Opinion & Commentary
Future medicine only for those who help themselves
This not only points to ever-greater capacity constraints in public hospitals. It also points to modern medicine's ability to save us from ourselves - so long as we can access the advanced treatments available. If we eat hamburgers three times a day, open-heart surgeons can unclog our arteries. We can cheat a heart attack by taking cholesterol-reducing drugs, which we can wash down with a thickshake, if the mood takes us. And if obesity wears down our hips, they can be replaced.
Medical breakthroughs mean doctors will soon be able to do even more. High-tech innovations on the horizon will deliver new drugs and procedures to treat diseases linked to poor lifestyle - cancer, heart disease and diabetes.
But the problem is that the Australian population is ageing, as well as becoming more obese, and will contain triple the number of elderly people in the next 40 years. Big numbers of elderly people will want access through Medicare to expensive treatments able to alleviate chronic conditions. This is bad news for the shrinking proportion of PAYE taxpayers of tomorrow, who will have to pay tax at higher rates than current generations to sustain Medicare. However, in a globalised economy, governments simply won't be able to raise taxes high enough for all Australians to receive "free" access to all new medicine the sick will want.
The restrictions at Queen Elizabeth Hospital suggests treatment will increasingly be restricted based on people's behaviour.
Certain public hospitals in Britain have recently introduced "lifestyle" criteria to deny knee replacements and heart surgery to the obese. Smokers have also had their names removed from waiting lists because they are more difficult and more expensive to treat.
It is true doctors have always had the discretion to withhold treatment on clinical grounds. Doctors at Queen Elizabeth say ensuring the best patient outcomes is behind the new restrictions. But in Britain, the financial plight of the over-burdened National Health System has driven the moves to deny certain patients treatment. When ageing and new technology put the financial squeeze on old-fashioned health care financing systems such as Medicare, expect similar bans here.
Public hospitals will have to ration high-tech, high-cost procedures and draw distinctions between patients based on their personal habits. Medicare is not going to be there to care for the so-called "undeserving sick".
In a free society, we should have the right to live as we choose, even if we dig ourselves an early grave. But we can't really expect our rights to include "free" provision by government of all possible medical care, in every circumstance, which might save us from our self-inflicted fate.
Discriminating between the sick also means the government lecturing people about what they should and should not do. This also goes against the grain of a free society. But if most Australians continue to rely on government to finance their health care, it is government which will ultimately say who should not receive treatment. Lifestyle is shaping up as the key criterion to decide who deserves priority.
The bottom line is that access to certain treatment will increasingly depend on controlling our own health care. The undeserving sick are going to need an alternative to Medicare, such as private health insurance. Or maybe we need to consider medical savings accounts, which, a bit like the superannuation system, lets people save their own money to cover their medical expenses.
Dr Jeremy Sammut is a Research Fellow at Sydney-based The Centre for Independent Studies.
