Becoming Australian? Two different approaches to health care reform in the United States

Abstract

THE ?SUBSTANTIAL PRIVATE SECTOR?1 ROLE in Australian health care has sometimes given rise to fears of ?Americanisation? of the Australian health care system, particularly in the media. For example, in 2000 Kenneth Davidson wrote, ?The USstyle health financing route being taken by the Howard Government is mad and bad.?2 The US system is the ?leading example? of ?inferior system performance?3 and is often viewed as a system to be feared and avoided. Despite spending far more per capita than any other country on health care, the United States nonetheless fails to provide equitable health care for everyone. The system is ?a paradox of excess and deprivation?,4 spending far more than other systems without providing adequate care and treatment for all. Although the US system is seen as frightening in Australia, broad historical and political similarities such as the ?strong?5 role and ?long history?5 of private insurance and powerful, vocal physicians? groups1,5 make the Australian experience a useful comparative one for US policymakers. As Altman and Jackson note, the US system will probably not develop into a fully public system, but a system combining private and public aspects along the lines of the Australian model is possible.5 Furthermore, while politicians in the US at the state and local levels have attempted to address the issue of universal or near-universal coverage for some time, previous efforts sought to expand coverage using existing programs instead of establishing a new system.6 More recently, the state of Massachusetts and the county (municipality) of San Francisco have introduced near-universal health care programs. Although introduced nearly simultaneously, their development processes and structures differ. In addition, the Massachusetts plan in particular was viewed as a potential model for future sub-national and possibly national health reforms. Thus, this short paper examines the two plans as two different approaches to health care reform in the US and compares them to the Australian system, asking the question whether or not current reform efforts in the US make the system more like that in Australia, or are likely to do so in the future.