Tens of millions of Americans cannot afford health insurance and medical costs have been the leading cause of personal bankruptcy in the USA. Millions must tolerate the effects of treatable conditions and the social and economic costs of such inequity are difficult to imagine.

It goes without saying that the American system is extremely rewarding for the medical profession, for private hospital corporations and for the private health insurance industry.

Meanwhile, the American "safety net" programs are so under-resourced and overburdened that to most taxpayers they are practically useless.

Had it not been for the introduction of Medibank (later Medicare) by the Whitlam government in the 1970s it is likely that Australia would already have arrived at a system as bad as America's.

Before Medicare, private health costs bankrupted many Australians and according to one oft-quoted study, inability to pay medical bills was the most common cause of imprisonment for debt.

The point blank refusal of the American private health-care industry to countenance equitable reform, even though much fairer service delivery models can be seen in other parts of the world, demonstrates the danger inherent in allowing the profit motive to gain more ground in Australia's health system.

Sceptical scrutiny

Australians are extremely lucky to have an affordable and generally effective universal health scheme that covers or subsidises the cost of medical appointments, hospital treatment and pharmaceuticals.

Some organisations with an interest in profiting from the provision of health services would like to take on bigger roles in the Australian system.

In a handful of instances they may have a case, but in general their representations deserve the most sceptical scrutiny.

Abdicating too much control to the private sector will only encourage the already evident cost spiral in which service providers dictate prices and compliant health funds follow their lead.