It's only fair to share…

Health reform is on the front page in Australia, again. Prime Minister Kevin Rudd revealed a plan for the Commonwealth Government to take over the funding of public hospitals from state governments. Prior to being elected in 2007 Mr Rudd promised to fix the health system and stop the “blame game”.

Funding of the health (read “disease” system in Australia is split between the two levels of government. In simplest terms the Commonwealth raises tax dollars. It then gives the states a pot of money under the Australian Medicare agreement, to run the public hospitals. This allows Canberra (the capital) to blame the states for not wisely spending the money they have and allows the states to blame Canberra for not providing them enough money to do the task.

Strange anomalies occur. For example, if you get a prescription from a doctor in a private practice and get it dispensed at a pharmacy, the Commonwealth will in part pay it for. If you get a prescription at an emergency department and it is filled out there, it is paid for by the state. See a specialist in their consulting room and it costs the Commonwealth. See the same specialist in a clinic and he will be paid by the state. This has also led to attempts by both levels of government to try to push costs on to one another. For example hospitals now send people home with little or no medication whereas previously they got two weeks worth. This “pushes “ the cost of tablets onto the Commonwealth.

These discussions about funding cause the eyes of the average person to glaze over. The dollars involved are astronomical. The Treasury’s Intergenerational report suggested that spending on “health” would rise from 15% of Commonwealth outlays to 26% by 2050. Type 2 Diabetes is estimated to increase six fold by 2033. It is already estimated that obesity costs Australia $56 billion a year.

As usual all these arguments centre on how to pay for an inexorable increase in demand for services. The issue is the same in the USA and all western countries. Australian Health Minister Nicola Roxon told Fairfax radio taxes might need to rise, as “ …we have to be able to fund delivery of services into the future”.

Has it ever occurred to any of these politicians that the solution may not be in trying to fund more and more services? Has it occurred to them that the solution may be in finding ways to lower the need to provide services? Are they aware that 75% of spending on services is already for preventable lifestyle related conditions, which are preventable, or reversible with simple changes to how people live their lives?

Or is it better politics to promise to fix people and hence make themselves look important. Oppositions always promise to fix health. When in government they find that they cannot do this. I doubt it comes as a surprise.

Western Medicine is great at acute care. If you break your leg, I do not believe that herbs or meditation will fix it. However Western medicine does chronic disease very badly. It offers expensive pills and technology when lifestyle changes are what are needed. This is why our disease systems are unable to cope with demand. They are not suited to the task. Hospitals are not the answer to diabetes obesity and other lifestyle related chronic diseases or the consequences thereof. Hence our systems are struggling. More of the same will not be the answer.

The answer lies in the hands of individuals who can choose to be healthy rather than wait for the system to “fix” their disease. In this scenario the disease systems will easily be able to cope with the demand for what they are good at, treating acute illness and injury.