Delaying aged care, disability support and other public services may contain spending in one part of government, but the costs don’t disappear. They move to families, hospitals, review systems and the people left waiting for help.

Governments ration services because they have to, and economists have given us a raft of euphemistic terms to make that sound both respectable and inevitable: allocative efficiency, opportunity cost, resource constraints, fiscal sustainability and, when all else fails, the marginal benefit of spending the next dollar somewhere else.

What we are much less inclined to talk about is the extraordinarily expensive machinery required to stop that next dollar being spent on you.

In Australia we ration health, aged care, disability support and help at home in many ways, but one of the most effective is time, because if the government does not actually refuse a service but instead makes you wait for it, the expenditure can be postponed while the person remains notionally entitled to something they may or may not receive before circumstances overtake them.

The Productivity Commission tells us that in 2024–25 the median wait from approval to commencement of a Home Care Package was 245 days, while somebody at the 90th percentile waited 366 days, which means that after an older Australian has established that they need support to remain at home, we have developed a system capable of taking the better part of a year to provide it.

There are, of course, perfectly good reasons why government needs eligibility criteria, assessments and safeguards, and nobody sensible is arguing that anyone who rings Canberra should be immediately dispatched a taxpayer-funded shower attendant. But there is a point where managing scarce resources becomes an industry in managing access to scarce resources.

That distinction is important because the person who is waiting does not simply sit politely in a chair for 245 days until somebody appears.

They or their carer have to find out what is happening, whether the assessment has been completed, whether another form is required, whether their circumstances have changed enough to require........

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