Monday, 22 April 2013

Facing reality

I have long been arguing that our universal free entitlement to public health care is unsustainable.

My latest contribution in this vein is dated nearly a year ago can be accessed through this link:

modern-titanics-5-sustainability of free health care services

A change of government does not change basic facts.  And the fact is that economic managers can control the price of a commodity or they can control its quantity but they cannot control both.  In this case the commodity is public health care services and the price has been controlled by putting it as zero, free of charge, to all members of society irrespective of their status and needs.   As a consequence governments can never provide enough resources to meet the demand at price level zero and unavoidably rationing creeps in, through over-crowding, long queues and waiting time to access to such 'free' services.

One could make the same argument about free education but the reality there is different.   Whilst the entry in the education life cycle is reducing due to low birth rates, the entry level in the critical age of health care needs is exploding exponentially as baby boomers go on pension and pensioners enjoy longevity which demands more resources and expensive interventions which were not demanded when longevity was lower.

It is therefore not without reason that the Ministries complaining most about the state of the handover from their predecessors are those related to health care, including our hospitals, health centres and care of the elderly.     Unpaid private suppliers whose claims were not budgeted for, chronic shortage of resources in our hospitals and other similar complaints cannot be resolved by trying to micro-manage the Emergency Department by elected politicians.  Unfortunately such micro management could complicate rather than resolve problems as political pressure being what it is,  patients from the Minister's district will receive preference over others, even those more deserving.

The political corpse must respect our intelligence.  Irrespective of political commitments made such commitments have not been made for ever and if we have to change anything in future we must start sensibilising public opinion as of now.   We must admit  that at some point in future, if we are going to protect our fiscal sanity, we must take hard decisions to keep our health care system sustainable and only free to those that cannot afford to pay.   In the formula there must be a new way of doing business at our state hospitals and elderly homes where management efficiency will produce more with less.

Even if changes will go through in the next legislature the work for such changes has to start now.

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