Today Prime Minister Julia Gillard introduced the legislation for the National Disability Insurance Scheme. This Medicare-like scheme is a very important reform, a long time coming for people with a disability, who have suffered under inadequate and differing support regimes from state-to-state. The NDIS will create a national framework under which the needs of those with a severe and permanent disability will be met.
The introduction of the legislation in the House of Representatives is just the first step. NDIS trial sites will be launched next year, but there is still a need to keep the pressure on, to ensure that the fully-fledged system will be realised.
Up until recently, most of the negative debate around the policy has been about the cost. It is significant, requiring approximately $15 billion a year from the first full year of implementation in financial year. That time comes at the end of this decade. But the scheme can and must be funded. There are numerous ways to ensure that it is fully funded.
This week, in an opinion piece in The Australian written by Doron Samuell from SR2 Healthy, relatively new arguments came to light.
In the first instance, Mr Samuell argued that, “lured by the promise of taxpayer dollars, it is inevitable that disability services will come to be dominated by large, corporate players in the post-NDIS world.”
Later in his op-ed, Doron Samuell provides an argument which says that this is already occurring. So really, what we will have is the status quo. It is hard to envisage that smaller providers could be crowded out even more than they already are.
For equipment, like wheelchairs and other mobility aids, disabled people will most likely choose to use bigger organisations that might have the capacity to carry a broader range of stock and therefore, more cost-competitive products.
For services, users will probably choose to use a mixture of smaller, community-based organisations and larger “corporatised” ones. This will, again, at least maintain the status quo. There is also a strong chance that smaller organisations able to adapt to client needs under the NDIS will be able to grow if they can prove they provide good services.
The idea of the insurance scheme, as it will apply to many applicants, is to give users, capable of decision-making, the choice to pursue services from providers that they perhaps already identify with.
Also on the question of choice, Samuell made what amount to some pretty offensive, not to mention inaccurate comments about the capacity of people to choose wisely under the disability scheme. He actually claimed that the disabled were “often unsophisticated” purchasers and asked “these consumers going to make the right decisions?”.
Well, of course those who have a capacity to make decisions for themselves are overwhelmingly going to make the right decisions according to their needs. People with a disability are no less rational than ‘able-bods’ and nobody else knows their personal requirements better than people with a disability themselves. No doctor, no healthcare professional, no bureaucrat understands disability better.
Mr Samuell also appears to have forgotten a provision in the bill, which allows for funds to be provided to a carer or directly to a service provider in the event that someone eligible for NDIS funds is unable to make or communicate decisions for themselves on their own care needs. The latter is a worry because, again, bureaucrats should not be making these kinds of decisions.
Samuell also states that “the NDIS will need to ensure that buying decisions are scrutinised, audited and reviewed”. The legislation actually provides for this.
Doron Samuell does go to the question of funding. He does this from the position that Medicare, the system that the National Disability Insurance Scheme is based on, is under-funded and has a bloated bureaucracy.
There is a danger that the NDIS will be under-funded. There is always that danger when government embark upon significant reforms, that costs might be under-estimated. But what is clear is that the claim about Medicare only coping “by progressively lowering the standard of care to maintain its universality”, will almost certainly not apply to the NDIS.
A bloated bureaucracy is of some concern. There will need to be a significant number of jobs created or filled across the states and territories to oversee the agency. However, the bigger concern should be too much centralisation of the increased bureaucracy.
Finally, Samuell’s contention about the NDIS not being based on insurance principles is neither here nor there. What is important is that this landmark reform provides adequate support for those it is targetted at.Getting bogged down in definitions is pointless.
The biggest concern should be making sure the introduction of the full scheme occurs in 2018-19.