What Health Crisis?
The failure of the Federal Government to reach agreement with the States and Territories, illustrated by Western Australia’s refusal to put its snout in the trough of money offered, has focussed attention on the crisis for government budgets both State and Federal. Conservative projections of the trend in health consumption indicate that the health sector will within a decade or two demand the entire government budget to satisfy it. This makes the health crisis a potential catastrophe for Australian society as a whole, not just the insatiable beast which medicine has become.
There are several fallacies which become obvious if one examines the health debate closely. Firstly, it is not about health. It is primarily about funding medical intervention in a hospital setting. Secondly, it only oils the squeaky wheels, and does nothing to reduce the burden of disease which is threatening to overwhelm our capacity to remain a caring and just society. Thirdly, no amount of meddling with the sources of funds or the division of labour in the health industry will solve the root problems which are driving the progression of disease in our community. Forthly, we have a false belief in the capacity of the medical industry to deliver health, overlooking that it is an industry founded on disease and accustomed to profit from it. The Federal Government is not responding to the crisis in health, but the crisis in medical infrastructure. The link between the two is a presumption which is yet to be proven.
We are daily becoming fatter, more stressed and more depressed, while becoming less able to maintain a healthy lifestyle and satisfy the demands of modern living. Inevitably this leads to more disease, and greater demand on the hospital system. The current federal government “health reform” does not address these facts. It does nothing to stem the growing morbidity which is feeding the real crisis in health.
The reality is that we need a cultural shift to overcome the problems of health and disease in our community, and it needs to reach the level of individual lifestyle choices. This is an area where politicians are afraid to go, because it risks costing them votes. No smoker or drinker wants to be mothered by a politician, and politicians who advocate reform at this level of lifestyle are soon ridiculed. But without addressing the drivers of morbidity in the community, and while we have an aging population, the exponential increase in demand for medical services will not stop.
No doubt as more people choose to make lifestyle changes to better their long term health, pressure will increase on politicians to protect their interests and add a cost to adverse choices. The question for the non-smoker, non-drinker will be, “Why should I pay through my taxes for the inevitable consequences of my neighbours foolishness?” The evidence is out there, and the enormous costs on the community as a whole have been calculated for both smoking and drinking, as two prime examples. Yet government presently recovers only a fraction of the cost of dealing with the disease burden which results directly from these substances over the lifetime of users. It cannot be long before the user will have to pay the inevitable cost of their choices up front. Until then, we cannot say we have faced up to the real cost of these products and those who choose to use them. But it could be a while before a politician appears who has the courage to admit that cigarettes should cost $100 per packet, beer $250 a slab, and a bottle of whiskey the price of a small car.
Our fear of death has caused us to elevate the medical doctor to the status of a demi-god who is sanctified from all self interest. This allows their trade union, the AMA, to spruike about the public interest while their members gouge enormous incomes from meagre health budgets, without anyone having the temerity to examine the cost effectiveness of doctors in health delivery. Yet comparision with the levels of health enjoyed by third world communities would indicate that there is no direct relationship between the number of doctors per head of population and indicators of health in the community they serve. More doctors are not necessarily the answer, and the 15000 or so people who die annually in Australian hospitals from causes other than the illnesses with which they presented are testament to this fact. As pressure increases on hospitals, the rate of medical accident will also inevitably increase.
Obesity is epidemic, and cooking shows the new pornography. As a direct result of our affluence and preoccupation with the senses we have become obsessed with food to the extent that it has become another drug, with a whole set of associated diseases, from diabetes to bulimia. While our lifestyle has become more sedentary and reduced our bodies demand for calories, our cellular memory causes us to store today’s bounty as a precaution against the famine which never comes. The tragedy in all this is that good diet is generally overlooked as being more cost effective in preventing disease than pharmaceuticals are in curing it.
Hospitals are now having to learn from their colleagues in the veterinary industry and refit with equipment similar to that designed for managing large animals, directly as a result of the increasing average weight of patients. Hydraulic lifts, oversize wheel chairs, reinforced and wider beds, increased staff per patient, all a direct result of our obsession with food.
It could be said that there is no health industry in Australia, only a medical industry. The health industry, such as it is, is not yet recognisable as a mainstream enterprise, and is certainly not funded by government. It is not the squeaky wheel.
It is at the level of lifestyle and social responsibility that we must look for the causes and solutions to the crisis in health, not to the size of a cheque which offers no promise to deliver.