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March 15th 2010 print

Peter Smith

Unhealthy health care

Cutting waiting times doesn’t necessarily improve treatment. I recently fell off the top of my washing machine (never mind why I was up there) and sought help from a local hospital.

The bottomless pit of health care

Government ministers for health and finance were reported as squabbling over soaring hospital waiting lists. Who, Roxon and Tanner? No, it was McGimpsey and Wilson. Who the heck are McGimpsey and Wilson, you may ask. Well, they are two ministers in Northern Ireland but it doesn’t matter because it could be anywhere.

A popular local musician went to a hospital complaining of chest pains. He was kept untreated for 80 minutes in the waiting room before he collapsed and died. Where, Sydney? No, Philadelphia. It doesn’t matter because it could be anywhere – perhaps not entirely, because he was then robbed of his wristwatch.

In the UK, one of the Labour Government’s health targets was to reduce waiting time for hospital treatment to 18 weeks. I don’t know whether this target has been achieved. I recall Bob Carr in 1995 pledging to cut NSW hospital waiting lists in half. That certainly was not achieved. But again, it doesn’t matter where you are, or how long the hospital queues, there will be a politician promising to cut them.

In the US, government spends more per capita on health than anywhere else. In the last ten years public expenditure on health has doubled against a rise in GDP of less than 50 per cent. Taking public and private expenditure together, the US spends 16 per cent of its GDP on health. But they are still not happy. President Obama wants taxpayers to subsidise the extension of private health insurance to another 30 million Americans.

Expenditure on health is a deep pit which gets deeper all the time as technology produces ever more expensive procedures, equipment and drugs to keep us up and about and alive longer. Australia’s expenditure on health – public and private- amounts to 10 per cent of GDP. As you can see we have a way to go to catch up to the US; as does everybody else. If your income is, say, $80,000 gross how would you like to spend another $5000 a year on your health to catch the Americans?

And so to Rudd’s latest plan: more federal funding and control, and local hospital networks to produce a better use of local resources by, for example, directing patients to whatever is the local hospital which can treat them more quickly. This might reduce waiting times below whatever they would be otherwise. I have no idea, but I do know that whatever the outcome it will not be enough. People will still complain that they have had to wait too long and there will be attendant political mileage to be gained. When the Rudd plan came out some people were interviewed on the local TV news. One person with a minor injury, complained about being kept waiting for six hours in a public hospital. It is no fun being in a waiting room for six hours but remember that the treatment is free. For a lot of people, who pay no net tax at all, free treatment means other people pay for all of it. In these circumstances, is it reasonable to complain? Most of us have waited for six hours and more at airport terminals when we are paying passengers.

As well, all this concentration on waiting times pays no heed to the quality of the treatment. Cutting waiting times doesn’t necessarily improve treatment. I recently fell off the top of my washing machine (never mind why I was up there) and sought help from a local hospital. I was seen relatively quickly but not I think with the same thoroughness as was my wife at a different hospital, some three or four years ago, when she slipped and fell backwards onto a step. We tend to be competitive about whose injury was worse but both agree her treatment was better – not quicker mind you, but better. How do we measure better? Would you rather wait six hours and see a seasoned professional or three hours and see an intern; would you rather wait to have a battery of relevant tests or have a quick cursory examination? If you want everything; speed, seasoned professionals and the tests, are you willing to pay for them?

Health care is a good not an entitlement like, say, free speech. Someone has to pay for it. The unpalatable truth is that we can’t afford to give everyone timely, top quality, health care. We would need many more seasoned and skilled doctors, many more nurses, many more hospitals and hospital beds, much more top of the line equipment and many more spare organs for transplanting, and the wherewithal to pay for them. It can’t be done. Just like I want but can’t afford a week’s holiday in the Royal Suite at the Burj Al Arab. At the end of the day there is no difference. Why do people think as a community they can have things they can’t afford as individuals? It is a product of the entitlement culture, which has been growing since the end of the Second World War. Health is just one example. We should be despondent about it, it has put most western governments in hock, and no end is in sight because most politicians live off pandering to it.

Peter Smith, a frequent Quadrant Online contributor, is the author of Bad Economics