Medicare: Where are we? Where are we Going?

The Medicare debate is often dominated by relatively short run issues which reflect the immediate interests of the major players: the government, doctors, private health funds, and hospitals. When Medicare is placed in a broader, international perspective there is little doubt that it is a good scheme. Its most obvious weakness, the instability of private health insurance, may lead to substantial structural change but this is not inevitable. In the very long run there are some more serious obstacles that the health system, in whatever form, may encounter and these may result in the need for some ethically difficult decisions concerning the equitable treatment of the population.