Tuesday, April 08, 2008

Cry Havoc

Most countries in our peer group got rid of private armies a long time ago. Instead, the government decides how many soldiers the country needs. It decides how much they are going to be paid. It decides where they should be stationed, and how many, and sends them there. This seems to work.

We also have a government-run system for internal security. The government decides how many police we need, how much to pay them, and where to put them. This also seems to work.

In our country, we have a system of public schools which is run along similar lines. The government decides where we should put schools, decides how much the people who work in them should be paid, and distributes teachers to schools where they are needed. This seems to work reasonably well. It would work better if the government were not simultaneously supporting a parallel private sector system with a massive system of inequitable subsidies. But still, you never read about the schools in Wilcannia, for instance, going under because they can’t find teachers.

So what is the problem with rural doctors? If we are going to have medicine controlled by the public sector, then let’s have medicine controlled by the public sector. We shouldn’t have to put up with a private army of health care mercenaries when we could have a professional service. Why can’t the government just decide how many doctors the country needs? Decide how much they are going to be paid? Decide where to put them? And send them there? Why wouldn’t this work? Sure, there might be some leakage to the private sector, just as there is with schools, but I don’t see why this should be a big problem. Public sector GPs could have rostered days off. They could work reasonable hours. They wouldn’t have to worry about paying enormous insurance bills. I’ve heard the argument that doctors would all go overseas if we tried this, but that would only prove we were training the wrong people to be doctors. People motivated solely by greed, with no true calling to public service. After all, our army isn’t haemorrhaging people going overseas to join private armies. Our police force isn’t decamping en masse to serve in Sweden. Even our public school teachers seem to be staying in the country, by and large.

You'd think this would be the right time, with a 70+% approval rating and a bulging surplus, for a Labor prime minister to take on the AMA. Time to start putting together a professional public health service as world-class as our professional public armed services. I will keep myself in readiness to read all about it in the papers!


Dave said...

I agree with everything except the too-optimistic sentiment of the last sentence :)

Marco said...

I have a few nuances to put forward that don't really counter the main thrust of your argument.

1)There is some bleeding of trained soldiers to private overseas "armies" (security outfits in Iraq etc). This is likely to get worse in the future, but in general, patriotism is very high among this lot.

2)Looking at my base model of public vs private, health policy needs an overhaul, and some "deployment" of doctors will be ideal.

Long term needs such as preventative medicine, health education, health infrastructure and emergency units would be better public and deployable. A military unit for natural disasters could be enlarged and deployed all over the place at other times.

Most short term needs, such as palliative care, respite, most elective surgery, cosmetic surgery, drug manufacture should be private.

Marco said...

In short, I am optimistic that there will be an expansion of the defence medical staff, that they will be routinely deployed where there is a shortfall, at times when there is no other urgent need. Elective surgery will continue to be a private matter, and will become more and more efficient and responsive to customer requirements and desires. people can just cry to the moon about public waiting lists. If it is important enough, begging and borrowing to appropriate departments should pay dividends.