As if  state governments didn’t have enough problems with their hospitals, there’s a new and virulent life form at large in them threatening to infect patients and staff.  The Prime Minister in health reform mode (political taxonomy: Ruddivirus) is spreading like wildfire in hospitals across the nation, programmed to turn even the most right-wing surgeon into a rabid centralist and transform old patients who are rusted-on Liberals into fans of that nice Mr Rudd who wants to fix the hospitals.

Today it’s Hobart, another day, another hospital visit by Rudd, talking to doctors and nurses and patients about how those recalcitrant states want to stop him from empowering them in running hospitals.

It’s Us Versus Them, is the Rudd message.  “Them” being state politicians and bureaucrats.

Having started his Prime Ministership with a commitment to co-operative federalism and a claim that wall-to-wall Labor leaders could be a benefit, not a problem, Rudd is now basing much of his re-election strategy around picking a fight with the Premiers.  That some Premiers don’t want a fight is neither here nor there.  An unsourced story in the Daily Telegraph about closures of regional hospitals in NSW was seized on by Rudd, who suggested either NSW bureaucrats or Ministers were running a scare campaign.  Kristina Keneally and Carmel Tebbutt barely had time to get a denial out before Rudd was asking “knives or pistols?”

And there’s the growing stoush with John Brumby, who says there’s no support for Rudd’s plan.  Apart, presumably, from three-quarters of Victorians.

It’s a different form of retail politics, but potentially very effective.  And it’s a new form of triangulation, a mix of Bill Clinton, who differentiated himself from Democrats and Republicans, John Howard, who happily picked fights with state Labor governments, and Peter Beattie, who distanced himself from his own party in the Shepherdson aftermath.

Where’s Tony Abbott in all this?  With whom does he side?  He can’t side with either, so he has to differentiate himself somehow.  My colleague Richard Farmer suggested Abbott as a former Health Minister would be happy fighting the Government on health.  Abbott certainly had the title of Health Minister, but health policy was run during the Howard years by the Prime Minister’s Office — in the same way it is run now by the PMO.  Abbott was great for doing Pollie Pedal and other worthy causes, but lost the big decisions during his time in the portfolio — Howard decided RU-486 would be a conscience vote; Abbott was rolled after the 2004 election on the Medicare safety net; Howard overruled a takeover of funding for hospitals.  In the 2007 election campaign, Abbott was a liability, especially when the Mersey Hospital takeover was stuffed up.

It’s quite a contrast with his now-forgotten predecessor Michael Wooldridge, who racked up some impressive achievements in the portfolio in far more straitened Budget circumstances.

Perhaps that’s why Tony Abbott and Peter Dutton botched their response last week.  It’s forgivable that Tony Abbott was lost in the outback when the package was unveiled — he has a long-standing commitment to indigenous issues and shouldn’t have cancelled his Alice Springs trip just because the Government sprang its health policy.  But the coalition has known this package was coming.  The details might not have been clear but its overall thrust was, particularly because the Government had a lengthy report from a hand-picked panel.  We’ve had “Mr Blah Blah Blah” and a tax scare and Abbott pushing an elderly patient in a wheelchair, but there’s been virtually no critique of the policy.

Meanwhile, Kevin Rudd continues his hospital tour, implicitly aligning himself with patients, doctors and nurses against the much-reviled “bureaucrats” and Labor politicians who oversee them. It’s clear now why Rudd was prepared to endure some political pain so that this debate could be delayed into the run-up to the election.

Running a health system is a tough job, and Australia has one of the best and most efficient health systems in the world if you judge it by its outcomes and our health spending.  But you’ll hear nothing about that from the Prime Minister, the ex-bureaucrat at pains to explain that we need fewer bureaucrats.  And it’s a message that will go down a treat at hospitals across the country. No one ever went wrong telling voters what they wanted to hear.