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Queensland health debate needs a dose of reality

By Michael Cook - posted Thursday, 17 October 2002

Health 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.

The Intergenerational 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 evening.

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 patients themselves.

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 of life".

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This article was first published in The Courier-Mail on September 18, 2002.

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About the Author

Michael Cook edits the Internet magazine MercatorNet and the bioethics newsletter BioEdge.

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