Modern medicine has achieved extraordinary things. Antibiotics, advanced surgery, diagnostic imaging, emergency medicine and numerous pharmaceutical treatments have saved countless lives. Yet alongside these achievements, something has gone seriously wrong with the organisation and delivery of healthcare. The medical profession, traditionally centred upon the relationship between an independent physician and a patient, has increasingly become entangled in vast administrative systems, corporate interests, government regulations and financial incentives that do not always serve the interests of the sick.
In a recent article, The Failure of Modern American Medicine, published on October 22, 2026, Dr Robert Malone and Dr Jill Glasspool Malone examine the transformation of American healthcare from a profession dominated by independent practitioners into an industry increasingly controlled by hospital corporations, insurers, government bureaucracies and large institutional employers. Their central argument is that the independence of physicians has been progressively eroded, while patients have become secondary to the administrative and commercial machinery surrounding medical treatment.
Although their analysis concentrates upon the United States, many of the same criticisms can be applied to Australia. Our healthcare system differs significantly from the American model, particularly because of Medicare and the public hospital system. Nevertheless, the underlying problems of bureaucratisation, declining professional autonomy, rising costs, workforce shortages and institutional self-interest are increasingly familiar to Australian patients.
The Malones make an important distinction between genuine free enterprise and corporate concentration. A competitive marketplace consisting of independent medical practitioners is not equivalent to a healthcare industry dominated by enormous corporations operating within complex government reimbursement systems. In the former arrangement, professional reputation, patient satisfaction and competition can exert considerable influence. In the latter, administrative efficiency, financial targets and compliance requirements may increasingly determine how medical services are delivered.
Australia has developed its own version of this problem. General practitioners must navigate Medicare billing requirements, accreditation procedures, professional regulation, electronic record systems and numerous administrative obligations. Many of these requirements have legitimate purposes, including patient safety and accountability. But their cumulative burden can consume time and resources that might otherwise be devoted to clinical care. The independent suburban GP, once a familiar figure who knew generations of families, increasingly operates within a system shaped by institutional requirements and financial pressures.
The consequences for patients are becoming difficult to ignore. According to the Australian Institute of Health and Welfare's Australia's Health 2026, approximately 27 per cent of Australians aged 15 and over who needed to see a GP in 2024–25 delayed or missed an appointment. Some 7.7 per cent reported that cost was a factor, compared with 4.1 per cent in 2015–16. Although government initiatives have recently improved bulk-billing rates, the figures illustrate continuing problems of affordability and accessibility.
These difficulties are particularly troubling because primary healthcare is supposed to prevent relatively manageable medical problems from developing into serious conditions requiring hospital treatment. Yet Australian statistics suggest substantial deficiencies in this preventive function. In 2024–25, approximately 799,000 hospitalisations were classified as potentially preventable, representing 6.3 per cent of all hospitalisations. These included conditions that might have been better managed through timely primary care, although not every individual admission could necessarily have been avoided.
The financial burden is also substantial. Australia spent approximately $270.5 billion on healthcare in 2023–24, while direct out-of-pocket expenditure reached $44 billion. These figures raise an obvious question: why does a country spending such enormous sums on healthcare continue to experience significant difficulties providing timely and affordable medical services? The answer cannot simply be that insufficient money is being spent. Attention must also be directed towards how resources are allocated, how services are organised and whether the institutional structure encourages effective treatment.
One particularly serious Australian problem is the shortage and uneven distribution of general practitioners. Government workforce modelling has projected a shortfall of approximately 7,700 GPs by 2033, increasing to 12,400 by 2048 without adequate corrective action. Rural and regional communities face especially severe difficulties, with patients sometimes required to travel considerable distances or wait extended periods for treatment. Such shortages place additional pressure on hospital emergency departments, which are then expected to manage conditions that could often have been treated more effectively in general practice.
This represents a fundamental contradiction in modern healthcare policy. Governments repeatedly announce new programmes, administrative reforms, funding arrangements and bureaucratic initiatives, yet the basic requirement of having a doctor available when someone becomes ill remains inadequately fulfilled in many communities. The administrative system may expand even while the personal medical service it is supposed to support becomes more difficult to obtain.
The Malones also raise the issue of medical records and the enormous administrative infrastructure created around electronic documentation. Australia has embraced similar developments through My Health Record and the wider digitisation of healthcare. Electronic records can improve continuity of care, reduce duplication and make important information available during emergencies. However, they also introduce questions about privacy, cybersecurity, data access and the growing dependence of medical practitioners upon complicated information systems.
The danger is not digitisation itself but the assumption that technological and administrative sophistication necessarily produces better medicine. A physician spending substantial time navigating computer systems, entering information and satisfying documentation requirements may have less time for the patient sitting across the desk. The consultation risks becoming an exercise in completing institutional procedures rather than understanding the individual.
There is also the problem of medical harm itself. The Australian Institute of Health and Welfare reports that approximately 220,800 hospitalisations in 2024, 25 involved at least one recorded hospital-acquired complication. These included healthcare-associated infections, medication complications and surgical complications requiring unplanned returns to theatre. Not every complication is preventable or evidence of negligence, but the figures demonstrate that modern medical treatment carries substantial risks requiring continuing scrutiny.
The broader issue is sometimes described as iatrogenic illness: harm arising from medical treatment or intervention. This may include adverse drug reactions, surgical complications, infections acquired in healthcare settings and other unintended consequences of treatment. The existence of such harm does not mean that medicine does more damage than good. Rather, it means that the medical system must be judged not merely by the treatments it provides but by the total consequences of those treatments, including avoidable injury.
An institutional culture that rewards activity, throughput and procedural compliance may not always provide adequate incentives for restraint, prevention and individualised care. More tests, prescriptions and interventions are not automatically equivalent to better health. Sometimes the most appropriate medical decision is careful observation, lifestyle modification, withdrawal of an unnecessary medication or recognition that further intervention may cause more harm than benefit.
The question of professional independence is therefore central. Doctors require the freedom to exercise informed clinical judgment, guided by scientific evidence, professional ethics and the circumstances of their patients. This does not mean freedom from accountability or the rejection of evidence-based standards. It means recognising that medical practice cannot be reduced to bureaucratic algorithms or financial performance indicators.
The COVID-19 period intensified public debate over these issues. Government mandates, institutional policies, professional disciplinary procedures and disagreements about medical evidence raised difficult questions concerning the relationship between professional autonomy and public health authority. Whatever one's assessment of particular pandemic measures, the experience demonstrated how strongly political and administrative decisions can influence medical practice. The lesson should be that emergency powers and professional restrictions require transparent justification, proportionality and independent scrutiny.
Another dimension largely missing from contemporary debates is the historical role of charitable and community-based medicine. As the Malones observe, religious institutions, nonprofit hospitals and charitable medical organisations once occupied a substantial place in American healthcare. Australia also possesses a long tradition of Christian hospitals, charitable nursing services and community medical assistance. Such institutions remind us that medicine need not be organised exclusively around either commercial profit or centralised government administration.
The Christian understanding of medicine places particular emphasis upon the dignity of the individual, compassion for the suffering and the moral obligation to care for the vulnerable. The patient is not merely a consumer, a billing category or an administrative unit, but a person whose wellbeing deserves attention. This ethical conception is not incompatible with scientific medicine or commercial enterprise. Indeed, it can provide an important corrective to institutions that have become excessively preoccupied with organisational growth, financial performance or bureaucratic self-preservation.
None of this requires abandoning Medicare or pretending that an unregulated medical marketplace would solve every problem. Australia's universal healthcare arrangements provide important protections against financial catastrophe, while public hospitals deliver services that would otherwise be beyond the means of many citizens. The American experience itself demonstrates that corporate medicine and insurance-driven healthcare can produce enormous expenditure without guaranteeing satisfactory access or outcomes.
The appropriate Australian response should therefore concentrate upon decentralisation, professional independence and institutional accountability. Independent general practices should remain viable, unnecessary administrative burdens should be reduced, and patients should enjoy meaningful choice wherever possible. Greater emphasis should be placed upon continuity of care, early intervention, prevention and transparent assessment of treatment outcomes. Public funding should support effective healthcare rather than merely the expansion of administrative structures.
The fundamental problem is that modern healthcare increasingly risks confusing the size and complexity of its institutions with the quality of the medicine they deliver. An expanding bureaucracy is not necessarily evidence of improved healthcare. Nor does greater expenditure automatically translate into healthier patients.
The Malones have identified a serious structural problem in American medicine, but Australians would be mistaken to regard it as an exclusively American phenomenon. Our own medical system exhibits comparable pressures, even though its funding and institutional arrangements differ. The challenge is to preserve the genuine achievements of modern medicine while resisting the tendency for healthcare to become increasingly centralised, impersonal and administratively dominated.
Ultimately, medicine exists to serve patients, not governments, corporations, insurers or bureaucracies. Its success should be measured by the quality of care, the prevention and treatment of illness, and the preservation of human dignity. When the machinery of healthcare begins to overshadow these objectives, reform becomes not merely an economic necessity but a moral obligation.
The recovery of medicine must begin with a simple principle that modern institutions too easily forget: the patient comes first, and the system exists to serve the patient, not the other way around.
https://www.malone.news/p/the-failure-of-modern-american-medicine