Peter Smith

Yummy, free health

Free public healthcare: voracious and insatiable

Please, put up your hand if you understand the import of the COAG’s Health and Hospitals Network Agreement (“the Agreement”) for the provision of front-line health services? I don’t, I admit it. It is all smoke and mirrors to me.

I have read newspaper accounts, with diagrams, however tedious they were, without gaining enlightenment. I eventually downloaded the Agreement, to see if reading the firsthand account did the trick. This was a desperate measure to take, akin to reading the instruction manual accompanying a new mobile phone or other electronic gadget. Unfortunately it didn’t work either. So I am still left in the dark about something claiming that it ‘will ensure future generations of Australians [what about us you might ask] enjoy world class universally accessible health care’. How actually will it work, dare I say it, to ‘revolutionise’ the delivery of health care?

I think I know some things about the plan. I know there is going to be a new funding arrangement. I know a funding pool is to be created to pay for public hospitals. I know that the Commonwealth Government will contribute 60% into the pool; in part using around 33% of GST revenue. I know that the States will retain control of public hospitals and that some Local Hospital Networks, each with its own board, will be established to group manage major hospitals in close proximity. I know that the Commonwealth Government intends to pay for all of primary health care and to establish Primary Health Care Organisations throughout Australia to coordinate such health care at a local level. I know that three new authorities will be established: a National Funding Authority, a Hospital Pricing Authority and a National Performance Authority; and that the remit of the Australian Commission on Safety and Quality in Health Care will be expanded.

This tells me that there will be new boards, new authorities and organisations, and additional layers of administration. None of it tells me necessarily that more front-line health services will be delivered per dollar spent. By the way, the Agreement also says that there should be ‘no net increase in bureaucracy’ but I put this down to a flight of fancy.

Let me cut to the chase. This new way of divvying up funding and administering health services may make things better. But it might, just as well, make things worse; it has happened. Suppose you employed 72 management consultants to work independently on the problem of healthcare delivery. My bet is that you would get 72 different plans. It would not be like the legendary Septuagint translation all over again. So whether this plan is any good; is any better than the Roofing Insulation plan or the BER plan or the Green Loan’s plan is moot. Let us suspend judgement, but in the sure and certain knowledge that however good it is, it will never be good enough.

Free public healthcare is a voracious and insatiable beast. Kevin Rudd recognises this, which is why he offered state premiers billions of additional dollars of taxpayers’ money to get them to sign up to the Agreement. We have been told by Rudd and Roxon that this money will fund more GPs, more elective surgery procedures and more hospital beds, and cut down the waiting time in emergency departments to a maximum of four hours.

AMA President Dr Andrew Pesce predictably qualified his welcoming of the extra beds by saying that “that the number is well short of what we feel is necessary”. Of course it is, and ever will it be.

The problem is that public health services are free at the point of delivery. Now put this together with increasingly sophisticated and expensive medicine; with an aging society; and with an increasingly dependent society demanding the best of care while clogging the system with assorted neuroses, and minor ailments and injuries, and what you get is an intractable queuing problem. Economics doesn’t stop working because we are dealing with health. Providing valuable and scarce goods and services at no cost will always lead to queues. The only way of getting close to a solution is to charge at the point of delivery.

It is just plain silly, for example, to think that it would be an affront to civilised society to expect those attending an emergency department in a public hospital to pay, say, $100 to get attention. Special arrangements could be made for the very few without the necessary means. Short of that, the last thing that should be done is to make a visit to the emergency department of a public hospital brief and pleasant. That will simply encourage people to attend who would otherwise wait to see their local GP or care for themselves, as might have happened fifty or sixty years ago.

I remember as a kid in the 1950s under England’s ‘free’ national health service, that the one thing that kept us away from seeing Dr Thomas at the end of the road was the fact that we knew his waiting room would be crowded with sick people and that he might disappear in the middle of it all to make an emergency house call (they did that in those days). Better, usually, to go to bed with an aspirin than to face that. And most of us lived to tell the tale.

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