The emergency department is full, we don’t have enough beds for our elective patients, budgets are yet to be determined, and now we have an election.   Health, however, seems a largely irrelevant issue.  More important issues such as bathing attire and earlobes seem to have taken over.

It was reassuring that even in an election, work goes on, with former Prime Minister Kevin Rudd undergoing urgent gall bladder surgery in a private hospital, staying twice as long as the recommended public hospital stay for such surgery.

What have we to look forward to?   A Labor win sees a chaotic plan based on a 60:40 funding split, unclear responsibility for acute health care and a series of new health boards whether we need them or not.   Liberal Party victory would bring a resolute focus on private healthcare and little support for an ageing, overburdened public health system.

So what should our two aspirants for the Lodge consider?  Julia Gillard was Shadow Minister for Health and Tony Abbott was, in fact, Minister of Health.   Both are highly intelligent and well-informed politicians.   Both know the escalating cost of health care is currently believed to be unsustainable and hope some other leader will deal with it in the future.

The questions they need to answer are the three Rs, Rationing, responsibility and Reliability.   Our health system cannot afford to be all things to all people.   Services need to be rationed and rational.  The present trend in expenditure on health is unsustainable.   Health professionals cannot make the decisions on what the country can afford.   It falls to our elected representatives, who duck the issue on the grounds that to take it on is political suicide.

Part of the strategy to control health costs is to increase public awareness of responsibility for their own health.   Smoking, obesity and exercise are all areas that individuals can control.   Government should use a carrot and a stick to help influence behaviour.   Increased government support for obesity surgery seems to largely ignore the underlying problem.   Walking to school and improved school sports arrangements offer more chance of success than present TV advertisements in getting our children used to exercise.

Whatever treatments are offered by our health system, they need to be reliable and safe.  Government claims to be looking at this, yet does not fund data collection on most surgical procedures and their outcomes.   There is little point offering masses of elective surgery if it fails to achieve the desired outcome.   Reliability and appropriateness of interventions and treatments need careful monitoring.   Billions can be wasted on well performed, inappropriate interventions.

Whether Gillard or Abbott wins on August 21, I doubt either will take on the real issues in health.   Political leaders are obsessed with staying in power.   Given that they are only likely to stay two or, at most, three terms, why not look beyond their inevitable defeat and leave an enduring legacy rather than a transient moment in command.