BACKGROUND: This paper is an edited version of an invited paper submitted to the Australian Health Care Summit on 17-19 August 2003. It comments upon the policies which have dominated recent debate and contrasts their importance with the importance of five issues which have received relatively little attention. METHODS: Policy is usually a response to identified problems and the paper examines the nature and size of the problems which heave led to recent policy initiatives. These are contrasted with the magnitude and potential cost effectiveness policies to address the problems in five areas of comparative neglect. RESULTS: It is argued that recent and proposed changes to the financing and delivery of health services in Australia have focused upon issues of relatively minor significance while failing to address adequately major inequities and system deficiencies. CONCLUSION: There is a need for an independent review of the health system with the terms of reference focusing attention upon large system-wide failures.