
If that economist’s plan is ever implemented, however, all experience suggests it will disappoint, as people are rarely amenable to being planned. Worse, to the extent the plan has rationalised policy responsibilities, it will have disabled the tension that had previously produced workable compromises. A new economist will then be commissioned to come up with a new plan to fix the problems of the old one. And so policy will lurch from one plan to the next, leaving the affected people dazed and confused, but can-do politicians with something to do.
“Thus,” writes British philosopher Michael Oakeshott in Rationalism in Politics, his critique of politicians of a rationalist mindset, “political life is resolved into a succession of crises, each to be surmounted by the application of ‘reason.’ Each generation, indeed, each administration, should see unrolled before it the blank sheet of infinite possibility.”
As if addressing Rudd and Abbott, Oakeshott continues, “To patch up, to repair... [the rationalist] regards as a waste of time; and he always prefers the invention of a new device to making use of a current and well-tried expedient.”
So two cheers for the “current and well-tried expedient” of Australia’s federal–state blame game. It may not be, to paraphrase Oakeshott, the “best” approach, but it is probably the “best in the circumstances.” •