So, the class war is alive and well in the halls of academe, it would seem.

"Australia has a vicious two-tiered health system. The affluent and powerful go as private patients... [the] poor and powerless... cannot purchase services privately"

That is the broadest of generalizations, and like all generalizations, is patently false.

According to a PHIAC/ATO/ABS analysis in 2006/7, nearly 3 million Australian adults with incomes lower than $40k were covered by Private Health Insurance. Also, the Australian Institute's 2005 report showed that 24% of Australians with household incomes of less than $25k were covered by Private Health Insurance. Sure, the percentage increases with disposable income, but so, I would imagine, does plasma TV ownership.

Most importantly though, given that a family can get good Private Health Insurance for around $1,500 p.a., the writer should take another look at his statement that:

"the poor and powerless... eat, smoke and drink more..."

A pack-a-day smoker chooses to spend around $5,000 p.a. on his habit. How, in the name of rationality, is this the fault of our health system?

Taking out Private Health Insurance is largely to do with personal, family priorities, not wealth. And the money is not removed from the overall health system - by allowing individuals to prioritize their health in this manner, the public system has less pressure on its waiting lists.

(Whisper it not abroad, of course, but private hospitals have a pretty good reputation for efficiency - after all, they are businesses, and businesses value efficiency.)

We have a good blend of public and private in Australia, with a first-rate public system that has a great track record for mending people - I would rather be run over in a Sydney street than almost anywhere else in the world (although some Scandinavian countries are pretty good too, I've heard).

I emphatically disagree with Mr Baume that he has shown that:

"What exists here is scarcely an indicator of a civil society. It is certainly not an indicator of a fair society. It is scarcely an indicator of a caring society."

Great sloganeering. Poor contact with reality.

Yet another whine from a rusted on leftie about how they would spend other people's money better than it is currently being spent. Especially if they had more of it.

And comments about how the poor and "powerless" drink and smoke more and practice less preventive measures are code for yet more nanny state intrusion. What he really means is he (or those who think like him) would really like to supervise how others spend their own money

People always talk about "our" such-and-such "system" when it's being run unsatisfactorily and irrationally by the government, don't they? No-one ever talks about "our" pizza "system", or our shirt system, or our friend system.

The author's complaints have nothing to do with the medical system per se. They have to do with the fact that poor people can't buy as much stuff as rich people. If this is immoral, then human freedom is immoral. Why not just strike to the root, and ban all freedom since people obviously can't be trusted, by their *voluntary* actions, to come up with outcomes that the clever know-it-alls would like to achieve by *force*?

But what is the alternative? Why should any inequality be tolerated? Why not simply make the tax rate 100% of everyone's product, and then government can redistribute income so everyone's income is equal? Bliss! But of course the author won't own up to his own ridiculous and anti-social logic.

It never occurs to him that government might have anything to do with causing the problems he is concerned about. That the overwhelming single cause of poverty is government, with its endless taxes, inflation, wars, bureaucracies parasitising productive activity, occupational licensing, and endless capital consumption, which the author is all in favour of.

In declaring anything he doesn't like as immoral, the author completely fails to deal with the fact that *everything* he stands for in this article is based on extortion. That doesn't rate a mention in his scheme or morality apparently.

What we have here is just a re-run of the nutty communist idea that inequality is intrinsically "not fair". The underlying idea is that the process of wealth creation is one by which everyone equally contributes to a common pool, and then mean and nasty people take unequally from it, while government - the monopoly of force and fraud - is the fountain of all that is good and productive. In short, a complete inversion of reality and morality

This sounds like Peter is feeling guilty. Guilty of having nestled in the larges of tax payer funded comfort all his life.

I wonder if he felt guilty when he sat in the seat of a director of Sydney water. Surely he would have thought, with his belief in fairness, that there was someone more qualified, who should be sitting in the seat.

As an old bloke, without health insurance, I don't think our health system is too bad. It's pulled me through 3 heart attacks pretty well. It hasn't done such a good job with a couple of other problems, but that's probably my fault for picking a problem that's hard to diagnose. It's not for lack of trying, that I've not been sorted.

Yes down here in the dirt, at ground level, it's not too bad. I don't doubt it would be much improved if a head hunter took the top 500 managers out of the system. Replace them with a hundred or so small business managers, & we'd get 10 times the value for money, but that goes for most public service areas.

Medical euthanasia

There is something rotten in the State of Tasmania and it could be the same in the othere states as well.
This is the transcript of Airlie Ward from the 7.30 report in Tasmania talking to the CEO of the Menzies center on his leaving to go to another position.
http://www.abc.net.au/news/2011-11-04/professor-simon-foote-interview/3636862
In it, he virtually admits - that there is a time coming when patients who are dependent on the public health system will be assessed and if they are found to be not worth the cost, will be left. She actually remarks that this amounts to medical euthanasia.
His reply is, in my view, evasive. So it would seem that the ripping out of hundreds of millions of dollars from the health system, is a deliberate move to either force low income Tasmanians to join a health fund and take the burden from the State or to bring in a subtle form of eugenics.

Professor Simon Foote: “We can’t actually afford the level of service that many people sort of desire and over the next decade we are definitely going to be faced with more and more difficult decisions about whether to spend money on someone for a particular procedure or not and I think going into the future the answer to that question will often be not rather than yes.”
Airlie Ward: “Sounds like medical euthanasia?”
Professor Simon Foote: “Well it’s not necessarily euthanasia but it’s you know it’s , we are going to have a finite budget and we have to spend that budget wisely and we make those decisions already you know, for example there are drugs that we don’t actually have access to in Austalia because they are too expensive, so those decisions are at one level or another already being made, I just think we will see them being made more frequently in the future.”

Congratulations. This is a short and incisive analysis of our illness industry. The only bits you need to add is how the professions are siloed and work against other and the woeful quality of health bureaucrats who are more interested in their careers than making decisions to benefit patients.

The worst thing about the Australian health system is the ideology that besets it. The same ideology afflicts the school system as well. It's this nonsense of public (good) vs private (profit driven therefore bad) provision. There is no logical or medical reason not to operate an integrated hospital system, including both public and private hospitals. Much so-called elective surgery could be undertaken in private hospitals, particularly those which specialise in particular areas, such as cataract surgery. Patients with Commonwealth Health Cards and other entitlements will be treated as they are now and the government will enter into funding agreements with private hospitals to undertake the relevant surgery. Public hospital waiting lists will be reduced and the needs of the poor and powerless more adequately met. This would be step 1 in an overall reform programme. Stepo 2 would involve tackling the large number of aged patients who are in hospital beds when they should be in nursing homes.

Senior Victorian may have a point, but transferring the public overload to the private sector is probably not really feasible, and would probably cost as much or more than correcting the deficiencies in public health.

Private health services exist because of demand, demand not being adequately met by the public sector - in terms of range or timeliness, quality maybe, and possibly some lack of salubrious facilities. And they exist because sufficient numbers of people are willing to pay to have such services available to them, mostly, but not always, via private health insurance - which spreads the cost, and offsets part of the final bill, like any insurance. It will probably always be thus, unless the public health purse was doubled or quadrupled, and maybe even then.

It is perhaps unfortunate that there is a need for private health services, and private aged-care facilities, but this is really situation normal, as there will probably always be those who demand it and can afford to pay, and as public health will probably always be subject to cost limitations.

It is nonetheless true that the most complex procedures are almost exclusively restricted to the public sector - transplant surgery, oncology, and cutting-edge research - and will probably always be thus because of cost. Is there too much cutting-edge, complex pre- and post-natal care, life-prolonging intervention and such, at the expense of basic essential services to the bulk of the populace? This is one very complex judgement call.

To give due credit, the author has identified a number of areas where services may be improved and skilled staff shortages reduced, but the ultimate deficiency is funds shortage, combined with an increasing population, and an increasingly aged population.

Unless we can all lead a healthier lifestyle, and then just drop off the perch without warning, it is only more funds which can address the deficiencies. But where is this to come from? Higher taxes, reductions in some other services, or a leaner economy, reduced or fixed wages, and with more extensive health services education? Perhaps these latter options are not too outrageous?

The costs of an ailing and inadequate health system are felt not only by the patients, but by the flow on costs to other sectors. People unable to access mental health services who cause a flow on effect to social security, homeless services, justice systems and etc. Those with a disability who need a number of services, and find that the inadequacies that exist within one area are simply compounded by the lack of co-ordination between areas - two doctors sitting in adjacent offices who can not see the same data, see the same patient but do not talk, etc. All of this causes a flow on to both people with a disability and those who care for them requiring social security support instead of being able to work, clogging up hospital wards because there is no rehab available, entering long term therapy programs when what they need is short term support to get them back on track. These are absolutely outcomes of having an illness based system, not a health based system. We can do better, and we would all benefit from it, because the current system is inefficient, inadequate and brutal to those who need it most.

Unreasonable emergency room wait times. Find out more at, http://seemyopinion.blogspot.com/2011/11/unreasonable-emergency-room-wait-times.html.

I am intrigued by the comments about poor people and lifestyle choices.

How poorly educated do you have to be not to get the message that smoking makes you much more likely to get cancer?

How poorly educated do you have to be not to know that eating a lot of high sugar foods and not exercising increases your risks of bad becoming overweight and illnesses such as diabetes etc?

How poorly educated do you need to be to not know that regular heavy drinking damages your body?

It does seem fair to say that buying food that's less processed and with less additives can often be more expensive than buying heavily processed food which is full of additives. As others have pointed out the costs of cigarette's and alcohol is not trivial either.

Perhaps there are more things that we can do on the health side of the equation to help those who really do want to be healthier with. Not sure what is practical that's not already been tried in one way or another though.

Most of the local parks in my area now have some basic exercise machines in them, we've got a great system of paths around for those who walk, run or cycle.

The TV carries plenty of stories on weight loss, health etc. Some with good advice.

It seems to me that that governments of all political persuasions have put a lot of effort into trying to educate people and provide basic resources to help those who drink, eat and smoke more and exercise less to do things differently. Most of the rest is choice or excuse.

We can and should look for opportunities to do things better but I don't think that the author is being fair to our society with the nature of his attack on it.

R0bert

compared to the Philippine 'health' coverage system, Australian Medicare, for all its faults, is still light years ahead. One example from a recent press article: a low salaried couple with the mother delivering a premature baby. The hospital refused to allow the mother access to the baby until the parents paid P700,000 (about $AUD15, 555)for the oxygen, humidifier and all the other technical aids that were used to keep this premature baby alive.
Then there's my mother-in-law who's 84, who had a fall a coupple of years ago. She thought she was fully covered so she spent 10 days in a private hospital, then she got the bill: PhilHealth refunded her a small amount, but the 'gap' amounted to more than P100,000 (sound familiar?)
So the family had to scramble to pay that gap before it got worse. Oh, yes, she needed a blood transfusion, so after many hassles we got some blood from the Red Cross, but there was an 'administrative fee' of P1,500. And nurses don't check on the patient day and night - that's up to the carer, a trusted family member who also provides the patient with food and pharmaceuticals.

We've been here 4 years in northern Mindanao, in Cagayan de Oro, a great little town, just don't fall ill or have an accident or be a victim of crime: the medical costs will devastate you more than the injury ever would.

And just remember that it was Gough Whitlam who gave us Medibank, at least it was a start, although it didn't cover dental and optical and psychiatric. Maybe one day it will. But appreciate it while you can.

People using public hospitals and not declaring their private health insurance.
Elective surgery because someone doesn't like the shape of their god given nose.
Using emergency department for non urgent cases

Peter Baume has clearly described Australia's divided illness management approach to our non-Health system.

There is extra funding coming into sickness care by having a private dimension added to a public system. However, the private dollars take away finite professional resources from the possibility of an integrated public system, and use those resources to optimise private incomes without optimising health outcomes.

There is no obvious private fee-paying business model for an efficient health promotion system. One usual private approach is to con people into buying expensive unneeded "vitamins" when things are going well economically. It took the financial collapse of Nauru to force the populace to walk everywhere, and eat fresh local food to reduce their prevalence of diabetes.

I look forward to contributions to this forum that suggest methods for an efficient health promoting system that "private" primary care practitioners can implement along with their illness management

Peter Baume is on the right track. The well off consume a disproportionate amount of the national spend on health. Money spent does not equate to better health outcomes. The US spends more as a per cent of GDP on health than any other country but life expectancy is less than in countries where the spend is much less.

The big problem in Australia is not that we have a private and a public system but that the private system is largely funded by the taxpayer in an uncontrolled fashion. The public sector is restrained by the yearly budget handed down by the feds and the States. The private sector is free to expand as fast as it likes with the Federal government picking up the tab for substantial parts of the costs of doctors bills (including for pathology and XRay), pharmaceuticals and in-patient care by way of the Private Health insurance rebate. The PHI industry claimed that 'coercing' people into membership by way of penalties for joining after 30 would see a reduction in premiums. Despite their claims the PHI industry has enjoyed increases in federal funding by way of the rebate in excess of inflation year in and year out.

If taxpayers' money was directed to where it was needed we would all be better off, thepoor and the wealthy. It's enough to drive someone to drink.

Hume

There are models of primary health care that go beyond traditional illness-based general practice. Examples of these include the GP Super Clinic model (The original Rudd/Roxon paper "Fresh Ideas, Future Economy" is quite good despite the awful implementation), the Centre for Policy Development's Primary Health Care Centre model (download from http://cpd.org.au/2007/06/a-new-approach-to-primary-care-for-australia/)and the Wellness Centre model (downloadable from http://www.aph.gov.au/house/committee/haa/healthfunding/subs/sub081.pdf).

What is obvious but missed by most is that there has to be different (not necessarily more) models of funding.

The reality is that Australia will not be able to afford to continue letting patients develop chronic diseases when they are preventable

John Wellness,

You posted, on 30/11, 11.40pm:

"The reality is that Australia will not be able to afford to continue letting patients develop chronic diseases when they are preventable"

Could you expand on this John, with some examples perhaps, as it is an interesting tack? All I could think of was the likes of the education campaigns about smoking, obesity, carcinoma, diabetes, diet/exercise and such, or regular checkups/testing for say bowel, prostate, and breast cancers, or are you suggesting genetic predisposition screening perhaps?

Also your 'different models of funding' is an interesting thought, and all I could think of was perhaps funding on the basis of outcomes, rather than simply on services provided, but then I can't see how this might work. Can you elucidate please? Thank you.

Peter.

Peter Baume is on the right track. The public system should be properly funded, available to and used by all Australians - this is actually cheaper to all than our current two tier system and would encourage a quality service. The total pool of health professionals is finite - when they work in the private sector they are not providing care in the public sector: it is a fallacy to believe that using the private system will take the pressure off public hospitals. Allowing the health of the poorer members of society to deteriorate and not providing adequate care is bad for the whole of society and financially expensive in the long run: benefits, loss of work hours, and the long term effect on children. A mark of civilisation is how we treat our most vulnerable. Sadly, we are witnessing this deteriorating, and no, it is not fair.