Ostensibly, the focus and raison d’être of our health system is the care of the sick, but of late it appears that the system itself is sick. Waiting times, not only for elective surgery and access to general practice but also in our overstretched emergency departments, have generally been seen as the main symptom of this malaise.
However, more acute symptoms have recently emerged, encapsulated in the recent newspaper headline “Free health care dead: user-pays system fear as Medicare on life support”. The system appears to be in fiscal turmoil, as hospitals hover ever closer to insolvency, unable to pay their accumulating debts. There have even been suggestions that public hospitals open private wings to underpin their financial viability.
Echoing this concern, a recent media report noted: “A boom in the use of Medicare has prompted official caution about the sustainability of the scheme, which costs more than $14 billion a year and rising”.* Yet the flurry of media reports questioning Medicare’s sustainability may simply be political kite flying, testing the electorate’s readiness for change.
For more than 30 years, Medicare has ingrained in the Australian psyche the expectation that free medical and hospital care is a basic right. It is as much a part of our culture as the Ashes, Aussie Rules and meat pies. But we now live in extraordinary times of global fiscal crisis, mega-deficits, and a health care system that consumes gargantuan chunks of our gross domestic product.
Gough Whitlam, the founder of Medicare, noted some 40 years ago that “Australia could be a nation free from financial worries that go with illness and incapacity. The Australian economy is rich enough to place the benefit of medical security at the disposal of every one of us”.
With Medicare in fiscal meltdown, one wonders what it will metamorphose into.
The Medical Journal of AustraliaMartin B Van Der Weyden, Editor.