On and on they go, these socialists. “Based on need, not ability to pay” … “Health-care is a right” … “common good for the benefit of all Australians” … etc, etc; while all the time sweeping the gross injustice being committed against those who are compelled to pay for it under the carpet.

How do you define need? What about those who require medical treatment due to a lifetime of smoking, overeating junk food, and excessive alcohol consumption?

The fundamental problem with all this rubbish is that when you eliminate the natural feedback between benefit and cost, demand spirals out of control. The only way to maintain this state of affairs is to take more and more from those with the means to pay, and give it to those without.

That is neither just nor sustainable. It’s simply the mob attempting to rationalise away theft.

Oh for goodness sake Winston. If you're so unhappy living in a society, go and buy a small island somewhere where you can pay people to come and build a hospital for your private use, a private road to get there, a private school to educate yourself in, and a private army to defend it all.

Society has costs. And to my thinking, healthcare should be one of them. There are very few of us who could afford our own private MRI and surgical theatre, but most of us can afford one-millionth of one.

Nice cocktail of right wing libertarianism and fundamental misunderstanding of the present system Winston.

The current "health care" system isn't a health care system at all. It is primarily a rather dysfunctional disease treatment system.

The best way to minimise cost of treating diseases caused by "a lifetime of smoking, overeating junk food, and excessive alcohol consumption" is to devote more effort to reducing the number of people who do those things.

As for defining need, it may be politically courageous, but it is ethically and technically feasible. For example the NSW government has just banned vanity cosmetic surgery procedures from public hospitals, in favour of freeing beds for more serious cases. (Whether the ban lasts longer that road closures around the Cross-City Tunnel, we have yet to see.)

Less in the political limelight (apart from stunts like Abbot's RU486 one) is the Pharmaceutical Benefits Scheme administration, which is continuously making decisions on need and cost-effectiveness, about which drugs should be available to everyone on a subsidised basis.

Since a large proportion of hospital cost is funded by GST revenue, an impost on all Australians, I don't see where the accusation of theft comes from. Rather it could be argued that government subsidy of private health benefit scheme costs is giving away to the affluent middle classes money stolen from everyone else.

I agree completely that we have a system that treats illness rather than a health system. Encouraging a substantial shift of funds away from the hospital system into preventative healthcare and discouraging Federal Health Ministers from urging people to use "free" hospital facilities are both fundamental to addressing the crisis in healthcare in Australia. I look at current Australian hospital waiting times and wonder just where we would be right now had Medicare Gold eventuated. Telling people over the age of 70 that they could have anything they wanted, no matter how trivial, bsolutely free of charge, was insane in terms of health economics and demand management and wards full of pensioners taking the government at its word would be the last straw in this and other States.

Regards

Kevin

Quote“ It is difficult to achieve a sustained focus on the source of our problems in health and the reforms needed to address them. The issues are complex and inter-related and there will be no quick fix or simple solutions. A co-ordinated and concerted effort is required from state and federal governments, “consumers” of health services, private health service providers, and a myriad of other key stakeholders, if we are to implement sustainable solutions.”unquote

Some health problems are self inflicted such as drug & alcohol abuse, eating disorders to cite a few.

However, the largest single contributor to health problems is industry.
In acknowledgement of this, governments have enacted legislation requiring PAYE employees to be insured against injury and one would assume that is the end of the problem…. Not So….Although the Insurance Industry makes provision for injury incurred but not reported (IBNR) just try making a claim without irrefutable evidence in cases of slow onset.. You have more chances of winning Lotto.
Once ceasing employment, Industry is off the hook despite the work environment being the primary cause of an Illness or injury which cannot be easily verified without a class action and probing investigation….I am mindful of a major blowout of Workers Compensation costs in NSW in the ‘80’s following such an action in a poultry factory where many migrant workers sustained RSI from a particular repetitive task and were unable to continue work. The cause was discovered by a Workers Health Centre in Lidcombe which has records of migrant women who had developed Tendonitis. Inhalation of substances cause many illnesses which do not become apparent until years after exposure ceases…e.g. Asbestosis and Silicosis
Instead of premium payments to insurance companies who profit from any surplus, Industry should contribute to their workers general health wellbeing with direct payments to Medicare which provides lifetime treatment.

We need a system of universal health care. We don't want to return to the "user pays" systems of the past or follow the United States for profit health system.

My ex-neighbour gave birth to a son with brittle bone disease in 1935. She did not smoke, drink or gamble. The family was responsible for rearing him, they had to move from the city to a country town which would allow him to attend school, they spent 20% of their [modest] income on his surgical boots every time he grew. Mrs S. used to tell me details of how she would tightly budget.

When loved ones have been at death's door we are confident that we have access to the best care available in Australia, we don't have to worry about the $2000 cost per dose of chemotherapy.

Most of the health care costs are clocked up in the last 2 years of life so why should some one who has worked for 40 years and paid their taxes be denied access to health care or be forced to spend a day per week filling in forms for rebates.

We don't want a US style health system because the most common reason for bankruptcy is unpaid medical debts. The cost of health insurance is so high that its usually part of your salary. In the US all employees who work more that 30 hours per week have to have employer paid medical insurance. Hence the large number of part time employees. 75% of Walmart employees work less than 28 hours per week.

In Victoria the government has renovated public hospital wards then sold them [cheaply] to private operators. One private hospital is currently under contract of sale to another but the sale has drawn out so long cynics wonder if this isn't a ploy to wipe out the competition and gain themselves a maternity ward - a cash cow. Private hospitals chronically understaff and are dependent on agency nurses employed on a daily basis. This is unfair employment practice.

It’s disturbing the way some socialists dismiss opponents as advocating “every man should be an island”. Most of us are not saying that at all. I am saying that we need to put freedom and choice back into the equation, and to do that we need to get the government out of our lives - the health system being a case in point.

The reason it is a “rather dysfunctional disease treatment system” is because it’s a centrally-planned bureaucracy attempting the impossible – trying to prove that governments and bureaucrats can perform better than businesses competing for customers in a free market. In the absence of feedback from shareholders and customers it’s impossible to optimise the millions of decisions that need to be made, particularly given that the government simply takes the funds it needs. Imagine if you could run your business that way.

Advocating even more regulation to try and determine genuine need doesn’t solve anything – it still boils down to subjective opinion administered by a bureaucracy, making it even more inefficient and money-wasting.

I can’t understand why many contributors to this forum are so resistant to the simple idea of letting each of us be guided by experiencing the consequences of our own actions. If we smoke, we get lung cancer. If we want to be treated, we save or borrow the money needed. If we want to secure ourself against illness, we take out insurance.

Is it because they all are on the winning side of the socialist bargain?

How is it okay to demand instead of user pays, someone else pays? What is wrong with a simple, self-regulating system that doesn’t require an army of bureaucrats?

Theft is an appropriate word to describe the way the government takes what it needs for its ever-expanding operations and dishes it out to favoured groups. It is certainly not the basis on which we can form a just society, because it places the government above the law that applies to those whom it is supposed to serve.

In 1935 doctors in Victorian doctors banded together to form HBA. The doctors started HBA as a health insurance organisation so that their patients would pay them for treatment. HBA was set up as a doctor's income protection scheme. I have no quibble with that.

HBA is now owned by AXA - a French insurance company.

Clearly I would be seriously annoyed if Medibank Private was sold off. I am told that the health insurance premiums are set so that the smaller insurance funds can survive. I would like real competition, health funds free to set contributions low enough to weed out the inefficient. Unlike the system of government regulation that has existed for 25 years.

And why should children's access to health care be dependent on the wealth of their parents?

Winston Smith should work in the United States for a year then tell us what he thinks.

Winston Smith: "... we need to get the government out of our lives - the health system being a case in point."

Like the US system...

Princeton economist Paul Krugman writes (NYTimes, Nov 14 2005):

"I'm not an opponent of markets. On the contrary, I've spent a lot of my career defending their virtues. But the fact is that the free market doesn't work for health insurance, and never did...

"That system is now failing. And a rigid belief that markets are always superior to government programs - a belief that ignores basic economics as well as experience - stands in the way of rational thinking about what should replace it."

Why?

"... good insurance is hard to come by, because private markets for health insurance suffer from a severe case of the economic problem known as "adverse selection," in which bad risks drive out good.

"... insurance companies don't offer a standard health insurance policy, available to anyone willing to buy it. Instead, they devote a lot of effort and money to screening applicants, selling insurance only to those considered unlikely to have high costs, while rejecting those with pre-existing conditions or other indicators of high future expenses.

"This... is the main reason private health insurers spend a much higher share of their revenue on administrative costs than do government insurance programs like Medicare, which doesn't try to screen anyone out. That is, private insurance companies spend large sums not on providing medical care, but on denying insurance to those who need it most."

Krugman also pointed out in a column a few weeks later that the most efficient and highest rated supplier of health care in the US is the federal government Veterans' Health Administration.

"the lesson," he wrote," of the V.H.A.'s success story — that a government agency can deliver better care at lower cost than the private sector — runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today's Washington."

Medicare is "user pays concept", we pay the Medicare levy, we expect to get a service for money paid, a simple concept really to most of us, except Winston of course, for whom everything is a communist plot.

If the Howard Government claim there is not enough money to provide a great service, simply raise the Medicare levy by .5% and get on with it, for some of us it is a life or death experience, perhaps that suits a purpose, is there something we should know?

During the last ten years the Howard administration has tried all types of incentive and coercive tactics to steer people into private health funds. To name a few he has raised the medicare levy for those who wish to opt out of private health, then came the lifetime cover campaign and the ridiculous thirty percent rebate. Despite all this the take up is still only a miserable forty two percent and then primarily skewed to the older populace. I have no problem personally with private ownership of services but in this case the likes of Howard, Winston Smith and co just don't get it. The majority aren't interested in private health cover in the current form.

The dismal performance in public health is mostly blamed on incumbent state governments but this argument looks rather flimsy when one considers the fact that all states and territories have sufferred an ailing health system for years. The federal government has alot to answer for since they continue to flog the traditional worker unions but fail to take on the two most powerful unions in the country, namely the AMA and the college of surgeons. The plain stupid vote buying thirty percent rebate has not achieved it's purpose of cost support to the consumer but instead, like all other subsidies has only fuelled massive price hikes in fees by placing further demands upon a supply constrained product. The price rise being about equal to the value of the original subsidy. Over the last few years this appalling waste of about three billion dollars annually could have easily funded over one thousand acute care beds in our public hospital system, virtually wiping out the waiting lists in one fell swoop.

Medicare might have it's warts, but run properly it could not possibly be worse than what we have now.

Make anything free and your supply system will collapse from too much demand.People will use it not out of need or necessity,but because they can.Try it.Make hot dogs free at you school canteen.People will gorge themselves until they're ill,just to prove a point and the same has happened to our medical system,only those in real need are missing out.

Increase the pension and make all pay $5.00 for a visit to the GP and those with chronic illness be exempted.Do likewise for the rest of the country and the demand will fall.Get people to explore alternative medicines that work and encourage healthy lifestyles.We all have to be more responsible for our own health since we will all go broke eventually, trying to extend our lives on the borrowed time of past decadence and irresponsible actions.

Nothing is free because we even have to make some effort to breathe the air that sustains us.

My dear Arjay. I agree with much of what you had to say except the part about alternate medicine. To suggest such a thing makes me think you must be very well off indeed. Unlike traditional medicines, alternative medicines are not listed on the PBS and as such are extremely expensive. Unfortunately, the AMA will make sure that situation doesn't change in a hurry. Wildcat.

The medicare levy should be either abolished or adjusted to reflect the true cost of public health.

Currently the medicare levy is set at 1.5%. I would propose that it should be increased to 8% and marginal tax rates reduced by 6.5% to keep the change revenue neutral. Then at least the electorate would have a proper appreciation of what the public health service is costing them each year.

If this is deemed too complex then we should just abolish the medicare levy and increase marginal tax rates by 1.5%. Then at least the current deception could be layed to rest.

Well said Terje.

Of course one of the problems with private health insurers is they can chose who they provide cover to so people with pre existing conditions have no cover. This means:

the family of a high income lawyer has no cover because wife has a type of eplepsy that caused her to nod off in boring meetings

a lecturer invited to teach and research at an ivy league university, was unable to take up the position because his son was in and out of the childrens hospital for first 7 years of his life. The son is now normal.

Terje wrote "Make anything free and your supply system will collapse from too much demand.People will use it not out of need or necessity,but because they can.Try it.Make hot dogs free at you school canteen.People will gorge themselves until they're ill..."

Evidently he gets his ideas on the economics of demand and supply from watching children under 7 at birthday parties, or young males under 25 bingeing beer.

Most people in most circumstances do not behave like this at all.

If we are going to analyse this with late 19th century economics, we might at least respect the concept of diminishing marginal utility: apart from an initial small number (which in the case of chopsticks is two) each additional unit of consumption is less valuable than the previous one.

In the case for example of consuming general practitioner medical services (which since introduction of Medicare and despite depredations of the Howard government is still free for many), at some point for most people the marginal utility actually becomes negative. A health niggle becomes too small to be worth the bother of setting up and attending an appointment and worth less than the opportunity cost of spending the time some other way.

Earlier in this thread Winston Smith put forward the same silly idea as Terje. Am I supposed to believe that if Terje or Winston buys a slab of beer or a bottle of spirits that, given once the purchase is made the cost is a sunk cost and the marginal cost of consumption is nil, that they will immediately scoff the lot? I don't think so.

Why don't these people simply use their brains instead of parrotting - incorrectly - the thoughts of long-dead economists?

In a recent paper for the Productivity Commission, a Federal Government advisory body, Andrew Podger reviewed Australia's health care system. From http://www.newmatilda.com/policytoolkit/policydetail.asp?PolicyID=273&CategoryID=7 (with a link to his full paper):

"Based on his analysis, Podger identifies four key structural problems in Australia's health system: lack of patient oriented care; allocative efficiency; poor use of information technology; and poor use of competition...

"Podger favours a full Commonwealth takeover of the financial responsibility of the health system...

"First, there is a need to strengthen general practice and improve its links to allied healthcare, so as to improve care planning for the chronically ill and frail aged and play a larger role in prevention through assessments and advice for those most at risk. Strengthening primary care for Indigenous communities is also essential. Secondly, electronic health records and other IT support should continue to be a priority... Thirdly, there should be small steps made towards 'single funder, funding-follows patient approaches' for the frail aged. This would make it easier for a consistent, patient oriented approach to be provided... Fourthly, further and targeted investments should be made into preventive health in areas such as smoking, obesity, nutrition and physical activity. Finally, additional energy should be directed to improving competition in acute acre and clarifying a sustainable role for private health insurance...

"The incremental changes that Podger proposes are intended to provide clearer direction to health reform and would also support serious consideration of a Commonwealth takeover in the not-too-distant future."

Notice that simplistic cures like tipping more money or more doctors into the current mess don't receive highlighting.

MikeM claims that the theory of marginal utility shows my "parrotting" of ideas is “silly”. Perhaps he needs to revisit the premises on which marginal utility is based.

Human wants and desires are essentially unlimited. That does not mean that they are unlimited in the sense of wanting a limitless supply of a single good, but rather in the sense of scope. Of course an individual may feel that another trip to the GP is not worth the bother, but that doesn’t stop that individual from seeking other, perhaps more expensive, forms of health care and treatment.

The demand is limitless, which is why it must be moderated by some method. I would advocate a free market as the best way of carrying this out.

Regardless of which economic theory you follow, the point surely is whether it is legitimate to require, without consent, those with means, to fund the health care of those without. I don’t think it is, for reasons provided in other posts.

Winston Smith wrote, "Human wants and desires are essentially unlimited."

What an improbable claim.

Evidence?

An improbable claim?

Surely you don’t really believe this, do you?

Given that we have moved beyond living in caves, and are currently reaching for the stars, it’s the corollary which lacks evidence.

Winston,

You may be some weird creature whose wants and desires are essentially unlimited, but the rest of us aren't.

Keynes warned about people like you in his concluding words in "The General Theory of Employment, Interest, and Money", http://etext.library.adelaide.edu.au/k/keynes/john_maynard/k44g/chapter24.html

"Practical men, who believe themselves to be quite exempt from any intellectual influences, are usually the slaves of some defunct economist. Madmen in authority, who hear voices in the air, are distilling their frenzy from some academic scribbler of a few years back..."

You are channelling voices from more than a century ago.

Dir!! The GATS agreement has been in motion ever since the Hawke days.

Labour has ridden on the back of Medicare, only they signed the deal and the Liberal party have carried the torch and implemented it.

We can see by the Corporatising of our utiltise and our Australian Assets, the sale of Telstra is one of them, according to the GATS.

The GATS agreement that Labour initiated states that nothing will be pubic. Everything will be privatised.

So Labour have been flogging "Medicare", only to know that they will have to privatise it according to this "TREATY".

Sure, Yep, Labour always working for the people. Ugh!

Medicare was set up in February 1984 by the Labor government set up by RJ Hawke.

Its Liberal policy to sell off Telstra and utilities like trains, gas and electricity. I fail to see why utilities that the public have built and paid for are going to be run more efficiently by a myriad of American owned companies.

Take electricity for example. In western NSW the electricity provider is Countrywest and in Victoria the electricity provider is TXU, Texas Utilities. In a 3 year period Countrywest trained up 800 apprentices and TXU trained up 3 apprentices.
Who has this country's future at heart?
Who is out to maimise profit for their overseas owners?

At the moment our Pharmaceutical Benefits [Payments] System which is considered a world class example of how to provide drugs effectively and fairly is under threat from big pharma. The big pharmaceutical companies want to break the power of the Australian government to set the price, when the price of a generic drug gets to high the PBS system has ordered it from a cheaper supplier.

Why do I worry about poor people. Well if only those with health were treated then doctors wouldn't be able to prescribe the best treatment, they would only offer the cheapest treatment, so that doctors have less practice with the best treatment. In other words, the standard of all australian health care falls.

MikeM,

In public life I am often exposed to contemptuous remarks from those who see nothing wrong with the forced redistribution of wealth that must necessarily accompany socialist schemes such as Medicare. Derision and personal attack seem to be their weapons of choice, rather than reasoned argument against the points I make (for those, see my earlier posts). You seem no different.

I am well aware that one of the foundations of socialist thought is the concept you believe in - that human wants and desires are limited, or if not, one should make every effort to discipline oneself and others to achieve that state. However this does not accord with reality or freedom, and if it were true, we would not be in any position to debate such issues by means of technological advances such as those that make this forum possible. We would all still be walking everywhere, and communicating face-to-face only.

If you are interested in developing your understanding of these issues beyond the writings of Marx, Keynes, Galbraith, and Krugman, I recommend this book for an excellent and provocative insight: http://www.capitalism.net/Capitalism/CAPITALISM%20Internet.pdf

Health care system of any country need to be dealt with two aspects.How to remain healthy and how to be cured at time of ailments.Generally medical care is taken granted for health care system.But factors influencing the health should be taken equally important as medical care in total health care system.It has been proved already only medical care system is unable to keep people of any country to remain healthy.So is importance of public care system within total health care system to be looked into.