A grim discontent with healthcare in many Western countries is intensifying, exposing cracks in a strained system.

The recent murder of a US health insurance CEO, along with the dark wave of public sympathy for the assailant, warns us that health system inequity and failure may culminate in extreme ways.

Australia faces its own challenges: escalating medical costs and burdened public and private hospitals, even as international healthcare corporations post record profits. The growing corporatisation of healthcare, driven by insurance companies and hospital conglomerates, is a concerning glimpse of one possible future for medical care. A significant portion of Australian healthcare funding now leaves our shores for these international corporations and their shareholders.

Yet media coverage presents an unbalanced narrative. While corporate healthcare profits receive measured reporting, medical practitioners face scrutiny and criticism, frequently without evidence. I wrote the piece below in response to a two-year media campaign suggesting widespread billing fraud among Australian doctors, particularly anaesthetists and surgeons. Much of this reporting revealed misunderstandings of the health system and medical billing while ignoring how such stories serve corporate healthcare interests, even as the same corporations encourage attacks on doctors from the sidelines.

I submitted this op-ed to several Australian media outlets, but it remains unpublished. I'm sharing it here to contribute to a balanced understanding of the role of medical professionals in Australian healthcare.


Trust is the foundation of anaesthetic care

In our first five minutes together, I must become the most trusted stranger in your life. It was 3 AM, and I was the on-call anaesthetist covering two private maternity hospitals in one of Australia's capitals, meeting a first-time mother who needed an emergency caesarean section. Despite the early hour and my tiredness, this young family's day had been longer. A mix of excitement, exhaustion, fear and hope – and now this couple must trust a stranger at one of life's most vulnerable and significant moments.

Despite her anxiety, we quickly built rapport: kind words, gentle reassurance, and a joke with her nervous partner about how he, too, will need a catheter once we get started. Despite the connected leads, the rhythm of monitors and my spinal anaesthetic, we transformed an emergency into something approaching "normal", even celebratory, a testament to the efficient work of our team. What was routine for us is a singular, life-changing moment for this young couple. Our team worked hard to maintain the balance of safety while delivering a positive, memorable experience.

One of the paradoxes of our work is that anaesthetists practice in a unique space where excellence frequently means invisibility. I often tell patients that the best anaesthetic is the one they don't remember having. While this is neither always desirable nor even possible, the look of disbelief when a patient smoothly wakes up to be told surgery is already complete, can be the greatest reward. Yet this excellence — this practised invisibility — makes our contribution hard to value or understand.

The value of this invisible excellence is substantial. In Australia, 39% of babies are delivered by caesarean section – and all of these require the careful care of an anaesthetist. Over 4 million anaesthetics are given annually in Australia and New Zealand by 8,000 ANZCA anaesthetists, three-quarters of whom are specialists who have completed over 10 years of medical and specialist training. Many anaesthetists hold multiple postgraduate degrees beyond specialty training, some even PhDs, further driving the quality and excellence of anaesthesia forward.

Australia's anaesthesia safety record ranks among the world's best, built on this demanding training, rigorous standards and peer accountability – excellence that underpins the community confidence in our care. When threats to the reputation and trust of anaesthetists occur, the profession acts decisively. The recent case of a senior anaesthetist's resignation demonstrates not whistleblower suppression but rather our profession actively protecting its integrity and reputation. Similar peer pressure occurs in the rare situation of exploitative billing – we point out and chastise unacceptable professional behaviours when seen.

For our young couple welcoming their first child, the emergency caesarean section proceeded quickly. With practised skill, the obstetrician gently delivered a stunned, floppy baby. The paediatrician, hiding any stress, quickly transformed this flat infant into a squawking, flailing bundle, lifting every heart in the room. In this private medicine setting, the anaesthetist and paediatrician (both on their third emergency caesarean of the night) work independently of the hospital. We navigate the complex decisions about billing for emergency care and balancing patient access with financially sustainable practice, especially given today's cost-of-living pressures.

The recent allegations of widespread Medicare fraud in The Age and ABC News show a fundamental misunderstanding of anaesthetic billing practices. Like many anaesthetists, I accept the insurer's payment as the full fee for many patients (though not all) – what we call 'no gap'. Some anaesthetists deliver all their care as 'no gap'. Others set their fees independently of insurer rebates, resulting in routine out-of-pocket charges. All anaesthetists prioritise transparency: we discuss fees before surgery whenever possible, provide written estimates, and ensure patients understand their likely out-of-pocket costs. This transparency ensures patients are fully informed and involved in their care.

Private specialists decide their billing rates to sustain their practice, not to exploit or profiteer. Fee decisions are grounded in ensuring the financial sustainability of private practices, enabling ongoing access to quality specialist care 24/7. It is relevant that one of the forces driving the surging closure of private maternity units around the country is difficulty accessing emergency anaesthetic and paediatric specialists.

The more significant problem with private medical fees lies not in unsubstantiated allegations of widespread fraud, but in complex and often contradictory Medicare rules combined with indexation that has lagged inflation for over 30 years, impoverishing our health system and undermining patient access. When billing mistakes happen, they are almost always unintentional and just as often to the doctor's disadvantage as benefit.

Yet rather than addressing these system-wide challenges, recent coverage has focused on unfounded allegations of widespread fraud, striking at the heart of the patient-anaesthetist relationship. Casually making accusations of systematic exploitation risks eroding the trust that modern anaesthesia relies upon.

In anaesthesia, we ask patients to surrender their autonomy to a near stranger. We do not demand or take this profound trust - we must earn, protect, and honour it. When misconduct allegations arise, we act decisively because trust, once broken, is nearly impossible to rebuild. And just as oxygen is essential to breathing, trust remains the foundation of safe anaesthetic care.