“Careful, he might hear you”

Australian healthcare is under siege. Its ramparts are being battered by purpose, process, people and pence.

At professional “talkfests” or in the media, the purpose of Medicare — its universality of access and equity of care — has its detractors and defenders. Whether the process should be public or private is vigorously debated, and the demands of people, whether professionals or the public, become the ordinance of lobby groups. But strangely, missiles inscribed with the pence of healthcare costs are few and far between. Indeed, our political leaders’ references to healthcare costs are muted by the caveat, “careful, he might hear you,” as if the public should be sheltered from the reality.

“Money makes the world go around”, and healthcare is part of that world. It now consumes more than 9% of our gross domestic product and this proportion is on the increase. Indeed, the dominance of money in healthcare is reflected in the comment by a recent visitor from the World Health Organization, that worldwide the real minister of health is the Treasurer!

Jonathan Shapiro, a United Kingdom health expert commenting on the UK’s free National Health Service noted, “It is as though we were all at a great ‘all you can eat buffet’. Not only do we eat too much, but we get angry if there is even a short break between each groaning platter. This wouldn't happen at an expensive restaurant, where we'd realise that our meal was actually costing quite a lot. If there was a way of getting the public to understand the real cost of each NHS procedure, perhaps their enhanced sense of responsibility might help to contain rising demand and costs.”

Supporting the rising costs of our healthcare system is society’s call, but the choice would be better informed if politicians were forthright about the true costs of health and stopped sheltering behind the “careful, he might hear you” syndrome.