Well said! This WHO study (PDF) might be relevant to the discussion, it seeks to rank the efficiency of health care systems based on the below criteria and shows which countries are currently achieving the best results.
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What do the privately insured get now thatâs better? I mean really? If anything, then is it value for money?
Good question. What they seem to be doing is cost-shifting. In the process, they sacrifice cost-efficiency and equity.
Comparing the US medical industry (they donât really have much that Iâd call healthcare) with nations that have public health care, Iâd say the greater the distance from the private sector, the better the national health and well being.
How about a national investment? A healthy population is more cost-effective. There are limits, of course, but the Totalitarian Capitalist approach neglects human resources to the nationâs cost. Itâs false economy.
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A timely article on the wonders of American style medical care and how insurance can be so good. It is likely a Fresenius in-network provider would have taken the $16K or a bit more and called it a profit. When one goes out of network or has no insurance they come for the full fee. Be afraid of the self absorbed like Mark Fitzgibbon who thinks this works for anybody except the shareholders, and the pollies they have in their pockets.
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Health insurance: how much will you pay to boost specialistsâ incomes?
This article tells us that private health cover is not viable without government subsidy and that even though many steps have been taken to prop it up it is still unsustainable as its income base shrinks and costs balloon. These subsidies appear at odds with the professed free market attitude of the present government.
One apparent option is to let the system die and redirect the substantial subsidies into the public system.
Is this the ideologically-driven maunderings of a left-wing journalist in a left-wing rag or is it a fair assessment of the real situation?
For those who donât want to bring politics into a forum about consumer services could you explain how the situation might be improved without some political will and how that might come about if consumers say and do nothing.
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Good health is only ever evident in hindsight. True some of us take up poor habits and increase the odds of needing increased level of assistance. Others draw a short straw at birth and need to live with health conditions that need to be effectively managed for a lifetime.
I note the discussion within the SMH counterpoints younger healthier individuals minimising their cover or opting out verses those with ongoing needs or higher risk profiles trying to stay in the system.
What ever the solution, it needs to be universal and non discriminating. The cost outcomes need to be fair and equal.
The costs in part are driven by the level of care, and services. This is not a unique situation.
In education, which is universal, the private and public systems coexist. Albeit with debate around value. Whatâs different compared to medical services?
One self evident observation.
Education providers deliver through employment contracts, whether private or public. There is no major system of independent delivery by protected occupations and powerful representative professional bodies.
Does the education system need to be more like our health care system, or does our health care system need to be more like our education system?
The government has a major interest in both?
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Yesterday I encountered the built-in obfuscation of every âextrasâ plan I looked at. The impetus to look around was from receiving a quote for some crowns. The extras âheadlineâ limits seem to be carefully planned to obfuscate. My simple example, and probably one of many, is as follows.
Plan headline: unlimited $dental per year with sublimits
Crown headline benefit: Max $1,000 per person per annum, with sublimits
sublimit: $800 per crown usually shown in smaller print or another column but rarely highlighted on the glossy sales brochure.
If anyone has been to a dentist in recent times saying hello is expensive, and a crown is north of $1,200, sometimes pushing the $2,000 mark per each. If one needs two crowns the benefit is thus $800 for one, $200 for the second in my example, if done in the same year where many of us who miss the finer print or do not get cover quotes prior to proceeding would expect one crown to be covered to $1,000. Those who do get cover quotes are often surprised about the slight of hand and only then start reading the finer print.
The marketeers and apparently government are happy because if one looks carefully enough the âcatchâ is there, while âthereâ is usually not prominent. To its credit the example of cover for a crown is in the governments privatehealth single sheet synopsis, if you can find it.
Iâll not go into the paltry âcoverâ for dental work excepting it seems an international and universal truth dentists extract top dollar for their services as well as the occasional tooth, and that insurance wherever, of whatever kind, does not begin to subsidise it in comparison to almost anything else, even though dental care is one of the most important factors to support good health through decent nutritional intake.
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And in an ageing population. Itâs much more cost effective and less risk to keep your original teeth where ever possible, than the alternative.
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Daughterâs cost of two crowns and a mouthguard (tooth grinders she be) $6,000. $700 for the mouthguard aloneâŠrip off I say but she got quotes and that was the cheapest she could find. Private Health $800 rebate on the costâŠa joke of a system. Only the Health Scheme and the practitioners end up benefitting, the patient is just the means to the money stream. We need true Universal Health Care and remove the Private Health Industry out of everyday peopleâs lives. If some are rich enough and want to go privately I say good on them but everyone should be able to get great health care if we just removed the profit gouging systems we have in place now.
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One interesting suggestion:
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An insured patient would get one bill â from their insurer â which would include their excess and any additional cost the hospital has advised them about in advance.
That would surely help transparency and keep costs down how? Seems like it would make a contest between the specialist surgeon and the hospital as to who gets how much of the pie. Since both want it all a bill such as âTreatment for XXX gap is $47,000â might not be helpful to understand who got what, who is greedy, whether the hospital padded their part of bill with $50 bandaids or not, and who might be inefficient. Ringing around for quotes might be easier, but when in need how many can and how many will?
Requiring their fees (private hospital, surgeons, anaesthesiologists, etc) to be posted publicly seems more of an incentive to charge the right amounts, and allowing the patient to approve who assists re their fees. They will bleat every patient and surgery can be different, but there are baselines.
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Perhaps even more useful for those who need to travel. Or live in a regional community with only one choice of hospital and one or two specialists. Being able to assess the saving vs costs of going further away becomes a little easier.
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Once again this report reminds that some of the problem with private health is designed-in by government by the restriction it cannot cover anything out-of-hospital.
Removing that restriction could open a pandoraâs box for the medical profession to increase its wealth by increasing their fees and thus disadvantaging private patients more than today, so fixing it is not straight forward.
I doubt âweâ would accept a demise of the private option but it seems that the government subsidy coupled with the in-hospital limitations minimising what it can offer re insurance may have been carefully and perhaps cynically crafted to appeal to a certain block of voters who are not rich, yet libertarian minded and suspicious of anything socialistic such as our Medicare in not providing them what âthey deserveâ.
They have their window dressing that looks good, at least until they need it and face reality. Yet if one has enough wealth there is a benefit of avoiding long queues and picking ones own surgeon and hospital regardless if the clinical outcomes are essentially deuce.
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Why is the system called health âinsuranceâ?
Insurance is a statistical game. The insured is prepared to pay a series of installments to avoid being exposed to a big bill from a comparatively rare but costly event. The insurer provides risk cover by assessing the total risk for the events insured for the whole pool and sets the premiums to a figure that covers the probable payouts plus operating costs plus profit. We rely on competition to keep the last two figures down but for many reasons (including restriction of information available) that doesnât always work.
If they are at all rational the insured will take their business elsewhere or even self-insure if the premiums are judged as too high for the cover. Part of setting premiums relates to individual risk. If you live in an inner city postcode your premiums for house contents will be much higher for the same goods as if you lived in the regions because the risk is much higher. But health insurance doesnât work like that. If your risk is higher due to genetic accident or simply advancing age your premiums are not higher.+++
So to break even, much less make a profit, the system relies on the Young and Healthy supporting the old and sick. The difference in value is considerable and if they are rational the Y&H will self insure during their salad days and quickly join up when middle age hits. Individually the Y&H will not do their duty for the vague promise that when they are Old and Sick they will be looked after. A system built like that is destined to go broke. Subsidies do not help! If anything subsidies make it worse by drawing out the process, adding more subsidy will not stop the defection of the Y&H which is the heart of the problem.
The answer to this conundrum is to make it compulsory by building it into the tax system. So collectively the Y&H have to pay and the O&S receive until in the course of time the one becomes the other. This is more or less how the public system works. But it is only insurance by the normal meaning of the words if you accept that making premiums compulsory is acceptable and reasonable, as it takes away the ability of the individual to decide if it is value for money.
The private health system is a weird cocktail that has been through the political shaker more than once. As many have observed it is simply unsustainable. My personal view is that it cannot be made sustainable and that any polie who says it can be is a fool or a liar and just kicking the can down the road so the garbage isnât at his/her door. Dismantling it is a nightmare because it was sold on the basis of a whole lot of promises (which are rarely delivered) but people still want. Getting voters to accept that they cannot get service from their choice of doctor whenever they want it for a modest extra fee will involve confession of institutionalised fibbing. As both sides of politics have dirty hands it isnât possible for one to blame it all on the other.
The question is which will have the least cost, killing it off under controlled conditions or allowing it to die of natural causes? My bet is the second will cost more but that will be the solution of choice because we are ruled by politicians not statesmen. There will always be the hope that the other blokes will have to take the blame.
+++ This is broadly speaking; there have been some odd quirks from time to time. Itâs called community rating.
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Being rational and older, although that does not imply wisdom.
I wonder where 40+ years of private health insurance premiums have now gone? And if that financial investment in the system were suddenly to disappear, can I claim it as a tax loss?
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You have no equity, it isnât an investment at all it is sunk money. If the scheme is scrapped I cannot say what will happen as I cannot foresee all the consequences, presumably you will be offered some other cover. That may be different to what you have now, as will the cost.
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Putting all that money currently spent by Govt on supporting PHI and increasing by perhaps a couple of % the Levy would I am sure turn our Public system into a brilliant service, that would provide timely intervention for anyone who needs medical treatment (I include Dental in this). The current thrust as it seems to me to turn our system into a more US based profit machine rankles me.
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Choice Survey into PHI
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Not to mention the financial penalty imposed by the government if a consumer would otherwise choose not to âbuyâ the product. When you have an effectively captive market, that is a disincentive to provide good service at a good price.
Because the government makes the rules and that is what the government has required. That wouldnât happen in a normal market, and likewise the health insurance premiums would depend on your postcode.
Even though it is easy to complain about sky-rocketing health insurance prices and blame a range of factors and actors, I suggest that if the private health insurance system were to disappear tomorrow, we would still have sky-rocketing health costs. Thereâs no free lunch.
At least phase it out gradually by squeezing the tiers down and the rebate rates down.
It seems a bit bizarre to me that a family with a household income of $280,000 (more if there are kids) is getting a taxpayer-funded subsidy at all. Surely they havenât convinced themselves that that is what it means to be poor? Once a handout like this is established, it becomes politically so difficult to get rid of it.
If you are referring to the Medicare Levy, how about an honest approach from government ⊠scrap the Medicare Levy completely and roll the percentage into the income tax rates?
These days the Medicare Levy is used for convenient tinkering and concealment of tax rises. It never covered more than a small proportion of the total health budget.
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The US doesnât have much of a health cares system. What they do have is an obscenely profitable medical industry. Thatâs the Liberal/IPA ideal.
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I have no problem rolling the Levy in beyond that if it shows separately then people can see more easily if the Levy is actually being spent in health care than if it just is anonymous in itâs role as a part of a tax rate. Another reason to list the Levy as an item is the State Govts have their portion of the Levy take so much more easily identified. Sometimes if rolled in the reasons for a tax component get lost over time.
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