Thursday, January 31, 2008

Building Pressure - and other beasts of burden

New reports today point to another legacy from the Howard Decade: Private Health funding from government has accelerated relative to Public funding -

"The figures show in the last decade, average annual spending on private hospitals has risen by 25 per cent, opposed to less than eight per cent on the public system. Ms Power from the Health Care and Hospitals Association says over the same decade demand on the public sector has increased by 25 per cent.

PRUE POWER: We have a situation where public hospitals, who are responsible for pretty much all the emergency care in Australia and for a lot of the complex medical and surgical care in Australia, have been sucked dry of funding." [link]

Leaving aside, for a moment, the question of whether or not this shift is a sign of an increasingly stratified society or one of a much-needed movement into market-based decisions, what I find interesting is the language used to explain, describe and even narrate this shift.

One common phrase is 'taking pressure off the public health system'. This is related to the concept-phrase of 'burden'. Who or what is un-burdened when public-funding is redirected into the private health industry? What sort of system or institution might be de-pressurized by this redirection?

"JOE HOCKEY: By strengthening the private hospital system, the Government has been able to take some of the pressure off the public system. But under the Howard government, health funding grew from $19.5 billion to almost $52 billion last year, a massive increase.


The head of the Australian Medical Association, Doctor Rosanna Capolingua says increasing private spending is good for public hospitals.

CAPOLINGUA: Thank goodness that private hospital support by government has been increasing. The private sector in health has been providing an enormous amount of care to patients. The (inaudible) of delivery of care in the private sector is absolutely crucial because it helps to take the burden off the public sector.

SAMANTHA HAWLEY: Is the AMA finding, that the cause of this increase in funding that the private sector is receiving, that the pressure on the public system has reduced?

CAPOLINGUA: We have had a significant increase, almost doubling in private health insurance take up rates in Australia in the last ten years or so. If we didn't have that, then the burden on the public sector would be far greater than it is now." [link]

It's clear that re-directing a flow of public funding from public to private hospitals acts on Demand: the injured and ill once would have gone to the Royal X, but now are admitted to St. Z. Less demand directed at the public sector, more resources (human, medical, beds, urgency) that are thereby freed up and ready for those who can't afford private health insurance. Sounds very reasonable and prudent.

Yet, there are some hitches here and it's at the semantic level that the nature of these problems become both muddier and disturbing.

Consider: if someone ill or injured takes a bed at a private hospital for surgery, they are, according to the logic of pressures, releasing the sorts of pressures that oppress the poorer members of our communities. It's a short step in this chain of argument to attribute the use of private health insurance to altruism: we help the poor and needy (by helping ourselves - Adam Smith 101).

But if we private health insurees-users are altruistic, releasing pressure from the op-pressed, then according to this rationality, this form of reasoning, how should we characterise the sick and ill who have no choice but to use the public hospital system?
We are altruistic, they are . . . under pressure . . . or a form of pressure?

We release pressure - they build it up.
We are lessening the burden on the public health system - they are . . . a burden.

What must it feel like to be told that what you do amounts to pressure and burdens? It's enough to make you want to re-form yourself, to govern yourself better to be more flexible and lighter (because burdens and pressures have weight). But where do these much-demanded qualities of flexibility and lightness come from? Can we choose or learn them?

To go back for a moment and consider the other phrase used in this news report from Prue Power:

public hospitals . . . have been sucked dry of funding

Is this sucking dry how the burden is being lifted and pressure released? The altruism of the private-health insuree-user sours once their action is characterised as sucking dry.


We might be in need here of some help from late-1970s Rolling Stones:

I'll never be your beast of burden; My back is broad but it's a hurting; All I want is for you to make love to me; I'll never be your beast of burden; I've walked for miles my feet are hurting; All I want is for you to make love to me

We are perhaps the beasts of burden - our bodies fall apart, disease strikes, accidents happen, violence continues - who need healing, who need the care of the doctors, orderlies, nurses and administrators of the public and private health systems. But if the public hospitals are where those who are most burdened walk for miles to get to, then it follows that the burdening of public hospitals is what always happens at these places of healing and care. They are always subject to burdens and pressure - and transferring government wealth into the less burdened, less pressurized, private hospitals, actually exacerbates the state of our public hospitals.

Over at Public Opinion Gary Sauer-Thompson asks for data across state systems - both public and private - that would permit real comparisons.
[Photo is of Lake Burley Griffin - Canberra, Australia]

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