Questions
Are doctors currently trained to keep people healthy or treat sickness?
Would the 'system' support and resource a family doctor to keep a given number of families healthy regardless of cost?
Doesn't Medicare support a 'sick care' system?
Doesn't economics dictate who is treated in hospital and for how long?
Aren't families and individuals being asked to carry the burden of post hospital care themselves?
Why is the hospital system deprived of the training health care worker?
Didn't we deliver better health care before we allowed economics to dictate how our hospitals were run and by whom(managers)?
Isn't the declining number of nurses largely related to stress from working in an overstretched workplace with an expectation that they will be solely responsible for their scope of practice?

So many questions - but where do we go for the answers - neither side seems ready to bite the reality bullet.
It seems that economy driven policies have rationalised 'healthcare', if you can call it that, into the crisis we now experience.

Is there anyone with the courage to look at putting people first? Medicine, it seems, has become big business to the detriment of all those dependant on it for care and employment.

In spite all of the problems that beset our Health system remains one of the best in the world - some what counter intuitive dont you think ?.
we are grinding towards a crisis though - and part of that has a lot to do with the burden of chronic illness - and there is not a lot that can be done about that.
But a good deal of it has to do with poorly administered systems - hospitals by and large are loosely coupled , chaotic systems that deliver a fairly good product despite the pressure under which they operate.
The over burden of bureacracy that runs as a more regulated system is where a large part of the problem lies - our health spend is escalating but slower than other parts of the world but we cant keep the lid on it much longer - before we need an organisational voer haul at the top of the pyramid before we look to changing delivery systems -

sneeky,
Mate you are so right, and the loss of $1 billion in federal funding in 2004 didn't help one little bit.

sneeky is spot on our health system is close to the best in the world with its private/public mix.

Most of the problems are in no way related to medicare per se.

I live with a chronic illness and most of my Doctor (GP) visits are to refill prescriptions, get referrals or to get pathology requests.

My face to face GP visits could be dramatically reduced if I could see a "nurse practitioner" or "physicians assistant" freeing my GP to do what he really should be doing.

How much GP time is spent filling in forms required by various Govt. agencies? Too much in my view.

The last thing we need is an American style system where treatment is decided by insurers not Doctors and the "Managed competition" model worries me.

Stephen and Anne-Marie are asking the big questions. To be sure improvements in procedures and accounting can help maintain and improve our excellent health-care system. And I am sure that they are not advocating putting the axe to the good system right now. I think they are saying two things. (1) That we are tilted towards curing rather than preventing or avoiding, and that this tilt is going to result in our being swamped by insatiable need. (2) that the nature of our poplulist political electoral system makes it difficult for political leaders to act rationally in order to adjust our approach to health care. We need big thinkers like Stephen and Anne-Marie. And we need geniuses of politicians who can speak the truth without fear of losing votes.

I don't work in healthcare so I won't claim to be an expert however I have worked in Europe, the US, Aus and Asia. Though I admire the Amercians for many achievements their healthcare system is not one of them. I'd really hate to see it copied here and judging by the responses it doesn't seem likely.

I don't see why adding a preventative branch wuold be such a problem. In every state we have quit (smoking) campaigns and the like.

The big bureaucracy should be solvable without changing the premise of medicare, basic health care for all.

The endless bickering between the federals and states has no easy solution. Sometimes I do feel that it makes sense to move health and education to the federal level. The feds should keep in mind that these are high compromise portfolios and that they will be held responsible at the ballot box.

While we are thinking big and radical, I think that abolishing the states and adopting proportional representation would solve a lot of current issues. I grew up in Holland with a PR electoral system. The big difference is that todays opposition party might be a coalition partner in the next government. Overall politics becomes more civil and allows for parties to adopt shades of grey in their policies. Now if one party says white the other says black and nothing constructive happens apart from pompous statementment by the political leaders. NZ already moved in this direction it is time we followed. The system is much more democratic and ensures that everyone has a say.