The media attention to the $7 co-payment for a visit to the doctor, and whether or not this aspect will ever be put into law, have rather overshadowed one of the purposes for which the co-payment was apparently intended: The Great Medical Research Fund. There was so much to discuss when the first Hockey Budget was announced that somewhat regretfully I had to let the Fund pass by.
Now Mr Palmer has said that there is no way that the co-payment will pass the Senate, but then he has made other pronouncements with similar determination which subsequently proved not to be entirely accurate. So I’ll provide him with some ammunition he probably neither needs nor wants: the proposed Fund is a nonsense.
To refresh your memory, the Treasurer said that savings from various health measures, plus the cuts to hospital funding, and the co-payment’s contributions as well, will all go into a Medical Research Fund that should reach about $20 billion by 2020, with about a billion a year arriving for medical research a couple of years later. The capital will be capped at $20 billion (what then happens to the all the savings, co-payments and cuts in 2021 eludes me), and only the interest will be available for research.
The capital will be managed by a group known as the Future Fund Board of Guardians, which sounds especially trustworthy. Its members are all bankers or funds management people, and their chair is Peter Costello, who is yet another of our past nominations for the title of ‘World’s Greatest Treasurer’. What could go wrong, you ask.
You could also be excused for thinking that a lot of thought must have gone into this project, given its size and purpose. It seems, however, that the public servants working on it only started in April, six weeks before the Budget announcement. But that’s OK, because the Rudd Government’s NBN, according to the Treasurer, was sketched out on a drinks coaster on a plane flight. In comparison, six weeks is almost an eternity.
It was not, however, quite enough time for anyone to have worked out just what sort of research would be undertaken with this money. Was it for preventative medicine, always the sickly child in medical research expenditure? Or perhaps clinical trials? Or yet again, converting basic research into useful applications? No one seemed to know.
Certainly the Chief Scientist didn’t know, and he wasn’t asked for his advice, either, though he does have a background in medical science. He hoped that the purpose was not made ‘too narrow’ — not just more money for grants, or for more grants. Who knows?
Would the Fund produce another body to oversee the expenditure, or would that be the responsibility of the National Health and Medical Research Council? Who knows? The NH&MRC has a current expenditure of just under $900 million a year, as does the Australian Research Council. This means that of every two dollars that comes from the public purse, medical research gets one, and the other goes to everything else for which competitive research rules apply. You might wonder whether or not a 1:1 ratio is the right balance.
As I understand it, if the scheme goes ahead in the fashion outlined in the Budget, then by 2022, all else being equal, the quantum going to medical research will have doubled: two of every three dollars will go to medical research. Is medical research in Australia actually that important? We are good at it, yes, and have won Nobel prizes for it. But we are good at lots of other things, including in areas where the Nobel Prize does not apply.
There was a lot of hand-waving by the PM and the Treasurer at the time, about possible cures for cancer and other medical breakthroughs. We know that a medical breakthroughs are announced in the TV news almost on a weekly basis, but it’s not obvious that cures for cancer are just around the corner, waiting for the Great Medical Research Fund. And no one ever seems to go back to find out whether in fact the breakthroughs ever actually broke through to a cure.
There are three great weaknesses in the Great Fund. The first I have just mentioned: the new funding will distort what is done all around Australia, in applications for enrolment in universities, for research money, for postgraduate study, and in other ways. To what end? Will we be healthier as a result? What advances in other disciplines will not eventuate because so much money has gone into one area? Who knows?
The second is that too much money in any one area leads inevitably to much more poor quality research, which is the bane of every discipline. A few months ago I made that point in another context, and repeat it now: you can easily waste money on research. I remember Jim Wynegaarden, then the Director of the National Institutes of Health, telling me in 1987 that he had asked the President not to provide more money for cancer research, because the first-rate people were already fully occupied, and second-rate research was worse than useless.
The third is that it is no small matter to train those who are to undertake good research. I’ll repeat myself again: the process requires much time as well as much money. I can remember Bob Hawke saying airily, at about the same time as I was talking to Wynegaarden, that his Government would provide the funding for 75 postdocs, for something like research into salinity. He had no idea what he was talking about. You can’t just produce 75 postdocs in a given field because you have money. It takes a decade or two.
None of the above is any kind of rocket science. Anyone who has had anything to do with the business of research funding could have told the Treasurer that. I guess it didn’t matter, because it was a Hollowmen moment: they needed something to sweeten the co-payment pill. And it doesn’t matter now, because the co-payment seems quite unlikely to get up.
Sometimes you just wonder how ideas like this ever see the light of the public day. I put ‘Great’ into the title because the whole episode reminded me irresistibly of the Goon Show episode, ‘The Giant Bombardon’, and it deserves the same stirring DRAMATIC CHORDS. And of course the Goons themselves.[Update: Dr Philippa Martyr has written a most interesting essay on much the same topic. I read it within hours of having posted my own brief essay. Hers is in the July/August Quadrant — ‘Should the Commonwealth Fund Medical Research?’]