"Australia desperately needs a debate about health funding. We need to decide what sort of health care we want for all our population" (Dr Stephanie Auchincloss, Australian Doctor 22/1/99).

Of course we need such a debate, but we must ask the right questions.

We need to ask why 70% of the population has to wait for many months for surgery whilst those with money are treated within weeks.

We need to know why most patients first question to me after we both agree that surgery is necessary to relieve their pain and suffering is "How long will I have to wait?", and why the answer is often 9 months or more.

We need to know why it takes six weeks for me to get a patient into physiotherapy in the public sector and 24 hours in the private sector.

We need to ask why we not only continue to have a two tiered health system but we support the tier for the well off with taxpayers’ funds.

We need to know why governments have colluded to allow or foster a decline in the public hospital system.

We need to know how efficient and equitable the private and public health services are so that we can explain why the government is supporting the private health system at the expense of the public system.

We need to address the economic inefficiency of the continuing battle between State and Federal Governments as they attempt to avoid responsibility for health care.

The answers to the questions of access all relate to adequate funding. The answers to the questions about support for the private rather than the public sector relate to misconceptions about, and misinterpretations of, the facts about our health system as well as an ideological position regarding so called economic rationalism and private enterprise.

So what are the facts?

We already have a very good heath insurance scheme. It’s called the Federal Government. It takes our premiums (taxes), and spends them on our health. Collecting the premiums is fairer than with the private system. Everyone pays but the amount depends upon income and spending capacity (direct and indirect taxes). Private health insurance premiums are the same whether one has an income of $20,000 or $500,000. It’s more efficient. Medicare running costs are about 3%. Private health insurance running costs are about 13% of their budget Services under either scheme are not free, but may be free at the point of service

There is a private insurance industry which must be supported, or must it?

It isn’t as efficient at its job (insurance) as Medicare. It isn’t as equitable in its collection of premiums as Medicare.

There is a private health system which must be supported, or must it? The most privatised health system in the OECD group of countries, in the USA, is one of the most unfair and unhealthy health systems amongst developed countries but spends almost twice as much of its GDP doing it. Do we want to follow their example?

Means testing more parts of the health system like public hospitals just makes it a safety net for the `have nots’. Do we really want to increase the divisions between the `haves’ and the `have nots’? Even if the answer to that is yes we need to be aware of the consequences of such a policy for the quality of the public system which even Kerry Packer used in an emergency.

Federal-State battles over responsibility for funding continue to waste taxpayers’ money. For example, cost shifting from State to Federal Government by privatising outpatient services saves State governments money but costs taxpayers more because the fee for service payment is considerably more than the sessional payments to doctors. Can we really believe that there is a government desire to make the system more efficient, or are we looking at economic IRrationalism at its best?

We do need to address the ever increasing cost of first class medical care in an aging population. We must not address this problem by supporting an explosion in the private health system whilst reducing the quality of the public system. Controlling the ever increasing costs of health care by allowing more private enterprise has not worked in the United States where 14% of GDP is spent on health care to produce a much inferior health system. We spend 8.4% of GDP to fund our system.

We have a high quality health system now. We can improve it. Let's debate the real concerns with the correct facts.

Tim Woodruff
President
Doctors Reform Society, Victoria

Edited version published in Australian Doctor 12 Feb 1999