If you’ll forgive the earnest tone, I’d like to propose a toast.
To a friend who’s almost always there when you need them most. To a system that aims to treat people fairly and respectfully.
To a quiet cornerstone of Australia’s civil society.
Yes, it’s not perfect, it’s perpetually preyed on by profiteers, and its work can be patchy, sometimes.
But here’s to Medicare.
Happy 40th.
Painful birth
As some readers well remember, the birth of Australia’s publicly-funded universal health system was not easy.
First delivered as Medibank by Whitlam’s Labor government in 1974, it was viciously attacked by doctors’ groups and conservative political parties, which effectively killed it off, a year or so later.
It wasn’t until 1984, after the election of Labor under Bob Hawke, that Medicare was formally launched. It reduced people’s big medical bills, cut the costs of healthcare nationally, and even drove down inflation.
But the idea of a taxpayer-funded system of free or low-cost care remained abhorrent to many in the medical community and the Liberals.
Doctors worried about falling incomes and government influence. The then opposition leader, John Howard, famously said the government should have ‘taken a knife’ to Medicare, describing it as ‘one of the great failures of the Hawke government.’
Popular success
Unlike John Howard, big majorities of Australians have consistently supported Medicare. Some political observers have even suggested that the Liberals only won government in 1996, and Howard became prime minister, largely because they finally ended their opposition to Medicare.
Along with providing affordable access to hospitals, doctors, nurses, drugs, tests, and treatments, a strong publicly-run Medicare has also helped keep a lid on the overall costs of healthcare.
In Australia, we spend around ten per cent of total GDP on healthcare. This is similar to European countries, but just half of what’s spent in the US.
With its market-based system, the US spends close to 19 per cent of GDP. That’s one-fifth of the entire economy spent on ‘healthcare’, while at the same time Americans tend to have poorer health outcomes than comparable countries.
I was lucky enough to study health systems during a Harkness Fellowship at Harvard University.
I learnt a lot about the inequality, inefficiency, and inhumanity of US healthcare.
It’s not really rocket science. Health systems based on solidarity tend to be fairer, more effective, and cheaper.
Of course, Medicare could be stronger on many fronts.
On the one hand, access to needed care can be hard to come by, particularly in some remote and regional communities. Public hospitals in many places are hurting and waiting times unacceptable.
On the other hand, Medicare is too often vulnerable to the vested interests which are driving the problem of too much medicine.
From corporate-controlled general practices to giant pathology companies, from big pharma to pharmacies, private for-profit players all push to sell more. The result is increasing amounts of harmful and unnecessary care, and wasteful increases in costs, threatening the very viability of a universal system.
The biggest challenge for Medicare, and health systems everywhere, is tackling this problem of too much of a good thing.
In just 20 years, the number of annual subsidised prescriptions under Medicare has jumped from 160 million, to over 220 million today. And the annual drug costs from $4.5 billion to over $17 billion.
There is incontrovertible evidence that many of those prescriptions are unnecessary and harmful.
Deprescribing
The problem of ‘polypharmacy’, particularly among the elderly, is so out-of-control that good doctors are now learning the art of ‘deprescribing’.
The Australian Commission on Safety and Quality in Health Care has repeatedly identified examples of overuse, including too many planned caesarean sections, too many colonoscopies, and too many inappropriate antipsychotics.
Globally-renowned Stanford University Professor John Ioannidis told me a few years back that ‘we’re just spending so much, and we’re wasting so much, that healthcare is one of the leading public dangers for health.’
Ioannidis is one of the most cited medical scientists on the planet, and has sat on the editorial boards of some of the world’s most respected scientific journals. ‘I think at some point, we need to fight against medicine’, Ioannidis told me. ‘It’s becoming really dangerous.’
There are ways to tackle these challenges, collectively, to better manage vested interests, and strengthen this vital public infrastructure. And there are ways we can protect ourselves and our loved ones from the dangers of unnecessary care. But they are columns for another day.
Medicare is a manifestation of our humanity, so in its birthday year, let’s celebrate this solidarity.
♦ Dr Ray Moynihan has been known to break out in a rash when confronted with for-profit healthcare.
For four decades The Echo has printed the stories some people loved, some people hated, and some pretended not to read. If you want us to keep telling the truth, the real truth, not the sugar-coated version. We’ll need your support to keep the presses rolling. 
