Universal healthcare is a privilege and a right that we must protect to ensure the healthy future of Australia. As medical students and doctors, we are more than simply practitioners of medicine. We hold more responsibility than solely the management of disease. A key responsibility of our profession is advocacy for the health of our patients, the health of our nation, and the protection of our public health system.

The recent election has highlighted the fragility of our public health funding, and the willingness of both sides of politics to use Medicare and public healthcare as a political tool to serve their own agenda. This short-term and selfish thinking has the potential to abolish equal and fair access to healthcare; this is something that is, and should continue to be, a universal right for every Australian. The opportunity to live a long and healthy life should not be decided by our wealth. As it stands, the health gap between those from upper and lower socioeconomic backgrounds is significant [1]. The ramifications of freezing or removing funding to Medicare and public healthcare will be widespread. The current policy of a “freeze” on Medicare will increase out-of-pocket costs to all patients, impacting patients from lower socioeconomic backgrounds significantly. The effect of this freeze will be two-fold, with the added effect of increased practice costs in areas where patients cannot afford to pay out-of-pocket fees [2]. In turn, this will impact practice viability, and in lower socioeconomic areas, some practices may be forced to close, leaving vulnerable groups with limited access to healthcare [2].

The result of increased out-of-pocket fees will be an increasingly privatised healthcare system, and one does not need to look far to see the detrimental effect of such a system. In America, the healthcare system screams of inequality. It is a system where doctors are often placed in tremendously difficult situations, and are often left with no option but to turn away patients who are unable to afford healthcare [3]. America has a per capita healthcare expenditure that far exceeds that of other developed nations, however, public spending only covers 34% of residents in the United States, compared to every resident in Australia and the UK [4]. What is most damning about these statistics is that despite exorbitant healthcare expenditure, predominantly at a cost to patients or their insurers, the life expectancy American citizens languishes at 31^st in the world, well below that of Australia, which is ranked fifth [5]. But that is not where the inequality stops. The privatised, self-funded system in America also stakes claim to the highest infant mortality rate amongst all developed nations, and a higher prevalence of chronic disease than that in developed nations with a universal public healthcare system [4]. If we are to preserve the health of Australians, we must take on the responsibility to advocate for healthcare as a universal right for all Australians.

In the lead up to, and in the days following the recent election, the Australian Medical Association (AMA) and the Royal Australian College of General Practitioners (RACGP) have been highly outspoken regarding their concerns about the inequality of funding cuts to Medicare. This advocacy, along with campaign material centred on Medicare, led to a strong response from the Australian public at the election, making it evident that Australians value free universal healthcare. However, this has not led to a response from parliament about the freeze on Medicare funding. Without a change in this policy, 57% of GPs have said they will increase out-of-pocket expenses, and 30% have said they will stop bulk billing [2]. This will directly affect patient access to healthcare, and has the potential to have a detrimental impact on Australian health outcomes, similar to health outcomes seen in America. As medical students and doctors, we are on the frontline of these changes, and it is our responsibility to protect our universal healthcare system. It is an issue that needs all of our support.

As a highly educated and privileged group, we need to ensure that governments understand the ramifications of cutting funding to Medicare and public healthcare. Universal healthcare needs to remain a priority in Australia and a right for all Australians, young and old. The health of our nation reflects the spirit of our nation, and it is the role of all medical professionals to advocate for equality in healthcare. Our advocacy need not make headlines in newspapers or fill prime-time television slots. Through simple conversation we can raise awareness about the importance of universal healthcare. It is our role to ensure that Medicare and public healthcare remains a priority, not just for the next election cycle, but for the long-term, so that future generations of Australians can enjoy long, prosperous, and healthy lives, just like the Australians of today.

Conflicts of interest

None declared.

References

 [1]       World Health Organisation. Health Impact Assessment: The determinants of health [Internet]. World Health Organisation; 2016. Available from: http://www.who.int/hia/evidence/doh/en/index1.html.

[2]       RACGP. Antifreeze campaign – fact sheet for GPs and practices [Internet]. RACGP; 2015. Available from: http://www.racgp.org.au/download/Documents/News/Antifreeze-information-sheet-GPs-and-practices.pdf.

[3]       Weiner S. I can’t afford that!: Dilemmas in the care of the uninsured and underinsured. J Gen Intern Med. 2001 Jun;16(6):412–8.

[4]       Squires D, Anderson C. U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. The Commonwealth Fund; 2015.

[5]       World Health Organisation. Life expectancy 2015 [Internet]. World Health Organisation; 2015. Available from: http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/.