Dispense with the misguided utopian myths about our health-care system.

We have a monopoly medical system where only those who come from approved courses at universities can access medical benefits. We have restrictions on the entry of overseas-trained people at the same time as we have increasing shortages here. And so on.

Established players claim it is only an interest in “standards” that hold up new players. But they accept and condone, at the same time, the shortages that exist in Australia.

How do we fix it?

This will require a reorientation of the public debate to recognise, and emphasise, that resources in health care are always finite, and that choices always have to be made. Our population must face the fact of increasing ageing, and determine how much public money we should allocate to interventions for people at an advanced age.

But the question is: how might those resource allocation decisions be made? At present, decisions are made. It is just that it is not always obvious how they are made, or who is making them. Some decisions are made by young registrars; some by area accountants. Others are made by ministerial offices, and some are made by admitting officers, especially where responsibility is seen as being to the institution rather than to the community.

There are two sides to any coin. There are costs and benefits to any decision. A decision not to treat “X” might mean a decision to allow treatment of “Y”. But “X” might then die sooner.

Those that argue costs without benefits, or vice versa, are misleading the public.

The best way that decisions seem to have been made so far is to let the public (rather than professionals) decide. This can be done by using what are called “citizen juries”. In this model, juries are empanelled in the usual way, and addressed by advocates for each side of the proposition. The juries then decide. At least in this model, it is clear that a choice has been made, and what costs and benefits will follow.

An American philosopher has invited us to consider withdrawing public subsidy for certain procedures after certain ages. This could be a progressive withdrawal, and would still leave open the option of using disposable income for certain procedures (this is the case now with simple cataract removal in Victoria).

No state Premier and no Prime Minister has told the Australian public the truth, about the possibilities, or the facts.

But something needs to done. For as it stands, our current debate on health is dishonest, misleading and unsustainable.