JOURNALIST: Prime Minister, Lyndal Curtis from ABC Radio Current Affairs. You set very high expectations for this reform before the last election. When are people going to see things getting better? And if people don't see things better or don't feel that this reform will fix the system, do you deserve to be voted out of office?
PM: Well, the Australian people will make their judgments on whether we're fair dinkum about reform or not. What you've got before you is, I think, the biggest single reform of the Australian health and hospital system since the introduction of Medicare. We've got our sleeves rolled up in terms of when it begins. We intend to get on with the job now.
I began discussions with the premiers and chief ministers this morning. I spent an hour or so on the phone with them. The response was mixed. We'll see how we go when it gets to COAG.
But you know something, the time for delay is gone. Too many years, too many decades, have been wasted in people nipping around the edges of this one. This is fundamental. We've got to get it right for the health system for the future, and also for the economy for the future as well.
HOST: Mark Metherell.
JOURNALIST: Prime Minister, Mark Metherell from The Sydney Morning Herald and The Age. When do you expect to see declines in waiting times for elective surgery and emergency department operations?
PM: One of the key findings from the Health and Hospital Reform Commission was on this very point, and that is the unacceptable waiting times now for those on elective surgery waiting lists and those who can't get there, and those who arrive at accident and emergency. And I think the data was contained in my speech.
As I also indicated in my speech, beyond these fundamental reforms to the structure and funding of the system, we have further to say, again, on the question of accident and emergency needs. We will make statements on that in the near future.
Can I say, though, the whole point of our reform is to get this down to much more acceptable levels in terms of community expectations. One of the ways in which we intend to do that with local hospital networks is to negotiate with those hospital networks what is an acceptable, respectable waiting time at accident and emergency? That is one of the key conditions for future engagement with local hospital networks.
Obviously, circumstances will vary across the country, but the Australian people have a right to know what their local hospital network signs up to in terms of an acceptable waiting time at A&E, and when it comes to elective surgery, when you can get your procedure done once you've been clinically assessed as needing that procedure.
HOST: The next question is from Malcolm Farr.
JOURNALIST: Prime Minister, Malcolm Farr from The Daily Telegraph. New South Wales has the most inefficient hospital system in the Commonwealth - not by a little bit, by a lot. Won't demands for standards of efficiency penalise New South Wales in terms of funding? Won't it mean that, in fact, waiting lists might increase in New South Wales under your scheme?
PM: We intend that no existing state or territory health system will, first of all, be any worse off during the transition period to the new Australian health and hospital network, and, secondly, once our new proposed funding responsibility where we take on 60 per cent of the growth for the future kicks in, let me tell you those states will be better off.
Let's go to the core of it here - for the first time, the Australian Government is saying, loud and clear, to the nation at large and the good people of New South Wales, that we, the Australian Government, permanently, for the future, are taking on 60 per cent of the burden for your recurrent hospital costs, for your hospitals' capital needs, and for your hospitals' training and research needs as well.
That has never been the case before, so in terms of stepping up to the plate and making a difference, Malcolm, I can think of nothing more fundamental that will make a difference for the good people of New South Wales, and from time to time the very long suffering people of New South Wales when it comes to certain of their hospitals.
HOST: Paul Bongiorno.
JOURNALIST: Paul Bongiorno, Ten News, Prime Minister. Who will run the National Health Fund? Will it be run out of your department, out of Treasury or out of the Federal Health Department? And how do you answer the charge that if federal public servants can't run a national pink batt scheme, how are they going to run this?
PM: Well, can I just say to you in response to that, Paul, what I said at the very beginning is that this Australian health and hospital network will be funded nationally and will be run locally. That's what must occur here.
What has been the core gap in the system so far? Frankly, waste in the existing system through duplication and overlap between the Australian Government and the states. Secondly, inadequate certainty of future funding for the system's growth in the future. We step in to make that difference.
That's one half of the equation.
What's the other half? To make sure that your local hospital networks have the power and the scope to deliver those services on the ground in a manner which is best tailored to local health needs.
If I, for example, was to look at the good people of Port Macquarie, one of the places where I went for a local hospital consultation - let me give you a classic example. What they said to me, and this is no reflection on any individuals associated with the health networks of New South Wales, but they said: "Here we are in Port Macquarie, we've got a couple of adjoining smaller hospitals as well. We know that we would logically fit into a local hospital network. We know each other, we can work well with each other, but guess what? All the decisions are either taken in Sydney or at this massive region - Area North, I think it is in New South Wales - vastly removed from our community of interest."
So on your key question of who actually delivers the service, the service is delivered locally through the clinical leadership which will run the local hospital networks. That is the overwhelming playback from the clinicians that we have met right across the country - funded nationally, delivered locally. We believe that is exactly the right balance for the future.
HOST: Danielle Cronin.
JOURNALIST: Prime Minister, Danielle Cronin from The Canberra Times. What do you say to the argument that this might just re-cast the blame game, where the local health authorities blame the Federal Government for failings in the system and vice versa?
PM: Well, I think the key element of this reform is two bits. First of all you have the Australian Government, for the first time in the history of the federation, taking the dominant funding responsibility for the future funding needs of the public hospital system - capital, recurrent, research, training - and into the future. That's the first thing.
Up until now that has not been the case. There has been a perverse incentive alive within the system whereby, given that the Australian Government did not have majority funding responsibility for the public hospital system, getting as low as 35 per cent, and that is only for the recurrent needs, that, frankly, why should we, the Australian Government, worry too much about the performance of the hospitals? You knock that right on the head by the Australian Government, for the first time, taking on the dominant funding responsibility, entrenching it for the future.
But the second part of it is this - by confirming that we will take 100 per cent of funding responsibility and policy responsibility for what's called the primary health care system, GP and GP-related services out there in the community, these two principal arms for the delivery of our national health system are therefore either fully controlled or predominantly controlled by one level of government - that's the Australian Government.
Therefore, the perverse incentives which have existed before for blame game between one direction and the other are effectively removed. Of course, the operation of the system is going to test everyone out. But I believe this knocks on the head the reason for blame game, cost shift and waste and duplication that we've seen in the system for decades and decades and decades.
And I believe, passionately, the Australian public want to see that put behind them so we can then get on with the business of investing in the growth of the system for the future - better health, better hospitals for working Australians.
HOST: Question from Laura Tingle.
JOURNALIST: Laura Tingle from the Financial Review, Prime Minister. I'm just taking up Danielle's point - if I've had a really bad time at a local hospital, who am I going to blame in the future? Am I going to blame you or am I going to blame the local hospital network? I mean, how do you see the politics of this actually operating? Are you essentially seeing a system where the states are no longer politically accountable?
And that leads to two more technical questions. Who in future will set the overall health budget? You've said that Commonwealth will just keep picking up the tab, but are you seeing a position where, over time, you could actually see the Commonwealth picking up, say, 90 per cent if costs continue to rise? And who would make the decisions about restructuring hospital services with population needs?
PM: Let me take those in order.
In terms of who ultimately is politically accountable for the system, in terms of the national funding for the system, it's quite clear from what I've said today that we, the Australian Government, have stepped up to the plate to take on this dominant funding responsibility. That has been the core of the, frankly, the cancer in the system so far. The number of meetings I've sat around where one side blames the other permanently for who is responsible for the overall funding underpinnings of what we need for the future - that is now put behind us.
On the second point, which is who sets the health budget, and should the 60 per cent rise into the future. Can I say we have spent long and hard working our way through this. We believe that 60 per cent gets the balance about right. We still want the states to have some skin in the game. That is why we're doing it this way. We're also very conscious of the fact that we want the system to still be operating tomorrow and the next day and the day after for all those things which are currently on foot within a system which millions of Australians will depend on in the days ahead during the period of transition.
On the question of setting of budgets, can I say this - a key element of this will also be shaped by determining what I said before in my remarks as the efficient price. We have said in the papers, and you will see it before you, that we will establish an independent pricing authority which will set the appropriate price for a given hospital service. That, through a system of activity-based funding, will be then translated into how we budget for the future, both the Australian Government and the states.
This is a new funding discipline. It is not just handing over the blank cheque as in days past: 'here you go, here's a blank cheque, x billion dollars, go away, don't tell us what happens'. This is quite different. It actually pays for each service as it's delivered by each unit of the nation's local hospital network, and that is what will shape the combined budgets of both the Australian Government and the states.
And I wrote very carefully the third question you asked and I can't read my own writing.
HOST: Restructuring services to population needs.
PM: Ah, yeah, restructuring services to population needs.
Within what's called the activity-based funding formula, it will be tailored to the local demographic circumstances, the local concentration of particular health conditions, and therefore will be tailored to population dynamics, gender balances, concentration of particular diseases, and as you would know from the data, this varies across the country.
So in terms of shaping, specifically, future population growth but also the composition of populations, the formula we've come up with, we believe flexibly deals with those local variations, and it's one of the matters I was discussing, for example, with the Chief Minister of the Northern Territory this morning, who has particular challenges in his part of the country.
HOST: Sandra O'Malley.
JOURNALIST: Sandra O'Malley from Australian Associated Press. Prime Minister, you've committed to no net increase in the bureaucracy under your reforms. Given the drive for efficiency and the basic emasculation of the state health departments, couldn't there actually be the alternative problem where there could be eventual job losses or at the very least dislocation of workers as they have to move to where the jobs are, and in this regard, aren't states just an easy target given how unpopular they are?
PM: I think we've been working through this for a long time to work out where the problems are in the health and hospital system. I'm not going to stand up here today and engage in, sort of, a new form of the blame game, which is 'aren't the states a terrible bunch of people'. I just don't think that's productive.
People want to move on. They want solutions. They just don't want permanent criticism.
Secondly, in terms of the way in which we shape this for the future, it's going to be really important to have a system which is completely tailored to local needs. That's why we have this strong emphasis on local hospital networks. That's why we believe we can get the balance right in terms of what local communities want and demand, and we think we're heading in the right direction to do that.
On the question of job losses, can I say this: what are people saying around the country? They want more frontline services. They think our system is, frankly, bureaucrat-ed out, and they're probably right. We want more people in the frontline.
Whether it's state bureaucrats, Jane Halton is here with us today, federal bureaucrats, the Australian public want more people delivering frontline health services. The virtue of what we have put forward through these local hospital networks is that we anchor this very much in local communities.
And we believe that if it means shifting a position from the main street of Sydney to, frankly, a local hospital network in downtown Port Macquarie, I'll tell you where I'll be supporting - that's downtown local Port Macquarie, and the same right across the country.
We believe that is the right way to go. We think, frankly, we have sufficient bureaucrats in the system right now.
HOST: Phil Hudson.
JOURNALIST: Prime Minister, Phillip Hudson from the Herald Sun. You've changed the GST equation a bit to have a dedicated share of the GST going -
PM: The Premiers said a lot, but go on.
JOURNALIST: - to health. What did they say?
PM: They said other things as well. Some of them were monosyllabic.
JOURNALIST: Given you've changed the GST relating to health to have a dedicated part of it, why not change the GST to have a dedicated part of it going directly to education? Surely it's just as important.
And, a sort of a technical question, when does this reform actually start? When are you going to put this new funding in place?
PM: On the question of education v health, I think you would find, given what we've been doing of recent days with Julia on the future of the national school curriculum and more recently with the quality education agenda, and more recently again with the huge capital investment that's in our schools funded by this Government, the education revolution for us is front and centre. It's a core national priority.
But you know something? When it comes to health and hospitals, the figures are very confronting.
One: without change, the health and hospitals budgets of the states will overwhelm their state budgets by somewhere between 2035 and 2045. That's a pretty confronting piece of data.
The second is look at just the growth in the GST itself, averaging about 6 per cent each year. What's the average growth in states and territory health budgets at the moment? About 11 per cent per year.
There is a gap emerging, and the question arises, therefore, as to how we fill this gap. Which you brings you back, thirdly, to what the Intergenerational Report found for us all. With the increase in the Australian population and the ageing of the Australian population, the proportion of our people who will be over the age of 65 and the intensity of the health care services that they will need means that we've got to redesign the system and the way in which it's funded.
And the final part of it is this: to do it properly, it's not just making sure we've got the long-term funding of hospitals right - it is critical that we get the long-term funding and structure of primary health care right and preventative health care right and post-acute health care right, as well as aged care right. The part relates to the whole, because if we do get this right then we can reduce the overall hospitalisations that are occurring in this country.
There's some data, I think, contained in the Report, which you would have seen, about the hospitalisation rate in Australia relative to other countries around the world. We are right up there. Now, if we had a properly integrated system, primary care working well, the other arms of the system working well, preventative health care kicking in over time, you know something? You could make a big change there.
So, in answer to your question, get the design right, get the bits working together, and we can therefore handle these long-term funding challenges which face the system. But to do it now, frankly, there is no alternative but to take this part of the GST funding, dedicate it to the health and hospital system for the future and then get on with the deeps reforms I've outlined in my remarks.
JOURNALIST: And when will it start?
PM: Oh, on the timetable for implementation, '10-'11, the negotiations through COAG, of course, will occur in April. If we get agreement, of course, we would establish then an implementation arrangement with the states and territories to get on with the job from the get-go. In terms of '11-'12, the states would commence creation, under their statutes, of local hospital networks, payment of 60 per cent of recurrent expenditure and capital on public hospital services through the states would begin, and we would start to the progressive transition to the Commonwealth of state-funded general practice and primary healthcare. Then, from '12-'13, from 1 July 2012, shift to activity-based funding paid directly to local hospital networks.
That is the implementation schedule that we've outlined.
HOST: The next question is from Michelle Grattan.
JOURNALIST: Michelle Grattan of The Age. Mr Rudd, can I ask you about your Plan B if you can't sweet-talk those premiers? Given the history -
PM: Were you listening in, were you?
JOURNALIST: Given the history of referenda in this country, and that no doubt you'd have Tony Abbott saying "No", and presumably some of the state premiers too, what would be the chances, do you think, of getting such a referendum through? And if you didn't, what is Plan C?
And secondly, the hospital system is quite lumpy with some states doing well and other states doing badly. Do you therefore think that a uniform plan, the uniform plan that you're proposing, is more appropriate compared to one tailored to the particular state of the hospitals in various parts of Australia?
PM: I think - can I take your second question first and then come back to the earlier part. On the question of tailoring these reforms to local circumstances, and plainly this country is vast, and it's broad, and it's different in terms of the health needs in northern New South Wales as opposed to around Alice Springs. And it's different in downtown Melbourne to that which you find in rural South Australia.
The reason why we have decided upon local hospital networks is precisely that. We understand directly that the needs of this country differ vastly, and secondly, that some states are better than others in certain categories of existing health delivery. One of the reasons for example we want to move to what's called in the papers 'an efficient price' for delivery of services is that we want to test what one system is doing against another currently, for example, in the price of a hip replacement. It is a vast differentiation between one part of the country and another - why is that the case?
So therefore, there is a system which enables us to do that. But, more importantly, we have the flexibility built into local hospital networks to make it work flexibly in dealing with local communities. And that, I believe, together with taking local population changes and disease concentrations into account, is a flexible way of responding to local needs. Funded nationally, run locally, to deliver better health services and better hospitals for all Australians.
On the question of dealing with the states and territories, we've got a ways to go between now and the 11th of April or thereabouts, the 11th or the 10th or the 12th, it's ah - there's a bit of discussion this morning whether it's the 10th or the 12th because some of the Premiers have a problem with the 11th, but I think they're okay for the 11th. So don't hold me to the 11th, it'll be a day or two either side - is that we've got a way to go in working this through with them. And I believe we have a reasonable prospect of making progress with them.
But I go back to what I've always said, Michelle. If we can't get there cooperatively, there is one alternative. And that's exactly what I said prior to the election. I've reaffirmed that today. And that is the course of action that we would embark on under those circumstances.
But we've got a ways to talk through this yet. And if you were sitting in a state Treasury at the moment and trying to work out your long-term future, and you saw the Australian Government saying that through the rest of this decade that we'll take on the lion's share of the growth needs of the system, I think a rational analysis from a state's point of view may point you in the direction of working with us, rather than against us. But we'll see which way they jump.
HOST: Matthew Franklin.
JOURNALIST: Hi Prime Minister, Matthew Franklin from The Australian.
PM: Hi Matthew.
JOURNALIST: Just with regard to these local area networks. You're from Queensland -
PM: Local hospital networks.
JOURNALIST: Yeah. Being from Queensland, you'll understand this from your youth. Won't these just be - who will hire, appoint, fire, what will be their accountability? Will you just stack them with mates, Labor hacks and union bosses? And two - And two -
PM: And for the second unloaded part of your question?
JOURNALIST: And two, it leads from the question, your answer to that last question - surely you've got Buckley's chance of getting the states to hand over the GST? Aren't you just setting yourself up a nice populist election campaign where you can bag both Tony Abbott, the states, and big nasty bureaucrats who want to make everything bad for everybody?
PM: Two categories I've got here is hacks and Abbott, they are the two elements of that question.
Let me go to the first part, first. You know something, as is outlined I think, clearly, in the documents, the local health networks would be established under state statute. That is appropriate. Secondly, in terms of their governing councils, they'd be appointed also under state statute. We, the Australian Government, however, reserve to ourselves the right to take a very careful look at anything - repeat, anything - which may occur which does not reflect local community sentiment in terms of where, for example, you might want a local hospital network to have its boundaries. And secondly, who most appropriately should lead them.
What I find overwhelmingly across the nation, and having been with Christine Bennett, with Nicola, and so many hospital consultations around the country, is that, frankly, local clinical leaders, your local specialists, your local GPs, your local practice nurses, people who are passionate about their community, passionate about the healthcare system, they almost self-select in terms of who becomes members of these local governing councils.
We passionately want this system to work. So in terms of JV Aardvark III who might be the Secretary of the Miscellaneous Artichokes Union, I think you can rest easy on that score.
On the question about why we're doing this, can I just say I have been since a young fella passionate about getting the future reform of our hospitals right. I had a lot to do with hospitals as a kid, mainly inside them rather than out. And yeah, a lot of family connections with hospitals, not all of them pleasant. And so I want to get it right.
HOST: Karen Middleton.
JOURNALIST: Prime Minister, Karen Middleton from SBS Television. There's been a little discussion publicly lately about the way you communicate, and you've engaged in some discourse on this yourself in recent days -
PM: What does discourse mean? Is that a conversation? A chat? Okay, right. Just want to simplify it a bit.
JOURNALIST: Yes, I should lead by example - fair enough. You do have a new plain-speaking opponent, much has been made of that. But some of your colleagues are suggesting that there are other things involved too. And I was just wondering why you think there is this new criticism resonating at the moment about you personally, your communication, and your leadership, it seems.
PM: Well look Karen, I don't pretend to be some sort of perfect leader, I never have been. So, everyone's got strengths, everyone's got weaknesses, I'm like everyone else out there.
The key thing, though, is just to acknowledge where problems have arisen, as I said the other day, to do better, deliver more, get on with the job, and deliver the basics. That's what we're doing today. That's why health and hospitals has been a core part of our priorities for a long time. You know something, this doesn't pop out, you know, overnight. This is something we have worked and worked and worked on over a period of two years, if I go back to when we appointed Christine.
Similarly, the work done by Julia recently in releasing the national school curriculum. That doesn't just pop out. It's the product of work and work and work over a long period of time. So on delivering the basics, we're getting on with the job. But the bottom line is this. You've simply got to acknowledge where problems have arisen, fix them, and then get on with the job, and that's what we're doing with health and hospitals today, I think that's what most people in Australia would expect me to do.
HOST: Question from Mark Riley.
JOURNALIST: Thank you, Mark Riley Prime Minister, Seven Network. On your example of the two individuals with hip problems, assuming they're both public patients, the local hospital board determines that they should go to private hospitals -
PM: Local hospital network.
JOURNALIST: Local hospital network, Prime Minister, the man with the orthopaedic shoe, I stand corrected.
PM: No, someone else is talking about boards, I'm just making a point.
JOURNALIST: None of us are bored, Prime Minister.
PM: No, no, I was talking about Mr Abbott and his boards, mate. You want to keep this going?
JOURNALIST: Sure. I want to get back to the dicky hip.
PM: Each time you throw one up, I'll belt it back. Off you go.
JOURNALIST: Assuming that they both are found beds in the private system, I'm just seeing some problems there. Can you assure those two individuals they won't face any additional out of pocket expenses for going into the private system -
PM: Yes.
JOURNALIST: How are the private - going to bring the private hospitals on board if those who are making so much money out of private practice now don't see that as being attractive in the future? And also, won't that be an active disincentive then, given that you're saying they won't be out of pocket - won't that be an active disincentive to people to take on private health insurance, especially hospital cover?
PM: On the question of the public system, let's call it buying given hospital services from the private system, this is not new as a concept. In fact, I think way back when in Queensland I remember us starting to do that back in the 90s. I recall, correct me if I'm wrong Matthew Franklin, doing something like this at the Prince Charles Hospital. But therefore it's not new as a concept, it's been around for some time, and frankly I think it's a great example of how these two parts of our hospital system work together.
What I find around the country is, frankly, a very productive, creative relationship between these two arms of the system at the coalface. And for us to have, if you like, the backstop, the insurance if you like of a further place to go helps us keep the wood on the public system, but also provides the necessary backstop for the patient.
In terms of the incentives, therefore, that it provides for people, look, my experience in terms of people taking out private health insurance is that these are intensely individual choices which people make, mindful of their own family histories, their family cultures if you like about whether you've always been privately insured or not, and I think people who have done that in the past will do so in the future.
My responsibility as Prime Minister is to make this public hospital system work as best as it can for all Australians. We're a party which began with a deep commitment to universal healthcare, and delivering, you know, universal guarantees. That's part of our DNA as a Labor Party, and as a Labor Government. We're proud of it. That's why we want to make this system work. We'll do so in partnership with the private system. No ideological hostility towards the private system at all. But Mark, on the ground, I really believe we can make this work, and there's examples right around the country of where it's working already.
HOST: Andrew Probyn.
JOURNALIST: Hi Prime Minister. Just, I'd like to explore this notion that you're going to put up 60 per cent towards the local hospital network. How do the states pay? Is it going to be through that network? And that could of course cause some more monosyllabic answers. But secondly, how much flexibility is in your efficient price mechanism to allow for the greater costs of delivering health outcomes in places like rural WA?
PM: Yeah sure. I think firstly, in answer to the first part of your question, we would expect both levels of Government to provide their funding streams into local hospital networks. Remember, what's the key underpinning reform here? It is that local hospital networks are able to deal with the flexible delivery of hospital services to their wider community. They'll be governed by national standards, as I said before, clinical standards, performance standards, standards which go to what happens at accident and emergency, elective surgery, as well as hospital readmissions, re-infection rates.
But so much flexibility will be actually placed in that local leadership to make it work, and for it to work effectively, our money, the Australian Government's money will go directly to them, and our expectation is that that's where the states will deliver their funding stream as well.
On the second point which is how do you make sure, again, you legitimately ask the question about rural WA. Vast differences, often small communities, and how are they assured that their needs are taken into account. I point to two things.
One is, we really get it, in terms of the work which Nicola has already done in relation to the incentives scheme supporting literally 2,500 doctors out there which in the past did not exist, in order to encourage those folk to stay delivering those services in the bush.
So we actually understand what it means to encourage and keep frontline medical service people out there in rural and regional Australia. But in terms of the formula itself, around activity-based funding, it can and will be tailored to all those factors of isolation, of population growth, and on the local concentration of diseases, which does differ from one part of the country to the other.
If you want to know for example, again, to answer as far as Port Macquarie hospital goes, again. When we went up there and the operation of, you know, a formula for giving money out to them, they said 'here we are at Port Macquarie, this hospital was built to cope with X population and now it has three times that population'.
But there was no formula, flexible formula available for them to enable them to grow according to the population. It becomes a series of one-off political decisions taken at head office.
We've actually got to get beyond that. Where the population moves, you've actually got to have a funding formula which can move with it. That's what we're on about with the proposals and the reforms that we've put before the Australian nation today.
HOST: Just two more questions. The first of them is from Mark Kenny.
JOURNALIST: Mark Kenny, Prime Minister, from The Advertiser. It's been reported that Tony Abbott went missing overnight in the desert, he was lost for some hours, unaccounted for. Just wondering - you look surprised - I' wondering, did you receive any reports about that, and just how worried would you have been, or were you?
PM: I'm sorry. Why I looked a little blank is no, I hadn't heard of that. But I've been talking to a whole bunch of people about health this morning.
Secondly, I assume Tony is all okay, and certainly I would wish him every bit of safety if you're out there in difficult parts of the country, and so, good on him for being out and about in the middle of Australia.
HOST: Our last question today is from Renee Viellaris.
JOURNALIST: Mr Rudd, Renee Viellaris from The Courier-Mail. There's a lot of money being pumped into preventative care. There's a lot of carrot, but where's the stick? Where - why should healthy taxpayers keep paying for the unhealthy lifestyles of people who smoke too much, eat badly, where is the personal responsibility?
And secondly, your taskforce recommended taking a class action against tobacco companies, and also raising the excise on cigarettes, which hasn't been done for 10 years. Where do you stand on those things?
PM: On the question of preventative health care, you are right, it is part of the total, you know, policy picture for the future. Unless you're acting on that, you can't deal with the rest of it over the long term.
I also said very carefully and deliberately in my speech that we have further to say on preventative health care in the future about how it's organised, and what we do within it.
The reason why I think governments often back away from preventative health care is simply this - the benefit to the nation and the benefit to the health budgets as you know is only ever yielded a decade plus, or sometimes half a decade plus if it's, you know, a real change in the way in which people manage themselves.
And that's why people say oh well, that doesn't deal with an immediate headline for tomorrow morning. We've actually got to get beyond that. Preventative health care is part of it. The dividends to the people themselves, the health of Australians, the productivity of the economy, workforce participation is real, if we get this right.
But it's longer term. So I simply say in response to an entirely valid question, we've got more to say on preventative health care, and that's why I indicated it together with mental health and a couple of other areas, we'd have something further to say in the period ahead.
As for today, what we have been on about is getting the fundamental reform of the structure, the funding, long-term for our Australian health and hospital system right. That is what we're on about.
People across Australia are fed up with the blame game. They're fed up with cost-shift, blame-shift. They are fed up with waste in the system. They want to see that fundamentally changed, so that we can get on with the business of delivering better health and better hospitals for all Australians.
Doing it in the way in which we've suggested, funding it nationally, running it locally, we think it's the right way to go. But beyond that, there are a series of other specific reforms which we've yet to come to, and you've identified one of them.
HOST: Thank you very much.