Here we are, already eight years into a new century, and still we’re stuck with a health system trapped in the bowels of the last century, if not the one before that.

And it doesn’t look like the dinosaur is going anywhere fast, according to the message that Canberra sent this week in announcing the new National Health and Hospital Reform Commission.

The most obvious message was that the health system will continue to be run for the people who run it (the politicians and bureaucrats, the professional groups, the commercial interests) – and not those who have the most to benefit from real reform. You know, those inconvenient, tiresome people known as patients.

What else can be inferred from the glaring omission of anyone on the Commission who could be said to explicitly represent the interests of patients and the broader community?

Don’t give me the line that you so often hear, that the well-meaning doctors, policy buffs and other professionals on the Commission have all been patients at sometime themselves or are perhaps even related to patients, and so are perfectly well equipped to represent their views and concerns.

We’ve got a health system that too often fails to meet patient and community needs because of exactly that type of thinking.

And it’s a shame there aren’t more people with rural health expertise on the Commission because rural areas have often been the sources of the greatest innovation in health. Necessity being the mother of invention and all that.

The other clear message is that wide-ranging reform is off the table, that this Government will fiddle at the edges but daren’t touch the central, burning issue of the distortions being created by inequitable, inefficient private health insurance policies. Many proponents of health reform have been alarmed by the symbolism of appointing as Commissioner the chief medical officer of a health fund, even though she has a varied background, including time spent in public hospitals.

It is telling that many were hoping for an outsider as Commissioner – someone not beholden to the professional or industry interests that dominate health policy. Indeed, the Australian Healthcare and Hospitals Association put forward Justice Michael Kirby as its choice.

It would be nice if the passage of time proves otherwise, but this week hasn’t generated widespread confidence that the new Commission will live up to its name as an agent of reform.

Just last week, one of the more vigorous advocates of health reform, John Menadue, told a meeting of medical administrators and public health experts that “the health debate continues to be largely a private conversation between the minister, privileged doctors and special interests. The public is excluded.”

Which might help explain why Menadue’s not on the commission. He has been pushing for some of the tough decisions needed to help create a system able to respond to the needs of the people of the 21st century.

Peter Fray

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