Issue 36 / 26 September 2011

AUSTRALIAN health reform is a cacophony of conflicting and confusing arias.

In March 2010, then Prime Minister Kevin Rudd delivered his long-awaited address to the National Press Club titled: “Better health, better hospitals: The national health and hospital network”.

Conscious of the historic importance of the occasion, he intoned: “Today we are delivering on the most significant reform of Australia’s health and hospital system since the introduction of Medicare almost three decades ago”.

He went on to say the government would deliver better health and better hospitals by establishing a national network “funded nationally, and run locally”. It was, he said, the first time in history that the federal government would take on the dominant funding role for the public hospital system.

Local Hospital Networks would run the hospital system to be funded from GST revenues, Rudd said.

But some four months later, on 23 June 2010, Rudd was deposed as the Prime Minister by Labor Party heavies and his vision for health is in danger of suffering the same fate. Indeed, the national health and hospitals network continues to be one of the many arias in Australia’s continuing comic opera of health reform.

In February this year, a soprano was centrestage — Prime Minister Julia Gillard, singing from yet another libretto, proclaiming her government would boost hospital funding and fast track the Local Hospital Networks.

Our national health reform opera is crammed with many arias by different composers and different singers, usually without the controlling vision of a conductor. In short, not only is the score continually changing but different performers vie for dominance in a dizzy kaleidoscope of roles.

If we were to compile a magnum opus of the different discarded arias for health reform composed in the past 10 decades, we would shake our heads in dismay at the law of unintended consequences. Despite all the passion, commitment and dedication, a comic libretto of national proportions has unfolded.

Significantly, no health reform composer or aficionado has yet been prepared to bear the cost and responsibility of bringing the opera to completion. And, ominously, this tension is soon picked up by the divas, who sing their frustrations in a chorus known as the “blame game”.

Opera participants, drawn from various health bureaucracies and medical professional bodies, compete to amend the score without due reference to other players or to the cast as a whole.

Meanwhile, the ever-patient public is driven to despair by the cacophony emanating from these health reform librettos. They pine for the finesse and brilliance of a composer like Handel, Mozart or Rossini.

Health reform in Australia needs a visionary composer and inspired conductor to bring together the many players, and produce the harmonious performance that the Australian public deserves. It is not an enviable role.

Rudd stepped up to the podium but was unceremoniously thrown off the stage before the end of the first act. In the absence of such leadership the final production of this health opera still has a very long way to go.

Dr Martin Van Der Weyden is emeritus editor of the MJA.

Posted 26 September 2011

5 thoughts on “Martin Van Der Weyden: Comic opera of health reform

  1. Dr Amanda says:

    Agree with all above who are saddened by our falling into NHS medicine. I have had the privilege to be around medical students doing electives in the UK and they compare our 2 systems minutes before they graduate and say that the aged, unworkable hospitals, and the standards in general should not be the way Australian medicine goes.

  2. Dr Shirley Prager says:

    I fear the latest act – Medicare Locals – will end in tragedy rather than comedy. Australians will lose our excellent healthcare system and gain UK style managed care. Eventually it will be replaced by US style managed care when Medicare Local companies are sold to global corporates.
    I suggest Australians boo Medicare Locals off the stage.

  3. Dr Merle Wigeson says:

    Fabulous image, but possibly the “Rocky Horror Show” would be a more appropriate analogy with “a step to the left, and then a jump to the right………”
    The real problem is that the health bureaucracy is like a weed that has overgrown the plant it is based on – administration sucks up a disproportionate share of time and funding, leaching the life out of both the health community and the patients.
    We do not need grandiose new health schemes of any type – we need one word – SIMPLIFY.
    We need to connect the patient with the appropriate healthcare as quickly and simply as possible. We need to abandon mantra such as “evidence-based medicine” which have spawned a plethora of unnecessary investigations. (By all means confirm your diagnosis, but if you do not have some idea of what is wrong with your patient by the end of taking a good history, and (horrors) examining them properly, a battery of tests will produce the answer only by accident.)
    Of course, we have also gone down the line of treating the lawyer we assume our patients will hire in the future, rather than our patients in the present, and spending more time on caring for our paperwork rather than caring for our patients.
    Of course, the chances of any bureaucracy agreeing to dismantle itself for the greater good is less than zero, so we should all reserve tickets for the next season of the National Health Reform Grand Comedic Opera – a tragedy in way too many Acts.

  4. ex doctor says:

    I think it was Sid Sax who said that it was hard to hear the arguments in healthcare funding for the deafening sound of axes grinding. I am also reminded of an observation of Professor Douglas Gordon that Muddles don’t change, only muddlers.

  5. Elliot says:

    What a wonderfully appropriate analogy.

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