"THERE are four pillars which assure the quality of Australian life for all: the minimum wage, the age pension, compulsory superannuation and Medicare. The national disability insurance scheme has the potential to be the missing fifth pillar."
Bill Shorten's words provide some perspective to the magnitude of what has been put on the policy table by Canberra this week. But it's not just the future of disability care in Australia that is under consideration; how we confront the challenges of an ageing society and best look after our oldest citizens in a potential overhaul of the aged-care system has also been under the spotlight in a huge week for social policy reform.
The Productivity Commission's comprehensive reports into both issues were published this week, the Gillard government responding immediately to the disability report and calling for time to consult on aged care.
Shorten, the Assistant Treasurer and ex-parliamentary secretary for disabilities, and Families Minister Jenny Macklin have long been champions for an NDIS, a scheme that would fundamentally transform disability support and care for hundreds of thousands of Australians from a system of rationed government benefits to a Medicare-style universal no-fault insurance system.
So when the commission's disability care and support report, which was always going to recommend an NDIS, was released by the government months ahead of schedule on Wednesday, the burning question was whether they had sold the vision to cabinet.
The big hurdle is cost.
The commission estimates an extra $6.5 billion a year on top of existing disability spending - bringing the total up to nearly $14bn - is needed. And it says the money should come from consolidated revenue. In the present economic flux, endorsing big spending initiatives has considerable political risk.
The answer came on Wednesday morning at the Noah's Ark family care centre in the east Melbourne suburb of Heidelberg.
Before Julia Gillard gave it, she took some time to greet local mothers living in the maelstrom of the present disability support system; mothers with tired, pleading eyes.
"Look, Mum, it's Julia," five-year-old Samson Osborne said to his mother, Salima.
Samson, who suffered a stroke in utero and has multiple issues with the right side of his body from his tongue to his feet, bounced up and down on a mini-trampoline when the PM wandered over to shake his hand.
"Thanks for coming to see me," he said simply. He could have been speaking for the entire disability sector.
Gillard then fronted the cameras, announcing the government would begin work with the states and territories on measures to build the foundations of an NDIS.
"I certainly want to see a national disability insurance scheme. I share the vision of a national disability insurance scheme as the right way forward for our country," Gillard said.
Macklin agreed. "It is a transformational change," she said. "It is a day we'll look back on and remember that this is the day we started to transform the care and support of people with disability to make a difference to their lives."
So what exactly has begun here? The Productivity Commission says the present disability care and support system is "underfunded, unfair, fragmented and inefficient, giving people with a disability little choice and no certainty of access to appropriate supports". And as the population ages, the stress on the system is only going to increase.
The commission's vision, now supported by Gillard and her government, is for an NDIS that covers everyone in Australia if they become disabled.
And about 410,000 people presently living with a significant disability would receive funding support under the system.
Long-term, high-quality care and support would be provided, at an additional cost (beyond the present $7bn a year spent in the sector) of $6.5bn a year.
"Funding of the scheme should be a core function of the government [just like Medicare]," the commission says.
An NDIS would cover care and support services such as physical and psychological therapies, domestic help with cooking, cleaning and shopping, home and vehicle modifications and personal-care needs, such as help with showering and toileting.
The commission also recommended a no-fault national injury insurance scheme for those who suffer catastrophic injuries, such as the loss of a limb, or a brain or spinal cord injury. This would stop the inequity of a person's coverage for loss depending on how and in which state the injury occurred.
Critically, the NDIS appears to have bipartisan support, with Tony Abbott encouraging the government to move faster.
"I think what people now want from the government is a clear timetable for change and a clear and definite funding envelope," Abbott says.
Gillard has started the ball rolling on disabilities, but reforming the aged-care system requires more consultation, she said in Canberra on Monday on releasing the commission's report on aged care.
With demand for aged-care services increasing by the year (by 2050, 3.5 million Australians will require them, up from one million now), the Prime Minister did commit to a timetable of sorts, saying "there is a recognition of the need for reform" and that
it would begin in this term of government.
Again, with aged care, as with disabilities, there is concern about the limited number of services available, the flukey quality of care being offered and the opaqueness of the system, the commission says in its report, Caring for Older Australians.
"Older Australians generally want to remain independent and in control of how and where they live, to stay connected and relevant to their communities and be able to exercise some measure of choice over their care," it says.
It recognises the vast majority of people want to "age in place", staying in their own homes for as long as possible, hopefully until they die. Only 20 per cent of the 3.5 million people using aged-care services in 2050 will be in residential care.
For disability care and aged care, big structural changes are an inevitability, and the commission's recommendations offer a clear and workable path forward.
In both cases reform will take longer than a term of government, in the case of disabilities more than two.
We need our politicians to put the bats away and take the long view. For all our sakes.
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