Listening for meaning: consumer voice in a system built on value

We talk a lot about value in healthcare: in policies, in funding models, in reform agendas. But meaning comes up less often. And when it does, it is usually in passing, as if it is soft, sentimental, or optional. In the real world though, not in policy documents, meaning shows up in quiet, vital ways: especially when life becomes unaffordable. I think it is time we treated meaning as foundational.

We seemed to discover a cost-of-living crisis only when it began affecting middle Australia, and more specifically, swinging voters. All at once, governments started scrambling to respond. They rolled out measures built on the assumption of a level playing field and a shared ability to access healthcare.

These responses are often shaped around the needs of people who are white, cis, English-speaking and middle-class. These are the same people who are more likely to know how to navigate systems, ask the right questions, and absorb out-of-pocket costs. For them, this support might even be enough; indeed, the healthcare system may be serving them well right now.

But for others – including people managing chronic illness or disability, people who face racism, or those navigating insecure housing – these so-called universal measures feel distant. Promises made in press releases rarely land perfectly to applause in clinics or waiting rooms. Right now, in some communities, essential healthcare is already out of reach. Affordability just makes the gap wider.

There is something quietly frustrating, almost absurd, about watching the same systems that allowed inequality to deepen now reach for one-size-fits-all solutions. Such an approach treats historical, and often structural, exclusion as something a new policy can simply erase.

The healthcare system, for all its good intentions, often repeats the habit of offering universal answers to unequal realities. It listens more attentively to industry than to the people who rely on it. It rewards those already inside the tent, those with titles, access, reputations and networks. Just outside that circle, consumer voices wait to be asked. They wait to be legitimised. They wait to be welcomed.

If the healthcare system was a person and they paused to listen to me, here is what I would say. This is not your money, it is public money. You spend taxpayers’ contributions, including from the very people who find themselves unable to access care, and yet you treat those people as if they must first earn the right to be heard. Meanwhile, those who profit from the system are consulted as a matter of course. Perhaps you are afraid of what people might say if you really asked what they need. Ask anyway.

Consumer voice is not one voice. It is layered. And it is not just about filling out the feedback form. At the individual level, it is about people feeling safe enough to speak and confident enough to decide. Locally, it is about consumers helping shape services that reflect their community, not just a funding model. At the national level, it is about power: sitting at the table where policies are shaped and structures are debated. In all of these places, consumer input should be seen not as an optional extra but as essential architecture. It needs to be built in, not bolted on. The voice of lived experience is not lesser than professional expertise. It is the most important perspective of all.

Health remains one of the few public systems where power is rarely questioned. That power is layered – professional, cultural, financial and symbolic. It brings recognition, influence, prestige and protection. For some, even small steps toward equity might feel threatening. Sharing decision-making or redistributing resources may seem like a risk, especially if your ambition, role, identity or status is built on having more power, not less. That is how tightly power has been held, and how much change might feel like loss to some.

In that context, value-based care is often introduced as a solution. It may well offer improvements, for some. But it begins from an assumption that the core problem is efficiency rather than access. When consumers say ‘any care is better than no care,’ they are not asking for value. They are asking for visibility. They want care that is safe, timely, respectful and possible. For many, value is a conversation you can only have once you have made it through the front door. Until then, being seen is the starting point.

There is a hopeful thread within value-based care: by delivering better outcomes more efficiently, reform could free up resources to invest in equitable solutions. But this outcome is not guaranteed. Unless consumers are meaningfully involved in deciding how those resources are reinvested, especially those most affected by inequity, the system risks repeating old patterns in new clothes. Value can only serve justice when it is shaped by those who have lived without it.

There is much important work being done on value. But I want to highlight meaning. About what it feels like to be turned away from support because your condition does not meet the threshold. About what it means to skip appointments because the bus fare competes with the cost of medicine. About the meaning of justice, trust and care in a system that too often speaks about people instead of with them.

Before we chase value, we need to sit for a while with meaning.