The health system is a social indicator

The poor and powerless drink more, smoke more, practice preventive measures less and find it more difficult to understand what health professionals say. And yet the public system often takes the sickest, the most complicated and the most difficult - and the super specialised hospitals shine here.

What exists here is scarcely an indicator of a civil society. It is certainly not an indicator of a fair society. It is scarcely an indicator of a caring society.

The current unsatisfactory situation is compounded by old and creaking administrative arrangements between tiers of government - those arrangements persist when they should be changed as a matter of justice.

Those with control of budgets know that there are inequalities - inequalities between rich and poor, between powerful and powerless, between urban and remote Australians, between Aboriginal and non-Aboriginal Australians, just to mention some.

Decision makers live with these inequalities. They accept that some people cannot find beds. They accept that some people cannot access the amount of services requested for them. They accept that some people miss out on services - for example, and shamefully, the lack of residential care for aged people. They accept that some people get sub-optimal access, or care, or results. They do not provide a greater share of the tax cake to "health" services - partly because to do so would mean that some other area would have to receive less.

What is very disturbing is that our system is certainly better than the public healthcare system of the United States and probably better than the entire United Kingdom healthcare scheme. In the United States, there are few and poorer services for indigent people, and in the United Kingdom queues seem to be longer for almost everything.

That seems to tell us that the inequalities affect some countries emotionally less than they should. There was vicious opposition to a proposal from President Obama to extend more medical care to more people - morally bankrupt behaviour from the opponents.

The shortages of staff that exists in Australia, sits poorly beside press stories of properly qualified practitioners from (say) Canada being forced to do language tests and finding registration difficult in this country.

Our learned colleges are proud - and rightly so - about the high standards they set for anyone who would obtain one of their qualifications. But there is a disconnect between those high standards and the difficulties too many qualified people face to be allowed to practice at all.

There is no need for our colleges to reduce any standards, but there is no sense in the universities having some stranglehold over registration. It seems to me the recognition should be made easier and that the colleges should maintain high standards. Both are possible. The Australian polity would be better off with such a system.

Some of our work practices also need attention. For example, Australia's anaesthetics practice, where too little use seems to have been made of anaesthetic nurses.

Another is our failure to ensure the supply of enough physicists to care for all our radiotherapy machines. There will be marked shortages of people to do caring jobs in the decades ahead - we know now where the shortages will be and what they will be - and we are doing too little to plan now to meet those shortages. Such shortages are due, in part, to a rapidly ageing society.