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The Forum > Article Comments > Get-off-your-butt money! > Comments

Get-off-your-butt money! : Comments

By Jeremy Sammut, published 21/9/2007

Medicare foots the bill: should we be able to escape the consequences of our lifestyles because open-heart surgeons can now unclog our arteries?

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Another piece from the Centre for Independent Studies which is described by sourcewatch http://www.sourcewatch.org/index.php?title=Centre_for_Independent_Studies as and socially conservative think tank based in Sydney
Organisations with links to it
- BHP Billiton
- Shell
- ICI - now a subsidiary of Orica
- Vincent Fairfax Family Foundation [8]

Some of the individuals who fund the CIS include [9]:
- Dame Elisabeth Murdoch - Mother of media mogul Rupert Murdoch
- Neville Kennard
- Robert Champion de Crespigny

Many right wing Liberals believe that we should have a user pays health care system and if you get cancer then you get only the health treatment your family can afford.

Thie author is using the increase in obesity rates in the population to ration health funding to “the deserving poor”.

Obesity is more prevalent amongst poorer people who have less money to spend on food and limited access to gyms and recreation facilities. Reminder posters today a loaf of white bread is $1 a kilo of potatoes is $3, apples are $5 a kilo.

I believe that a universal health care system leads to better health for Australians than a user pays system that the CIS would like where hospitals, multiple insurance companies and operators all seek to make profit from our health care.
Posted by billie, Friday, 21 September 2007 9:16:50 AM
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A new expression has entered our vocabulary - “sit down money”. I like it!

Making a responsible choice? No such thing for a lot of people. Only no choice works. Close down all junk food outlets and cake shops. We need prohibition. Then the only way you can get an apple tart is to find the dark back alley which has the patisserie speakeasy. Then you knock on the door and ask for Joe.
Posted by healthwatcher, Friday, 21 September 2007 9:18:35 AM
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The better question would be 'should the taxpayer pick up the tab for personal stupidity? And why focus on this small percentage of health care users?
Posted by aqvarivs, Friday, 21 September 2007 10:06:06 AM
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So Billie, do you think we should have unlimited universal heath care? Are you willing to have your taxes jacked up to pay for it?

The author is not suggesting what you think - this is not about "the deserving poor", but rather about each and everyone of us bearing the health consequences of our own decisions. It is a notion which is equally relevant to those who earn lots as it is to those who earn less.
Posted by BN, Friday, 21 September 2007 10:29:16 AM
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Hmmm.... Correct me if I am wrong but Medicare was established to provide universal access to "Healthcare". Health care is broader than just infectious diseases and accidents. To define healthcare in such limited terms is erroneous.

There are sound reasons why Governments should be in the business of developing policy that mitigates risk; so long as the benefits of early intervention and preventative healthcare outweigh the costs. I for one, am happy for my taxes to fund a program to refer the obese to weight management programs if it reduces the tax burden I would have to bear to support health treatment for probable related illnesses they would suffer in the longer term.

Libertarians and civil rights advocates alike should be wary of programs that mandate behaviour change. Good policy in this area should be about not only making people aware of the health impacts of obesity but also making it easier for people to take action to mitigate those risks. It should not be limited to ONLY raising awareness if there are other cost effective ways of reducing the burden to all.
Posted by Voevod, Friday, 21 September 2007 11:10:52 AM
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BN, do I want to pay higher taxes to support a universal health care system? YES, and I bet I paid more tax than you did last year. The agenda of supporters of CIS is to introduce a user pays health care system and sell off Medibank Private. I have my health insurance with Medibank Private and do not want my money going to whichever foreign insurance company buys Medibank Private.

A CIS supporter suggested that a [specific] cancer patient should only have access to treatment that they could pay for. The person seemed oblivious to the fear and pain the patient could be suffering. So if we do want to adopt a user pays health care system then we should introduce euthanasia for those patients who can’t afford treatment to improve their quality of life from exist in pain, fear and social ostracision if they have facial deformities like cleft palates.

In a population of 22 million people there is no reason why one health insurance organisation can’t work more efficiently than the current 100 odd. If you assume that public service organizations are inefficient you are insulting hard working, honest, intelligent public servants including members of the armed forces like Aqvarivs.
Posted by billie, Friday, 21 September 2007 11:28:41 AM
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The only way to reduce the pressure on costly acute care is to concentrate many more resources on keeping people well. Obesity becomes increasingly difficult to reduce over time. If it is not tackled early, it may never be tackled effectively. Only a new approach to primary health care, with health promotion and prevention programs located in multidiscipliary clinics in every community, working throughout a person's life cycle to prevent simple problems becoming complex and expensive to treat, can be effective in stimulating people to adopt healthier lifestyles. The burden of disease, and especially of chronic disease, falls most heavily on the least affluent, most socially disadvantaged - those least likely to be covered by US style health systems.
Posted by Johntas, Friday, 21 September 2007 11:40:04 AM
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Billie,

I'm not particularly interested in getting into a "mines bigger than yours" discussion, but I find it hard to believe that you paid more tax than me.

The CIS may have a notion of selling off medibank private but that has nothing to do with medicare, the general funding policy for medicare nor of the general medical concept that preventation is better than a cure.

Throwing money at something that wasn't prevented (when it should've been) is not good policy - it's the expensive downstream effect of very bad policy.

The author was right in saying:

"This means that today there is less reason than ever before to take care of your health, regardless of the enormous social cost, particularly when healthcare is largely “free”. While ever Medicare foots the bill and protects people from the consequences, this will not encourage people to modify their lifestyle.... social policy experts recognise that unless there are consequences, people will not change their behavior"

In this country, we have a behavioural problem which leads to preventable conditions like obesity. Rather than throw "bad" money at something that wasn't prevented, I'd rather throw "good" money at the prevention, especially given the benefits to society in general, not to mention the lower burden on the health system.
Posted by BN, Friday, 21 September 2007 12:01:46 PM
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billie, that's ex-serviceman or ret. serviceman. And it's no insult to me to take a hard look at a service that cost the taxpayer large and ever increasing dollars to maintain it's inefficiency, especially with a intellectual malaise with in general society that has the population showing poor personal management skills and the somewhat ridiculous idea that government should answer for their stupidity or clean up after them. You may be happy with the continual tax increases but, I for one whould like to see less dependency on government and a smaller taxation schedule.
I'd also like to see a change in general education that puts more emphasis on life skills. We have plenty of young people leaving university with no more clue than when they went in.
Posted by aqvarivs, Friday, 21 September 2007 2:39:31 PM
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Subsidise commercial weight loss programs? Are you joking? The only ones that work are those that offer advice on diet and exercise, and only then when that advice is put into consistent practice. Is there anyone in the western world that doesn't know that already? Can anyone seriously suggest that confidence tricks aimed at the ignorant and stupid such as Balin tea, fat re-distribution medications, visualisation therapy, useless homeopathic nostrums, spirulina tablets, hypnotism, massage, etc etc should be subsidised? Why not burn a few witches as well? If the government really wants to assist then the subsidy should work in reverse - subsidise non-use of medical facilities. Then people such as myself who eat properly, exercise consistently, and avoid alcohol and tobacco etc would get some reward for not going to the doctor. Let the fatties, pissheads, smokers etc lose out by being that way.
Posted by GYM-FISH, Friday, 21 September 2007 3:49:54 PM
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Gym-Fish. The perfect person has not been born yet. Keep up the excercises, they sound as though they make you Happy!
Posted by Kipp, Friday, 21 September 2007 5:43:20 PM
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Dear Kipp
I haven't the faintest idea what you are talking about, however I have no doubt that I would find your comment to be very clever and perceptive if only I could understand it! Thank you.
You give me fresh heart to carry on!
Posted by GYM-FISH, Friday, 21 September 2007 6:10:50 PM
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There is some good thinking in this piece, except that the trick is to promote individual responsibility for improvements in cardiorespiratory fitness. Why? because improvements in fitness are related to decreased levels of chronic disease independent of weight, and are more readily achievable than significant weight loss, even though these are associated. That's why, in a recent piece on Radio National's Perspective,(http://www.abc.net.au/rn/perspective/stories/2007/2023406.htm) I advocated a scale of graded payments for a) having fitness assessed in conjunction with general health checks, and b) showing verifiable improvements in fitness over a six month period. Get the scheme right and you provide nothing but incentives for verifiable, individual reductions in the risk of chronic disease, and thus, on average, a reduction in the burden this places on our health system. Surely this is preferable to a) ignoring this most significant (poor) health issue, b) expensive and poorly focussed public health campaigns with uncertain outcomes, c) undue subsidies to providers with no verification of results. Most importantly, it provides support and opportunity to the highest risk individuals, without removing responsibility from them for their own health behaviour.

Charles Worringham
Independent Candidate for Ryan
Posted by Charles Worringham, Friday, 21 September 2007 10:00:09 PM
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The idea that doctors should be empowered to make judgements about who "deserves" treatment is absurd. They are paid - handsomely - to treat diseases, not to triage or discriminate against individuals on the basis of "lifestyle". We pay our politicians to guarantee services, not to decide whether all of us deserve them. It seems odd to me that someone from a libertarian "think-tank" would recommend that doctors, as representatives of the state, determine whether or not someone merits treatment, on the basis of the pleasures they have pursued throughout their lives. Sounds like nanny wagging her finger to me. The philosophy underpinning socialised medicine is less riven with contradiction: treat everyone, without favour, on the basis that guaranteeing medical care is a necessary element of any society that pretends to civilisation.
Posted by jason_a_w, Saturday, 22 September 2007 10:12:46 AM
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Perhaps if one was to look around rather than thinking in isolation, responses to this suggestion would not be so clear-cut:-

How many of the incredible people who run animal shelters, rape crisis centers, volunteer their time and services for the good of the community, work in social services etc. etc. are overweight?

Now, compare that to the numbers of self-absorbed, narcissistic people who are found in every gym, at health food stores, at de-tox centres and so on...and who have never contributed to the common good in their lives.

Yep, of course not all fat people are selfless, nor are all fit people uncaring: .....and that's exactly why medical care needs to be given objectively. How the hell does it become a doctor's, or a committee's, or even a taxpayers - responsibility to judge who is more worthy to live and who to die? Who is even capable of judging?
Posted by Romany, Saturday, 22 September 2007 1:45:24 PM
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I hope poor life style choices includes people who hurt themselves while climbing mountains ,joggers who twist an ankle or get bitten by a dog,hikers who get lost and suffer heat or cold problems,gym junkies who
overdo it,politicians who fall off exercise bikes,reckless drivers who have accidents.The list goes on and on.Are we going to say that only healthy,fit and flu sufferers are entitled to free health care.By all means advise people to lose weight,quit smoking and live healthy lives but don't disadvantage those who don't.Living a healthy life didn't save Pritikin the diet guru.
Posted by haygirl, Saturday, 22 September 2007 5:26:37 PM
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There's another leg to this debate. As Australians get fatter and they demand their rightful access to healthcare, what they will do is put so much weight (pardon the pun) on the health system that it will no longer be able to cope. In fact, the system is well on the way now.

What happens then? Does the Government just let the system go under? If people themselves do not pull their collective fingers out, the Government is going to have to do some rationing of beds etc. The question then is: should the rationing be done on a rational basis (eg charge extra to those that are unfit) or ask the fit population to pay more to subsidise the rest? There's a limit to how far people are prepared to go either way.

It doesn't take much thought to realise that the only sustainable solution is that people pull their fingers out.
Posted by RobP, Saturday, 22 September 2007 5:47:11 PM
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Whilst speaking with a workmate - "The Doctor put me on Crestor, thank God I can eat whatever I want from now on."
Whilst standing in a lunch line behind a generously proportioned couple - "I'm going to have a diet C**e today. (He went on to order a bucket of chips and a vanilla slice- the diet drink was his adipose offset I suppose.)
Whilst grocery shopping - a rambunctious toddler is rewarded with a M**s Bar. Later, at lunch, an even younger baby sits in a high chair fingering and slobbering over a generous serve of some kind of deep fried potato nuggety things.
These are a minute sampling of the kind of attitudes that exist and that constantly force changes to out health/health insurance system.
Also, by the way,I object to paying the Medicare levy while having private cover. This double hit is no more than a subsidy to people who make poor, stupid, avoidable life choices.
RobP, Haygirl and aqvarivs - More power to you.
Posted by enkew, Sunday, 23 September 2007 6:25:48 AM
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