Spot on Jeremy.

There is a problem tho - for many Australians, Medicare is considered a right which must be maintained at any cost, and the notion that it's unfeasable will be heresy to many.

It's time for Australia to grow up and face reality.

"The "free and universal"' taxpayer-funded health systems of the twentieth century were created in an age when medicine was rudimentary and inexpensive,"

The reason we are told that governments collect taxes, is to pay for things like schools, hospitals and roads etc. So if our health care is funded through taxation.

How can it be 'free'?

admittedly governments would like to spend our taxation dollars on things other than the reasons wea re told that they are collected for.

To loose our medi-care arrangements and follow a model similar to the United states which, by the way is the same model of health care in third world countries. This model is that if you can afford to pay for your own health care then you do, if you cant afford to pay for health care then your life expectancy rate is dramactically reduced.

Medi-care is a luxury we can not afford to loose, because the alternative especially for many retiree's is that health care cost similar to the US do not take long to bleed a retirement fund dry.

Unfortunately for us Australians there is no Canadian or Mexican boarder to cross to buy the exact same medicines at half the price paid for in the US.

There are perhaps many times that the medi-care dollars have been poorly directed by those in power.

Perhaps if our government stopped spending money on committing Australia to wars started by the US we would have the requisite money to spend on health.

The nonsense coming out of the CIS these days is getting more and more absurd and desperate. I can only hope it's because they can see that people are waking up to the reality of what neoliberal free market fundamentalism is - little more than an extreme ideology with very little evidence to back it up. Healthcare in particular is one area where the evidence overwhelmingly points to it being far more efficiently and reasonably provided by a single taxpayer-funded system than by competing private insurance funds.
There're many areas needing improvement in our health system, but making access to life-saving treatments and drugs dependent on ability to pay for them is categorically not one of them. Fortunately it could never be sold to the voting public anyway.

dnicholson, you've missed the point entirely.

Most of the medicines that will be used in the future are being developed overseas. That means that we'll need to purchase them which is a cost the government will need to bear. As each year passes, these new drugs and therapies are becoming more and more expensive.

This is reality.

The article is right in saying that purchasing these drugs (etc) and giving them to everyone carte blanche will require sums of money which are unrealistic - would you like to have a lowest tax bracket of 50% working up to 90% (or more) to pay for this alone?

The reality we all face is that we have an aging population and a shrinking tax base. There will come a time in the near future where the health system that we currently "enjoy" will no longer be feasable.

It's nothing to do with right-wing-ism - it's the practical ramification of our world.

No mention of how oil decline will make healthcare as we know it just a pleasant memory. But the news need not all be bad. Cubans now have a longer life expectancy than US citizens as well as universal health care but at a fraction of the energy cost. There is a lot we could learn from them.

dnicholson, unfortunately it doesnt have to be sold to the voting public. You only need an election win that achieves a full balance of power in both houses, and the govt can claim it "has a mandate" to do whatever it likes - look at the full sell-off of Telstra (being the most recent rip-off/backflip that comes readily to mind).

To say that doctors used to save people from misadventure rather than lifestyle choices is to be deliberately ignorant of lifestyle choices of old. Why do you think so many died earlier? A awful lot were smokers, heavy drinkers, and consumed diets high in burnt meats and saturated fat (think bread and dripppings, people). I'd argue that our diets have drastically improved over the last 50 years, thanks mainly to higher levels of affluence, better transport, refridgeration and education.

Yes, I agree that we now have much higher cost equipment, which is no doubt driving up the costs, but we also used to have much higher levels of service availability in regional areas as well. Many country hospitals have closed, or downgraded to the extent of simply being a place to go to die (no surgery, no maternity, etc). We USED to be able to fund these things, so we are obviously saving money there.

One of the biggest eaters of money in any area is administration. And I am not talking about the individual hospital administrators, as from what I can see they are generally overworked and underpaid. I am talking about the vast bureacracy that sits within the system, eating up masses of money, but not actually producing anything (or even directly supporting production).

Most people over 75 are kept alive artificially by medical researchers playing God, and greedy pharmaceutical companies.

Over-population is the main cause of our current environmental problems. Too keep alive people who would have died naturally 20 years ago is ridiculous.

Only yesterday, my 87 year old mother-in-law, who suffers severe pain, said that she “couldn’t” take more than the recommended daily dose of pain killers because it was harmful! She would rather suffer pain just to live a little longer. My own mother has no quality of life at 89, and is a burden to herself and everyone else.

People now think that they have to live as long as they can, and should get a medal for it! Old age is “celebrated” by one retirement home advertisement in Adelaide, determined to squeeze as much money out of elderly people it can, and too milk tax-payer subsidies going to people who should have died years ago if nature was allowed to take its course.

Anyone past the old “three score and ten” years is definitely on borrowed time. If they can live longer naturally, good luck to them. But this stupid mania for keeping old people alive, just because science enables it, is well past its due by date.

Let nature take its course.

The claim is that universal health care as delivered by schemes such as Medicare is unsustainable. What does “unsustainable” mean?

Currently about 25% of our taxes goes to health services. If Medicare is unsustainable at this figure, then at 50% it wont be. It all depends on the priority one places on good health.

I have had some work done on my ankle which has enabled me to walk normally again. Most of the cost was covered by Medicare.

Being able to walk normally is of more value to me than a warplane costing a billion dollars to protect me from an enemy the government will not mention by name or yet another tunnel in Sydney to temporarily solve a gridlock problem in a city which has become too big to be efficiently managed.

In the 19th century much of nature was still pristine and there was sense of community due to a lack of easy mobility away from one’s locality. These have been significant loses.

In compensation, today we have the world’s best music in our homes, we have beautifully illustrated books and we have women’s lib. But, it is modern medicine which really makes living in the 21st century better than living in the 19th .

To argue against universal health care is a failure to get our priorities right.

Oh please. Another report from the Centre for Independent studies favouring scaling back government assistance. Surprise surprise.

The solution posed by the author is removing medicare altogether. Quite frankly, this is a total copout.

Where's the discussion about reassessing the responsibilities under medicare? I get that with an ageing population, costs will skyrocket, but it would seem to me that instead of just absolving the government of any responsibility in relation to health, the solution would be to ensure that conditions that are likely to strain the system - such as arthritis and obesity related conditions, are shunted into a different system.
Just because healthcare is changing, is a poor excuse to embrace a user-pays model of health entirely.

If the government can just opt out of services such as health, what are their actual responsibilities?
With education also facing drastic changes with a shift toward the private sector, I can't help but wonder why we're blithely letting the government absolve itself of duties in these core sectors, while still collecting tax - of course, the CIS are essentially advocates for a low-taxing government that carries little responsibility at all...

As you'd expect, a member of the CIS understands a complex problem in purely economic terms. This prediction of war between the generations assumes that young people would be quite happy to see their grandparents living in pain and poverty if it could save them a dollar.

Others in this forum have made imaginitive suggestions for solving the problem such as refraining from getting involved in expensive and pointless wars, and thinning out the expensive and pointless layers of bureaucracy.

How about adding some serious public debate about voluntary euthanasia? Whenever we discuss that topic dozens of boomers chip in to say they don't want to be ancient but have no choice. We could combine the humane and the economically convenient. Leigh's mother aside.

Any neo-conservatives at the CIS care to take up the challenge and introduce that public debate?

medicare was not set up in the 1800s! nor indeed in the first half of the 1900s! as 'medibank' it was set up only 30-35 years ago! the notion that 'back then' health needs and care were in the rudimentary and deplorable situation set out in the article is simply inaccurate. even if it were (which it certainly was not!) this would hardly be an argument for 'ditching' medicare now. as a previous commentator (above) has said, medicare is paid for out of taxes. this is what taxes are for. perhaps it would be better to concentrate upon the tax system, making sure that it is established and maintained so as to properly fund public needs - including health, education, transport, etc. this would be preferable to the current fashion of seeing taxation as an inappropriate burden - particularly on high earners and those who can transport themselves into 'companies' so as to avoid tax.

These are the arguments we saw in the 1930's under the regime that Hitler took over and made his own. Once you have killed off all the oldies, who then will you recommend this group turn its attention to, hmm? There are so many flaws in this argument it is hard to know where to begin. So I won't. I would suggest that if this is the result of all the hard work that the oldies put in to raising people such as yourself, then we were wrong. Go back to the drawing board, dear, and gather ALL the facts before making such absurd hypotheses and projecting them on to an unsuspecting public.

According to the editor of the Bulletin of Medical Ethics, Richard Nicholson (in the 6/10/06 (London) Times Higher Education Supplement), half the money that will ever be spent on an individual's health care will be spent in the last six months of life. It is dying that is particularly expensive, not aging.

The problem is known and identified in this article. Without a solution being stated...there is a reason...

In terms of cost, the three main areas of cost is infrastructure(hospitals, equipment, maintence...most thankfully established...and provided no future parliament acts to sell it to private sector...we should be ok...), then staff(wages...which for work done is lower than due...all suffer and why Victorian nurses striking was repulsive...they already have controlled work enviroment...4patients/nurse...everybody else respond to work demand which varies from twidling you thumbs for hours to knee deep in blood and guts...just the nature of the field...and paid more/hour than most including junior doctors who take on far more liabilities....and want more because other states are paying more...), and finally cost of investigations/medicine...its where the cost escalates with technology and time...eg mri 250-600+dollars...did not exist 20 years ago...

So forseeable that to keep population healthier and living longer is going to carve out bigger chunks of budget...till something cracks...

Solutions are so unpaltable that nobody want to be the first to say them...eg criteria to who should recieve curative treatment and whom supportive treatment only etc...I think as a society we have to come to terms with death and dying, as we have about living...and perhaps not choosing agressive medicine to live a few years more...so the money can be used on babies and children to live a whole life...eg see 'results' as example http://www3.interscience.wiley.com/cgi-bin/abstract/75500891/ABSTRACT?CRETRY=1&SRETRY=0 ...liver metasis in cancer meant rapid death 20 years ago...now "per life year gained with HAI vs. systemic chemotherapy: £24,604'...meaning still death but get more time...

Sam
Ps~medical practice becoming investigation based...moving away from 'skills of history/examination' based diagnosis where well trained doctors can arrive at diagnosis without blind battery of tests but highly selected ones...and decreasing costs...for this to happen the medical schools in Australia are going to need a through overhaul...

The first few lines says it all, although a casual glance at an everyday GP surgery waiting room will indicate that increasing lifestyle related medical costs are rather more 'across the board' than this article seems to suggest - much of the money seems to go on the younger members of society.
Perhaps some of the money thrown at Medicare would be better spent in subsidising fresh fruit and vegetables, and gym subscriptions. It seems to me that the majority of health problems could be prevented or corrected by appropriate lifestyle modifications. How anyone in this day and age is dumb enough to smoke, and to drink to excess, is beyond my comprehension.

Reducing the amount spent on preserving lives that extra 6 or 12 months needn't be "unpalatable", provided it occurs as a result of those who have no wish to have their lives so extended having the option of accepting that their time has come. Something like 80% of Australians support voluntary euthanasia, so presumably most of us would be prepared to make such a choice when it becomes clear that our condition is almost certainly terminal, and that our only respite is drugs and life-support machinery.

The Centre for Independent Studies is a right wing think tank that is hell bent on turning Australia into a meaner nastier society where immigrants get half the pay of Australians and health care is used as a wedge politics of intergenerational conflict.

The Liberals really want a user pays health care system with no discussion on euthanasia. Like many Asutralians I can't see the virture of suffering from terminal disability in fear and pain. I resent catholics imposing their beliefs on the community.

I am sure that eliminating the private health fund rebate and retaining ownership of medibank private will control health costs. If we have overseas ownership of private health funds the federal government will be improving the profitability of those funds with limited audit of their financial operations.

Leigh, I do believe you are becoming more callous in your old age. You were once nothing but a burden to your mother, but you resent it being the other way around??!! I take it that you would also want to with-hold treatment for patients younger than 70 that may or may not survive? And what about premmie babies? Its very expensive to keep them alive and its a hell of a gamble with the very early ones. Do we just let them die?

The fact is that even the coalition govt has recognised that those over 70 can still be useful, contributing members of society, by allowing super contributions up to the age of 75 (provided a work test is passed). This recognises (probably as a result of Howards age actually), that older people can still work and contribute, as well as leading healthly lives. Yes some may be sickly and a drain on health resources.

My family shows the extremes. On one side no-one has lived past 65, and the only remaining member is just 55 and has already been accepted into a nursing home. The other side, no-one has died before 65 (except from TB, and that's going back many years), and live-spans are usually over 90, and in one case 102 (and she lived on her own in Melbourne, so was relatively healthy).

Your adoption of 70 is entirely arbitrary and without merit, particularly given that it is lower than the average life expectancy.

What a nasty bit of work. One would respond to the content, but there isn't any.

Not only do I wish jeremy ill, I wish he gets ill in America, so he can experience firsthand the joys and efficiencies of a free-market health care system.

It must really stick in the maw of the CIS that publically funded healthcare always outperforms the private system.

"The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from primary care physicians about their medical practices and views of their countries' health systems, confirms the patient survey findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.

Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care."

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678

Shame on the editors of the SMH and Online Opinion for even given space to such lunatic proposals.

The article started badly and then found its feet in the second to last paragraph:

"While the baby boomer generation is retiring on tax-free superannuation and negatively-geared property, over-taxed and debt-ridden younger taxpayers are expected to supply ageing "boomers" with health care of a far superior quality and quantity. Add in the generational wealth divide created by the housing boom, and the stage is set for real intergenerational conflict over the future of Medicare."

I think he might have 'buried the lead'.

I'm not going to go into boomer whine mode. The problem isn't health. The Feds would love it if we all went in to Private health care schemes - but that ain't going to happen. The author knows that even with an ageing population we can fund healthcare. That model has been proven. Just one years budget credit (say $14B) would fund Medicare until 2050.

The problem lies in superannuation and especially liquidity for a fair percentage of the boomers. They need to save more. The story is about savings.

It is true that we may not be able to continue Medicare as it currently exists but before we abandon universal cover we must try the following options:
1. Look at preventing illness. The lowest estimate of preventable illness I have seen is 30%
2. Pay GPs to keep patients well rather than treating them when they are sick
3. Properly evaluate new technologies and drugs including a long term cost benefit analysis.
4. Properly evaluate existing technologies and drugs. Many give relatively small health gains at large expense
5. Involve the public in determining the priorities for health care. An informed public, far more than health professionals, will target resources towards services that are underfunded - like mental health an indigenous health.
6. Allow better tradeoffs between various parts of the funding system, e.g. paying for counselling and exercise programs rather than say antidepressant drugs
7. Eliminate the bureaucracies in both state and commonwealth health departments that spend valuable resources watching over each other
8. Design hospital organisational structures to meet the needs of the patients, not the needs of the health professionals

Creating a more effective and efficient health system should be our first priority - there may well be enough money already to avoid making the decision to cut Medicare

"As you'd expect, a member of the CIS understands a complex problem in purely economic terms."

The article fails in economic reasoning also, chainsmoker. It gives no consideration to the idea that medical treatment may increase a person's economic productivity. It also assumes that the benefit per unit cost of medical care will decline. You might note that the development of a treatment for tuberculosis resulted in huge cost savings, making economically productive citizens out of invalids in the process.

It is like reading an article calling for the abolition of public schools on the basis that they will become more expensive. Education has the potential to improve a person's productivity. So does medical treatment. It has been found that people tend to overestimate the cost and underestimate the benefit of a good education.

http://www.abc.net.au/rn/rearvision/stories/2007/2077387.htm#transcript

Jeremy Sammut seems to be making similar assumptions for the provision of public health care. More an economic cretin than an economic rationalist I think.

The main failings of the health system stem from it trying to be all things to all people. Trying to do more and more on the same budget simply means doing all of it badly.

The health care system should focus on basics first. The zero sum game should be to do what really makes a difference and do it well. The funding of 25% of taxes for health care should be capped to prevent resentment building, and the budget based on the procedures that yeild the best results.

I heard a doctor describing a new treatement for terminally ill patients that could extend life for about $50 000 per patient year. In his opinion this was good value for medicare. If you are that patient maybe, but for the many patients who have to forgo basic medical procedures or end up miscarrying in a toilet, this is probably not the case.

I firmly believe in universal health care, but with many new expensive procedures now coming available, the health system needs to make some tough choices.

If we can't afford health; What is the point?

Is it better to spend
60 million on an empty "Detention Centre" on Christmas Island?
10 billion on Spanish Ships?
60 million Gift to Chevron Mobile?
50 billion for Pollies pension fund(run by an o/s company - public servants already have one super fund how many more do they need?)

How much does it cost us to treat mental illness in jails?

How much does it cost us for such poor Dental health?

Tired of politicians never listening to a word you have to say?

The Australian Government is thinking about setting up a 'blog' to let the public have their say on public policy.

Have your say on what shape it should take here

www.openforum.com.au/Survey

Yes, it's for real.

Well Michael in Adelaide,why don't you go and live in Cuba?

Maybe the author is right.

Maybe we should just scrap the whole thing and let everybody fend for themselves - a form of natural selection where the weakest and poorest would eventually become extinct, leaving the rich and healthy to inherit the world.

The problem with that may be that the poor are needed to actually create the wealth for the already-wealthy.

A two-tier health system may be a solution - but then again, we already have one of those!

Maybe access to basic medical assistance is just a basic tenet of civilisation?

This is just too hard. I'm so glad we have some economic rationalists to make all these decisions for us.

Market Forces, unrestrained, contrary, if not highly unreasonable set political, will end up costing citizens their value resource benefits, given the price government has to pay for basic services in Medicare.

ALERT: I believe the 2013 Election is going to be dark-hued and somber if we don't balance the need to build community infrastructure, through a platform of sustainble "common-sense", which is technically basic to health economic's.

Our services are running like a household on fastfood. Borrowed time (inflated) and CRISIS. The Howard Government thinks it can just buy what it has not planned for. Then it say's (rural people) who are feeling the pinch and,... who have little access to services, "you should just move to the city"!.

Sure we have arguement for beds, diverse staffing needs, maturnity services, age-care and other needs such as primary health. But what about the WASTAGES of FUNDS embedded in the administration of this super-scientific medical framework?

EXAMPLE OF A BASIC CASE STUDY:

ie: A subsidised VITAMIN B pak made up of 4 doses costs $3.50 (for the whole pak?).

To administer one dose (per injection) it costs around $54.00 per visit, as this is what a private practice can charge, through bulk billing, to administer one of the satchels, from the pak.

IS THIS NOT A INFLATED COST and RIP-OFF?

Is this not highly UNCONSCIONABLE.

The total cost of the (3.50 subsidised Vitamin B pak), which takes less than 2 minutes to inject per time, for a consumer, costs the tax payer $216.00 total plus the susidy, once the charges by a practitioner in a private practice is properly added.

For decades we had been told to "TIGHTEN OUR BELTS". No money for services and the rest.

I believe the books are fudged with spurious statisitcs and costs that protect a pseudo based set of economic policies.

A nation hiding the "risk factors" and stacking it with the "invisibles" is a decieved nation.

Fairness through the task of good economics has been under-mined in many industries, and is dividing the productivity of our future.

http://www.miacat.com
.

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

"Care and profit compete directly for the health care dollar and those who can bring themselves to compromise on care will be most profitable. This problem has been recognised for 2000 years. The system is very vulnerable for sociopaths to exploit."

The above link is to a website which contains an enormous amount of information.

In the US their market driven health sector out performed the financial sector in earning profitablity for the share holders in the 1990's.

Very bluntly it is a myth that the private sector can perform better on delivering health care!

Sure no health delivery model is perfect, however under the American market driven model, something like 70% of the costs/profits are generated from around 30% of the population.

In the near future demand for health care will increase and for those who are interested in good share holder returns investing in the private health industry will do just that. the health care may not be very good, but the profits will make more than a few people turn a blind eye.

Once you let econometrics determine social policy you fall into the deep well the current Govt has taken this country. Labor is prone to this as well. Social Darwinism reigns supreme. It will be interesting to see what the 'X' and 'Y' generations think about subsidised health care when their own bodies start to fail. I suggest the neocons amongst you will look back at the architects of social medicine more kindly then. Econometric projections always inform decisions that favour the well off in our society. That is why social equity considerations and more reasoned analyses of economic productivity are required. Some of the postees here get it. If you view society as nothing more than an amalgam of relative productive units then you just won't get it.

So why doesn't the writer advocate the abolition of the private health insurance subsidy?

Surely a subsidy like this is unconscionable for any new right warrior and would be a good first step towards a rational health system.

Good work JamesH. I checked out the link you gave us;

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

And I agree it has a wealth of information. I also agree that Australians ought to beware, "In the US their market driven health sector out performed the financial sector in earning profitablity for the share holders in the 1990's. " and "..it is a myth that the private sector can perform better on delivering health care" under the present rules of the economic framework.

To suggest a reply to Shal's question, "Surely a subsidy like this is unconscionable for any new right warrior and would be a good first step towards a rational health system".

Yes the subsity system is required and so is the private/public partnership to help governemnt resolve the core problems. However, the problem in health (as John H points out) is similar to the problems we have in the economic's of unrestrained, contrary, uneven based free-trade, when a private sector is rewarded for doing the unconscionable, rather than lawfully restrained for its unethical aspects.

In the bigger picture it is a competition juxtaposition. The problems of billing for consumer benefits in car repair insurance's (over pricing) the horror mechanisms utilized by banks, housing developers, housing investors, company shareholder's and the like. Our economy needs to find policies that help everyone WIN.

In theory it is one reason why we try to choose economically the government who can help balance free-trade ethic with the needs of the "whole society", by promoting fairness constructively through economic policy.

We are our worse own enermies when we fail to be applied and work to address the core issues through a "responsible" or mindful political vote.

Our chances under the present economic system of resolving the sustainable issues in the present economic-political climate, will become increasing Ad Hoc, unless we use our speech, and right to vote, to make the true stand.

http://www.miacat.com
.

"We" cannot afford health insurance? This article should be read alongside
http://www.nytimes.com/2007/11/03/opinion/03herbert.html

Helen

Yes Helen the US health system is cruel and inhumane.
We don't want to go there.
"Lonnie died on March 26 at age 45. The cause of death was cancer, aided and abetted by an absurd, unnecessary and utterly unconscionable absence of health insurance."

One of the things we could do to reduce costs is to attack the Doctor's unionised "closed shop" with regard to medical education and especially specialist training.

For a start a billion or two could be set aside in a Future Fund to fund bursaries and food and rent to deserving students who want to do medicine.A center of excellence for medicine say at Utas where rents are manageable and employment is needed might be a start. Perhaps we could swap a Tamar Valley pulp mill for it?

Who made the absurd assumption that getting a 99.99% mark in the HSC makes you a good outback GP?
Or having 2-3 degrees before you do medicine makes you a better doctor? I imagine such people would be bored witless as a GP.

Doctors and their powerful political organisations control the supply of GPs and especially specialists.
This is very basic economics. Reduce supply and the price goes up.
The system is designed for doctors to make more money not for the country's health.

As a pensioner paying 25% of my income for private health insurance is a real struggle, but I am too frightened of the run-down public system to drop my private insurance. Soon, one day, I will be forced to.

I wish that people like Jeremy and his admirers could explain to me how a non profit organisation, like public health care, is less able to provide health care than organisations, private hospitals and insurance companies, who exist solely to make profits for share holders.

The mantra of increasingly expensive health care is a loosely bandied about expression. The majority of surgery and other treatments have vastly improved in efficiency. Three decades ago something like a cholecystectomy meant weeks in hospital. Now one day max.

For almost all eye surgery there is no hospital stay anymore.

I could go on. The high end expensive whiz bang health care is few and far between and still almost exclusively provided by public health. Like organ transplantation.

Australians pay high personal tax, including medicare, we have GST, we pay stamp duty, we pay tax whenever we tank up the car. It is ludicrous to suggest that we cannot afford universal health care.

I'm all for capitalism and the free market, but is everything in a society simply a commodity to be bought and sold and only available to some?

Why should a wealthy old man be able to afford some kind of treatment that would be denied to a healthy young man because of cost? He may have to go to war to 'protect the old guy's way of life'.

Leigh, private health does not mean it only goes to the seemingly deserving. Old wealthy women can get their boobs done and face lift, but you will not be able to afford to have your compound fractured leg fixed properly.

Personally I think we should largely privatise our armed forces. The US is already showing the way.

A fair society still needs universal health care, but not everything needs to be funded by taxes.
We need universal health care that helps to prevent people becoming chronically ill and disabled - burdens on themselves and on us.
That prevents people being driven into poverty and losing their homes because of medical expenses.
The US model of health care is appalling. A Time-Life article once found that 90% of people who BECAME poor, were driven into poverty by medical costs.

Costs of medicare can be reduced by removing some inessential procedures from the list: eg
1 At present medicare funds quite a lot of inessential and expensive medical procedures and medications, some of which is defensive medicine driven by fear of law-suits.

2 Most old people dread being kept alive like Struldbrugs if they become mental vegetables by costly 'heroic mesaures' for years and years instead of being allowed to die naturally but with minimum pain.

3 We could well put more onus on people paying more towards treatment of illnesses they have brought upon themselves, ignoring doctors' advice - as with many consequences of alcoholism, avoidable diabetes,noise-related deafness etc.

4. Psychological problems of people unable to live with how they are already - eg sex changes, much cosmetic surgery, and even some IVF - which could be reduced by better informed people, and for the latter, more ways to share in care for children needing love.

Preventive medicine can also reduce greater medical costs later, eg dental care, since poor dental health brings on other health problems.

(I am 78, and needed far more medical treatment during my adult life 22-50 than I have in recent years. I would like to see breakdowns of how Medicare is spent and on whom. Some claim that the average period of illl-health before death is two years, regardless of age.)

That means that we'll need to purchase them which is a cost the government will need to bear.

Isn't this the case now?
Me thinks a system of research and manufacture of treatments, drugs etc need be invented, unless of course we can persuade drug companies voluntarily to give up their right to patent drugs for as long as is now.
NO need to rush out to sell your shares, it ain't about happen.

Being a famous scientist is rarely a satisfactory reward today unless thru that you become a millionaire. There lay the problem, perhaps our honours system too requires rejuvenation.
As Indians and and others have proven medicine can be relatively cheap
It's the years of research that costs.
Some therapies have always been for the rich and powerful, and nothing I know will change that.
Could we have more info from the author how he extrapolates our predicament?
For instance where does the logic lie for it to be a crime to take your life whenever one chooses, done legally, generally means it wouldn't be so messy for others to clean up?

fluff4

"Australians pay high personal tax, including medicare, we have GST, we pay stamp duty, we pay tax whenever we tank up the car. It is ludicrous to suggest that we cannot afford universal health care."
AGREED++

This issue was brought home to me recently when my wife had an impacted wisdom tooth.
She could not get an appointment to see our (expensive but better than most) dentist.
She rang the dental Hospital and was told she could have an "emergency" appointment in 12 months. (!) (How much Pethidine would that take!)
Mostly the Dental wait is three years.
A dentist friend often does Rotary help in Tibet, but what about Australia?
What does it cost our economy to have such poor dental care?

I recently had an operation for bowel cancer.
While I am insured to the hilt, and a pensioner, I had to find $5,000 for my (excellent) surgeon. The comment from a medical friend was "Yes these young ones know how to charge don't they? ha. . . ha"

It is crunch time for our health care service, simply because the demand is going to increase over the next 15-20 years.

If our political masters get it wrong and do not put into place NOW an effective stragdy to be able to meet the increase in demand, many more people regardless of age with experience adverse effects as a direct result of political incompetence.

The idea of the 24 hour clinics is good, except for one point.

Where are they going to find the staff?

Michael2, a great job was done on you frightening you re private health insurance.

Don't you think it strange that you are insured, that taxpayers are subsidising private Health and that you are still out of pocket by that much? You would scream blue murder if that happened with your house insurance, personal insurance, car insurance, life insurance, but it is somehow accepted with health insurance.

Recently my daughter had her tonsils removed. I paid up front to a surgeon, the surgery was performed in a public hospital and his secretary says: 'Hey, you are less out of pocket than if you went to a private day hospital with private health insurance!'

Private Health insurance is a great feeling, until you need to make use of it. Then you realise you would have done much, much better if you had kept that money in your own pocket over the years.

I have worked in both public and private Health (over almost 30 years), and had experience in both systems from a patient's perspective.

What I can tell you is that the care in the public system is excellent, you will not be charged any excess, and not only that, but because of intense public scrutiny and reporting systems, it is far less likely that an untoward event is hidden. The public only thinks that private health provides better care, that is because 'stuff' is kept in house. Not good for business you see.

I maintain, the whole private health insurance with the astronomical gap is a rort. As for care, the doctors and nurses are trained and educated in the same institutions. The difference is that a private hospital is loathe to employ much of its own nursing staff. It is cheaper to rely on agency staff. How well are their skills maintained? Do they have the requisite skill to work in all areas?

Think about it.

Personally, if I became seriously ill, needing Intensive Care I would want to be in a big public hospital.

There have been some excellent suggestions on this forum on how to reduce costs to the public health care system, while not depriving people who can be helped. A more rational attitude to death and dying is probably the most important.

Other things that haven't been mentioned would include breaking the current cosy arrangements. Somehow union busting never includes the doctors. There are probably numerous procedures that could be done by paramedics or by GPs on salary who have been trained as "mini-specialists" to do common procedures. In the US nurse practitioners do colonoscopies, and their success rates are just as good as those of specialist doctors.

The Pharmaceutical Benefits Scheme could stop paying for brand name drugs when a generic in that class becomes available, unless the doctor can come up with a good reason why it is not appropriate or the patient is willing to pay the difference.

The big pharmaceutical companies do lots of research to come up with "me too" drugs to get around each others' patents. Why not have a government research institute and nationalised pharmaceutical company to do the same thing on our behalf?

Give one level of government responsibility for both hospitals and nursing homes, so that cost shifting doesn't end up blocking beds in hospitals.

Divergence,

Wow someone with a solution! I heartilly agree and wish and hope our feds will see the light too.
I don't think it will happen though, the states have already lost so much influence as to become less and less relevant and their all disfunctional except when it comes to hanging in there for power and other treats.
fluff4

Recently I had a conversation with a person who had the misfortune of having to go to an american hospital emergency department, it cost him $3,000.

He also told me of a mate who had ruptured his appendix whilst in the states, his hospitalisation included a few days in intensive care. this cost $1,000,000.

Medicare is a luxury we cannot afford to loose.

Today was confirmed as labors' opportunity to make a difference. The leadership and future cabinet will be best ever opportunity to make a difference in health care.
I trust insider opposition will remain as it has been seen but not heard much of. In view of this the sadsayers may join us in the hope for the continuation of a successful community service I hope for everyone, not least the aborigines.
Good luck Kev!
fluff

I certainly hope Labor doesn't stuff this one.

In 1992 the number of university places for medical students was drastically reduced and also running concurrently has been the decrease in public hospital bed numbers.

I understand that whilst today the number of medical student places has increased, the majority of these places are going to full fee paying students who come from overseas.

So our doctor shortage is going to get worse.