The National Health and Hospitals Reform Commission (NHHRC) was set up a year ago to review the Australian health system. Prime Minister Kevin Rudd's pre-election promise — "to end the blame game between Canberra and the states when it comes to health and hospitals" — merely registered the obvious fact that the hospital system is in crisis.
On February 16, the NHHRC handed down its interim report, with 116 recommendations.
But do these recommendations address the many problems that beset the delivery of health care in Australia?
The central recommendation, that comprehensive primary healthcare centres be set up, revives a proposal that was embedded in the original Medibank package in 1975.
The original scheme was soon done away with after a few pilot projects were scuttled in the face of organised opposition from the Australian Medical Association and other professional bodies.
Since that time the health system in Australia has been altered by a succession of Labor and Coalition governments.
With each successive manipulation of the original, if flawed, template, the cost of health sevices has risen for working people. Universal free health care has dwindled. Medical services are now often dependent on how much your local GP chooses to charge for a consultation.
Over the same period, the hospital systems in each state have been in perpetual crisis. Private healthcare cover has become a lynchpin of federal government policy.
None of this real history is discussed by the NHHRC. The report focuses on primary health care and argues that primary care delivery, and not Rudd's proposed federal government takeover of hospitals, should be the key federal responsibility.
In proposing community-based Care Centres as the basic cell of healthcare delivery, the report is simply recognising the proven superiority of public, community-based, provision of health services.
If we want to avoid the US disaster, where 17% of GDP is spent on health while 40 million people have no health insurance, this is a necessary first reform.
However, the NHHRC wants to deliver this package within the already existing Medicare funding and health insurance parameters.
Likewise, while there is also a welcome recommendation to overhaul the national dental services, the commission calls for a further 0.75% rise in the Medicare levy to fund it.
While the new clinics may be located in any number of rural and urban communities, there's no suggestion that patient costs will go down — although access to health care may improve.
The health cost rising spiral is not just due to the existing model of primary health care based on private medical practices — important though this is — but on the profit needs of the broader private health industry: the big pharmaceutical companies, the specialist medical colleges and the private health insurance mafias.
Thus, while the NHHRC report also addresses mental health issues, aged care and the dire state of Indigenous health it dodges the two big elephants in the room: who runs what and who pays?
Despite the commission's primary health care focus, the report only notes that "governance — or who should 'run' the health system — is without a doubt the single most controversial issue we have been asked to tackle".
The commission asks whether the funding model should stay as it is now; whether the federal government should become solely responsible for all aspects of healthcare delivery through regional health authorities, or whether, in the case that the federal government assumes responsibility for all health services, compulsory social insurance for every Australian should be introduced — assumed to require a levy of 14% on an individual's taxable income.
There's no "none of the above" box for us to tick.
The NHHRC report waves the carrot of better primary health care for all, but with a huge price tag determined by an underlying assumption that Australia's health industry elites are untouchable.
The real alternative doesn't rate a mention: a public, community-based system, funded by public health insurance and democratically managed by users and salaried health professionals committed to the noble goal of quality public health.
[Dave Riley is a member of the Socialist Alliance national executive and a retired registered nurse.]