1. Australians enjoy spectacularly good health compared to their counterparts in almost all countries. Australian men live two years longer than their (wealthier) American male cousins. Australian women live one year longer than their (wealthier) American female cousins. Australia is in the top half dozen countries for most of the parameters used to compare health in different countries.

2. To achieve these excellent results, the proportion of their income Australians use to pay for their health care is only average compared to other rich countries. Australians pay 9% of their income to achieve excellent health. Americans pay 16% of their income to achieve lousy health.

3. The return on investment for clinical care is dwarfed by the return on investment for public health. Yet we still allocate 98% of our health care expenditure on clinical care and only 2% on public health. Up to 2000, Australian governments spent $140 million on needle syringe programs to reduce the spread of HIV among injecting drug users. But these programs saved up to $7.7 billion. (No, I am not having a Barnaby Joyce moment — I mean billions).

4. Getting better health is not just a matter of ploughing even more dollars into clinical care. Or even into public health. It is also a matter of improving housing, education and employment. The substantial reduction in road crash deaths in the past few decades has significantly improved the health of Australians. Decreasing our high levels of inequality would help. Australia has high levels of inequality compared to most other rich countries.  High levels of inequality come at a price.

5. It took 27 years for both sides of politics in Australia to support universal health care, which was first proposed as a policy by a major political party (ALP) in the 1969 federal elections. Labor again proposed universal health care in the 1972 elections (which it won). Universal health care was only passed by parliament after a double dissolution. The Liberal Party opposed universal health care in every election from 1969 to 1993. This Opposition played a major role in the Liberal loss in 1993. The Liberals went to the 1996 elections pledging to keep Medicare. Medicare has improved the health of Australians and enjoys very high levels of public support. Health care reform takes a long time. Major health care reform takes even longer.

6. Gough Whitlam recognised the need to ensure a single funder for heath care in the 1970s. It has taken almost three decades for this basic reform to get to the stage where it is now being proposed by a Prime Minister. Having one level of government (states) fund hospitals while another level of government (Commonwealth) funds primary health care and nursing homes is a recipe for disaster. This arrangement has enabled Australians to develop Olympic gold medal standard skills in cost shifting. The duplication and cost shifting is estimated by economists to cost billions of dollars. For many people working in health care, this estimate is very believable. Making health care more efficient means that improvements in health care become more affordable.

7. Improving health in Australia will always be a major challenge while coverage of the latest juicy example of clinical incompetence in a hospital sells large numbers of tabloid newspapers.

8. Australia does have several health areas where results are worse than embarrassing. The gap in life expectancy between Aboriginal Australians and the majority population is several times longer than the equivalent gap between indigenous and non-indigenous populations in other New World countries (such as New Zealand, US and Canada). It is now well accepted that mental health services have been under-funded for decades. Improving funding for mental health services is happening and is apparently even starting to attract votes. Unfortunately, alcohol and drug treatment services are still way behind other health services, are still grossly under-funded and don’t look like attracting any votes.

9. Not all the health care reforms needed are complex, difficult and expensive. Australia has relatively few beds for supervised accommodation. These beds are needed for people who are too well for hospital care but unable to manage in the community. Because of this deficiency, many expensive hospital beds are silted up with patients who should not be there. These patients are usually elderly, or mentally ill or have alcohol and drug problems. But who is going to change their vote to recognise a politician who created supervised accommodation beds?

10. Australia needs to keep vigilant about emerging potential health threats. We saved many lives and many dollars by responding to HIV promptly, vigorously and effectively. Let’s hope we respond to obesity just as effectively. And other threats in the future.

Peter Fray

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Peter Fray
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