In denial

Australia has many health issues. Many are related to one another. Politicians and the media don’t like that. They don’t like talking about multiple issues at one time. It’s messy and complex and difficult to explain, let alone deal with.

It’s easier to pretend to have the answer to one issue at a time. But this state of denial is making the situation worse as a number of those health issues converge. So, just for once, let’s stop and think about the big picture.

Massive growth in demand for healthcare isn’t going to stop anytime soon. Our population keeps growing. Ageing increases demand since older people need (and deserve) more support. Chronic disease keeps increasing - growing four to eight times faster than the population. And social expectations exacerbate demand as aches and pains that our parents accepted as part of life now have to be fixed immediately please.

Costs of healthcare are escalating. New drugs are harder to find, develop and trial and then are more expensive. Medical technology such as artificial joints are increasingly sophisticated and consequently are expensive. The cost of medical infrastructure and staff keeps going up. And unfortunately there are limits to how much we can spend before we move into unsustainable federal and state deficit budgets.

Along with increasing demand we have a workforce which is relatively declining in numbers. We have an ageing workforce with consequent retirements or shorter working hours. We have peaked with our imports of overseas doctors. Despite shrill demands of the community and governments around Australia, there isn’t much likelihood we can train enough people to replace those we are losing. Our entire workforce is shrinking relative to the population - that’s why unemployment keeps going down. And while we have fewer and fewer children to train, what are we going to train them as? We don’t just need doctors and nurses. We are also critically short of allied healthcare providers, pharmacists, dentists, radiologists and so on. We also don’t have enough people for every other trade and profession in Australia.

Can we agree on those three facts? We have massive, increased demand for services. That demand is increasingly expensive to service. And we have increasingly fewer people to service those demands.

The key point is that we can’t deal with any one of those issues in isolation - they feed on one another and they need to be dealt with holistically.

Dealing with issues one at a time is dangerous nonsense. Increasingly desperate states and territories engage in bidding wars against one another for increasingly scarce medical staff, pushing up basic costs of treatment everywhere. Resulting expensive healthcare budgets force governments to focus on hospital waiting lists at the expense of community health strategies to reduce chronic disease. Social demand forces bad policy decisions on governments just as bad political policy focuses on short term fixes rather than longer term strategies.

Healthcare in Australia has become a political minefield and faces becoming a community disaster. We need to take a deep breath, focus on the big picture and adopt some new strategies. Unfortunately, the best strategies we could adopt are going to cost the current community a lot of pain - we just don’t have the money to keep up the current (failing) strategies and adopt new ones.

So, for example, we definitely need to reduce expenditure on hospitals, even though that will mean current patients have to live with extended periods of pain and suffering waiting for elective surgery or treatment.

We probably need to start charging a co-payment to every non-needy attendee at public hospital emergency departments to reduce demand to a manageable level. We can wrap a safety net around that policy for people with healthcare or senior’s cards but everyone else should be charged. Research suggests that a co-payment of as little as $5 would be effective. We also need to abolish bulk billing for every non-needy attendee at general practices.

We certainly need a national salary and benefits schedule for all healthcare workers. Decentralised wage fixing and pattern bargaining across jurisdictions for a scarce commodity simply exacerbates the cost of healthcare. I don’t suggest for a minute that we shouldn’t pay staff a good salary. But the current system is wasteful and increasingly unworkable.

We absolutely have to have a massive redistribution of existing healthcare funds into preventative healthcare including a major component of community education that ensures people understand that their life choices have consequences and what those consequences may be.

We need all of health taken over by one jurisdiction, probably the Commonwealth. We currently waste about $3 billion in overlaps and duplication plus some unknown amount spent surreptitiously trying to shift costs from one jurisdiction to another.

Then, once we’re sure we won’t be wasting money propping up currently failing strategies, we must have a further massive injection of funds into healthcare to maximise the rate of change to a new model while minimising the current human cost of those changes.

Australia is facing an unmeasured crisis from the convergence of several well-established trends. Dealing with that crisis demands something more than simply more of the same: it is our current healthcare models that are at least partly responsible for the current crisis.

Dealing with that crisis is going to be painful, especially for those who are currently most dependent on the healthcare system (of whom I include some of my family) and holding our nerve is going to be difficult. Unfortunately, we now have little choice. In five years time, we will have no choice. Now is the time to begin debating and developing our new approach.