Libertarians see the ‘real solution’ as dismantling Medicare and making a clone of the US healthcare system where insurance companies are quite profitable for reasons I should not need to get into on our side of the pond, where we are still not quite so jaded toward profit motives; at least many of us aren’t, yet, I hope.
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I certainly don’t want that, however I am not convinced that a two tier system is necessary or sustainable.
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Which ever system of provision of health care the pendulum swings with which ever way the good ship Australia is listing near Lake Burley Griffin. Some of us grew up with one system, saw the rollout of universal health care, the debacle of trying to swing back the other way with Medicare private, and now we have a solution more like a camel that passes wind, belches and spits at will delivering unpleasantness at both ends of the political spectrum.
The private vested interests might see the pre Obama American system as perfection. If that were to come about there might be far fewer jobs to go around if the government is not propping the system up with Medicare. Either that or some big pay cuts required to keep them all employed and maintain our current standard of health care.
One data source (World Bank)
Australia 3.6 physicians/1,000 population
The USA 2.6 “ “
Europe. 3.8.” “
Perhaps the system of health care in the USA is just more efficient?
At extracting profits? 
Not a great outcome for the average consumer, of ever!
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In fairness one must also recognise that the US offers procedures we do not have access to without an airplane fare. They are not always the inventors of same, but are leading edge at rolling things out if one has the insurance or money to pay. Profits and greed cannot be beat to make things happen.
For the more common and mundane the US system is not only expensive and inefficient, it takes advantage of those with a lesser ability to pay and routinely bankrupts even solid middle class citizens who have insurance, if their malady is serious enough to hit the lifetime caps or they have high co-pays.
Obama Care was a failure mainly because the conservatives refused to allow it to happen, so all sorts of negatives were built in before they would agree to it. Such is the power of a ‘well funded democracy’. Most understand what I mean by that.
Yet, the US system does have that one ‘bright spot’.
For some of us, that is anything more than 3 stitches for a small cut from a kitchen knife
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I don’t think so. If that was the case, since my graph is percentages not absolute numbers, their bump would be in the born 1946-1960 part of the curve and all other age groups would be a little lower. Also their bump would be moving to the right over time. We are not seeing either of those patterns. That is not to say there is none of that effect at all, it would take more subtle analysis, but I can not see that it is predominant.
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In my opinion, neither dismantling Medicare (an exclusively private system) nor dismantling PHI (an exclusively public system) nor the current system (some of each) really goes to the heart of the problem, pun semi-intended: spiralling costs.
It is true of course that a public system can sustain bigger losses for longer.
That could be part of the solution but I don’t think it is just too hard “for some”. There are genuine obstacles. I suppose it depends on how authoritarian a government you are prepared to countenance.
For example, Section 51(xxiiiA) gives the Commonwealth government the power to make laws in respect of “pharmaceutical, sickness and hospital benefits, medical and dental services” (among other items in that clause) but goes on to say “but not so as to authorize any form of civil conscription” and likewise (xxxi) imposes the well known “just terms” requirement (made famous in The Castle). Both of those place limits on the Commonwealth government’s ability to constrain costs.
The suggestion was only that broadening the base helps to support the system. In the face of extreme adverse developments the system will collapse anyway.
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First Dog has a say. The catapult into the sun is rather appealing.
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This could have gone here or the thread about COVID-19 and health insurance, I picked here as it is a continuation of existing problem not something new due to the pandemic.
COVID-19 kicks along the trend.
Hordes of young Australians are abandoning their private health insurance policies after the coronavirus pandemic left health funds charging people for services many could no longer use.
In the first glimpse of the impact of the crisis on the private health insurance industry, the latest data shows almost 11,200 people aged between 25 and 29 dumped their private health insurance in the three months to March 31.
After elective surgery returns and otherwise life slowly heads back to normal after restrictions are lifted will we see those young people return to membership? My prediction is definitely no - they will continue to defect although not necessarily that quickly.
The trend of young people fleeing the sector has been a continuing concern for those within the industry and the Government, who fear the healthcare system could find itself in a “death spiral” if young and healthy people continue to abandon cover.
Yup. How long before anybody acts?
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Act how? I’ll start w/options:
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Stop subsidising private health insurance. Outcomes: private hospitals would possibly go to the walls and either there would be insufficient capacity for elective surgery across the population or government would need to replace that capacity and/or by buying them. Consider the financial and ideological issues surrounding the latter.
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Increase private health subsidies to prop up the private health industry. Politically attractive to many liberals but equally unattractive to almost everyone else.
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Remove many or all restrictions on what private health can pay for to include out of hospital expenses such as GP visits, lab work, and so on, American style. While it might initially look good to liberal mindsets, and it could attract new members, once the accountants were ‘met with’ to pre-approve procedures I suspect their personal attitudes might change. The insurers could be counted on to build their ‘preferred provider networks’ one had to attend or have no cover, not that some funds are not already doing that in some ways.
Others?
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My final question was not to hint that I know what to do but to point out that inaction isn’t an option either.
As I have argued above I don’t think a two tier system where one tier is optional is sustainable. A long term solution must be found and wasting time hoping things will improve can only make it harder and more expensive.
I find the parallel with the education system striking. Both health and education have:
- a mix of public and private funding,
- a mix of public and private service providers,
- the mix of State and Federal responsibilities and consequent buck passing,
- interminable arguments over the quantum and distribution of money,
- ideological differences and entrenched emotive attitudes,
- lobbying by vested interest,
- the practical problem that neither public nor private providers can supply enough service alone to satisfy the need,
- the problem that past failures have tended to poison the well, constraining future action.
I think the people of Oz want public support of both health and education systems. I think they want fairness in distribution of public funds and they accept that if citizens want more service than the public system provides there ought to be a mechanism for them pay more to get it. I find it quite damning that for decades our many governments have not been able to give the people what they want in either case.
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It is usually the case that inaction is a symptom of either not knowing what to do, or politics getting in the way of doing what you know is right.
Every one of your bullet points was right on, excepting
Reality is that given sufficient profit motive the private systems could grow to satisfy all needs but a (probably large) segment of the public could not afford that price. That is the American experience and why health insurance is a necessity of life, noting the costs, quality and cover across the US can be dramatically different. Therein lies one of the more Liberal tenets, sufficient dollars in pockets solves all problems; it is all supply side economics with those left out as consumers being acceptable collateral damage.
That is a grandfather statement. Who could argue? One group is fairly large and reports indicate it transcends political divides, and that is government should spend as much on private as it does on public (simplistically). That is augmented by some who think those who contribute more (eg pay more to private) should also be rewarded for their sacrifices by larger government contributions. One outcome is that the most elite private schools with the highest fees can get the highest or at least among the higher tiers of public subsidies. It seems perverse but that is how it is - public support for private education has become almost as much of a sacred cow as Medicare so neither side dares mess with it because so much of the electorate is split near 50-50 and people from all walks and economic levels go private or aspire to.
Which begs the question, what do they want they will also vote for? Zero public support for private schools or private health seems the most egalitarian with 100% of funds put into the public systems; but at the polls voters have shown that is not their big issue.
From another viewpoint, many are of the opinion if they pay taxes and government contributes $100 to X, why shouldn’t they get that $100 toward ‘it’ regardless of who supplies the service?
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We have often remarked that voting behaviour does not necessarily correspond with stated desire, or that no one vote can satisfy all desires so voting produces anomalies. In these two cases the issues may be getting passed over because there is no campaign by any party in the forefront of the thinking of the populace to fix either problem. Even if we care about the outcomes we do not perceive there is anything to vote for. In neither case are the outcomes yet bad enough for the public to demand a solution.
Education could lurch along for quite a while with no resolution while we remain oblivious. But general oblivion will not permit inaction in the case of private health as the clock is ticking and those who don’t care enough about it now will scream mightily if the system collapses because the young are voting with their feet.
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I just had to use this quote…Just Change Super funds/superannuation for Private Health Insurance Funds (PHIFs for short)…it becomes " In the PHIFs, there is a glut of PHIFs". Indeed there is a plethora of PHIFs such that a member of any PHIF has the value of their contribution to a PHIF reduced because of the cost of managing PHIFs. Every additional PHIF dilutes the value of the money put into PHIFs.
My opinion is that PHIFs have become less valuable and yet the cost of PHIFs has continued to rise. I am not against PHIFs but if much of the money spent on duplicating PHIFs and the Tax money spent on PHIFs was spent on Medicare I think PHIFs would decrease in number and consolidation would put value back into the results for members of PHIFs.
Anyway I am definitely all out of PHIFs with my money. (silent H strong P 
)
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(The tax subsidy for PHI is being phased down. The percentage has declined from its original value of 30% to 24.6% (from April 2021 i.e. a week away). That is the responsible way of managing change, rather than going ‘cold turkey’.
So perhaps this discussion is going to be academic.)
The question to ask though is: how much of the rising premium is due to inefficiencies of having many small players (if that is indeed the case) and how much would occur anyway for other reasons e.g. ageing population, increased expectations for treatment, declining health of the population (if that is indeed the case)?
It depends on the tax penalty for not having PHI. If both interactions between tax and PHI were eliminated overnight, commentators have suggested on many occasions that PHI would go into a death spiral, and disappear. There may be ideological reasons for some people to want that outcome.
I suspect that that would only serve to reveal the real problems in health costs (i.e. they would continue to rise), and there would then be additional problems to contend with e.g. governments unwilling to bear the political cost of ever-increasing taxes to cover the full cost of health - and the usual finger-pointing between Canberra and the states, serving to ensure that noone is accountable for a failing health system.
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An elephant in the room is the medical industry, not just the PHIFs.
In spite of some reporting bad experiences with bulk billing clinics, and I had a very bad one 15 years ago, I attend a bulk billing clinic and a ‘private practice’ clinic that does not bulk bill other than in exceptional and specific circumstances. The care from each is similar.
20 years ago the private practice clinic charged about 1.5X the medicare rebate. Since the rebate ‘freeze’ (pauses?) their fees have gone to 2.2X providing themselves with CPI or better incomes when all changes over time are taken into account. The bulk billing clinic seems to do fine on the medicare schedule.
In comparison my partner had $0.00 annual raises during her last 5 years in the public service. similarly to her peers and colleagues - excepting SES ranks on contracts who apparently got annual increases every year.
Since government has its own ‘arms length tribunal’ granting it increases, and their SES advisories are on contracts and doing well themselves it is little wonder they might not see the same problems or solutions as the general citizenry.
For PHIF, they are captives to the ever increasing fees surgeons charge, not considering the hospitals and ancillary providers that seem to only pop up on the final bills (anaesthesiologists, assistants, etc) who are also ‘taking care of their own business’. The PHIFs have started migrating to preferred networks to negotiate preferable fee for their members to keep the benefits payments in more control - yet the executive floors of the PHIFs are not always ‘managed’ themselves, so see the issue differently than many of their members might.
While from 2017, an excerpt from an article sums it up.
Executive pay packets at Australia’s biggest private health insurers have soared at the same time as consumers have endured a succession of above-inflation annual increases in the price of health cover. As newly-minted Health Minister Greg Hunt prepares to make his first major announcement, a likely 5 per cent rise to the price of premiums – coming on top of cumulative increases of 28 per cent since 2012 – consumer health advocates said customers would be “irked” to learn that insurance bosses have in some cases doubled their multi-million dollar remuneration packages over the same period.
There seem to be so many problems to ‘fix’ (address) it has to be difficult to know where to start without backlash. Then many responsible do not accept there is a problem because dollars are flowing to the right pockets and resulting in donations and votes, so nothing to see.
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As long as by income you mean “revenue”. Neither of us knows what has happened to the income of the people involved.
You may be familiar with the concept of the Tax Free Day. I once had a discussion with a surgeon about what his Insurance Free Day was, and it was shocking. (He was not proposing to perform surgery on me so had no direct incentive to exaggerate. It was just a friendly discussion.)
So there are many factors at play here, in that particular case the increasing willingness to take specialists to court and for courts to award eye-watering payouts, which ultimately reflects in the insurance costs that specialists have to meet.
As you infer there are many reasons a cost and price can rise, and one can give the benefit of doubt in any way one is inclined. Regardless some of the target reasoning will be right on and others will be furphies.
Are you implying that is never warranted regardless of egregious malpractice? Perhaps people led by the legal representatives have merely realised surgeons are not infallible, and their preventable mistakes go far beyond what can be addressed by an apology, such as life long hardships. Does that increase their costs? No argument but one also needs to accept the ‘industry’ shields the worst as well as those with an occasional oopsies with the most opaque protection mechanisms possible so consumers have great difficulty in picking ‘a good product’ by quality or price.
Absolutely not. I offer no opinion about any of the many cases that come before the courts every year.
The simple point is that every mistake, for whatever reason, with no justification, with some justification, costs money - and it is a very substantial amount of money i.e. a significant fraction of a specialist’s total overheads.
All of this feeds into health costs.
I don’t doubt that is true but it is difficult to take into account this kind of mistake. Specialists don’t generally make mistakes on purpose - and the nature of insurance is to spread the cost across all specialists (of a given type).
Example: You have a spot on your skin. You go to the doctor ‘just in case’. The doctor needs to cover her arse, so she refers you to the dermatologist. The dermatologist examines the spot carefully - and believes that it is not a melanoma. The dermatologist has to make a judgement call as to whether a biopsy is warranted.
Do the biopsy and whatever happens happens.
Don’t do the biopsy - but it turns out that it was melanoma and you eventually die of cancer. So then the dermatologist gets sued by your grieving relatives for not exercising adequate care.
Notice how, either way, the system is working to drive up costs - either unnecessary medical consultations and procedures, or a mass of legal costs and eventually an insurance payout.
No it is a result of all sized players. I don’t mean the total increase in premiums but I do mean a reasonable proportion of the increases. Even if a not for profit scheme requires wages, buildings, salaries, bonuses for the higher echelons, Boards who desire remuneration, CEOs who desire performance pay, maintenance of infotech and property, and if you add in things like surpluses to ensure money for growth this while not quite what For Profits take, it all means that premiums will rise regardless of whether Medical costs go up.
My opinion of PHIFs due to a combination of reasons have become less valuable to their Members, this includes the Rebate reduction on top of increased cost of Membership. I didn’t say in my piece about PHIFs that all PHIFs had to go, I just believe there is a strong case to sharply reduce the numbers. If you as a population are paying the salary of 100 CEOs and could be paying for just 10 there will be a saving, same for duplication throughout the system.
I am for the removal of Private Health from the hip pockets of Tax, if a person wishes to fund their own Private Health that’s a choice they can make. They still benefit from the Medicare system and thus taxes just I don’t see why their Private choice needs that public funding.
Interestingly but may only be for me the Start page wants username and password to access it.
