Minister Wendy Edmond's call for a state debate on the future of
health care is both sensible and timely. In starting the debate, however,
she has put her astonishing capacity for offensive remarks to good use.
Her abrasive, in-your-face comments have forced a reality-check on how we
should allocate scarce health resources.
Report about Australia's ageing population, issued with the last
Federal Budget, was another warning bell, pointing out that federal
spending on health probably will increase from the present level of about
4 per cent of the GDP to 8.1 per cent by 2041-42.
While the growing proportion of elderly will be an important element of
that spending, Treasury says it won't be the major problem. "Most of
the projected growth in health spending reflects the increasing cost and
availability of new high technology procedures and medicines, and an
increase in the use and cost of existing services," the report said.
"Consumers have a high demand for more effective treatments, and
expect these treatments will be provided to them soon after the technology
first becomes available."
Which means that a key factor in controlling health costs is the
ability of politicians to help the community have realistic expectations.
It is not a matter so much of cutting back on present services, as of
restraining demand for whiz-bang new services. The electorate needs to be
educated about the range of choices.
At the moment, public debate seems to be at the level of
"management by shroud waving", in the words of one health
economist. Tragic stories of children with rare and fatal diseases hit the
front page, while primary health care for disadvantaged groups like
Aborigines goes from bad to worse.
There is little awareness that governments' ability to include the
increasing range of cures and therapies in their Budgets will become more
limited. Edmond should be applauded, not maligned, for kickstarting a
discussion of what constitutes a rational, just, fair and humane standard
for allocating healthcare dollars.
However, Queenslanders would be foolish to heed Edmond's personal
opinion on what this standard should be. People were justifiably outraged
by her suggestion that money spent on dialysis machines was wasted because
the patients using them lacked "a really good quality of life".
Of all standards for allocating health resources, "quality of
life" must be the worst. Dialysis machines can give some people the
opportunity to live fulfilling and productive lives. I know one Sydney man
who works a 60-hour week by hooking up himself to his machine in the
The message of the Intergenerational Report was that the expectations
of a consumer society keep rising and rising. What the "worried
well" regard as poor quality of life may be quite acceptable to the
Further, "quality of life" arguments in health care
allocation quietly merge into bottom line arguments. The beneficiaries
tend to be children, infants, the fit and healthy and the tear-jerkers.
The losers are the chronically ill, the frail elderly, patients with
mental disorders and complicated cases.
Sadly, the Australian public already is being educated by the media and
many politicians to accept a "quality of life" health care
ethic. At the tail end of life, there is the movement for euthanasia. It
is extremely naive to deny that people will be pressured into assisted
suicide when their relatives and carers decide for them that they no
longer have quality of life.
In Oregon, where assisted suicide is legal, one of the leading US
Health Maintenance Organisations, Kaiser Permanente, which provides
comprehensive private health care within budget limits, has been trying to
recruit doctors to help patients who want to commit suicide. It certainly
helps contain health costs.
The debate over the embryo research Bill now before Federal Parliament
exemplifies the contradictory state of the health care debate. Even as
Edmond cites "quality of life" as a possible justification for
cutting back on dialysis machines, incredibly expensive stem cell
therapies are being promised to Parkinson's disease victims to restore
their quality of life.
By all means, let's have a debate. But let's start off with words like
justice, fairness and compassion before prattling on about "quality