The last diocese-owned hospital in Australia has something to tell the Parliament

On a Friday afternoon in September, a hospital chief executive from Lismore sat in front of a Senate committee in Canberra and gave it three numbers.

Seventy-three per cent of admissions at his hospital are people over 65. Seventy-nine per cent of bed days are people over 65. Three quarters of those patients hold private health insurance.

Then Peter Fahey said the thing the Parliament should hold onto: when we talk about policy affecting Australians over 65, we are not talking about a small part of our hospital. This is our hospital.

That is what a regional voice sounds like. It does not sound like a lobby. It sounds like arithmetic done by a person who knows every ward and every staff member in the building.

The measure in front of the Senate removes the age-based loading on the private health insurance rebate for Australians over 65 from April 2027. Catholic Health Australia has said what it thinks about that, at length, in a submission full of numbers.

The department’s modelling says roughly 44,000 people over 65 will give up their cover. Spread across a nation of 27 million, that reads as manageable. It is meant to read as manageable. National averages are built for that purpose.

But the fact is that nobody in this debate speaks for the Northern Rivers, or any regional areas like it. Regional areas are not an average.

St Vincent’s Private Lismore has modelled its own exposure and expects to lose between 1,200 and 1,800 privately insured patients a year, and between $2.6 million and $3.9 million in revenue. A large metropolitan operator absorbs a hit like that somewhere else on the balance sheet. Peter Fahey put it plainly to the committee – that somewhere else just doesn’t exist.

St Vincent’s serves a catchment of about 310,000 people and draws from a population of roughly 400,000 stretching from Coffs Harbour to the Gold Coast. It does about 10,000 cases a year. The nearest alternative is a small day surgery at Ballina that handles minor work. After that it is the Gold Coast, or two hours south. The public hospital a kilometre away has no spare capacity, and New South Wales carries the largest elective surgery waiting list in the country. As Peter Fahey told the senators, wherever the money comes from, the patient still ends up somewhere, and in the Northern Rivers there aren’t too many other somewheres to go.

So why do regional areas often go unnoticed?

Peter Fahey gave the answer himself, and it was the most honest moment of the hearing. Regional communities are not the squeaky wheel. Lismore has been through fires and floods, and its health workers kept turning up through all of it to look after everyone else. That is a community that has learned to absorb things. It does not hold press conferences. It is spread too thin and too far apart to speak collectively. If a hospital service of this size were disappearing from an inner Sydney electorate, it would lead the news that night and the minister would be doorstopped by Tuesday. Lismore gets none of that, and the silence is read as an absence of harm.

CHA members have standing to speak on this issue that others do not. Thirty-seven per cent of Catholic Health Australia’s private hospitals are in regional Australia, compared to 90 per cent of non-members. That gap is not an accident of property markets. It is the residue of a decision made by religious congregations more than a century ago to go to the places where care was hardest to provide and least profitable to deliver, and to stay there. St Vincent’s Lismore has been in that town since 1921. It is the last independently diocese-owned private hospital left in Australia.

There is a Catholic Social Teaching principle underneath this that is called preferential option for the poor. It is not a devotional flourish and you need not be Catholic to find it useful. It is a design rule. Start with the poorest and most vulnerable person you are meant to serve, work out what that person needs, and build the service outward from there. Do that and you will usually get healthcare right, because you have started with the person who is hardest and most expensive to care for rather than the person who is easiest to model.

Run that rule over this bill and you get a different picture from the one in the published impact analysis. You get an 82-year-old in the Northern Rivers with an 80-year-old spouse, a fixed income, a hip that will not mend on its own, and a two-hour drive to the nearest place that could have fixed it. Lower lifetime wages mean lower super. A house in the Northern Rivers is not the same as a house in a capital city. Many of these people have held their cover for 30, 40 or 50 years, doing precisely what successive governments urged them to do.

They are also the people CHA members will keep treating after the revenue goes. That is the part the modelling cannot see. When a for-profit operator walks away from providing a service, history shows that it is often a not-for-profit hospital that picks it up, and it does so knowing the service will lose money. But that generosity is being subsidised out of margins that no longer exist. Across the sector, more than 90 private hospital services have closed in the past six years, and the sector lost $756 million last year on top of losses the year before. Goodwill has been holding this system together in regional Australia, but goodwill is not a sustainable funding model, and government should stop treating it as one.