The architect of ObamaCare has predicted a showdown over health funding in Australia as it grapples with an ageing population, increasing levels of chronic illness and a care system that belongs "in chimpanzee days". 
Ezekiel Emanuel infuriated Americans by declaring that he wanted to die at the age of 75, and would not pursue medical treatment after that time that was designed to lengthen his life.
The life expectancy for Australians born after 2011 is 80 for boys and 84 for girls - four years higher than it is for Americans - which looms as a test to the health system.
A bioethicist and oncologist who does not agree with euthanasia, Dr Emanuel is in Australia at the invitation of the Royal Australian College of Physicians to give lectures on the ethics surrounding end-of-life decisions.
He said every Western country had "its own bizarre way" of funding health care and Australia was no exception. "The states fund hospitals, the federal government funds primary care doctors, and there's this private sector thing over there with private insurers and private hospitals," Dr Emanuel said. "You know, it's not smooth and elegant, it's not well designed, nobody would wish to emulate it."
One of the big challenges would be redirecting more resources towards keeping people out of hospital and treating them at home, which would mean less spending by the state government and more by the federal government.
"How Australia does that transfer - because it will make big sense in terms of saving the health care system money and improving the quality - is going to create tensions."
The federal government is reviewing Medicare and investigating a greater role for private insurers, in what critics fear may lead to a US-style managed care system, where insurance companies dictate which doctors people visit.