||Autonomy (Health Care -vs- Central Planning)
Dr Michael A. Reid
|The autonomy of individuals is one of the cornerstones of all democratic systems. Indeed the principles of autonomy are enshrined in the Constitutions of all democracies, to a greater or lesser extent. This enshrinement provides a legal protection for citizens against those who seek to transfer the balance of power away from the individual and toward the state.
Nevertheless, despite legal protections, there are a myriad of ways in which politicians and bureaucrats can undermine the primacy of the individual in a democracy. The Australian health care system provides one such example.
Australia’s "universal" health care system has a great deal to do with politics and the transference of power from the individual to the state and only a little to do with health care. Immediately prior to the introduction of Medicare, over twenty years ago, Australia had a very high standard health care system. The majority of citizens were covered by private health insurance, for both in and out patient expenses, and a high quality public hospital system was in existence. There were problems, to be sure, but overall the system worked well.
With the introduction of Medicare Australians abandoned a system of health care that was largely out of Government control for a system that was, even in its infancy, subject to a great deal of central control. As would be expected this central control has only increased. In the last generation, in contrast to all other sectors of the Australian economy, the health care sector has become increasingly bureaucratized and the health care market has become increasingly distorted. We now have a health care system that is determined by central planning and, in which, the state gathers and analyses an enormous volume of data on the health care of its citizens.
Moreover, the pace of transfer of power from the individual to the state is set to escalate. Schemes such as: "Managed Care" in private specialist practice; "Coordinated Care" in general practice and the "Accreditation" of private general practices will soon be the norm. These schemes are the next step in absolving the individual for taking any responsibility for his or her (or their children’s) health in favor of the state taking this responsibility.
At first blush it would seem inconceivable that the citizens of a democracy would allow the sate to take control of their health care, as has occurred in Australia. This change in the balance of power has, however, occurred in increments and with the benefit of the Government’s propaganda machine. Additionally, Australians have largely chosen to accept the government illusion that health care is "free".
Having successfully eroded the autonomy of Australian citizens via the vehicle of the health care system the bureaucratic classes have substantially enhanced their power. By co-operating with and extending such activity Australia’s freely elected politicians have abrogated their responsibility to be the leaders and guardians of our democracy.
** Dr Michael A. Reid runs the McLaren Vale Family Practice in South Australia and can be contacted at: