Regardless of any deliberations by the Productivity Commission, the most telling issue about our health system is its abject failure. Not that medical science and technology are falling behind. Simply that despite massive escalation of health spending, the health of the nation is on a downward spiral. Shockingly so. Extralopolation into the next 50 years tells a foreboding story as our unfit, obese children become middle aged.

Any deliberations on future health care needs and the provision of health workers must urgently place this chronic failure at centre stage.

Simple escallation (more of the same) means more failure. The notion of health care has to change dramatically, and this entails shifting our attention away from technological escalation and hi tech medicine - and transforming the workforce that underpins this paradigm.

Refocussing on the demand side of health and away from sexy supply side technology is a first necessary step.

It is unlikely this government will make substantial moves on the state of the health system - its attention seems to be committed to micro management issues like abortion/RU486 and PBS matters (read Free Raid - oops I mean trade - Agreement).

Any attempts to fix the system will be met with susbstantial dissent from existing stakeholders - in spite of their constant clamoring for improvements and reforms - as most calls are for more mopney to do more of the same by substantially the same people.

Doctors will reject the notion of professional substitution even though it has been going on for years and sometimes at their behest.
Registered Nurses do the same when less skilled nurses show the capacity to do their work as well - it is understandable but sadly dressed up as being in the patients interests when usually it is a turf war. that is not to say patietns interests remain cengtral to the argument but they are not all of the argument.

Health reform is long over due but it will take more vision and political will than either party in this country has demonstrated for quit some time.

Suggestions like Leeders will always be timely until we fix the problem - but it should be a process looking twenty to fifty years ahead.

for starters, people who buy cigarettes (myself included) and alcohol should have to swipe an improved medicare card (or the australia card) and then have to pay extra on thier medicare rebate, this way we would at least be telling people these behaviors are not ok and getting some more money for health.

secondly we need to change the way the health workforce is taught and run. for example, in the future it will be one and a half million low skilled nurses that will be hard to come by to look after the five million aged people in residential care. to do this we need to rip our the roots and slash the branches of the current system. No doctors (except perhaps a small few with 99.999999 uai) should be allowed to do doctor training and get rich without first having worked in a low level nursing position, whilst learning nursing at uni. those that can handle this (note to feminists, I agree this would largely be women) could then move on to registered nurses whilst they undertake the next level of uni. then those that can make it become specialist nurses while they do their next level of training. etc. all the way to specialist doctors. this would stop the money hungries, make sure there was always an appropriately staffed bottom of the pyramid, be cheaper (no rivalries between doctors and nurses, between doctors and psychiatrists etc as they all would have come from the same sh!t washing old persons home, and not be big on ego) and ensure the patient was always at the centre.

this would take about twenty years to impliment, as doctors are aging so we would need to continue as is, whilst we slowly built up the nursing sector to a degree where it could handle haveing lots of members working part-time studying part-time.

time for radical change before all our problems start, but only if we begin to change now.

Gecko, I doubt that many of our young generation will reach middle age. We already are witnessing a growing collapse in health of the junk food generations. With the current approach to medicine, we will continue to see the same results. Diabetes, pancreatic, heart respirory problems, are rapidly growing in these age groups.

Until health is approached by attacking the causes of bad health, nothing will change. Prevention wipes out the need for cure and would reduce trhe growing demand for more services and staff. The we have to look at the reality of our health professionals. It is a fact that many in the profession display really bad examples to others. Large proportion of nurses smoke, are overweight. They do a great job, but would better serve the community with a better example.

Fide mae, I would agree that training should include all entering health to start at the bottom and learn all about nursing, before going onto tertiary training.

However for someone that constantly tells others that they should get educated and are idiots. I would look at you own self confessed drug addiction, to see where your intellect stems from. A rock has more intellect than drug crazed, mentally unstable, angry, tobacco addicts.

I believe that smokers, should have no access to free medical care and should be treated as other drug addicts are, useless blights on society.

All the education, drugs or treatments will not overcome bad diet. You don't put water in your cars fuel tank and expect it to run for very long, why shouldn't it be the same for our own biological machines.

We need for Howard to fund a Health system first, then we can look at it becoming healthy, with an expected $17 Billion surplus, one must ask, why has Public Health been allowed to run down so badly?

Surely there is enough money to lift the standard of Health and Education, and have some left for tax cuts...

Alchemist, you remarked "I believe that smokers, should have no access to free medical care and should be treated as other drug addicts are, useless blights on society". I see where you are coming from but I wonder where a stand such as that would end. No access to free medical care for those overweight? No access to free medical for men who drink more then 28 standard drinks per week and for women who drink more then 14 standard drinks per week? No access to free medical for people who don't exercise and get high BP, Cardio Disease or even cancer? (given that there is plenty of evidence to show that exercise cuts such diseases by 30% or more depending on type of disease). No access to free medical for people who take excessive pain killers, given that there is evidence to show many cause liver/kidney/artery/stomach problems etc?
It surely would take care of our doctor shortage...but the population reduce rapidly!

Oh well nevermind nanotechnology will soon take care of all ills..although we may become dehumanised in the process.