Health+Care+Politics+-+who's+on+top+down+under

Name: Anita Pelecanos Student Number: n8103038 Tutor: Abbey Hamiltion-Diaz

**Cultural Artefact** [|Gerry Rafferty and Joe Egan "Stuck in the Middle with You"] The chosen artefact is a song called 'Stuck in the Middle With You" written by guitarist Gerry Rafferty, and keyboard player Joe Eagan, the two members of a band called Stealers Wheel. Gerry Rafferty and Joe Egan released this song in 1972 (Rafferty & Egan, 1972). The lyrics of this song support the meaning inferred by the title about being caught in the middle. The inferences are up to individual interpretation based on their audiences’ experiences of life, as there are little reliable explanations available. The resounding lyrics, "Clowns to the left of me, jokers to the right, here I am, stuck in the middle with you" suggest that the views of the songwriter are that he (along with someone else) are caught between two different nonsensical groups of entertainers and fools. The subliminal message of the pop sound exudes a somewhat comedic/light-hearted aspect to the song.

**Public Health Issue** The debate about the Australian public health care system’s structure has raged and policies have oscillated from a conservative leanings towards a user-pays policy, to the introduction under the Labor government of Medibank and Medicare (universal public-funded health insurance scheme) through to levies for non-private health users resulting in tax payers’ movement to private health insurance and various other modifications (Hilless & Healy, 2001). With the continuing changes in health care system policies, it is difficult for the average Australian to gauge which system work more efficiently and to where to place their trust in the ideologies of political parties. The artefact mirrors this confusion as to which health care direction to gravitate towards in terms of a left or right wing political approach. This essay will report on the potential health outcomes of Australians, the relevance of the various political party schemes and their effect on health status with a focus on the Medicare system, social predictors of health and those affected by policy changes. A final remark on how this all relates to the above artefact and how this has broadened my views for future learning will be discussed.

**Literature Review** Winslow (1920) states that public health is 'the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts'. Having a health care system that allows for this is imperative for the health of the population. For the 2007 to 2008 period, Australia's health expenditure was $103.6 billion dollars, with 70% of this funded by governments (state and federal). The life expectancy of Australians at birth was approximately 84 years for females and 79 years for males, which is steadily increasing (Australian Institute of Health and Welfare, 2010). The 2009 standardised death rate per 100 people was 5.7 (Australian Bureau of Statistics, 2010). As at 2003, the disability adjusted life years (DALY, a measure of the overall burden of disease) per 1000 people was 132.4 (Begg, Vos, Barker, Stanley, & Lopez, 2008). Reducing this burden is a priority for governments, as well as providing health care systems to cope with this burden. As Australia's population increases, it places a burden on health care services. The total health expenditure per person was $5221 in 2009, an increase from previous years (when adjusted for the GDP). In the same year, the number of Medicare services processed per person averaged 13.4, augmenting almost every year since 2000 (10.9 services processed). The percentage of those holding private health insurance was 44.4%, remaining steady for the previous six years (Australian Bureau of Statistics, 2011). In Australia, financing health policies (involving the Commonwealth and state governments) expends approximately 9 percent of Gross Domestic Product (GDP), which is a significant cost and increase from previous years (Australian Bureau of Statistics, 2011). An important variable in determining government spending is the cost to benefit ratio, whereby if the benefit outweighs the cost compared to other sectors it is worthwhile spending the money (Duckett, 2007, p. 37). Thus, achieving an ideal balance between health care system expenditure and population health equity and outcomes is critical to government policy. Opinions upon which policy is developed vary between political parties. In the current Australian political regime, the Labor party (traditionally a left wing social democratic group) abdicates for further funding for hospitals and universal provision of health care (Australian Labor, 2011). However, they are more conservative than the Greens party which campaigns for universal public health system (through implementing progressive taxation) and the abolition of private health care (The Greens, 2011). Marxism would follow a similar principle; socialism would be created regardless of the will of the people (Muravchik, 2002). Contrary to this, the Liberal party (conservatives) believes in the retention of full private health insurance rebates for all Australians to remove the burden on the public health system, extend private sector and individual initiative (that is not interfere/compete with private industry) and provide incentives for responsible citizens as opposed to taxation penalties (Liberal, 2011). Concrete evidence supporting a particular political system that provides superior health outcomes for the population is limited (Navarro, 2008; Navarro et al., 2006). The few documented studies have achieved a general consensus of results. Navarro et al. (2003) examined the time periods governed by social democratic, Christian democratic and conservative liberal parties of several countries from 1950-1998. Countries with redistributive policies (for example, social democrats) fared better in reducing inequalities and infant mortality. Espelt's et al. (2008) study supported this notion through a cross-sectional study of systems and populations in various European countries. For countries in Europe, it was advantageous to population health to retain political parties with redistributive policies (Navarro, 2006; Navarro, 2008). The evidence suggests redistributive policies are associated with lower infant mortality and higher life expectancies. Those with redistributive polices are generally social democrats while liberals are traditionally individualistic. However, many liberal countries still provide universal health care, such as the United Kingdom (Navarro et al., 2006). Public health seems to profit from universal social schemes (commonly found in Nordic countries) as opposed to means-tested schemes, since they are intended for the overall population, with both the poor and middle classes benefitting (Lundberg, 2008). However, swinging too far to the political left has it disadvantages. Intense socialist countries transitioning to democracy have avoided mortality predicaments and those against communism’s restoration have healthier lifestyles than those who are pro-communism (Cockerham, Hinote, Cockerham & Abbott, 2005). In Australia, there have been seven reform attempts since the first introduction of Medibank in 1975. This system and the current system were/are a hybrid system’s blend of the UK's public National Health Service (NHS) and the private, insurance based USA system (McLachlan, 2010). However, private providers in Australia are tightly regulated (similar to that of the Netherlands). Traditionally, the government has sought to achieve an equilibrium between public, private and patient out-of-pocket expenses with the shift of balance changing back and forth between Labor and coalition parties’ policies (Tuohy, Flood & Stabile, 2004). Achieving a balance between public and private health insurance is imperative for economical sustainability, which is now the challenge for governments (Boxall, 2010). Australians tend to distrust private providers as opposed to Medicare and are leaning strongly towards a public system. However, the extreme cost burden of publicly funded schemes has governments encouraging Australians to acquire private health insurance (Hardie & Critchely, 2008). However, a comparison of UK (universal public cover), Netherlands, Canada, Australia, New Zealand (a mix of public, private and patient funded schemes) and the USA (individual responsibility and some employer sponsored schemes) demonstrated that the USA has the greatest issues with cost-related barriers to primary care (Schoen et al., 2007). Some have suggested that politics and policies are not that detrimental to health improvement for Australia (Boxall & Short, 2006). As the health status of a country is influenced through multiple factors, it is difficult to pinpoint if a government’s health legislation is truly a predictor of health outcomes. Therefore, caution should be taken against simplistic views that ascribe political schemes directly to outcomes (Tapia Granados, 2010, p. 849).

**Cultural and Social analysis** The WHO states that 'the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being...' (WHO, 2011). In other words, health is defined as a right, not a privilage. Given this, one could conclude that every person should be able to have equal access to health services to achieve a high level of health. However, in Australia there are still disparities across cultures and economic status. Social, economic and cultural indicators are the major determinants of health (Bambra, Fox & Scott-Samuel, 2005). The health of the nation is not evenly distributed throughout the population. Those of lower socioeconomic status have higher incidences of long-term illnesses and shorter life spans compared with the general population. People in rural or remote areas also did not fare better with higher age-standardised mortality rates than those living in urban areas (Duckett, 2007, p. 28; Australian Institute of Health and Welfare, 2010). Those with disabilities, prisoners and Indigneous people also tend to have worse health outcomes than the general population (Australian Institute of Health and Welfare, 2010). Medicare does provide an equitable distribution of access to health care, but those of lower income are not likely to see the same doctor or be allocated to the same hospital bed as those of higher income (Doorslaer, Clarke, Savage & Hall, 2008). Front-end fees may discourage lower income patients seeking the care they need (Blendon et al., 2002). In a study of factors that influence health outcomes of older adults, education, income-to-poverty ratio and access financial support were important predictors of subjective health (Deshpande, Daugherty & Grundersen, 2008). Medical access policies are also central to health outcomes (Wisdom, Berlin & Lapidus, 2005). Marxists argue that capitalism breeds class division. This system regards health as a commodity to be traded as opposed to a human right. Those of lower socioeconomic status generally have more difficulty affording care than those of a higher status. Under the Australian system, the individualistic nature of capitalism and (therefore the Liberals) lends itself to those of the working class having to solely depend on the public health system for their health needs; a consequence of this being long waiting periods for non-life threatening surgery. Given that the majority of Australia's population are the proletariat (workers) and the small minority are the bourgeoisie (ruling class), from a public health view, designing a system to benefit the overall population would inexplicably concentrate on serving the needs of the majority (that is, the proletariat) (Gray, 2006, p. 33). This supports the notion for a universal health system, which would benefit those of a lower socioeconomic status. Those who would benefit from a socialist democracy (Labor) would be those of lower socio-economic class who traditionally would not have access to primary health services if it weren't for the publicly funded universal scheme Medicare (Veugelers & Yip, 2003). In an ideal world, everyone would be able to have access to health care without social inequity. However, the choice of health care system depends on many factors including the physical environment, historical and situational events, cultural values and the structure of society (Weiss & Lonnquist, 2009, p. 374). Responsibility distribution at government levels, voter views and the private health industries are important determinants of health resource allocation (Fox, 2006). Private industry stands to lose from a move towards a universal health care system. Policies are affected by what is economically fortuitous (Bambra et al., 2005). The liberal party ideology argues that to produce a universal system, a more aggressive tax system would be required and would result in a tax-payer protest (Paton, 1997).

**Artefact Analysis and Learning Reflections** The song 'Stuck in the middle with you' by Stealers Wheel, in reference to health politics, represents peoples’ struggle to know which political party would best serve their health needs and feel they have little choice between the major players of politics and victims of policies. The lyrics, 'Clowns to the left of me, jokers to the right' characterises the public's perception of politicians as being somewhat comical, insane and distrusted with respect to competency in the minister’s health portfolio and the benefits or lack of benefits of government’s policy decisions. Presenting this idea with some cynicism, people feel they have limited options of 'crazy' political party A, 'bewildered' party B or 'daft' party C and many people feel they are on the outer or ‘in the middle’ as the song so aptly infers. However, if there is evidence of a correct, fairway of implementing the health care system, then why are there inconsistent political party stances on this issue? Is it that there is a large gap between the evidence-based research and policy makers (Waddell, 2006) or is there no clear path? The literature and sociological analysis above suggests that a left of centre wing approach, such as that traditionally provided by the Labor party, provides a system with some protection for everyone from those of a lower socioeconomic status (through Medicare to provide better health outcomes of the population), to those who are given health incentives to preserve private providers ,thus minimising unsustainable spending. This assessment has taught me that there are many complex facets regarding political health policies and their affect on health outcomes. One should be wary about making assumptions as to whether the philosophies and policies of a Labor, Liberal, Greens or Marxist approach would work better; as the song says 'stuck in the middle'. It has also highlighted the social inequities in and the political impacts on the health system. For my future learning and reference, I shall not take things at 'face value' and shall endeavour to understand that in-depth research is important to uncovering the underlying themes.

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**Discussion Posts** 'Sport and Feminity Do Not Mix,' says who? Well done! This artefact really demonstrates the way women are materialised in the sporting arena. It is not often you see males in sport portrayed in this light. A good case in point (not mentioned in the essay) are the uniform rules for beach volleyball; men being able to wear shorts and a singlet while women are confined to either bikinis or high cut full-piece swimmers. You highlighted some good points such sport being associated with masculinity and physical strength and that there is a lack of representation of women in sport. The fact that employment in recreational sport is dominated by males and women are often found in the supportive roles is alarming. It may be important to note that this gender inequality may not only be found in the sporting field but in other social circles such as in the workplace.

'You are what you buy' - implications of Gen Y's consumerist behaviour This artefact is a good example of youth materialism. It is worrying that extreme cases like this exist. You have raised an important issue of the role that consumerism and individualism plays in the mental health decline of youth. The power that the media has in controlling this was a valuable point. The fact that it is also linked with identity is an interesting issue. Jean Baudrillard’s view on purchasing items based on their sign value to portray social values and class helps to explain this. Further research into how it exactly influences and manifests into the decline of youth mental health would be an interesting area of focus. Nice work!