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.