1994 Sidney Sax Medallist - Professor John Deeble

John Deeble seems a native of Canberra because he has lived and worked here in senior policy positions for over twenty years. But he is in fact a Victorian, having been born in the Wimmera wheatfield town of Donald, not far from the South Australian border.

John left school at the age of fifteen and went to work in junior clerical positions at the Peter McCallum Institute - Melbourne's specialist cancer treatment facility.

Through part time study he completed first a Commerce Degree at Melbourne University and then a Diploma of Hospital Administration from the University of New South Wales. His public policy career really began in 1965 when he obtained a fulltime research position at the Institute of Applied Economic Research at the University of Melbourne, headed by Professor Ronald Henderson.

Another of the Institute's researchers was Dick Scotton and John and Dick were to form a close professional partnership that has greatly shaped Australian health policy.

Much of this early history about John comes from Dick Scotton's recently published history of "The Making of Medibank." It records that:
" The complementary nature of their backgrounds, research interest and temperaments led Deeble and Scotton to a close and mutually supportive partnership, fortified over the next decade by shared experience. They worked jointly on all aspects of their research, to the point that it became impossible, at times, to say who had originated what. While they shared a general small-l liberal philosophy, neither was politically active or personally acquainted with politicians of either party. Their research and career objectives were basically academic."

Much of John's early work in health economics was the dusty pursuit of assembling the first set of Australian health expenditure statistics.

So John's progress from academic researcher to social reformer and Medibank architect was not planned or foreseen, but a case of analysis and personal experience shaping his world view.

For those who do not recollect the social problems prior to Medibank that motivated John's reforming ardour, it is useful to remember this anecdote from Scotton's book:
"The statistical analysis which prompted scepticism about the social outcomes of the voluntary system was fortified by a personal experience. A staff member of the faculty underwent an acute psychiatric collapse which resulted in her admission to a private hospital for several weeks, after which she received accounts from many doctors, most of whom she had no recollection of seeing. When she submitted her accounts to the health insurance fund of which she was a member, she found that her costs exceeded the benefits payable to an extent the financially embarrassed her. The medical fees were far in excess of the combined fund and Commonwealth benefits and her hospital benefits had been reduced to half the insured rate because she had been transferred to the special account on the grounds of a "chronic condition" - as psychiatric illness were customarily classified.

The staff member was too distressed to take any action on her own behalf. Scotton drafted a letter for her to send to the health insurance fund, which relented and paid here benefits at the full rate. Henderson rang the psychiatrist to ask him to consider the financial and emotional circumstances of his patient and reduce his fees. He was told in no certain terms that he had no status in the doctorpatient relationship, and that if the patient wanted any consideration she should confront him in person. Still affected by her breakdown, she never did. This experience highlighted the arbitrariness of a system in which the administration of informal means tests was in the hands of individual doctors whose financial interests were opposed to fee concessions based on their patients' capacity to pay.”

All these events resulted in a fateful meeting in Melbourne in June 1967 of Scotton and Deeble with Labor party leader and future Prime Minister, Gough Whitlam. Others at the meeting also played an important role in future national health policy - Dr Moss Cass was to become a Whitlam government minister; Professor Rod Andrew, the Dean of Medicine at Monash University; and Jim Lawson, then Medical Director at Footscray Hospital was to become Professor of Health Care Management at the University of New South Wales and the very first winner of the Sax Medal in 1986.

At the conclusion of a long discussion about the inadequacies of voluntary private insurance, Whitlam turned to Deeble and Scotton and said: “Well you're described the problem. Have you any solutions?"

It would take eight difficult years of political debate and planning before universal health insurance was delivered. But from that meeting onward John was committed to achieving that goal. Firstly through submissions to the 1968 Nimmo Inquiry into health insurance, and then in shaping the Labor Party's health policy for the successful 1972 election campaign.

Then came the difficult task in government as Special Adviser to then Social Security Minister (and now Governor-General) Bill Hayden of designing the administrative and legislative detail of Medibank. John chaired the Health Insurance Planning Committee in 1973, and became Deputy Chairman of the fledgling Health Insurance Commission in 1974. It is worth recalling that Sid Sax was a member of that planning committee, in his then role as Chairman of the Hospital and Health Services Commission.

Two and a half years of planning and political battles (including a double dissolution election fought largely on health issues) eventually resulted in the delivery of Australia's first universal health insurance scheme, Medibank, in July 1975. For the first time everyone could have free access to a public hospital as a public patient.

But all good prophets and biblical sagas must experience "the fall" before the ultimate redemption and the change of government in December 1975 meant that the original Medibank could not survive under a conservative government. John was forced to resign as Deputy Chairman of the Health Insurance Commission, and became an Economic Adviser in the Federal Health Department.

Eager to preserve as much of the Medibank program as possible, John worked with the Fraser Government's Medibank Review Committee and was the architect of the first 1976 amendments that allowed opting out of the levy into private health insurance for the higher earning half of the population. In designing a private insurance alternative to Medibank, John and Dick Scotton convinced the Fraser Government of the need for a government owned insurer, Medibank Private, which has now grown to be the largest private health insurer in the country.

Unfortunately the Fraser government could not resist constant tinkering and the eventual dismantling of Medibank. Disillusioned by this process John left the Federal Department and became the Inaugural Director of the NH and MRC's Health Economics Research Unit at the Australian National University. Between 1977 and 1983 John dedicated himself to the growth of health economics as a discipline, and re-established the health expenditure series he had first founded in the mid 1960s. He also became the founding president of the Health Economist's Group of the Economic Society of Australia and New Zealand from 1979 to 1985.

While pursuing these worthy objectives, John still keenly felt the political injustice of Medibank's demise and the social and economic waste that this created. From 1980 he aligned himself closely with the Labor Shadow Minister, Neal Blewett, and they jointly planned Medibank's resurrection under the name of Medicare.

For three years John supplied the Caucus Committee revised costing and administrative options, so that the Hayden Health Plan (hastily renamed the Labor Health Plan six weeks prior to the election due to a sudden leadership change) was resoundingly endorsed by the voters in the Hawke Government's election victory of March 1983. Medicare was much like the original Medibank, except that compensation grants to States replaced the Cost Sharing Agreements of the 1970s.

It's implementation was far smoother than the politically troubled Medibank and in February 1984 Australia had its second universal public health insurance program. John was again intimately involved in its planning, and has been a member of the Health Insurance Commission from 1983 to the present.

With the relative security of a decade of Labor government to embed Medicare into the social structure, John has increasingly turned his interest to issues beyond health insurance. He was the chief advocate for an Australian Institute of Health to become a central collector of statistics on the health status and utilisation patterns of Australians. John served as its inaugural Director in 1985 and 1986.

He has also been a member of the Health Care Committee of the National Health Medical Research Council. He was chair of the National Health Technology Advisory Panel concerned with managing the proliferation of expensive new technology in the health industry.

John was a major contributor to the National Health Strategy, and the author of its reviews of medical service use and the pathology industry. He has promoted international cooperation and the image of Australian health care abroad, through his writings on "Financing Health Care in South Pacific Countries" and his recent visits to South Africa to advise on universal health insurance for the newly united country.

John's social attitude and work ethic is exemplified by his studies over recent years of the deteriorating building and equipment capital stock of the public hospitals. Having perceived that this was becoming a major problem, he developed a methodology for valuing and ageing the useable life of hospital buildings and equipment.

There is a familiar pattern in all his work of identifying emerging problems; followed by extensive data collection and analysis; them formulating policy responses that fit the facts rather than the prejudices; and finally energetic, personal advocacy about these issues and policies to government, politicians and interest groups. His current position as a Senior Health Service Fellow at the National Centre for Epidemiology and Population Health at the Australian National University allows him to engage these diverse interests in public health issues.

In concluding, it is John’s personal qualities that make him a worthy recipient of this Award. There are four that come most to mind.

• Generosity
• Integrity
• Ingenuity
• Persistence

Firstly, generosity - John will lend his time and insights to anyone with a serious interest in the public health sector. Whether you are a supporter or detractor he will lend his time to educate and persuade.

Secondly, integrity - There are many who disagree with John but very few who dislike him. Those that do dislike him unknowingly reveal their own character flaws. John has sustained a consistent belief in universal public health insurance since the 1960s as the most feasible, efficient method of achievable an important social objective of access to health care. While generally a strong supporter of Labor governments, he is no unquestioning political stooge. His principled stands against Ministers on issues like medical co-payments and gap insurance have caused him considerable personal distress. John believes in the power of ideas and that long term principles should not be compromised for short term expediency.

Thirdly, ingenuity - many of us have seen John deal with an issue that has confounded health departments service and managers. His broad command of the issues, interests and dollars involved, allows him to see the options and connections that have escaped others.

Lastly, persistence - his career record really says it all. Once convinced of an idea's worth John will continue to research, argue and cajole until others take note. He is a persuasive advocate who can get the ear of the media and politicians for a good idea.

John doesn't believe in fads or fashions. He is an initial sceptic until he has researched an issue, but once convinced of its worth he is a persistent, persuasive advocate.