Here is an example of public medicine I have recently experienced. I have worked for 20 years in the public system and fled to a more efficient domain; private practice where I see normal Australians. Under Medicare, all patients have a large moiety of their fees paid but they may pay a "gap" as one could not survive on the government fee only. The majority of the population as happy to do this. My funeral director does not have Deadicare nor my baker Breadicare although death and bread are essential services.
My wife and I joined up with ATSICHS (Australian and Torres Strait Islander Health Service) which is funded by the Federal Government) in 2011 with great expectations. We are both specialists with altruistic leanings and a desire to do some good to the disadvantaged and marginalised in society. We went to a very disadvantaged outer city suburb as our specialties were in need.
After four months she resigned as she had only been sent two patients in four months in two separate "working class" [I dislike this term but it is here as short-hand] outer suburb ATSICHS clinics. She was a great loss as she had worked in aboriginal settlements in the gulf country as a young doctor. She is a kind and empathic doctor. It was all too much for her. She was very disappointed
I continued on not having seen a patient in the first four months. They said there were some "administrative problems." I wrote my monthly reports and fed back to senior management.
After six months of my continual pleading they finally gave me a password so I could use Medical Director like all the GPs in the clinic so I could access results.
The administrative incompetence of the clinic was appalling. I run a tight ship in my own private clinic. I would sometimes have less than half the patients on my list turn up although a bus was especially sent to pick them up from their homes and the service was free.
The appointment system did not work and there were referrals missing and things not filled out in time that I needed. I'd arrive to be met by staff only to be told that they were not expecting me. I was lucky if I saw three or four review patients in four hours. This would normally take me one hour in my private practice.
I used to put aside a whole day for the clinic. I am a busy specialist in private practice. I even took medical students with me as I teach them all with great expectations. Half the time we were idle. I felt embarrassed.
I kept writing reports to the administrators explaining the problems. I think they thought I was the problem but I knew that other specialists had left the clinic too.
After seven months, when at the clinic I was told by one of the GPs there that she could not get any patients in to see me as I was booked out. I later checked the computer booking list to find I had two patients booked in to see me. I finally resigned. I was appalled. How many times did I have to beat my head against a brick wall?
There was no camaraderie with the GPs there as I had hoped. They just sat in their rooms and largely ignored me. It was a mess. I walked away from this clinic having giving it seven months and at a significant financial loss. I had established liaison with the local hospital and was hoping something good could happen.
The AMA does not hear this side of the indigenous story and probably does not want to either as the hype of the successes is all they want to know. I had thought of doing more work of this nature even in the bush but am dissuaded from being involved any more. I was burdened by its incompetence and how the service of the specialist was not valued. Indeed the support money paid to me was squandered.
Public medicine does not always work. Public services often fail to be constrained by the need for efficiency, accountability and innovation. Imagine the Australian mining boom being run by government. Indeed the main problem was inefficient infrastructure eg trains and ports. This has been solved by selling trains and port facilities to private enterprise to make them efficient. QRAIL has become private and is listed on the stock market.
I think that government run institutions tend to get bogged down. Imagine Apple being run by the NHS or for that matter the Department of Telecommunications and Primary Industry; the latter to administer apple orchards and then the Department of Excise, Gaming and Liquor Licences for the ancilliary cider production. We could go on.....