The Health Debate – Kevin grins, Abbott grits and Journalists talk.

Let’s not beat around the bush: the Health debate at the National Press Club today was a clear win for Kevin Rudd. Tony Abbott came with no policy and left with little other than a reinforcement of his stereotype – namely that he is a bully who loves nothing more than to tear into Rudd.

Today Kevin Rudd circa 2007 came back to life, and he won the debate by steadfastly refusing to follow my advice of yesterday! Rudd knew the Big Picture was his winner, and he stuck to it. Details? Bah! He threw out some data – enough to make it seem like he had the facts at his fingertips, but there was very little filling in of the holes in the policy. Abbott on the other hand didn’t have the data on his side – mostly because his side stuffed up the numbers as demonstrated by the graph done by the Liberal Party to show Health funding under Abbott that had to be quickly redone this morning.

So nice of the Liberal Party to produce a graph which actually shows just how much extra spending there has been on Public Hospitals under the Rudd Government. (Seriously, there are people out there who think this organisation can win the election?).

So yes Rudd won, and the media can try all it likes to excuse this – by saying, oh well Abbott did as best he could without having a policy (which is kind of the whole bloody point I would have thought), or you can have others saying that the “worm” should be banned because it’s too biased (they’re right – in the past it has been biased toward opposition leaders!) – but the fact is Rudd cleaned him up. Abbott was supposed to be this great debater – it’s his thing apparently. But that’s if you watch Question Time and you like people who throw out caustic lines in front of a cheering backbench – but here’s the thing, no election debate will ever be held under those circumstances, it will be like today – and in conditions like today Abbott is no good. Why? Because as I have said again and again, he can’t stop himself from letting his hate of Rudd come out (as the handshake shows). 

He showed his worst side today – a big fake laugh, and lots of sarcastic jokes that showed a guy who is more suited to the role of minor Minister than national leader. If Abbott doesn’t know the difference between being a leader and being a Minister, he should know it now.

The big media response from today’s debate is that next time Abbott will need a positive policy to sell. The problem is Abbott doesn’t sell positive policies – that’s not his thing. His thing is to attack, and that alienates people big time. Abbott also needs to realise that he is up against the best politician of his generation in Kevin Rudd. Don’t believe me? Never forget Rudd killed Howard – you think that was easy?  Want further proof? Here’s Peter Dutton:

But Mr Dutton said the Opposition Leader had been a victim of debate timing.“There was a disadvantage for that reason,” Mr Dutton told The Australian Online. “But there was no consultation with the Opposition about when the debate should be held. It was dictated by the Prime Minister.”

Oh cry me a river Dutton! You’re playing for keeps here, if you expect Rudd to give you an inch, you might as well plan your after politics retirement right now. Every bit of political logic says not to give the Opposition leader a chance to appear on the same stage as the Prime Minister; it was all there for Rudd to lose today – if Abbott had “won” the debate, Rudd would have been savaged by the media (and likely his own backbench). Instead he walked away stronger than he was yesterday – that requires political courage and smarts to know that going against convention is the right thing to do.

And yet the media still thinks Julia Gillard is going to challenge Rudd! Just one last thing on Rudd’s supposed unpopularity: a good measure is to look at the 2PP compared to the Preferred PM. On the last Newspoll (Rudd’s worst, so I’m giving him no favours), Rudd’s Preferred PM to 2PP score was Minus 3 – ie he was 3% below the ALP’s 2PP. Tony Abbot, supposedly kicking arse in the polls, had a Preferred PM to 2PP score of Minus 18. Who do you think is a bigger drag on their party’s vote at the moment?

But now to the debate itself. I’m not going to go into the details of each answer – mostly because there wasn’t much detail! (and note to Kevin Rudd, you’ve clearly won the voters with the Big Picture, don’t stuff it up by getting the details wrong – those questions I asked yesterday still need to be answered – and the media and Abbott will keep asking them). Instead I’m going to look at the questions asked.

A quick note – any journalist who complains about Rudd going on and on, should look at how long most of these questions are – they make Bob Katter’s Question Time efforts look positively snappy.

Paul Bongiorno - Network 10
Prime Minister – why 60-40, why not 100%, aren’t you at least going to have a 40% blame game?

To Tony Abbot – I judge from your remarks today that you’re not happy with the 60-40, does that mean you want 100%, is that what you will hold out to the Australian people? And you’re critical of bureaucracy, who will run the hospital boards who will appoint them? Will it be a new layer of bureaucrats, or will you trust the states this time as you didn’t when health Minister and you felt they needed to hand over everything to the Federal Government.

A solid opening effort from Bongiorno. He tried to get some more policy out of Abbott, and there’s no real bias on display here, but it’s mostly big picture stuff as well –and it was easy for both to bat it away.

Sandra O'Malley - AAP
To both leaders – we’ve heard the horror stories of how the aging population will overwhelm the budget in the coming decades at the same time many of us drink too much, smoke too much, don’t exercise enough, adding to the burden of chronic disease: at what point do Australian need to become more realistic about what they can expect Governments to provide in terms of health care, and why shouldn’t there be a sensible debate about health care rationing as part of public health care policy into the future?

A bit of a “not quite sure what you’re asking” question – which meant Rudd was able to use the first preamble bit to get onto “integrated health care” which went down a treat with the voters. O’Malley may be right about health care rationing (I don’t know to be honest), but there is no way on God’s green earth any politician is ever going to say they will bring in a rationing of health services (even if there is in reality). So on that score it was a bit of a no brainer for both Rudd and Abbott, as they were able to sidestep it pretty easily.

The question did allow Abbott respond to Rudd’s answer by saying: 

“Sandra I’m at a terrible disadvantage in this debate because I’m not capable of waffling for 2 minutes like the Prime Minister is”

which went down about as well as does a joke at the local airport that you’re carrying a bomb.

Sue Dunlevy -The Daily Telegraph
There’s a gaping cavity in this nation’s health care and I want to extract an answer from each of you on the problem. Over 1 in 4 Australians has untreated tooth decay – ½ a million are waiting for up to 10 years to get dental treatment, and we’re getting Thai Buddhist dentists coming out to Central Australia to do charity work because there are not enough services in this country.

Kevin Rudd: your Health and Hospital Reform Policy on page 83 says we should have a nationally funded dental health plan paid for by a 0.54% increase in the Medicare levy, will you deliver it?

Tony Abbott: you say in your book, Battlelines on page 104 Medicare should fund dental care for every Australian will you deliver it?

As a journalist who specialises in Health-reporting, Dunlevy asked a good pointed question to both. Neither of course gave a pointed answer.

Abbott, perhaps not realising his previous joke died with the viewers, tried another one about Rudd and dentists:

The Prime Minister has had some medical experience being an anaesthetist in the House of Representatives.

It went down even worse (perhaps because it was very laboured and really has nothing to do with dentists – as my Dad said to me, “Anaesthetists? Huh All I get is a quick injection and away we go!” – Obviously Abbott had work-shopped this joke with Dutton and Bishop and it amused them)

Lyndal Curtis - ABC Radio
You both come into this debate with experience in health, as a bureaucrat and as a Health Minister, yet neither of you has brought your whole policy here, we’re only months away from an election, and neither of you have the full answers to questions, like how are you going to deliver more hospital beds, what are you doing on aged care, and what you’re doing on mental health, isn’t this just a chance for you to score political points from each other, and isn’t that just what voters are heartily sick of?

She basically asked why am I bothering to ask this question. A waste of a question really – and rather surprising as I think Curtis is a very good interviewer on AM. It would have been better to ask – what are you going to do about aged care or mental health.

The only good thing about this question was it provoked Abbott to respond:

I have two roles, if you like, one is to provide a credible alternative to the Government, and that’s what you’ll get in good time.

I don’t think he meant to suggest that is not currently a credible alternative to Government, but who knows, call it a Freudian slip.

Mark Riley – Network Seven
Prime Minister, of the $42b stimulus package about $16b was spent very visably on improving schools, school halls, and sometimes duplicate school halls and libraries, I wonder if you can explain why none of that money was spent on another sector – the health sector, the hospital sector is crying out for capital investment – we visited dozens of schools with you in recent months and it’s obvious that there’s a real need there for capital investment, why have there not been more operating theatres, more cancer centres built with that stimulus money that would have flowed through the economy just as well. And Mr Abbott if you take Government before the money is spent would you redirect some of the stimulus spending, the infrastructure spending towards capital investment in hospitals, and if so how much?

A long hack of a question. He brings up the Building the Education Revolution “bungling” (but of course wouldn’t be able to make a cogent case on the issue if he tried – unless he thinks 16 “questionable projects” out of 24,000 is bad) and then he displays a complete lack of economics’ knowledge and common sense if he thinks it would be quicker to build a hospital ward than a school hall. Also not every town or suburb has a hospital, whereas schools are spread everywhere. (I’ll forgive Riley saying “we visited dozens of schools” when he obviously meant “hospitals”.)

His question to Abbott was a virtual Dorothy Dixer that Abbott fluffed by saying he’d reveal all later. Though one good thing about the question is that it did reveal via the worm that the voters do actually like the education spending.

Laura Tingle – Financial Review
You’ve both talked about cutting bureaucracy as part of this whole exercise, but I’d like to know where between the 150 odd local hospital networks in the Labor’s case or the 750 odd local hospital boards in your [Abbott] case who would actually run things? Who are those bodies going to answer to, are they all going to ring Jane Halten [the Secretary of the Dept of Health and Aging] in the Department of Health? Do you presume that when you get rid of area health services in New South Wales there will be nothing between them and head office in New South Wales? How is it actually going to work so that all the money you both say the Commonwealth doesn’t get enough say in actually is accountable to the Commonwealth and Commonwealth taxpayers?

A good question by Tingle (if rather long and roundabout). She also showed she knows the phrases of the policies by referring to “local hospital networks” rather than “local hospital boards” in relation to the Government’s scheme. It was a good specific policy question, rather than being too “big picture”.

Matthew Franklin – The Australian
Hi gentlemen, to Prime Minister I’d like to follow up on Mark Riley’s question. I understand why you spent the stimulus money, but when you sat down and worked it out why did you decide that we need to put a building in every school rather than addressing what you here today say is a major problem and that is deficiencies in the health system, was it because you got more political bang for your buck by putting a school hall in every school, rather than a smaller number of hospital wards?

And Mr Abbott you have proposed top do something very un-Liberal – increase a tax to provide what some people say is an excessively generous paid parental leave scheme (but you wouldn’t say that would you – I think he just did... some people would) but I would just like to know, if Health is so important have you considered… and why don’t you lift taxes so that you can find the money to make the sort of improvements that I think we all can agree are needed in the hospital system?

Franklin’s question to Rudd was perhaps the worst of the day, and displayed even less economics acumen than did Riley’s. His question to Abbott was a better effort, but really did he seriously think Abbott was going to say he would increase taxes to pay for hospitals?

Abbott’s answer did allow Rudd one of his best lines when he noted: “I find it surprising that here we are in a big debate on the hospital and health system and Mr Abbott chooses to talk about anything else”.

Michelle Grattan - The Age
Mr Rudd Can I to take you to Private Health Insurance . Apart from the means test on the rebate which you haven’t been able to get through the Senate, can you guarantee that if you’re elected for another term there will be no more changes to the Private Health Insurance rebate arrangement?

And to Mr Abbott, you’ve talked repeatedly about the problem of divided responsibility – you’ve said in Battlelines that any hospital reform program is beyond the states, we know that you have advocated a Federal takeover of policy and funding when you were in government and Health Minister, why can’t you just say now “I believe in the Commonwealth being the sole of dominant funder and having made policy responsibility I will work out an alternative plan to the Government’s one, but taking that as the central principle?

A pretty easy question to Rudd – though some chance for a pitfall given his 2007 pledge on the rebate. The question to Abbott was very Big Picture, but even then Abbott didn’t go there – instead talking about bringing out a policy at a later date (he really had nothing to say).

Jayne Azzopardi Nine Network
Look I want to talk about what I think most voters think about when it comes to hospital reform, and that’s bed numbers. Now Prime Minister you’ve mentioned funding from the past but you still say we need more beds, yet your plan doesn’t actually specify any extra beds, how can voters take you seriously this close to an election when you’ve called this debate and you haven’t covered that issue?

And Tony Abbott you talk about consideration of the 3,500 thousand new hospital beds, is that an iron clad promise or could the number reduce if you can’t find the money?

Geez, Channel Nine couldn’t get Laurie Oakes to ask a question? It all smacked as being a bit work experiency – from the “look I want to talk about…” opening to the “how can voters take you seriously” line. Far too suited to A Current Affair than a serious leaders debate. She did at least try and ask something specific of Abbott.

Karen Middleton – SBS
Have the same question for both leaders. The Prime Minister mentioned earlier that the patient should be the centre of this. One of the common complaints we hear from people using the health system now is that even if you have private health insurance you’re still out of pocket when you go to the doctor or you receive hospital treatment. We’ve heard a lot about funding and the structure of the system, but I’d like to ask, what are you polices going to do to reduce the out of pocket costs of people actually using the system – the patients?

An interesting tack, but one that yielded little results. It was good to talk about the costs to patients, but to be honest I think her cause would have been better served if she had ditched the preamble and just asked the question in her last sentence – it would have been much more pointed and harder to avoid.  

Andrew Probyn - West Australian
My question is directed at the Prime Minister primarily, but I know you’ll want a say, and it’s about activity based funding of hospitals, which is (for normal people) a fancy way of saying you pay for services that the hospitals provide. Victorians have been doing this for 17 years, and they decided that the so called casemix doesn’t work for rural hospitals, in fact they dumped it, instead they give it block grants. Now why do you think Prime Minister that a Federal activity based funding model would work when the Victorian Health Minister says it won’t no matter what weightings you give it?

The question of the day – specific, based on research, and requiring a direct response. And best of all he got one – an admission from Rudd that the regional hospitals under his scheme may not be subject to casemix funding.

So that was the debate. I’ll say one last thing: I’m not a huge fan of Chris Uhlmann, but he was an excellent moderator, and should get the job in all future ones.