Controversial Ideas in Medicine

I had a fairly disjointed argument on the weekend with a would-be future political type. The crux of this segment was as follows: Him: "The states' power should be preserved because Australia is a federation of independent countries" Me: "But how exactly are Victorians benefited by keeping everything separate?" Him: "They should be separate as a safeguard to the federal government and because of history" Me: "But how does that benefit people?!" &c&c Australia is an odd country. It's one of the least population dense countries and continents in the world. 20 million people most of whom live in cities scattered along the coastline. A huge amount of empty space in which people do actually live, here and there. A great whopping big desert that we try and farm. Mostly developed and first world with one of the highest life expectancies  and best healthcare systems in the world... unless you live in a very remote Australia or are Indigenous. The biggest barriers to healthcare in Australia then?

• Geography
• Race/Indigenous status

Let me explain. There are country towns with a population of 300 which are inland and where the nearest tertiary hospital is greater than 5 hours away. By helicopter. Other towns with a population of 30,000 which have the biggest hospital by road for hours and are very strained. There are towns which are remote or even not that remote but where the closest big centre is in another state. Or where half the town is on one side of the state border and the other on the other side. This is problematic for many obvious reasons. Airlifting trauma patients is difficult. It is difficult to get patients from one state hospital system to another. There are funding issues. Doctors have to ... get this... apply for registration in both states (and pay an exorbitant fee) in order to perform the practicalities of working in a border town. The federal system in Australia is impractical precisely because of the size and geography of the country. Rather than facilitating healthcare in disadvantaged areas by tailoring policy it results in an ad hoc patchwork system where interhospital transfer (something crucial in remote areas where services are difficult to access) is exquisitely painful to organise and results in avoidable delays in getting sick patients appropriate care. The states and their laws are divided by history and accident rather than logic or relevance to modern Australia and its issues. As far as I can tell it only offers disadvantages to its citizens in its current incarnation. Perhaps in a much smaller and more highly populated country the state system would make more sense because it would just be a matter of there existing a protocolled system for treating and transferring patients. However, when you have little choice where to go and what to do and time is critical... it is inefficient, bureaucratic, and furthermore harmful. Conclusion: Whatever you do, just don't get sick in Broken Hill. Or chased by drunk guys because you're a drag queen from Sydney. Whatever.