The prime minister and his health minister must now realise how hard is the task of ending the “blame game” over public hospitals. It has taken just three-months, and the scent of more federal funding, for the acrimony to remerge between the Commonwealth and the States.

It’s more of the same old conflict but with a new twist. The Rudd Government is serious about paying for performance. But the State Labor Governments don’t want extra funding – the $2 billion in incentive payments on offer – to be tied to attaining measurable improvements in efficiency and service delivery – primarily reductions in waiting times. The States oppose benchmarking extra funding to performance because they don’t want to have to pick a fight over hospital reform with their political allies in the health bureaucracies and unions.

The Rudd Government’s health reform agenda attempts the unprecedented. The ultimate goal is to transform public hospitals – a public sector monopoly – into consumer-focused, price and quality conscious service providers. If the States can’t make public hospitals more efficient and cost-effective by 2010, the Prime Minister has pledged that the Commonwealth will take the hospital system over to do it for them. But would a second-term Rudd Government really tread where its State counterparts don’t dare? Does the prime minister really want to be heckled by health workers everywhere he goes round the country?

No wonder the States are playing hardball already – they know a hollow threat when they see it. So if the “stick” of federal takeover is all but meaningless, all that leaves is the “carrot” – to demand the States deliver more and better hospital care before they see any extra federal dollars.

If the federal government’s pro-reform position is to prevail at today’s meeting of health ministers – which is to discuss the terms of the next five year federal-state health care agreement – it cannot be distracted by red herrings. Proving that nothing has really changed in federal-state relations, State ministers of health have once again claimed that the real cause of the problems in public hospitals is lack of availability of GPs services. This is the perennial dodge the State governments use to abrogate their responsibilities.

According to this theory, State-run public hospitals are overcrowded, and emergency waiting lists grow longer and longer, because people who can’t see a GP are flooding into Emergency departments. The fault, in other words, is the Commonwealth’s, since provision of GP services is a federal responsibility.

According to the Queensland Health Minister, Stephen Robertson, it is “pointless” to criticise the performance of State-run public hospitals when the real problem is “inadequate resourcing of the primary healthcare sector”. Don’t even bother talking about hospital reform, says Minister Robertson, who predicts the Commonwealth’s attempt to improve elective surgery performance is doomed to fail, because “the same doctors and surgical teams that perform elective surgery are having to focus instead on ever-increasing demand for emergency surgery coming through emergency departments.”

This should be dismissed as a self-serving plea for no-strings federal funding which is illogical. If ERs are overcrowded and waiting lists are blowing out due to the number of patients requiring emergency surgery, then lack of GPs can’t be the problem, because patients requiring urgent treatment can’t be treated by GPs.

The claim lack of GP services is exacerbating the pressures on public hospitals is one the great myths of the health debate. It won’t die, despite the findings of a 2004 report by the Australasian College of Emergency Medicine into “Access Block” – the unavailability of hospital beds which leaves patients waiting on trolleys in corridors until a bed becomes free. Logically, the report found that lack of bed availability is caused by the growing number of particularly elderly patients who require admission. Non-urgent patients, who could see a GP, do not clog-up public hospitals wards and do not delay elective surgery, because they are never admitted into a hospital bed.

The health minister, Nicola Roxon has already talked tough, and told the States to be prepared to table their reform plans if they expect to get more Commonwealth money. The minister could do worse than to begin today’s meeting by distributing copies of the ACEM report to her fellow ministers.

Puncturing, once and for all, the big lie about lack of GPs being the problem would allow the ministers to focus on what the Rudd government really wants to talk about. Why aren’t public hospitals run as efficiently as possible, and what are State’s going to do about this?