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.

I don`t think a lot of money should be spent on preventative medicine at the expense of timely hospital or health professional care. With value for money being the big concern these days I don`t think you could readily assess the effectiveness of health campaigns. It is more important to get some help when you need it. If we want to talk about preventative care we need to look honestly at our society and values which contribute a lot to health problems, but which we don`t like to question. One example is the stress of workplaces with the need to keep increasing productivity beyond reason. There is the pressure on families from the pressure to move up in society or be the perfect family and the competition this brings out in people. A lot of behaviour which is dangerous to health eg drinking, stress, shopping disorders, bullying can be traced back to anxiety. We need to examine what in society is causing all this anxiety. We need to feel we are amongst friends to thrive in society which I don`t feel is the case now.

jillham

I agree that it is not the role of Medicare to fund "healthy lifestyle" initiatives but they are very important and should be funded from other sources.

After trying to understand what the authors of the article are saying I must disagree with one point.

"It favours curative over preventive care" this is a pet topic of mine and I suggest that "cures" are in fact the last thing that big pharma are interested in.

They are more than happy for people to take drugs for decades than to develop a cure.

My leukaemia was first described in 1874 but the mechanism is still unknown. In fact the stuff that is secreted by my wonky B lymphocytes has never been measured in a clinical trial.

H. Pylori was dismissed as rubbish, it could not cause ulcers. Cervical cancer was not caused by HPV, vested interests dimissing cures.

Expecting Medicare a universal health care system to pay for these things is misguided.

Funding of our world class research facilities and taking it away from commercial interests is one answer.

As an example Thalidomide is now being used to treat Multiple Myeloma, it used to cost $4 per treatment it now costs $10,000 per treatment.

I think there is a big role for Healthy lifestyle initiatives. Whether the money comes out of the medicare budget is debatable. But money spend on healthy life style now should be money saved in future medicare payments. Hopefully with a dividend.

Similarly money spend on education now provides for a more competitive workforce and thus a bigger tax base in the future.

Just over a decade ago a newspaper article said that public hospital spending need to be increaded by at least 12% a year to take in account inflation, medical technology, wages and an aging population.

This occured just before catch cries of improved effecincies, cost effectivness became fashionable.

Improved efficiency is a paradox within the public hospital system. It increases costs.

Add to this, is the mixture of various government policies and the failure to dress the chronic underlying problems within the public hospital system. Governments make promises of reducing waiting list and of improving performance of the public hospital system is little more than smoke and mirrors, there is no guarnatee that investing a billion dollars will make any difference as it evaporates before it gets to the areas where it is needed to make a difference.

Each new government compounds the problems created by previous governments.

The private sector is often held up as being the ultimate ideal. Yet in a country which spends the most on health care, the average life expectancy is much lower than Australia.

And in a chronic disease like renal failure, the health outcomes are very poor, unless you are rich.

Some solid good sense from Anne-marie and Steve! I do not disagree - just want to go further. More than any other part of the system, primary health care (PHC) is what citizens think they know about. Obviously they use it more than any other bit. Yet the extent to which they have a say in designing PHC is more or less zero (unless they are Aboriginal and a member of an Aboriginal Community Controlled Organisation, ACCHO).

Why not? I feel another Citizens' Jury coming on... to address the question: what's the good of PHC? Almost certainly whatever citizens come up with, fee-for-service medicine will not deliver the good they want.

In the meantime, for the rest of us, let's have our "ACCHOs"!

Maybe Anne-marie and Steve are right that we need to see health care reform not just in humanitarian terms but in terms of the value of increased labour productivity to the economy. That is sad but also amusing that a neo liberal government might be asked to endorse a Marxist labour theory of value!

Nearly 100 years ago the 1911 National Insurance Act in the UK was brought in largely because the troops who had fought in the Boer War were discovered to have been unfit - to die for their country. And COAG is currrently re-endorsing this sort of human capital approach to health where the value of health is to be measured in terms only of market value. Oh dear!

So let's ask the people. I think they will back humanitarian ideas. They are not dumb and in my experience, given good information, they are a lot more caring than government.

Gavin Mooney

Medicare is definitely not coping with any illness let alone chronic ones. I am on a disability pension and suffer from an autoimmune disease . Because my disease is systemic I have more than one specialist I need to see. In fact I have a GP and four specialists. Only one of these bulk bills and although I am billed at a slightly lower rate than someone without a pension the frequency of visits means my health care costs annually are extremely high.
I have a niece who works in critical care, her shifts can sometimes be as long as 12 hours. In a high stress area such as critical care that is way too long for anyone to work and often in that time she will be lucky to get a 10 minute break let alone a meal break. Our health system is in tatters and as long as the Federal and State governments continue to blame one another and do little about it, the worse it will get.