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The context for reform

1st Paragraph


"Satisfaction and Affordability"


Criticism Number 3

Samuel uses increasing "demand", declining satisfaction and, declining affordability to justify a market system. Neither argument is valid.

Declining Satisfaction

There is increasing dissatisfaction with health care. This is greatest in market-based systems and when marketplace systems replace state funded ones. In government run systems the main complaint is about a failure to properly fund health care. There is a perception that this, the most equitable and the cheapest system for providing care is being run down for ideological reasons.

CLICK HERE -- for more information about declining satisfaction.

Declining Affordability


Different Health Systems: - The response of different systems of providing care to the problem of affordability is critical to an understanding of the implications of marketplace solutions.

In Australia we think about private and public medicine. In our thinking we do not distinguish "for profit" health care from "not for profit" care provided by church and community groups. We also do not distinguish privately owned for profit systems from health care provided by market listed for profit companies. There are major and important differences between these groups which impact on the way care is provided and the consequences for citizens who use private services.

Public and not for profit systems are both intent on maximising services to the community within the limits of available funds. The primary concern is funding and this is the primary limit on care. In for profit systems the primary concern is profit. Care is limited by the necessity for profit and the competitive demands of the marketplace.

In developed nations the problems in care and affordability parallel the profit pressures in the various systems. The problems for care and affordability are most acute in the market listed companies. The prime and often only objective of groups entering the health care marketplace is to make profits from the sickness of others for the benefit of shareholders. The responsibility of the system is shifted from patients to shareholders. Commercial rhetoric and a plausible facade conveniently blur the ethical and moral implications. For profit systems are demonstrably the most costly and least affordable.

CLICK HERE -- to learn more about the development of different types of health systems.

CLICK HERE -- to go directly to the way different health systems operate and the profit pressures they face.


Declining care: - The information from the marketplace reveals deceptive marketing and misinformation, the widespread denial of care, misuse of patients for profit, and neglect of the frail and vulnerable. All this occurred at a time when large profits were being earned. It is not the lack of money that has given rise to these problems but the insatiable demand of the sharemarket for profit.

Not for profit facilities in contrast have maintained much better standards of care. During the PACMAN years they were unable to compete with powerful and aggressive corporate competition. Corporate chains purchased many of them. When money became tight corporate chains collapsed and government has been forced to rescue them. The not for profit facilities have proved to be more financially stable. They have continued to provide good care even when money was tight.

CLICK HERE -- for more information about what has happened to patients


The stability of the Health System: - Australia is currently experiencing a time of national economic well being. Even though the benefits are very uneven there is enough money to care for our citizens and to provide profits. Important to any consideration of affordability is an examination of how the system will respond when profits fall or when money is genuinely tight and rationing is required. The track record of corporations shows very clearly that they will respond in the interests of their shareholders and not of the community or the patients. If this happens care will be seriously compromised.

Samuel talks of "declining affordability" and "demand" in the same sentence. If we have concerns about affordability then demanded services may compete with needed services and in a market system demands will be met at the expense of needs. We must understand what we are talking about.

CLICK HERE -- to examine corporate stability, affordability and demand.

Samuel's Model - Satisfaction and Affordability

Samuel's claims of increasing costs due to technology and an aging population are valid. I have not studied the figures but am aware that others who have studied this believe that the claims are exaggerated.

The claim that we cannot afford to properly care for the needs of our citizens must be examined in context. The countries which are complaining most about affordability, and which are advocating market reform as a more affordable system are undergoing an economic boom. They have never been so wealthy and they have never been better equipped to provide adequate care to those who need it. The market systems, which they support, have been the most costly systems. Despite the much greater expenditure overall health in these countries has been inferior to that in other developed nations. Many citizens are unable to afford the sort of care available to everyone in more civil societies. In these countries big corporations have made billions of dollars profit from health care, profit which might have gone to providing better and more equitable care.

It is clear that market systems are much more costly than other systems yet these systems are being pressed on developing countries which genuinely do not have the money to pay for the care their citizens need. Under a market system it is multinationals from the wealthy countries which will be paid to provide whatever care is given. They will expect profits for their distant shareholders. Is this self interest or simply blind ideology?

The Context for Examining Samuel's Model

In this page and the links to it I have provided an understanding of the nature of the different systems of care, a description of market practices and market forces, and the importance of profit and decisions in the boardroom in determining care. This sets the context for my analysis of Samuel's model.

It is not only the similarity of concept in Samuel's model to the US system which is important but the way in which the same forces which he advocates have operated in similar situations in the US marketplace.

Samuel lays great emphasis on contracts, regulation and surveillance. None of these have worked effectively in the marketplace in the USA or Australia. We need to ask why they have failed.

CLICK HERE -- to proceed to the next criticism - Number 4

CLICK HERE -- to go to the next section of Samuel's speech.

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This page created April 2000 by Michael Wynne