Healthcare: is it a right or a luxury? | Tarik Sammour | TEDxAdelaide

[Music] I'm here today to ask you all to ask yourselves is healthcare a right or a luxury it's a vitally important question but before you respond allow me to challenge you a little I'll start with a story in 2015 I was offered an opportunity to spend a year training in one of the world's best cancer hospitals in the US this was a huge privilege for me and I was really excited to go the only strange thing was when I was filling out my starting paperwork for the job I was being asked questions like did my

two young kids have any pre-existing illnesses I was also informed that even if they were completely medically well I still had to pay about $25,000 a year in health insurance or I wouldn't be permitted to work there $25,000 now myself being the product of a more socialized public system here in Australia and New Zealand this was a foreign concept to me it was a little scary in fact the idea that children may not get medically treated if they didn't have the right health insurance organised by their parents what if they didn't have parents what if

their parents were on the minimum wage it felt wrong it felt unfair and this was in one of the wealthiest democratic nations on the planet but anyway I did the needful got the insurance flew to the US and I started work and this place was absolutely incredible cutting-edge medical and surgical services being delivered by some of the most brilliant and most dedicated doctors and nurses in their field but there was a catch and it was always looming in the background the best way to describe it is that this probably truly was the world's best cancer

hospital if you could afford it and I struggled with this idea on the one hand I had seemingly unlimited resources with which to treat patients which was actually frickin awesome I loved it but it was a bit like a guilty pleasure because I knew that for every patient I treated another would get rejected because they didn't have insurance or the right level of cover so one day I was sitting in the tea room between operations and I finally blurted out to a colleague of mine I said how can you live with yourself as a doctor

knowing that a large segment of your population can't access the care that you provide her answer surprised me she said the problem you have Tariq is you can only really see things from a British colony socialists perspective she said you regard health care as a birthright and feel that you're automatically entitled to it but have you ever considered that it may not be a birthright that in large parts of the world including here in the u.s. it's a very expensive luxury she then went on to say what makes you think that by being born a

citizen of a given nation that you are automatically entitled to a brand new big state-of-the-art Hospital the latest medical technology and the most expensive drugs money can buy funded by your government and taxes don't you see if that's what you want then you have to accept rationing and death panels because there's just no way that any government can pay for high-quality health care for all of its citizens it's simply too expensive so you have a choice crappy mediocre health care for everyone with long waiting lists or high-quality health care on tap for those that can

afford it I can't lie I was taken aback a bit by this I've never heard it sort of that clearly stated before but being as stubborn as I am I decided I'd dig a little deeper I started researching different health care systems around the world surely there must be a way to pay for high-quality health care for everyone and that's when I realized she was right at least partially you see in the developed Western world no matter which country you live in or what kind of healthcare system you have we are rapidly heading towards the

day when our health care will be completely and utterly unaffordable we may even be there already how did we get here well in some ways were a product of our own success the fundamental issue is this people are living longer and longer the median life expectancy in Australia is now well over 80 years old and is continuing to climb sounds great but the problem is it turns out there is a ceiling to how long a human being can actually live biologically and that's around 115 years old we have an expiry date no matter what science

fiction and health tech companies would have you believe so as we keep increasing people's ages to try and reach this upper limit the more and more difficult and therefore the more and more expensive it gets partly because we're fighting a losing battle against biology but also because we need to sustain and maintain the ever aging population that continue to use healthcare resources while they're alive it's like climbing a mountain that gets steeper the higher you climb so what should we do well the first thing I'll say is this don't freak out there is hope but

it does require participation by each and every one of us also like all difficult problems and all awesome TED talks we need a three point plan and I've prepared one earlier just for today so here we go point number one select a system select a system there are two basic ways to pay for healthcare a shared public system where we fund free healthcare for everyone through taxes and a private system where each person pays individually for the health care that they need either directly or through insurance which is better like most things there are pros

and cons of each the public system tends to be compassionate and altruistic in that it treats everyone young and old rich and poor equally but like most large government institutions it tends to be quite inefficient and very slow to adapt to change and slow to innovate the private system on the other hand is run like a business efficient high-volume revenue generating but it can also be quite brutal no money no product the truth is a hybrid system which leverages the advantages of both worlds is probably the best we're lucky here in Australia because we have

one of the most balanced healthcare systems around in terms of funding and it shows I promise this is the one and only graph as you can see compared to its peers Australia which is the graph the red the red line on the bottom actually spends relatively less of its revenue on health care despite having similar if not better outcomes in most areas the US which is the Green Line up to top has a largely privatized system and the three countries clustered in the middle have a more socialist public system either extreme becomes less efficient and

our role here is to continue to iterate and innovate and build on what we've got so that we can serve as an example of a balanced well-funded healthcare model but enough ego stroking let's move on to point number two of the three point plan and this is something we are terrible at care about costs that's a picture of me in the photo I'm the vertically challenged guy on the right in case you hadn't guessed you wanted the worst thing about this photo I'm actually standing on a step stool and it still looks like anyway in

all seriousness though during in the heat of the moment during surgery do you think I really care how much this stuff around the costs if you were that patient on the operating table in the photo would you want me to be worried about that or would you rather I just focus on the task at hand but you know what maybe we should all just grow up a little and start to treat our healthcare dollar like adults instead of kids in a candy store maybe as doctors we should start telling people how much things cost and

why and as patients maybe we should start listening and stop equating price with quality and actually there are plenty of areas where we waste healthcare resources on things that don't do anything at all a good example of this is wound dressings we have high quality evidence that wound dressings for simple surgical incisions don't actually do anything they don't prevent wound infections they don't improve wound and they don't even contribute to patient satisfaction it's true for the most part all they do is line the pockets of the companies that make them so if we're going to

be using wound dressings we should use the cheapest ones available and that's just one of many many examples where we could be reducing costs with zero impact on outcomes which brings me to the third and final point of the three point plan and this one's the most difficult quality over quantity as a society we need to start prioritizing quality of life over quantity of life one thing is clear at this point no one lives forever and the lucky few live well for the time that they have we shouldn't have to keep blindly pursuing an ever-increasing

lifespan for our population regardless of cost it's a losing game and it's not always right for patients either instead we should focus our energy on improving the quality of the time that we have this would be much more cost effective as a policy but it does require frank and open discussions particularly around cultural perceptions of life death and disability this is Michael Michael is 92 years old he's beaten odds he could be your dad or your granddad Michael also has bowel cancer and we recently looked after him in hospital the team did an amazing job

and he was very happy to be included in this talk now when Michael is deciding about whether he wants surgery and chemotherapy he needs to be allowed the freedom and the space to figure out whether extending his lifespan even further is worth it to him especially when you consider the negative implications the treatment might have on his ability to function in society he shouldn't be pressured by us assuming that he wants us to just go in all guns blazing regardless of the cost to him as a person simply to extend this life span this quote

was recently published in a paper talking about cancer treatment in it the goals of treatment are stated as being to prolong survival yes but with an acceptable quality of life and at a reasonable cost so let's go back to the question we posed at the start is healthcare a right or a luxury let's reflect on that again if something is a right but as a society we can no longer afford to pay for it does it then become a luxury maybe the question shouldn't be how do we define or label healthcare maybe the more important

question is this are we as a society willing to make the right choices so that we can continue to achieve those goals going forward for our population or are we simply going to stand by and watch while our rights and our luxuries become more and more inaccessible to us I'll leave that up to you to decide thank you [Music] [Applause]