As an expat American here for the past 8 years, I’ve cringed when you Aussies beat us at swimming or track. It made me decidedly nervous one day walking past Waverly oval to see Australians playing baseball, and playing it well. But it's been with sheer amazement watching Australian politicians try to fuddle up your health care system more than ours.

What about evidence-based policy? Example: the clearly demonstrated cost-benefit of secondary prevention for chronic disease, rather than waiting till more deterioration has occurred, requiring more costly services. Or evidence that NOT integrating systems (e.g., where every hospital has its own MRI scanner, or neurosurgeon on-site) increases costs without improving clinical outcomes.

Even without physician shortages as we have here, American hospitals don't each have full services in every realm of specialty care, other than major teaching hospitals such as UCLA or Yale. It doesn't make for best practices. Excellent specialty care results from concentrations of expertise supporting and expanding capability within that specialty. Individual clinician experiences of unusual cases requiring new treatment approaches are more readily determined and shared where experts can come together to evaluate and determine the best course of action; similarly, discovering shortfalls in approaches to diagnostic and treatment methods occurs more readily and is shared more rapidly where pools of expertise synergize. This is only possible with an integrated health care system.

Here's an idea: What about the real experts in medical care (doctors!) having a bigger role in health care policy than business managers (in the USA) or politicians (here)? The work hours and stress of practicing medicine are made worthwhile by achieving successful clinical outcomes and improving people's lives--even in the USA, the income for most doctors doesn't compensate for the costs to our lives in becoming and being a physician. Doctors know what serves their patients best, but quality of health care takes second priority where focus is on profits or votes.

Leadership is about doing what must be done for the community benefit. Putting the Tony Abbott's up as the Ian Thorpe of health policy leadership is drowning Australian health care.