Sunday, March 07, 2010

The importance of dumb questions

I am still taking a break until at least next Wednesday, but I could not resist this brief comment.

In my last post, The Australian Government's health care changes, I commented that I was becoming boring on certain issues. Listening to the media comments this morning on the Rudd Government's delivery problems, I don't think that I need say any more beyond noting that people are still not focusing on the systemic problems that make effective delivery very difficult. I will say more on this in due course because these are not unique to the Commonwealth.

I now want to go back to the things that I am best at. As KVD noted in a comment, it is impossible for the ordinary citizen to keep up with the myriad of Government announcements. That's the job of the media who do this full time.

In writing on public policy, what I can do is to ask very basic questions about policies based on my own experience. To ask these questions is to risk embarrassment because sometimes the answers should be self-evident. Still, it is surprising how often very basic questions throw up problems that need to be addressed.
There is something tremendously liberating in being able to put aside an obsession, in this case the Rudd Government's delivery problems. I wonder where this might take me?


Just recording this link so that I don't lose it. Glenn Milne had an interesting piece in the Australian that, if accurate, adds to our knowledge of the internal workings of the Government.


Anonymous said...

Hello Jim

I suppose this is a second bite at the cherry, but in fact my earlier comment was twofold:

a) no single commentator can credibly comment upon the whole range of government activity.
b) governments are elected to initiate and manage wide-ranging and quite disparate activities. It is not a sign of disorganisation when they attempt to do so.

Neither of the above is a criticism of yourself; in fact you are extremely consistent in limiting yourself to commentary on the process of government; that which I think of as the generic functions of any department.

Anyway, as this is a Sunday rant, I would like to offer a dumb solution to the health debate:

I believe that our hospital/medical system works very well, if strained. The real problem is that the system has too many “clients”. (I love PS-speak!)

Therefore my solution is to reduce the number of sick people, by attacking firstly tobacco, alcohol, diabetes and obesity. And build not one more hospital.

In other words, in twenty years’ time do we want more hospitals for sick people, or do we simply want less sick people?

(Now, I forewarned you it was dumb, but I’m still sorry to take up your time)

Best regards

Rummuser said...

I shall not comment on your government's problems with delivery. My dumb question is simply can you come up with one government any where on this planet that delivers. In the recently concluded budget session of the Indian parliament, our Finance Minister went on a chest beating exercise just like your Mr Rudd did and lamented on not being able to deliver governance.

Jim Belshaw said...

Hi Both.

Ramana first. I agree all Governments can have delivery problems. However, my comment on Australia is a relative one, focused on what I see as I decline in delivery performance. Looking back over Australian history, I actually think Australian Governments have been reasonably good at delivery.

KVD, I would agree that Governments are meant to manage wide ranging disparate activities. No problems. However, if we focus on the word manage, I am saying that Governments don't actually manage very well. Part of my argument in the case of the Rudd Government is that they have actually out-run their capacity to manage.

I broadly agree with you on the preventative health care point. However, that still leaves us with a hospital problem. In the city of Sydney/Eastern suburbs, for example, three general hospitals have been closed over the last two decades. I haven't checked, but I think that the number of hospital beds in this area is less now in absolute terms than it was twenty years ago, less relative to the size of the population.

There is nothing necessarily wrong with this. However, we need to understand how it has been achieved. Two things have been very important: average hospital stays have been significantly reduced, while an increased proportion of smaller procedures are now carried out in day centres. These things have allowed more people to be treated with fewer beds despite increasing medical technology.

Can this continue, for example by placing greater stress on prevention? If not, we are going to be looking at an increase in the number of hospital beds linked directly to population growth.

There are all sorts of other interlinked issues. For example, closure of emergency departments reduced the number of specialist training positions available, concentrating them in bigger hospitals.

This is becoming a post rather than comment, so I will limit myself to a final point. I do not yet understand just how the proposed changes might work in practice beyond the fact that they will have differential effects depending on existing systems and on varying demography and geography.