Perhaps it is better not to resuscitate

Roughly 10 per cent of Australian teenagers don’t get entry to their first or second choice of university course and most of that 10 per cent would be incapable of sustained high level study. That’s a fact. Tertiary entrance scores can’t tell us who would make the most empathic doctor or dedicated nurse but they’re usually pretty good at telling us who is capable of handling the study needed.

So there’s really not a huge untapped pool of teenagers just waiting to be trained as doctors or nurses: and persuading those who are available is not easy. They’re aware that it’s often dirty, unattractive work, dealing with life-threatening cases while the family stands by, ready to sue at the first opportunity. Much easier to just be an engineer or public servant.

Money is an issue because most politicians like giving away things - it costs them nothing personally and makes them popular with the electorate. So every federal health minister since Neil Blewett stood up in Federal Parliament in 1983 to introduce Medicare has told people they can get their problems cured. For free. Right now. No matter what. However trivial. However expensive. And right behind the federal minister has always been a state minister or premier bragging about how wonderful their free state health system is.

The community can hardly be blamed for believing them and for becoming hooked on “free” treatment. Trying to rein in overuse and inappropriate use of primary and secondary health care, so that we have some resources to devote to preventative health care, will not be easy. Look at the fuss every time the Pharmaceutical Benefits Scheme changes.

So that’s the gloomy side. We have an ageing and increasingly unwell population with an insatiable appetite for free healthcare on one side, and on the other side, we have a rapidly shrinking health workforce and a health system focused on fixing up problems after they happen, at enormous and unsustainable cost.

Is there anything that’s positive? Well, not much. Certainly not at the political level. Politicians like facile answers and proposals. They pretend that waving money around will cure the problems. And senior bureaucrats, chosen to defend the minister’s party line, aren’t a good deal better.

But the people who do know just how bad things are and who see the importance of “real” answers are the current health care providers. More and more of these people are looking at the problems and solutions. Role reallocation is clearly part of the answer: using nurses to maximum advantage; GPs and even specialists handing over part of their roles to others and each group focusing on what it is best skilled to do.

Better integration between the public and private systems is crucial. Having private doctors and appropriately funded community health services jointly focus on preventative health care will be a major part of the answer.

Training as many people as we can is also part of the answer but we aren’t yet completely sure just what we should best be training them as. That’s something we’ll have to respond to gradually as we work out the answers.

Encouraging and even obliging the community to take some responsibility for their own health is mandatory. Eliminating “free” public health care, except for very tightly targeted disadvantaged groups, will give better pricing signals to the community and income can be spent on providing incentives and support to the community to further improve their own health management. Unfortunately, of course, that will demand a bi-partisan approach since it would be political suicide for one party to do this.

None of these answers are easy. However, they’re ones that will work. Better community health, better use of available resources - human and financial - and better integration between private and public health. Without such answers, we are looking at a system sinking further and further into crisis with poorer and poorer outcomes except for those wealthy enough to afford something better.

Better in the end to not resuscitate.