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AUSTRALIA’S most popular politician, NSW Premier Mike Baird has been grappling with the dilemma of how to pay for health care.
He penned an opinion article in The Australian suggesting that raising the GST to 15% would pay for health care, saying “all funds raised would be directed to healthcare, compensation or tax cuts. This ensures our health services will be fully funded”.
Politicians often remind me of television advertisements that encourage us to buy things we can’t afford. The smooth-talking male voiceover tells us that by making this purchase we will “achieve the lifestyle that [we] deserve”, creating an expectation, a need and a perceived right to have what we want.
Yet Premier Baird is doing what most of us do most of the time — considering only one side of the equation. He talks about how to meet the cost of health care based on current beliefs about what we think we should receive.
Before we start raising taxes or going into greater debt, we need to consider what kind of health care we should expect, as well as what we think we deserve.
“Expect” poses challenges. Does my presumption of resources outweigh other peoples’ desire to meet their own expectations? Can I expect the community to prioritise and pay for my goals at the cost of its future wellbeing?
Clearly, our expectations are generated by a variety of influences and are not set in stone. Most of us sustain the hope that we and our family remain well.
In the past two centuries, our increasing successes in medicine have lured us towards the belief that our ailments can be cured, or at least controlled.
The health care industry (including doctors like me) encourages us to expect access to high levels of expensive services. These can generate enormous profits and employ many people, some with very high incomes.
Many of us only become more realistic about our expectations when we are touched by the lengthening shadow of our own death.
Dictionary definitions of “deserve” suggest an entitlement that has been earned (and perhaps paid for) by some action on the part of the recipient, but does not imply a right. I am not sure what currently entitles us to deserve unlimited health care — the fact of being an Australian does not seem sufficient. Am I entitled to the allocation of resources that might bring me a benefit, but to the detriment of my fellow citizens, both current and future?
I think that the word “deserve” should be put to one side in any serious discussions about the allocation of resources to health care.
We seldom weigh the benefits of our health care services against the opportunities for the future of our community.
Certainly, it seems there is an urgent need to openly consider what Australians might expect of their health services. Decisions should be shaped by a careful consideration of the benefits and burdens of delivering those services — both to the individuals receiving care and to the community funding the care.
We spend an awful lot of money (and generate a lot of debt) delivering health technology that brings little gain to individual patients. That money could have achieved much more short- and long-term community (and even health) benefit had it been spent outside the health system.
There are risks for our community if, like some gullible and starry-eyed TV ad viewer, we continue to shy away from considered decision making. However, it will take courage and leadership to confine our expectations to what we can afford.
We may well realise too late that we have conned ourselves into buying something that we cannot afford and, because we failed to plan wisely, we have indeed got what we deserved.
Associate Professor Will Cairns is Director of Palliative Care in Townsville and author of the eBook Death Rules — how death shapes life on earth, and what it means for us.
If the government is serious about healthcare it needs to strengthen prevention and that is not possible while bowing to the massive pressure of supermarkets, global dirt-food & soft-drink producers, pharmaceutical companies and profiteers from addictions like pokies and alcohol.
The difference new drugs make is negligible compared to the difference exercise, lifestyle and healthy diet can achieve but the cost (and profit) involved is massive, compared to the long-term and cheap option of prevention.
But with such profits at stake few politicians dare to tackle the big earners including private insurance companies and private health providers who sadly are also allowed to make a much bigger profit from costly treatments rather than from proven prevention.
As long as we reward treatment more than prevention we are actively taking away much needed future possibilities from the next generations.
Absolutely spot on!
We need to be provocative to attempt to have this in the public domain.
The natural human response is to believe one’s predicament is the most pressing and we have all seen situations where the patient (or relative) wants “no stone left unturned”. We also have a problem with:
1) the worried well
2) popular causes such as the pink ribbon effectively hijacking cancer funding compared with the less sexy but equally serious illnesses such as pancreratic, bowel and haematological malignancies
3) individuals with an emotional campaign via social media to override what have been previously well considered allocation of resouces in order to have their (usually hopeless) condition prioritised
4) doctors are not educated (generally) about the cost of investigations and treatments and the “blunderbuss” ordering of pathology and radiology often leads to an expensive invesigation of an “icidentaloma”
There needs to be more discussion about the realistic outcomes of a disease process including discussion about death.
Rights, needs, expectations, false hope, fanciful promises, desires, wants . . . . . . . . . .
Rights: all Australians have access to affordable health care (health professionals, public hospitals) through Medicare.
We need, and expect, to have this fundamental right.
Then there are the “blind faith” expectations, that a name will be given to our ailment and we will be given all relevant information about the condition; that treatment will be discussed and prescribed; and a timeline for our recovery will be indicated. That is, affirmative action – knowledge, prescribed drugs, blood tests, X-rays or whatever add to the sense of satisfaction regarding care. So, happiness is walking out of the doctor’s rooms with a diagnosis (medical certificate), a prescription and a referral.
Other than that, we want adequate numbers of health professionals (including nurses), and adequate, accessible , affordable hospital beds.
So, the public have the right, and have the expectation, that they will have access to medical care, and furthermore, they believe that they deserve adequate and accessible medical care because they have “worked hard and paid their taxes (and Medicare Levy) “. Thus, rights, expectations and deserts.
OK – GPs good old-fashioned doctoring is called for because The health care industry (including doctors like me) encourages us to expect access to high levels of expensive services.
The public are innocent.
Countries like Singapore and the Netherlands spent many years looking at health funding and have come to the same conclusion: taxes will never be enough for what doctors and informed lay people think is reasonable. The best solution is competing and tightly regulated private insurance, whereby the funds are forced to build up their investments over time – just the way our Future Fund has, and some of our State workers compensation and road accident funds have done (before the State politicians raided them). This isn’t easy and takes a long time and financial discipline, but it is the only way really high quality health care will be delivered over the long term. Relying on taxes means permanent rationing and long public waiting times forever.
Glenn Rosendahl poses a question for which the answer is relatively simple and straightforward. Set one’s priorities based on the principle of “what is that you must have, what is useful to have, and what is nice to have”. As far as politicians are concerned, they are all things to all men,women and children. “Promising the moon” is a pre-election ploy employed in all democracies the world over, anyway!
Will Cairns is addressing a small select group of intelligent people. Medical practitioners. The problem he has described is essentially the perceptions of a largely uninformed, only moderately educated and intelligent electors in a ‘democracy’. These citizens have a very clear and emphatic perception of their ‘entitlements’, and any politician who does not at present acknowledge those ‘rights’ will promptly end up on the electoral trashheap as a reject. This is a problem right across the Western world.
How do we balance the perception of ‘rights’ against the perception of ‘responsibilities’ in the public mind? ‘We’ are not the ‘public mind’. The problem is community perception. How do we change that? The real question is – how do politicians change that – without doing themselves out of their job?
Has anyone got any bright ideas?