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.