By PETER HARTCHER
Kevin Rudd deserves some praise, surely, for his boldness in seizing the reform task that everyone knows is necessary but no one else dares touch? Or does he?
Sure, a federal takeover of public hospitals from the states is popular. Six in 10 voters like the idea and only one in 10 is opposed, according to an Essential Media online poll last month. Australians trust Labor over the Coalition on health, by 46 per cent to 32 according to a recent Newspoll. So Rudd is treading on sure ground.
Michael MucciCredit: Michael Mucci
But which politician would want to make himself responsible for everything that goes wrong in every public hospital in the country, every wrong amputation, every miscarriage in a toilet, every misdiagnosed child, every bed shortage, every curmudgeon with an unanswered buzzer?
Not John Howard. Then health minister, Tony Abbott, urged that the federal government take control of public hospitals from the states. Howard was a tough politician but he wouldn't go near it. Yet a 12-year-old could see that without big change, the system will collapse. If your income is growing at 3 per cent but the cost of running your health systems is growing at 11 per cent, what's going to happen?
Either the country will go broke trying to pay for health, or health care will be savagely cut. Hands up if you want Australia bankrupted? OK, hands up if you want to see our over-burdened hospitals take swingeing budget cuts?
Right. So serious reform is the only option. That is what Rudd is now offering. And although many key details are yet to be announced, the basic model is credible and workable.
As Rudd told the Herald this week: ''Australians have been waiting for fundamental reform of health and hospitals for decades. A lot of people who've said to me: 'Don't touch this' - their motivation is always political. I never want to look back and say I didn't seize the bull by the horns.''
So Rudd deserves high praise for taking on a tough reform in the long-term national interest, right?
It depends. Rudd faces two mighty obstacles, apparently insurmountable.
His first big problem is the government does not control the Senate. It will need the Senate to pass multiple pieces of enabling legislation for the National Health and Hospitals Network to go ahead. To win the numbers in the Senate, Rudd either needs Tony Abbott's opposition to support him, or the votes of all seven of the crossbench senators, comprising the Greens plus Nick Xenophon and Steve Fielding.
Abbott has not yet stated emphatically that he will block Rudd's reform. But every word that he has uttered has been critical. Yesterday he said on TV that Rudd's plan was ''experimentation which hasn't been properly thought through''. He has complained that it would only add new bureaucracy, and Joe Hockey has said that it is not affordable. The opposition is showing every indication that it will, well, oppose.
And Abbott's entire strategy is one of full-frontal confrontation of Rudd. He will not readily give Rudd a big victory on hospital reform.
And then the Senate balance tipped decisively against Rudd when an independent senator, Steve Fielding of Family First, rejected the plan within 90 minutes of Rudd's policy being released. It makes you wonder about Fielding, the human publicity stunt. The country's top health experts took a lot longer than Fielding to form a view of the Rudd proposal, and, based on what Rudd has so far announced, most are guardedly positive.
Fielding either didn't study it closely, or else he is more expert than the experts. Or maybe he's a pathetic figure desperately seeking re-election, knowing that he'll get more media attention if he blocks a big reform than if he supports it. But he still has a vote.
So Rudd can forget the Senate.
The second mighty obstacle is the states. Rudd is seeking a takeover of the states' constitutional responsibility for health. They will need to co-operate. Or, if they won't, Rudd will need to take power forcibly - by putting a referendum to the people at the next election. Both options, at the moment, look to be closed to Rudd.
Some states, like NSW, are likely to co-operate. Others, like Western Australia and Victoria, are strongly averse. In which case, Rudd will need to call a referendum. The degree of difficulty here is ridiculous. Robert Menzies, Australia's longest-serving prime minister, said that ''to get an affirmative vote from the Australian people on a referendum proposal is one of the labours of Hercules''. That's why only eight of the 44 ever put have succeeded. That's a failure rate of 80 per cent.
First, Rudd would need to get both houses of Parliament to pass his constitutional amendment to allow a Commonwealth takeover of health. He would have no certainty that the Senate would agree. If the Senate blocked him, Rudd would have to go to the Governor-General for approval to put a referendum question to the people.
If she were to say yes, Rudd would still have to win the so-called "triple majority" - a majority of all voters nationally, a majority of the vote in a majority of the states, plus a majority of the vote in each of the states that would be affected by the change.
Hard? No, it's worse - historically, no referendum has passed if it has been contested by the opposition. Which brings us back to where we began - Tony Abbott's obstructionism. A referendum is virtually impossible as long as Abbott is opposed.
Rudd knows all this. He's not expecting Abbott's support nor the states'. As the Prime Minister told the Herald: ''You can sit down here and make a list of problems as long as your arm,'' he said, ''Starting with a bunch of premiers and state health ministers who may be in denial mode, with Tony Abbott who is in permanent 'oppose everything for opposition's sake' mode.''
So Rudd knows that, prima facie, his ambition is hopeless. If this is where the story ends, then this is not any bold ambition or worthy reform. If this is all there is to it, Rudd's National Health and Hospitals Network is nothing more than a talking point for an election campaign.
The signature reform of his first term, the emissions trading scheme, failed in the Senate. Rudd wants hospital reform to be the signature reform of his second term. But why should we take him seriously? The obstacles confronting his second-term reform are greater than those confronting his first. And he knows it. It's so hopelessly quixotic that Rudd is either just rolling this out as a rhetorical steamroller to crush all other topics and keep the battle on his preferred ground of health until election day, or he is dauntless and plans an extraordinary political war.
Which is it? He told the Herald this week that it was war: ''If people are going to play obstructionism … I'm sure they will pay a price for that. We are on about making a difference. To those state governments standing back saying we don't have a problem in our system - well, it's going to be pretty interesting in the weeks ahead as I go to the hospitals in their particular states and ask their health professionals whether the system can be improved. Don't expect me to be taking a backward step on this one bit.
''Any hospital, any state, any place, ask this question to a local professional: do you want the Australian government to take on the dominant funding role for the future for your health and hospital system? Do you need extra beds … extra doctors, extra nurses? Do you want to make sure you have the power necessary to run your hospital in the future under a nationally funded, locally run system? It will be very interesting to see what the answers actually are on the ground right across Melbourne, right across Perth, right across Sydney, starting at the Royal North Shore.''
This is a threat to raise a rebellion across the country, starting in the North Shore, Liberal heartland, led by the healthcare professionals and taken up by the crippled and the lame and everyone who is concerned about health.
Rudd is planning to generate a tsunami of public support so big that it washes away the political opposition. Barnaby Joyce managed something akin to this with his campaign that broke the national consensus in favour of an emissions trading system. That was populist, fear-based and negative. Can Rudd do the same, but in a positive campaign fighting for reform?
Rudd is looking to foment the first political revolution led not by spin doctors, but by real doctors. It's a big test.
Peter Hartcher is the Herald's political editor.