Health Care reform is in the news in Australia, the United States and elsewhere. The Rudd government has recently released its proposed overhaul plan for the Hospital and Health Care system in Australia over the coming years. The plan comes in the wake of a report previously commissioned by the government, Towards a Healthier Future for all Australians.

          At the same time the Obama adminstration in the U.S. has finally managed to get its Health Care Reform Bill through the Congress. The bill increases government health insurance subsidies so that some 30 million Americans , presently uninsured,  can get some cover, widens the government health plan to provide better care for poor people, expands taxes on the very rich to help fund the scheme, and outlaws  health insurance companies from refusing to provide insurance cover to those with known, pre-existing medical conditions. The reform will cost about $US94 billion a year. (The American Defence budget is around $US650 billion annually).

          The horrors of the American health care system have become quite well known internationally, especially with all the controversy over the Obama Health Care Reform Bill.   People live in fear of falling ill because they have incomplete cover or, in the case of the poor, no cover at all.  After one major operation, such as coronary surgery, bills of up to $US1 million can come in.

          For someone without health insurance there is really nowhere to go for medical help. Of personal bankcruptcies in the U.S. 62% are attributed to inability to pay hospital and medical bills. The United States is well down the life expectancy ranking in the OECD countries. It ranks 24th (life expectancy average of 79.4 years). Australia ranks 5th (life expectancy average of 81.2). The four at top ranking are Japan, Hong Kong,  Iceland and Switzerland.  This surely tells a story about the richest country in the world.

          The Australian Health Care story has been much more positive for what it has brought the people.  To a certain extent, the right to universal health care did start to emerge in the early twentieth century.  Publicly funded hospitals started to be built in the States, with access guaranteed to the public . After 1945, the ALP government, still in office from the war years, proposed a series of measures aimed at offering everyday people much better Health Care arrangements.  These measures included a free hospital system, funded from taxation revenue, compulsory health insurance, salaried doctors for poorer people in need of medical help, and the Pharmaceutical Benefits Scheme (PBS). Vested interests stirred up a storm (a little like in the recent U.S. events) and all of the proposals were blocked by failed referendums,  the medical profession's opposition or High Court rulings declaring them unconstitutional. The battle for universal health care had suffered a setback. But in 1951, the Coalition government (Liberals and Country Party), led by Robert Menzies, proposed a National Health Scheme which included a slightly adapted PBS, a voluntary medical and hospital benefits insurance scheme, a Pensioner Medical service and a more specified system of health grants to the States. The vested interests were generally accommodated by the Coalition government and the storm was largely quelled. Menzies' National Health Scheme brought many of the pieces together and marked a step forward in the winning of a universal health care right in Australia.

          In 1974  a new public health insurance agency – Medibank – was established by the Whitlam Labor government, followed in 1984 by Medicare funded from a taxation levy of 1.5%. Medicare was set up by the Hawke/Keating Labor government. Both health insurance agencies took important steps forward in strengthening the universal Health Care right. Public hospitals were open to all for treatment and 85% of doctors' scheduled fees could be reclaimed through Medicare. Those wanted to take out private insurance could do so and be largely covered for accommodation in private hospitals.

          Having a Medicare system and free public hospital access right are most important things for a country and people. For the old and sick, the mother, the child, the migrant, the injured they are vital.  They are a precious jewel that cannot be taken for granted.    Some of the old vested interests would pull Medicare apart if they had the chance.  They have tried and so far failed.

          Long waiting lists, scarce beds, exhausted medical staff and chaotic management in public hospitals today weaken the right of universal access to Health Care.  Those with a bit more money pay private health insurance and use the private system.   That is why the current debate in Australia and the planned action to “fix” the public hospital system are so important.

          We have come to know a bit more about the Health Care situation in the U.S. during the battle for the Reform Bill. We have something much better in Australia  and should aim to hold on tight, protecting and improving it wherever we can.

25th March 2010