“Australia has a health system that is the envy of the world, one of the key tenants (sic) of its success is its mixed public/private model.”

So begins Bupa Australia’s recent submission to the Senate Community Affairs Committee Inquiry into changes announced in the federal budget to private health insurance subsidies. (Bupa Australia is the largest privately managed health insurance group in Australia, with a combined market share of around 28%.)

It ends on a call to arms, that the private health sector must remain “viable, attractive and affordable for all Australians”.

Unlike submissions from John Deeble (one of the architects of Medicare) and others arguing that the massive public subsidy of private health insurance is inequitable and inefficient, Bupa has a powerful interest in maintaining the status quo.

It’s worth noting because BUPA’s Chief Medical Officer is Dr Christine Bennett, who until recently chaired the National Health and Hospitals Reform Commission (NHHRC).

The release today of the Commission’s final report must find her in a quite uncomfortable position.

On the one hand, she has to argue the case for health reform if the report’s recommendations are to have any impact; on the other, her employers are insisting that the status quo is just fine, thank you very much.

We can’t have it both ways. We can’t have health reform without pain, without there being losers as well as winners, and without confronting the powerful interests — whether professional, private or bureaucratic — that have a strong stake in maintaining the status quo.

If only it was as simple as taking two quick pills and waking up in the morning with a shiny new system.

The lesson from anywhere that has attempted health reform — whether at a small-scale local level, or with a grand national plan as has happened in Britain and Netherlands — is that it requires immense effort and political will.

If you’re not suffering prolonged migraine, then you’re just not trying hard enough.

A tiny insight into the challenges that policy makers face was splashed across the bottom of page 14 in the Weekend Australian. “Blinded by Labor” blared the ad from the Australian Society of Ophthalmologists, flexing their might against recent Budget changes to funding for cataract operations.

Yet any sensible reading of what’s needed in health reform is that, amongst other things, the incentives which promote specialist and subspecialist practice need to be turned on their head in favour of strengthened primary care. You can’t have it both ways — boosting primary care necessarily means taking some of the smile off specialists’ faces.

We have been hearing, ad nauseam, for years about why health reform is needed. Just to recap: our current system is not efficient or fair; there is plenty of room to improve both the quality and safety of care provided; and it is not well equipped to meet current and future challenges.

Will the NHHRC report set us on the road to the reform that’s needed? I haven’t seen the report yet (a promise it would be on the Commission’s website from 10.30am hasn’t been kept) but think the answer lies well beyond its covers.