In reply: Notwithstanding the differences in tone, Cleland and Meyers make the same substantive point: that a challenge I ignored in my short piece was the costs of meeting the different expectations of baby boomers. Regardless of the changed expectations I discussed in my article, health costs over the next few decades are predicted to increase from just over 9% of gross domestic product to over 12%.1 Economists recognise that societies appear willing to devote more spending to health care as they get wealthier, perhaps to avoid confronting the difficult choices involved in some rationing decisions.2
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- Alberta Health Services, Edmonton, Alberta, Canada.
Correspondence: Stephen.Duckett@albertahealthservices.ca
- 1. Goss J. Projection of Australian health care expenditure by disease, 2003 to 2033. Canberra: Australian Institute of Health and Welfare, 2008. (AIHW Cat. No. HWE 43.)<eMJA full text>
- 2. Calabresi G, Bobbitt P. Tragic choices: the conflicts society confronts in the allocation of tragically scarce resources. New York: Norton, 1978.
- 3. Hurley E. The Australian health care system: the potential for efficiency gains. A review of the literature. Background paper prepared for the National Health and Hospitals Reform Commission. Canberra: NHHRC, 2009. http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/A5665B8B9EAB34B2CA2575CB00184FB9/$File/Potential%20Efficiency%20Gains%20-%20NHHRC%20Background%20Paper.pdf (accessed Jul 2009).
- 4. National Health and Hospitals Reform Commission. A healthier future for all Australians — interim report December 2008. Canberra: Commonwealth of Australia, 2009. http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/interim-report-december-2008 (accessed Jul 2009).
- 5. Aaron HJ, Schwartz WB, Cox M. Can we say no? The challenge of rationing health care. Washington, DC: Brookings Institution Press, 2005.
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