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.