A decade ago trendy phrases like 'improved efficiencies' and 'cost effectiveness' permeated the public hospital sector. Then there was the grand plan to increase private health membership to take the strain off of public hospitals.

In just over 3 decades available public hospital beds have decreased by more than 50%, from in greater than 5 per thousand of population around 1980 to 2.2 beds today.

A decade ago in a report to the NSW treasurer, it was recommended that nursing numbers be reduced, too reduce labour costs. Health economist consultants even recommended against hiring nurses at the top increment of the pay scale.

Overtime for nurses was a rarity, today it is common practise.

The only blessing is that the people responsible for this mess, will one day have to experience it first hand, that is if there are any public hospitals left.

Ask most people what is high on the list of things important to them, and they will tell you: good health.

So, when people expect to pay for everything else they have, including necessities, it is quite strange that they expect to get health care for nothing.

Poor old Tom. My mother is almost 90, and she has private health cover. She pays for it out of her old age pension. Why can’t Tom and others do the same? Just how many other things does an aged pensioner have to spend money on - particularly as they are the ones most in need of health care?

Tom didn’t take out health insurance as a matter of “principle”, and he is now finding out what his principles (if that’s what not looking after yourself means) cost. Tom doesn’t really believe in principals though. At his age, he is costing taxpayers more than the young families struggling to pay for health insurance “just in case”, even though they and their kids are much less likely to have failing health than Tom who is a health disaster, according to the author.

As the author says, “Let’s forget old Tom”. And let’s forget everyone else who hasn’t made arrangements for health care in their declining years.

Free public health is a myth (mainly because public hospitals are choked up with bludgers lining up with head colds instead of paying to see a GP or finding a bulk-biller). Public hospitals are meant for emergencies only; few private hospitals provide an emergency service.

If good health is not worth the price – stiff cheese for those who think so

I have two thoughts on the article: for years now governments have been in self-congratulatory about their surpluses. What they ignore is that at the same time as generating a cash surplus they allowed infrastructure to run down. If governments had to account for their assest and liabilities as a company does they would have been recording losses not profits. That running down of infrastructure is now being felt in health, education, water etc.

Tom, of course, is a composite. If all these 'aliments' hit him over time he'd cope. But Leigh (above) makes a good point on health insurance (itself government subsidied as middle class welfare). My observation is that if you don't have access to a line of credit of about $5,000 (ie a credit card) you should have insurance. If you do have that access forget insurance as the cost of private health insurance is way over the top: it's a protected, subsidised industry after all, so no incentives to be cheap and efficient.

The funny thing is if Tom suffered something really serious like a heart attack he'd be taken by ambulance to a public hospital and be 'done' for free.

"Free public health is a myth (mainly because public hospitals are choked up with bludgers lining up with head colds instead of paying to see a GP or finding a bulk-biller). Public hospitals are meant for emergencies only; few private hospitals provide an emergency service."

Leigh - you unfortunately display an ignorance that is breath taking.

There are several reasons for the pressure on the public system:

1. Many people with private health insurance when faced with a life threatening/emergency medical situation opt to be treated in the in the public system as a public patient system for two reasons: firstly the treatment is world class and comprehensive. Secondly there is no “gap’ payment required when entering the public health system as public patient

2. The Howard Governments private health insurance 30% rebate. This means private health is being subsidised by our taxes. If these billions of dollars being poured into the private system were being poured into the public system – there would not be any waiting lists. The private health industry is being propped up by public money – it is inefficient, and, on ideological grounds only – even contrary to every faith in market economics the coalition possesses.

3. Waiting lists exist because those specialists who have taken the Hippocratic Oath are discriminating against public patients. This is unethical and immoral. And they do it for the extra money, (bribe?), paid to them by the private system. Why does the private system pay more? Because they have to offer people a reason to pay the expensive fees. They create the reason by creating a situation where public patients are second class so that private patiens are able to feel, and are treated, first class. And public money is being used to fund this forced inequity.

As for bludgers – surely accepting tax payer money for a private room and telly is bludging, (as when it comes down to it this is the basic difference in care between public and private - not quality but luxury), bludging off all us

Leigh I suggest very strongly that you explore this website.

http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/sociopathy.html

You wrote;

"Free public health is a myth (mainly because public hospitals are choked up with bludgers lining up with head colds instead of paying to see a GP or finding a bulk-biller). Public hospitals are meant for emergencies only; few private hospitals provide an emergency service."

I suggest that you get a job in a public hospital, this is the biggest load of crock I have ever read, except for politicans political speeches.

The first emergency rooms were for people who could not afford to go the doctor. Long before medi-care.

the bed block which occurs in emergency departments is not because of head colds. It is because there are insufficent public hospital beds available to admit the patients who need to be admitted.

In the USA private hospitals use to refuse to treat public patients presenting to emergency depatments, as a consequence a number of people died being transferred to a public hospital.

sure it is cheaper to let a person die rather than give them medical treatment and as a subsquence people who die on whilst on waiting lists save the governments money.

There is no doubt that the government is insincere about Medicare and is passing on user pays wherever it can get away with it. However that is not all of the problem.

I favour the primary health care model, however as long as government finds convenience in using GPs as 'gatekeepers' for access to medical services and benefits it will be difficult to meet emerging needs.

There are many 'conditions' which are normal consequences of ageing (or being female or male) that people have been persuaded into believing are diseases or at least symptoms of disease and these are consuming health resources.

Again, some older people seek and endure treatments for conditions where the treatment is at best of only marginal benefit or more probably, ensures an extension of life without improving quality of life.

As I see it, there is no way the community can afford to apply the full battery of tests and treatments that advances in medical science have made possible to all comers. Also as pointed out earlier, should we always choose to do that anyway when those procedures could marginally extend life but at the cost of quality of life.

Maybe people should be better informed about how to make the best use of they last years and that would usually imply time with family and friends rather than regulary being in hospital with tubes everywhere and a nurse standing by to assist performance of bodily functions.

Preventive medicine through more healthy lifestyles is the well-proven, cheaper and far more productive way to improve the health of the community. But what about men and women who refuse to stop smoking, or cut down on booze, eat vegetables and walk 30 minutes a day? What is the point of putting crowns in the mouth of someone who eats biscuits, drinks Coke and refuses to floss? How do we convince the community of the benefits of fluoridation?