Friday, August 04, 2006

Speech by Minister for Health Ageing

Health Ageing
Originally uploaded by Sydney Weasel.
A Press Club address is a rare chance to tell hundreds of thousands of TV viewers what the Government has done, what the Government is doing and what the Government plans to do next. It’s also an opportunity to explain the thinking behind the Government’s decisions to an audience which understands politics.

Almost every opinion poll rates health as the public’s most important issue. Health stories are a media staple yet, compared to (say) workplace relations, health attracts little philosophical controversy. The political argument is usually over funding (which, almost by definition, is never enough) or capacity for human error (to which all systems are prone). It’s instructive (and for the Commonwealth Government somewhat reassuring) that proposals to change the health system, rather than keep it essentially as it is, are the ones that generate the most political controversy. In health, people want problems solved. They don’t want systems changed unless, of course, there’s something fundamentally wrong with them, which is not currently the case with the health services for which the Commonwealth has principal responsibility.

1 comment:

Anonymous said...

Any discussion of health systems needs to acknowledge how well they work. Their organisational logic may leave much to be desired but, in practice, they mostly deliver good results. Every single day brings a million Commonwealth Government-subsidised interactions between doctors or pharmacists and their patients. Every day hundreds of lifesaving processes, often of extraordinary cost and complexity, are carried out at very little expense and more-or-less complete satisfaction to patients.

Because health services are highly complex and provided by an array of private and public entities, it’s more important than usual to respect the people in the system and to avoid unilateral policy-making. Markets are important mechanisms in health as elsewhere but they mostly have to be managed ones in this sector because health equity is just as important as health efficiency.

An instinct for conservative incrementalism is especially important here because people’s health is too important for experimentation. As the regular, largely ineffective reorganisation of the states' area health authorities shows, the unintended consequences of health reform are often more significant than the intended ones. Because health services can’t be interrupted, it’s even more important than in other areas to clarify what is a problem and what’s not; what problems can be solved and what can’t; and the extent to which solutions inevitably create problems of their own.

Critics scoffed when the claim was first made that the Howard Government was the best friend Medicare has ever had. From 1984, the Coalition had been vulnerable on health because it had opposed Medicare's creation. In managing the system in government, the Coalition has come to appreciate its fundamental strengths. These days it’s the ALP which sounds unconvincing in its support for Medicare. After all, it’s hard to be the party of Medicare while incessantly criticising it and promising to abolish the safety net or to help older people by dudding younger people.

Largely neutralising health as a political issue has been one of the Government’s big political achievements. Since 1996 the Government has painstakingly established strong health credentials, partly by big increases in spending, partly by carefully avoiding anything that could be described as ideologically-driven but mostly by constantly examining the system for practical weaknesses and doing what was necessary to address them.

For instance:

Since November 2003, the Government has introduced targeted incentive payments and rebate increases which have lifted the GP bulk-billing rate to over 75 per cent and to record levels for children and for people in country areas.
The Government has introduced the Medicare safety net which, even after modifications, will provide extra help to 1.5 million people this year.
The overall bulk-billing rate, for GPs and specialists combined, is now higher than in March 1996.
The Government has introduced care plans to help GPs better treat their chronically ill patients.
For the first time, there’s a Medicare rebate for services provided to chronically ill people by allied health professionals such as physiotherapists, chiropractors, dieticians, occupational therapists, diabetic educators and exercise physiologists.
Under changes announced since November 2003, nurses’ and, in limited circumstances, midwives’ services delivered "for and on behalf of" GPs can attract Medicare rebates for the first time.
Comprehensive health checks under Medicare are becoming available not just for people over 75 and indigenous people but for middle-aged people with risk factors such as diabetes, obesity or other lifestyle issues.
The Government is spending an additional $1.9 billion on mental health, on top of existing mental health programs such beyondblue which have seen suicide levels almost halve since the mid 90s.
Because indigenous people make comparatively little use of Medicare, the Government has increased funding for Aboriginal Medical Services from $100 million to $350 million a year.
The Government's new pregnancy support measures have been a source of personal as well as professional satisfaction. Writing in The Australian last week, Matt Price observed that "Tony Abbott has many talents", including, he added, "the knack of annoying battalions of Australian women with regular forays into the abortion debate". I’ve chosen to run this risk because, as all sides now seem to agree, 88,000 abortions a year (on the most reliable figures) are far too many. In my view, abortion is a tragedy, not a crime. Still it’s worth trying to bring these huge numbers down. If these initiatives help women to make genuine personal choices rather than socially-conditioned ones, if they help women in an almost impossibly difficult situation to feel less alone, they will ultimately be one of the Howard Government’s more significant achievements.

The Government has massively invested in training more doctors, nurses and other health professionals. Since 1996, new medical schools have been established or announced at the following universities: James Cook, the ANU, Notre Dame, Griffith, Bond, UWS, Wollongong, Deakin and the UNE. There are now 14 rural clinical schools and 11 university departments of rural health. The number of publicly funded medical graduates, just 1300 in 2003, will be nearly 2300 in 2012 (with an extra 900 full fee-paying graduates). The number of nursing graduates a year will increase by 3100 between 1998 and 2012, dental graduates by 110 a year over the same period, psychology graduates by 486 and pharmacy graduates by 297. Since 2003, based on Medicare statistics, the number of full-time equivalent doctors has already risen by 2.4 per cent overall and by 6.3 per cent in country areas.

In 1996, $6 billion was spent under the Medicare Benefits Schedule. By 2003, this had increased to $8.1 billion. This year, spending should reach $11.2 billion, a 39 per cent real increase over the life of the Howard Government. In 1996, spending on health and ageing portfolio programs was under 14 per cent of the total Commonwealth budget. This financial year, it will be over 19 per cent. This spending should be seen as an investment in people’s health, rather than as an astronomical cost to government, because it largely takes place in programs such as Medicare and the PBS where new benefits are subject to rigorous cost-effectiveness evaluation.

It’s often pointed out that health spending is projected to rise from under 10 per cent of GDP to well over 15 per cent by 2040. It’s less often remembered that health costs have already risen from about 5 per cent of GDP in 1960. This has not proven to be unsustainable because life expectancy at birth has risen by almost a decade to 81 years and Australia’s economic strength is much greater thanks, in part, to the fact that people die less often in middle age from cancer and heart disease. It can’t be assumed that health spending is automatically value for money any more than this can be assumed in other areas of government. Still, every country has spent more on health as it has grown richer, so the likelihood is that Australia would spend proportionately less on health only by becoming a comparatively poorer country.

Until last year, the PBS had been the fastest-growing area of Commonwealth health spending, increasing at a rate of 12 per cent between 1995 and 2004. Thanks to better doctor prescribing practices, measures such as the 12.5 per cent mandatory price cut for new generic medicines and also to safety scares over some popular drugs, growth slowed to just 2.8 per cent last year. Even so, the Government estimates 7.8 per cent growth over the next four years.

It's important to consider further future savings, not to spend less on health, but to create "headroom" for the very expensive but very effective drugs expected to be available soon. For instance, for some patients, Herceptin is expected to increase breast cancer survival rates from 85 to over 90 per cent. The Pharmaceutical Benefits Advisory Committee has recommended that Herceptin be made available on the PBS at a cost of about $50,000 per patient or up to $400 million over four years.

Understandably enough, pharmaceutical companies make big efforts to market their new products to doctors who, equally understandably, often feel obliged to recommend what is said to be the best regardless of cost. In the case of Herceptin, this has generated a media campaign featuring people forced to sell their houses to save their lives, with the inevitable demands that governments "do something", such as drop all the usual requirements for safety checking and cost-effectiveness analysis.

As new products become available to give extra time to people who are terminally ill or to save small numbers from horrible diseases at very high cost, there will be more campaigns of this type motivated by compassion and a vision of the good society as well as commercial self-interest. Government will also be held responsible if these new drugs fail to deliver as promised, or turn out to have unacceptable side-effects, or even just add greatly to pharmaceutical company profits. The Government has to weigh all these risks and make judgment calls knowing that the cost will ultimately be borne by taxpayers.

The Government would like to see more use of comparatively cheap off-patent generic drugs but this is hard to manage in a system where standard co-payments largely eliminate price signals. Discounted co-payments risk encouraging over-use and hoarding. Tendering jeopardises choice and the possibility that tiny differences in drugs might make big differences for some patients. The Government is currently talking to key stakeholders about securing a fairer price and greater volume for generic medicines so that innovative but expensive effective medicines might more readily attract subsidy. Of course, any change potentially affects the income of manufacturers, distributors and retailers, all of whom, inevitably, fear the worst and strive to ensure that it impacts on someone else, sometimes by exaggerating the potential downside for vulnerable patients.

Because for some people it can literally be a matter of life or death, health policy decisions often arouse very strong emotions. Stopping to count the cost of the latest miracle cures can seem so heartless but a responsible government still has to think through the consequences of what seem like good deeds.

The Government will shortly present new options for PBS reform. Following comment, an exposure draft of any legislation the Government considers necessary will be published with the parliamentary process to be completed, if possible, by the end of the year. The Government can’t promise everyone will be happy with its final decisions but does guarantee that no one should be surprised.

The Government is also concluding consultations with interested parties on the final shape of new legislation governing private health insurance. Again, there will be an exposure draft before legislation goes into the Parliament by the end of the year.

The Government wants funds to cover services once delivered in hospital but now done elsewhere for which there is no specific Medicare benefit. This means ending the artificial distinction between in- and out-of-hospital services so that funds can potentially cover from their main tables services that might substitute for an in-hospital service or help to prevent the need for an in-hospital service. For instance, physiotherapy, dentistry, disease management programs, chemotherapy in doctors’ rooms and home dialysis, to the extent not covered by Medicare, would be potentially coverable under the main table rather than under an ancilliary policy, with subsequent reinsurance advantages. Savings in hospitalisation costs should enable funds to provide more services out of hospital without higher premiums.

The Government also wants to end the nasty surprises when private patients receive their bill by ensuring that doctors and hospitals tell people, in advance, about out-of-pocket expenses they are likely to face. The most recent survey showed that 44 per cent of all private hospital episodes involved “gap” expenses averaging $720 and that 21 per cent involved payments for which no prior informed financial consent had been obtained. With Government support, the Australian Medical Association is advising doctors that failing to obtain informed financial consent is not acceptable professional practice. The Government is planning to conduct a further survey of private patients by the end of the year with a follow-up, if necessary, in April next year. If these surveys do not show that informed financial consent has become the norm in elective procedures, the Government will regulate to make it mandatory.

These changes are designed to make private health insurance a more attractive product without further financial incentives and without changing the basic architecture of the existing system in ways which disadvantage patients without private cover. Unlike the Opposition, the Government believes that private health insurance complements the Medicare system rather than undermines it. The more people have private insurance, the fewer who are likely to be on public-hospital waiting lists for elective procedures.

Perhaps the biggest single challenge now facing the health system is coping with the chronic diseases of an ageing population in a culture which has engineered exercise out of daily life and which is addicted to fast food. Lifestyle-related diabetes, "affluenza" as it’s been called, is the emblematic pandemic of the modern world. Depending on how it’s managed, it can take 15 years off people’s life expectancy. The basic problem is that people are literally eating themselves to an earlier death. Nearly two-thirds of adult males, half of adult females and a quarter of Australian children are overweight, with about a third of these technically obese.

GP management plans and team care plans under Medicare are one aspect of the Government’s response, along with the health check announced at the February Council of Australian Governments meeting. So is the after-school exercise program run by the Commonwealth sports department (now operating at nearly 20 per cent of schools) and the healthy eating grants for school canteens run by the Commonwealth health department (now taken up by about 60 per cent of schools). The Australian Better Health Initiative agreed at the February COAG should enable programs of this type to be extended and help nudge our system from just treating sickness to also promoting wellness.

Through the Commonwealth communications department, the Government is working to achieve more responsible food advertising to children and has run its own campaigns promoting fruit and vegetables and at least an hour of exercise a day. Advertisements do have some influence on behaviour, otherwise people wouldn’t pay for them. Still, banning food ads to children is a tokenistic pseudo-solution that’s been proven not to work. Quebec banned food advertising to children 25 years ago and Sweden banned it 12 years ago without any appreciable impact on obesity rates. In this area, bans are the soft option for governments more interested in looking good than doing good.

What’s needed is more information and awareness about what the food we put into our mouths is doing to us. People need to know that there are 275 calories in a Mars Bar, 280 in a Magnum ice cream, 161 in a can of Coke and 1080 in a large Big-Mac meal (which is about half an adult's daily requirement). People need to know that it takes an hour of brisk walking to work off about 300 calories. There’s nothing wrong with treats as long as people don’t indulge themselves every day and as long as they adjust their other food intake or their exercise regime accordingly. Still, it’s hard to over-estimate the scale of the problem, with every chance that life expectancies in developed countries such as Australia might actually fall for the first time in about 300 years.

Governments have maximum potential to make a difference when they take on ideological or institutional vested interests. The Howard Government has not picked all that many fights but where it has, on tax and workplace relations reform, work-for-the-dole, border protection, and participation in the global war on terror, to name some of the more important ones, it has contributed to lasting change for good.

Probably the greatest frustration for health policy-makers is lack of clarity over which government should do what and how it should be paid for. This is a particular problem for public hospitals which the Commonwealth Government part-funds but the state governments wholly run. The upshot is the states blaming the Commonwealth when anything goes badly wrong but the Commonwealth lacking any capacity to effect specific change, leaving the public confused and annoyed and wondering why little seems to change. This inherently unsatisfactory arrangement is almost certain to continue at least until the expiry of the current health care agreements on June 30, 2008.

The Government could conclude that any different structure might be even worse. Or it could put options on the table designed to deliver better services. Any proposed change would be about running hospitals better, not empowering Commonwealth bureaucrats. As the Prime Minister has rightly observed, Canberra-based public servants would be no better than their state counterparts if they tried to run hospitals directly themselves. Renegotiating public hospital funding arrangements will be one of the big health challenges of any fifth term.

Ladies and gentlemen, it is a great pleasure to be here. Yes, Ken, it was the election campaign when I was last here debating Julia Gillard. Before that, I think the CFMEU managed to cut off the live broadcast mid-stream when I was talking about reform in the construction industry. So it is nice to be here in a more benign portfolio, talking in a more mainstream way.

I have now been the Health Minister for almost three years. I never expected to be the Health Minister, but I have to say it has been an honour to occupy the position, in part because of the difference you can make, in part because part because of health 's importance in people's lives, but in significant measure because it has given me the opportunity to mix with some of the most articulate, committed, intelligent and idealistic people in our society on whose strong shoulders the health system fundamentally rests.

Questions and Answers


Mr Abbott, Greg Turnbull from the Ten Network. I want to ask you for a prognosis on health insurance premiums. It seems that over the past few years, wherever we've had one small step for inflation, we've had a giant leap for health insurance premiums. Last week we’ve had a giant leap in the headline rate of insurance leading to today’s interest rate rise. The main culprits were bananas and petrol prices but lurking behind petrol prices was a repeat offender in health premiums, which I think went up above the national average. Should we be bracing ourselves for yet more increases in premiums and what can you do to reign them back?


The short answer is, yes, you can expect health insurance premiums to increase in the years ahead, but I would like to think that premium rises, like any interest rate increase, will always be less under a Coalition Government than under any alternative.

You see, we actually like private health insurance. We think it is an important part of the health system. We think it takes pressure off the public hospital system and that's why we have put a whole range of measures in place to make it a more affordable, more attractive option for Australians. Now, we’re not planning an additional subsidy measures, but we do think that the kind of incremental change, important incremental change, the kind of significant liberalisations that we think the coming legislation will embody, will make it easier for the funds to offer their services competitive prices.

Look, I would love to be able to stand up here and say there will never be another premium increase. In fact, all I can point out is that between 1983 and 1996, premium increases averaged 11 per cent a year. Since then, they've averaged just 5.5 per cent a year.


Simon Gross from Science Media. I've got a broad-church question. I think about three weeks ago we heard here from Professor Barry Marshall, who shared the Nobel Prize for medicine last year with Robin Warren, and he was a member of the Lockhart Review and he spoke here of his support for the recommendation of the Lockhart Review in terms of allowing embryonic stem cell, or research that involves embryonic stem cells.

He also told us that he is a Catholic. I asked him earlier this week how he reconciled his Catholicism with his view. He said there are Catholics and there are staunch Catholics. So it seems the Catholic Church is a broad church. So if Professor Barry Marshall engaged in embryonic research, they would still consider themselves a Catholic and the church would embrace them. If they did, they would be an uproar in Australia. How could this be right?


Look, every Catholic is an imperfect Catholic, just that we tend to be imperfect in our own particular ways. I appreciate that there is a lot of emotion around this because there are a lot of people out there who are hanging on cures and they think that various forms of research might offer it to them.

I just offer these two cautionary notes. First of all, there is very little real evidence that embryonic stem cell research is the health nirvana that some of its more enthusiastic advocates portray. I think that some people have been guilty of over-peddling hope to vulnerable people in this area. The second point I make is that so-called therapeutic cloning is basically translating "Dolly the sheep"-type situations to human beings and I think that we should think long and hard before going down that path.


Michael Brissenden from ABC Television. Mr Abbott, I have a stem cell question as well. I understand that the discussions are still continuing and when you come back to Parliament there will be even more discussions and it’s a live issue within the Government as well.

I noticed a few key points in your speech talking about you’ve neutralised health as a political issue and one of the reasons you’ve been able to do that is you have avoided anything ideologically driven. Do you think there is a conflict of interest – I know this has been asked of you before – about you and your views being the Minister for Health, and what do you say those people who do have Parkinson's disease or something who may be looking at this as some hope, as you've said, and see your opposition to it as an ideologically driven opposition?


Well, I suppose I make a distinction between ideology in a rationalist sense and values, and I think there have been a number of very important human values which the Government has tried to be conscious of in all of its decision-making, and the fact that the Government has been returned four times now or elected four times now, the fact that that natural Labor majority that people discerned in the 1980s seems to have disappeared, suggests to me this Government has actually been pretty good at tapping into the deeper values of the Australian people. So I do draw that distinction between ideologies and values.

I suppose it's very hard when you are talking to someone who is afflicted, and who has been persuaded that a particular course of action is the right one. It is very hard to start muttering about the end not justifying the means, and yet that has always been a classic position in the Western ethical tradition, and I think we abandon it at our peril.

We don't have any trouble accepting, for argument's sake, that medical research no longer justifies particular kinds of experiments on animals. I don't see why we ought to have an absolutely rigid position that it can't also rule out, even [with] the most extraordinary potential benefits, can't also rule out some extreme practices with human material.


Mr Abbott, Eleanor Gregory from the ABC. During your speech you mentioned diabetes as one of the main health issues facing Australians and at the recent COAG meeting there was an agreement to focus on health outcomes, starting with diabetes. What is it you expect the states to do to achieve that, and how do you measure their success in doing so?


That aspect of COAG was an agreement to take this issue even more seriously and to come up with proposals. It wasn't an agreement on any particular proposals. I think that there is a lot that we have already done to try to address this problem in general and I would point to things like the GP management plans and the team care plans for people with chronic diseases, of which diabetes is probably the most obvious candidate; but I think it's a question of “watch this space” for what new things both the Commonwealth and the states will come up with.


Mark Metherell from The Sydney Morning Herald, Mr Abbott. You mentioned that you hoped to have some sort of an agreement on the PBS reform by the end of the year. Do you hope or is your goal to get back, for the Commonwealth, the many hundreds of millions of dollars in savings that have been generated by the increased availability of generic medicines, the money which currently tends to end up with pharmacies?


Our essential goal is to try to get the existing range of medicines more cheaply so that we have scope to pay for the coming innovative range of medicines. That's our essential goal. Now, precisely how we do that is currently subject to discussion, and the truth is that any money that gets taken out of the existing payments for existing medicines has all sorts of ramifications for the people who are providing those medicines, whether they be manufacturers, distributors or retailers.

Now, I think everyone accepts that in principle we ought to make more use of generics so that we can provide ourselves with more scope to pay for the innovative and effective new drugs coming into the system, but accepting something in principle is all very well. When it comes to the practicalities, if it impacts too much on me and my business or me and my livelihood, it becomes extremely difficult.

So the Government is involved in all of that delicate balancing at the moment. I think that discussions have been reasonably constructive so far. I think that all the principal parties – Medicines Australia, the Pharmacy Guild, the Generic Medicines Industry Association, the AMA – I think all of them are entering into it in a constructive spirit but I wouldn't at this stage want to pre-empt what we ultimately come up with, just that I am reasonably confident hat we can come up with some significant new measures that will restrain what would otherwise be the growth of the PBS, but I certainly don't anticipate that the PBS is going to become anything like a relatively static, let alone a declining area for growth in government spending.


Annabel Stafford from The Age. Mr Abbott, you said the public hospital funding agreements or state funding agreements will be one of the biggest fifth-term issues. Is this something your government intends to put a policy forward so that the public vote on those agreements, and what might it look like?


Yes, this is an issue which is going to receive increasing attention inside government over the next few months and then it will be subject to negotiation which will inevitably be semi-public in the months prior to any concluded agreement.

I think it is pretty obvious that there is going to be extensive public discussion of this next year and in 2008, and I have no doubt that anything which is floated will be carefully analysed by people for all sorts of good and not-so-good reasons for potential downsides. But, of course, anything that we are taxed with, anything that we are charged with, any problems that might possibly emerge with anything that the Government is considering, would equally emerge with anything that other political parties might be considering, so I think that we will all be in the same boat of dealing with difficult and thorny issues between now and the 30th of June 2008.


Minister, Ben Packham from the Herald Sun. You've advocated the educational approach in dealing with the issue of childhood obesity, informing people about the calories that are in their food and so on. How do you then compete with all the other messages that are out there on TV, and in particular junk food advertising, and do you think that there are always going to be people who don't get the message?


Inevitably there will always be some people who are more susceptible than we would like to less-healthy messages, but that's life. The question is, what is a reasonable approach for a responsible government in a free and pluralist society to adopt? You know, I'm sure if I was to decide that particular media outlets, for argument’s sake, were more responsible and better than others, and to try to enhance them and diminish others, people would say that that was very unfair and was the kind of thing that was quite incompatible with the exercise of government authority in a free and democratic society.

Look, I'm a reluctant regulator. Regulation is something we do when absolutely necessary as a last resort, when there is a clear benefit, when the benefits of doing something fairly clearly outweigh the potential cost, including all the transitional costs, then you consider new governmental programs, new governmental regulations.

Look, the point I make is not that some people are influenced for ill by advertising, I don't deny that for a second. The point I make is that we've got to accept a certain amount of suboptimal outcomes because we live in a free society and, to some extent, people need to be able to make their own mistakes.


Steve Lewis. Minister, you and I and most of the people in this room will be facing higher mortgage repayments as a result of today's decision on interest rates. A third rise by the RBA since the Government was re-elected in 2004, elected, I might add, on the promise it would keep interest rates lower than the Labor Party. How much damage [is] the latest rate rise going to do to the Government's economic credentials, and surely you, as a senior member, that your strong suit as economic manager will be badly damaged as a result of this latest rate rise?


There is no doubt that most people would be happier if interest rates didn't go up, but I think an increasingly economically and politically literate population understands that government can only do so do so much in this area. The real question is, is the Government better at managing the economy than the alternative? And I don't think anything which has happened over the last 18 months or so would cause reasonable people to question the Government's economic credentials.


David Spears from Sky News. Minister, you called yourself a reluctant regulator. The Government has, though, regulated very heavily in the area of advertising of cigarettes, for example, because of the health consequences. I'm interested whether you really think there is there is no benefit to be had in putting any limits at all on junk food advertising. Some of the states were clearly miffed last week when they believed they were prevented from even discussing this, some of the suggestions they put forward, particularly in limiting those in prime viewing hours of children. Do you have any thoughts on those sorts of limits or are you simply saying there should be no regulation all of junk food ads?


As this issue has been more widely analysed and discussed in health portfolios, it’s amazing how much more you discover about just how heavily regulated, at least potentially, these things already are. There is already a mechanism for people who think food advertising to children is misleading or wrong or inappropriate – there is already a mechanism for people who feel that way to complain, and there is a panel, an advertising standards panel, which can adjudicate on these ads. Looking at the composition of this panel, I don't think that particular panel would allow the evil capitalists to get away with too much, I can tell you that.

But, you know, I very much urge responsibility on advertisers, and I think it's important that the current discussions about a new code currently taking place under the auspices of the Communications Minister continue, and have a good outcome.

But the main point I would make is that the odd treat, even if it is a Krispy Kreme doughnut, is not a bad thing. It is a staple diet of that kind of treat which is a bad thing. It's feasting on these things in the absence of the kind of exercise program that you need to burn off all those calories. That's a bad thing. Whereas each cigarette does you damage. So I think there is a fundamental difference between so-called junk food and cigarettes, and what we really need to do is patiently and sensibly try to address the cultural issues which are causing the obesity epidemic. The real problem is that we still have we still have the food appetites of hunter-gatherers, but we have the opportunities for indulgence of medieval princes, and we need to bring it all into better sync.


Mr Abbott, I see you so often in parliamentary sitting weeks, dining over at Portia’s restaurant with those well-known supporters of Peter Costello, Christopher Pyne and Joe Hockey. You are often tipped as the person who might, if it ever came to this, be the one to tap the Prime Minister on the shoulder and suggest he might move on. So I wanted to ask you if it ever crossed your mind, over the last six months, that you might, in your regular chats with the PM, have suggested that now is the time for him to go? Are you disappointed with his decision, or do you think that he can, as your colleague Malcolm Turnbull suggested, break Sir Robert Menzies’s record?


Well, Jason, let me advertise your sister publication, The Sydney Morning Herald. There was a marvellous piece in there today and I would encourage every one of you to turn instantly to The Sydney Morning Herald op-ed page and read an article there under my byline. If anyone else wants me to write for them, I'm very happy to accept offers, I have to say.

Look, I am very pleased. I think this is a great outcome for the Government, for the Liberal Party and for the country because, plainly, this has been one of the really outstanding partnerships, the outstanding political partnership of Australian political history thus far, and the thing which has exhilarated me and I think so many other people, not just Liberal supporters, but people generally, is that it now looks like this partnership is destined to be a much happier one that other great political partnership that ended in such awful acrimony in 1991.


Mr Abbott, Sally Cockburn from 3AW in Melbourne. Just harking back to the Lockhart Review, which was I believe released last December. You mentioned honesty in reporting and you mentioned Dolly the sheep and human cloning. Would it not be true to say that that the Lockhart Review actually recommended nothing that would lead to cloning human beings, but would it also be true to say that those who object to stem-cell research actually can’t put that on the basis of saying there has been no progress in science? In fact, if you keep bans on science, you will never have progress. If you banned investigation into fungi in 1925 we wouldn't have penicillin. Would it be fair to say that while there has been no research, to not listen to a publicly funded and widely consulted review like the Lockhart Review and come out, without having political consultation within both Houses, to say we are going to reject it is a little premature and maybe some people say that the only view you could have against embryonic stem cell research is in fact a moral view, how would you respond to that?


Well, I would reject it, of course. Sally, look, I am all in favour of research and I've got to say Australian scientists are a great credit to our country. They have done wonders for us in the wider world and I am sure they will continue to do so. But there are some things that scientists should not do, just as there are some things that politicians should not do, some things that financiers should not do. I think that there are rightly limits on what people ought to do, and in my view, therapeutic cloning, so-called, is a bridge too far.

Now, I know that the Lockhart Review phrased its recommendations, couched its recommendations, in cautious terms. But allowing therapeutic cloning and permitting the resultant product to develop for 14 days is their recommendation now, but I would be quite confident that were we to accept that, in a few years’ time, they would be saying, let's let it go for 30 days; and a few years beyond that, we would have scientists of high standing telling us that we ought to let it go for three months, and so on. I just think that it will be better for all of us if we don't go down this path.