Providing equal opportunities for citizens to avoid illness and receive quality care is arguably the ultimate social justice issue.
Health is inextricably linked to happiness and that fact alone should demand health policies focussed on equity. Health is also a major determinant of individual and community productivity, further strengthening the case for health policies that will help as many of us as possible to be both happy and productive.
We are a wealthy country and can afford to offer each other a World's best practice health system. Australians want a health system in which timely access to a quality service is available on the basis of need – not personal financial well being.
Surely our desire to help each other, using equitably collected tax dollars, is a characteristic we would wish to underpin contemporary Australianism, breathing life into our wobbly but iconic Fair go philosophy.
Citizens of Australia have not been given the chance to verbalise these sentiments, unlike their counterparts in many other countries. They consistently tell pollsters however that they would prefer better services to tax cuts!
Health and today's reality
Our Health system is:
– Increasingly dysfunctional
– Unfair. Poorer Australians die far more frequently from preventable causes than do richer Australians. 17% of Australians cannot afford to have their prescriptions filled.
– Significantly compromised by a very severe work force shortage.
– Under such enormous pressure that, mixed in with the daily miracles created by skilled and dedicated professionals are unacceptable levels of misadventure in the nation's hospitals.
– Not structured to respond adequately to the rapid aging of the population.
– Beset by inequality in terms of access to and outcomes from an encounter with our health system. (Rationing, waiting times, rural and remote deprivation, absent mental and indigenous health programs etc).
– Frequently called on to address the adverse health outcomes from other unfair or ineffective policies that can cause so much individual and family stress. (Job security, poor pay; the working poor phenomenon, excessive work loads, migrant detention policies etc).
Politics and the reform agenda
The majority of the solutions to our health problems are obvious. They are known, from implementation in other countries, to be effective. But they remain frustratingly out of reach because of poor political leadership and vision.
– As is stated in Our Common Wealth, We have an Australian Government that has concentrated power to itself and which has an ideological ivory tower view that its policies provide Australians with the wealth they need to care for themselves. As a result the health of our citizens is increasingly polarised by the economic prosperity divide.
– Our Common Wealth also states that We have an opposition in Canberra sill too timid to assert its values and principles, which, if true to its tradition, should be very different from those of the government, especially around fairness and the belief that Common Health is one of our most important Common Wealths.
This failure of political leadership over many years has left us with:
– The unique and wretched jurisdictional divide that splits the responsibilities and care that should be integrated between State and Federal governments. Only the former Yugoslavia was similarly blighted. In 1991 politicians of all persuasions promised Australians they would end this nonsense. We are still waiting. The existence of nine separate Departments of Health for 20 million people wastes at least two billion dollars annually, splinters care to the most needy, and thwarts attempts to develop nation- wide cohesive collaborative policies.
– A workforce crisis that has only recently been partially but inadequately addressed. We still have no national policy to train sufficient Australians to care for our health needs. We continue with the ethically indefensible policy of taking talented (and not so talented) professionals from Third World countries that need them more then we do.
– No commitment to respond to the almost universal call to swing our health system around to prioritise ‘wellness'. We must remodel Medicare so that we can create primary care teams that provide prevention programs, earlier diagnosis and treatment and free doctors to do what only they can do including caring for the ill in community settings rather than sending them to overburdened hospitals.
– An under-funded and under-appreciated Public Hospital system which continues to offer many services to rich and poor alike that are unavailable in the private sector. The Australian government seems to feel that such hospitals are the rightful domain of the poor! The only major Federal policy to address the pressure on public hospitals involved establishing a 30% rebate on Private Health Insurance premiums hoping greater use of private hospitals would reduce demand on public facilities. It has not. Tax dollars collected from individuals who cannot afford additional insurance support the insurance of those who can!
– Denial of the opportunity (provided to citizens of many other countries) for Australians to dialog with government and health professionals to better understand the choices that must be made at a time of work force shortages, and to have government hear what the community wants from its health system. The community needs to know what would be involved in instituting a pro-active wellness model. Support should influence political commitment. However we have a federal government that does not believe in participatory democracy.
The much-needed journey
Australians deserve (and would demand if given the opportunity) their State and Federal governments to embark on a journey towards integration. The building of bi-lateral partnerships, featuring a commitment to policies focused on people rather than the politics of division, should progressively fuse interacting programs and dollars.
To simultaneously act on so many issues that urgently need to be addressed, all levels of government should agree to the establishment of a Health Reform Commission staffed by experienced State and Federal Bureaucrats working side by side with consumer representatives, health economists and health professionals.
Even with the currently available health dollars, reforms could provide more health, better health and far greater cost effectiveness. All that remains missing is the application by our political leaders of the principles being put forward today as we call on the community and our leaders to take action to preserve our Common Wealth.
This article is an edited version of a speech given at the launch of Reclaiming Our Common Wealth: policies for a fair and sustainable future at NSW Parliament House on Tuesday June 13.