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Only Through Original Thinking and some Courage Can Real Change Occur!

Our Health Crisis will Bankrupt the Nation

Recently Jo-Ann Miller QLD MP and member for Bundamba just outside Brisbane publicly “floated” the idea of penalising smokers and the obese for their unhealthy lifestyles by suggesting that people who become unwell through their own poor choices be pushed to the bottom of hospital waiting lists. She reasoned at the time that the Health Budget was being pushed to breaking point and that if current trends in obesity and “so-called lifestyle disease” continued (along with the progressive ageing of the population) it would soon “burst”.

She was of course shouted down at the time by both sides of the political divide and even doctors who allegedly supported such a concept in private were deafeningly quiet when the “debate” went public. It would of course be political suicide to commit to such a notion, after all 27% of Australian adults smoke cigarettes and more than 50% of Australian adults are now considered obese. Try winning an election anywhere outside of Burma (sorry Myanmar) or Zimbabwe with those numbers.

But if we move the discussion out of the political forum momentarily and take a look at what we have:

The Department of Health’s own website quotes that obesity rates have doubled in the past decade alone, Some major health reports have placed Australia at the top of the world for obesity levels and a study published recently in the American Journal of Clinical Nutrition has the growth trends in obesity amongst Australian women as the highest in the world

In 2007/08 Australia spent 9.05% of GDP on health and this figure has increased by around 5% each year for the past decade. Health expenditure figures no longer include in-home aged care as this is now considered welfare expenditure. So by 2030 the total expenditure on health will be approx 25% of GDP an absolutely unsustainable trend and all without factoring in the ageing population and unpredictable explosion in type II diabetes!

In a document commissioned by the Commonwealth Department of Health focused on strategies for reducing lifestyle disease it is estimated that if the growth trends for type II diabetes continue in Australia the annual health care costs for diabetes alone will increase to $8bn by 2032 (preventative health task force 2009).

I could go on but I can hear people nodding off so suffice to say that:

“Doing nothing or continuing with the current approach has the potential to bankrupt the country…….8 BILLION BY 2032 ON DIABETES CARE ALONE!”

National advertising campaigns have failed miserably the most recent of which is the “Measure Up” campaign which was a spectacular failure. In fact no national campaign on this issue has yet made the slightest dent in the problem you cannot hide from the numbers.

So how does Jo-Ann Millers proposal stack up now?

Well for mine shuffling sick people to the bottom of a hospital waiting list is a little cruel and un-palatable. However it is certainly high time the nation stopped kidding itself and asked those people that become unwell through the course of their own behaviour to pay at least part of the cost of their own health care.

This could be done a number of ways and sharper minds than mine will one day make a decision on how such a system is brought into existence. Direct models, indirect models (sometimes called taxes) who knows? But at some stage such a system MUST be part of our health care funding model.

How about this as a starting point for debate?:

• A progressive rollout of the system to allow people to adjust and modify behaviour
• Funding to be made available to assist people to assess their current health status and be given support to modify their   choices
• Private health insurers adopt a system where health behaviours affect premium charges. Currently most use ONLY age as a premium penalty
• Programs to commence with part cost recovery where patients pay a proportion of the cost of care where clear links between behviour and the treated - illness are established. The self funded component could then increase over time.
• Patient contributions be capped in a safety net style of system
• A national register for identified lifestyle diseases is established
• An income threshold is used to ensure that the most disadvantaged in society never go without health care

The above are all just ideas and each has limitations and implementation complexities, some may even be downright impossible. The debate however must be commenced there is too much writing on the wall and it is all in Bold Print: We are heading for a national health calamity!

It is high time for Australians to accept some harsh realities. Ultimately obesity cannot be blamed on someone else or even the government. If you are obese and/or morbidly inactive IT IS YOUR FAULT. As harsh as that sounds it has advantages. At least when something is your fault it’s yours to control only when we stop blaming will true progress begin.

Nobody said it was going to be easy and nobody wants to victimise those who fall ill despite near faultless healthy behaviour which raises another compelling point: Why should the care/resources for sufferers of such cruel diseases as MS or the entire raft of auto-immune diseases (all of which have no current plausible lifestyle link) be diverted to people whose illnesses are self-inflicted? Surely we have the capacity as a nation to develop a system that is both fair and compassionate.

The solution to a looming crisis will take visionary thinking forward planning and real political courage. All politicians know that health costs are spiraling out of control. They also know (I hope) that a solution will require a generational shift in attitude and tapping in to the only thing that has any realistic chance of success…………The “Hip Pocket” strategy.

There is a need to act very soon on this issue delay will mean even harsher decisions in the future. Essentially I am floating the rather novel concept of accepting personal responsibility and seizing control. I don’t believe for a minute that most Australians will do this easily we have been spoilt for too long. I would love to believe that an appeal to the heart and common sense would bring the much-needed change, I know of course that an appeal to the wallet is our only real chance!

I'd be interested in your thoughts.

Brian Cooke