What a very big load of codswallop.

We have already had almost two decades of cost effectiveness and improved effeciencies.

We now have 38% fewer public hospital beds than we had in 1985.

Anybody who says that increased competition will lead to reduced costs and improved service in the health care sector is either delusional or has no understanding that economic theory simply does not work for health.

The is one exception and that is the act of passive euthansia. Simply by either denying or making health care unavailable to certain groups of people will ongoing costs be reduced.

<The marketplace ideology which gives their activities legitimacy is powerful and all pervasive. Despite alarming insights which challenge the validity of market theory in health care, economists and politician continue to impose new marketplace solutions to the problems created by previous marketplace solutions.>
http://www.uow.edu.au/~bmartin/dissent/documents/health/central.html

Case in point is that at the moment the NSW government is trying to reduce staffing levels, at a time when there is an increasing demand for health care services, which then leads to increased waiting times, and a decrease in the standard of care. And still cost will increase.

As I said: "Besides a handful of pro-bureaucracy ideologues, most people understand why competition leads to a better outcome."

And then along comes James...

Strangely, to defend the anti-competitive approach, James points out that the current system is inefficient, ineffective and reducing bed numbers and staff numbers. He may think these are good things, but most people disagree. Unsurprisingly then, the only anti-competitive link he can find comes from a communist.

Even more strange, James & his communist friend seem to think that the current anti-competitive approach with a government monopoly provider of basic health care is an example of "marketplace ideology". I can only assume they are joking, or today is "Orwell day" where everything means the opposite.

Doesn't it make sense that if everybody was in the same health care system. Things would be better off.
At the moment we have a host of splinter providers, which i believe keeps costs high.
Medibank private works well because of the lack of shareholders.
Medicare + select sounds like they are on to something promising.
If everybody had a basic level of health care which included hospital cover as compusory, under medicare, then you can select over and above cover at an extra cost if you desire.
The 30% now provided could be redeemed and go towards this basic cover.
All in the same boat i recon.

John I will stake everything I own including my super, that your proposition will not work as you plan it.

Sure no health care system in the world is perfect. I have had more than a passing acquaintance with the competative American system.

There two major requirements to keeping health costs down, firstly it must be universal and secondly not for profit.

At present in Australia administrative costs are increasing, partly because more and more measures are being implemented to measure performance, which adds to costs.

I actually work in the health care sector, and competition in the health sector does not lead to better outcomes. Competition is about reducing costs, to improve profits.

There is an eye opening report into the performance of the RMH, where cost reduction was a major driving factor, that lead to poorer patient care and treatment.

sadly for our public hospitals the fights between state and federal governments have had a disastrous effect, and socalled cost saving measures actually have helped to increase costs in the longer term.

John
Excellent article. I couldn't see how anyone could object to it, and then along came James.

James
Can you see how it is mistaken, when government takes over health services, produces worse outcomes, and then tries to fix the problems it has created with more government interventions that in turn result in more of the same planned chaos, to call that 'marketplace ideology'?

"There two major requirements to keeping health costs down, firstly it must be universal and secondly not for profit."

James, why would not the same apply to all other goods and services? If competition and profit were wasteful, then surely the ideal way of providing goods and services would be to have one big government monopoly Department of Everything, thus keeping costs down. But if not, why not?

I have not read the article but I will. However, the truth of the matter is that we have a system where the people who contribute the most, have to also pay to see a doctor while those who contribute very little, or zero, get to see the doctor free of charge.

Now as long as this is allowed to continue, while the contributors (tax payers) are dwindling, then we are in fact burning the candle from both ends and the system is sure to fail.

200 years ago when our forefathers were planning this great nations future, they simply forgot to plan for those who expect a 'free ride'.

Nothing will change until some serious changes are made to our welfare system and our retired taxpayers, and future retirees for that matter are given a fair go.

Until then, the cookie jar simply will not stretch far enough.

Thank you for writing this rational article, John Humphrys.
I have no idea why people would be opposed to changes; it's not like we have a fair and economical health system where everybody has easy and equal access to the best health care.

You mention that the Netherlands has implemented such system and I've been aware of that because my whole family lives over there.

While it's up to the individual health companies to offer a variety of 'menu's', there are some rules that the Dutch govt set for the different companies to abide by, and I think that this is an important factor why the system is a fair one.

For example, anyone should be free to switch companies without incurring penalties and all companies should be easily accessible to anyone. Medical history, current health state and age should NOT be reasons for rejection.
A good combination of govt control and ‘free market’ makes this a fair system because nobody is discriminated against and everybody has equal free choice.

My mother, now a pensioner, has basic cover only and can afford to see any medical professional she likes. She’s had to see many specialists as well as physiotherapists, counselors, relaxation classes, heart-health education classes, free access to a hospitals gym for heart-health, healthy cooking lessons, (free prevention and /or recovery programs) and also sees a dentist twice a year for general check-ups and cleaning, has had some fillings replaced and had a crown, too. She had new spectacles and some permanent hair removal, too.

Her gaps? Nothing!
Medication is included, too, and is even delivered to her house.

Compare that with my family’s costs here in Australia. We have top hospital cover and extras, for which we fork out thousands of dollars each year and we STILL have gaps to pay wherever we go!
Simply seeing a physiotherapist, dentist or any medical specialist means there will be gaps to pay. Need medication? We pay for that, too!

So yes John, I fully agree that we do need changes and we do need a fair(er) individual-based system!

Welcome back Celivia.

The Netherlands sounds good.

I haven't bothered to read all this, but really if it ends up like America where people hold on to jobs they hate just for the medical insurance I don't want it.

Someone tell me how/why it wont end up like that?

I'm happy enough with what we have at the moment with the pikeys getting free sub-standard medical care, and the rich getting ridiculously overpriced rip-off adequate care.

I remember after paying basically $5000 in medical bills WITH private insurance for our first baby, we decided to go public for the second. It's all a mess of course, but I look at it like I look at the school system

public: As in, the public have a free system.
private: People who are rich, and don't like the public system, can pay through the nose for something better (or perceived as better) if they so desire.
problem: When the government gives money to the people who have rejected the system that the government provided for free. Just like grants to schools who have a spare $35 mil lying around and the kids go to France for school vacations.

Why should ANY industry, childcare, private health insurance, superannuation, private schools, get a free leg up and a license to print money from the government? If their service is right, and the price is right, people will pay for it and it will be viable. If not, they'll have to do something about that.

gotta agree with the author. i mean, just consider the brilliance of the u.s. system. how could anyone possibly question the benefits of competition when it comes to health care?

I agree that we should have some real competition in health care in Australia.

My first proposal is that the government immediately stop subsidising the private health industry. Let the private health industry prove its worth by standing or falling on its own merit.

The $3 billion saved annually should then be invested in public health, and let the public decide which they prefer.

Oh ... they already were deciding: they were abandoning private health in droves; until the Howard government bullied and bribed them back.

Few things make me want to spew more than money grubbing doctors.

Full medical ought in my opinion be an inalienable right of all people in any decent system of governance.

Medicine is like food and water, everyone one needs it on tap. If that means we need to make lots more doctors who all get paid less then so be it. Regulate them, as clearly indicated by the plight of the Original Australians and some low income groups, the money grubbers form the a.m.a. have their own pockets as too high a priority.

Currently, medicare is optimized such that the best time to money ratio in terms of profit is something like a 6 minute consultation. And those on medicare who book extended appointments and get chucked out early can no longer protest the over billing fact because the system, designed by an idiot, "push button" assigns your rights away in advance.

What a joke! We may expect an increase in medical errors without a shadow of a doubt i.m.h.o.

Priority number one is that people get plenty of treatment, not the lifestyle of doctors. For those who just want to make money, go and be an exporter.

I agree there should be more competition between health insurance companies.
However, there will always be those people in our community who will not be able to pay for even basic health cover, for whatever reason.

We do need a form of medicare to care for these disadvantaged people.
What the government failed to do was to ensure that all people are at least asked to pay a nominal fee for all services in public hospitals.

When GP surgeries don't bulk bill, then many people will turn to hospital emergency rooms to find a 'free' doctor and free medicines, leading to overcrowding in these departments and a waste of resources.
Gone are the days when health providers are expected to serve the public from the goodness of their hearts, with no monetary gain!

Most Doctors aren't money grabbing as some posts have suggested. It is very expensive to run GP surgeries and the government does not pay appropriate renumeration to cover a bulk billing practice's expenses.

Why is it that people in our society are more willing to pay for their pet veterinary fees than for their own medical expenses? Because they aren't given a choice.

We can't go on expecting healthcare for nothing.
The medicare levy at least makes a start in making the system fairer.

There seems to be two different stories here.
Can someone tell me what John Humphreys is saying.
Does he want more competition ?
Does he want more govt involvement ?

John and Peter, I was very fortunate as a child that my parents could afford private health cover, as I had a high number of broken arms.

My nanny, had a brother with a deformed arm and I ask her what happened, and she told me that he had broken his arm and they could not afford to go to the doctor.

Today it doesn't matter if you are wealthy or poor, broken bones are treated, thanks to government interference.

Now if Australia had remained with the American model of health care, health care for the poor and disadvantaged would have remained either non-existant or been at a very low standard.

In America the cost of health care can send you from being relatively well- off to being bankrupt. So government interference has protected many middle income families in Australia from experiencing bankruptcy as well.

Even pre medi-care(bank) public hospitals recieved revenue from these sources, government (taxation), private patients, and third party accident insurance. As far as I know all public hospital beds(wards) for private patients have now been closed.

We have two decades of reductions in health care spending (public hospitals) and at the same time our population is increasing at an alarming rate, without the infrastructure to deal with it.

In 1985 the states closed many psychiartic hospitals, sold the land to developers and promised to improve community services for psych patients, this has not eventuated and now our prisons serve as defacto psych hospitals.

Sadly John because you are saying what our politicans want to hear, we will be forced to gone a pathway which in the end will not work in the way you intend it too.

I do not deny that too much government interference, results in poorer outcomes.

One of the biggest cost drivers is that in the last 6 months of a persons life, is when the most money will spent on them.

Houellebecq:
” I haven't bothered to read all this, but really if it ends up like America where people hold on to jobs they hate just for the medical insurance I don't want it.
Someone tell me how/why it wont end up like that?”
Hi Houellebecq! Well, it’ll be clearer to you if you read the article. The system in America now has an employer-based system…. But if they follow the Dutch system, this means that people are buying their own health care insurance and that there is subsidized care for those (e.g. elderly, poor…) who need it.

”I'm happy enough with what we have at the moment with the pikeys getting free sub-standard medical care, and the rich getting ridiculously overpriced rip-off adequate care.”
With the new system there may not be a two-tier system but there will still be options to upgrade to a higher level of health care. If basic medical care is compulsory but if there are options to upgrade it so that it is suitable to individuals’ needs, then there should be something for everyone.

”Why should ANY industry, childcare, private health insurance, superannuation, private schools, get a free leg up and a license to print money from the government? If their service is right, and the price is right, people will pay for it and it will be viable. If not, they'll have to do something about that.” I agree to a certain extend… but if the private system (I’m just going to talk about health care here because it’s already such an involved and difficult issue that I need to stay focused) provides a service to the whole community and benefits the nation, I can’t see why there shouldn’t be a basic amount of money (that otherwise would’ve been spend on health care insurance provided by the government anyway) to support this private industry. BUT in return the government has to keep an eye on these health care insurance providers.

Hi JamesH:
“Competition is about reducing costs, to improve profits.”
Hmmm, there is truth in that… but in Health care it is also about customer satisfaction. It would be good if patients/customers could give ratings that would be openly displayed so that new customers could base their choices on the feedback of others. Openness about performance of an industry is very important, I think.

Hi Bushbasher,
If you read the article, you would know that the author is not talking about blindly following the system of the USA. He is talking about an improvement to the system by doing something different. Even Obama has intensely looked at the systems of some other countries, such as Switzerland and especially the Netherlands because it is said to have the best medical system in Europe.
It is not perfect, but it is the best that any other country has come up with. It is a universal system, meaning that it includes EVERYONE, while it is still adaptable to every individual’s needs.

Well *SuzeOnLine* I'm shocked to see you trotting out the platitudes of the a.m.a.

The only thing I can say in your defence is that the underlying industries supporting medicine also need to be regulated.

The economy can be expressed as a mathematical equilibrium and everyone can't be a millionaire.

There are only a fixed amount of resources, even for a wealthy nation of barely 25mill.

I have 2 GP's. One with a specialisation in sports medicine and the other with a specialisation in another field.

One drives the latest Saab turbo, and the other a 7 series BMW, both with plush homes in tof suburbs.

Meanwhile, some people in the Australian community suffer. The a.m.a. should be thankful that the likes of me aren't making the rules, and I note that even canberra gasped in disgust at their latest demand for a pay rise.

celivia, i know the author wants to do "something different". but i also know the author is chanting "competition" as if that's the magic wand to make sense of health care. well, if it is, then the author is obligated to explain why the u.s. system is a complete nightmare.

Hi Bushbasher.
I’d like to have a better understanding, too, why the US’ health insurance system is a disaster and the Dutch system a success, while both are based on market competition.

I can think of a few reasons: mainly lack of transparency and insufficient freedom of choice (but try telling Americans that they don’t have enough freedom!).

Realistically, we cannot expect insurance providers to care for the well-being of customers as their job is to make a profit. And the more care a customer needs, the more costs are involved.
That’s why, in the USA, providers reject people with pre-existing conditions or the elderly, or charge them a higher premium.
So, the Dutch Federal Govt set some basic rules/regulations. Insurance companies are obliged to accept anyone and are not allowed to charge higher premiums to people with pre-existing conditions and the elderly. But, because the government compensates them for people who are more expensive to care for, everybody is welcome.
This is called ‘risk solidarity’.

However, there are providers that give incentives to those with a healthy lifestyle. Buy a low-fat vegetarian meal at a restaurant and claim part of your bill! Approved products (such as low-fat, low-sugar) on supermarket shelves are also claimable.

Also, the US system is organised too locally, while the Dutch system is a federally regulated one.
In the US, people are not free to buy their health insurance from companies in other states, so there is no need for the states to compete with each other.
The Dutch system offers total freedom because customers can buy their insurance policies from anywhere they wish; they are not obliged to stay local.
And, insurance companies even pay out to people who have medical treatments outside the country.

Changing insurance providers is also easy in the Netherlands as their choices don’t necessarily have to be employer-connected like it is in the US, which is restrictive.

To be continued

Also, the costs for services in the US are not transparent enough.
This reduces freedom of choice also. Without adequate and easy to understand information about price and performance, one cannot truly have free choice.

There needs to be no artificial cap on doctors’ wages if customers are able to compare costs and have the freedom to find better prices/services elsewhere, even internationally.
Besides, wouldn’t a cap on wages lead to fewer practicing doctors or encourage them to work fewer hours, causing less competition, which means higher prices?
Doctors in Canada, who’ve reached their cap, simply go on holiday for the rest of the year.

Transparency of costs and services (e.g. patients’ rating system) will force doctors’ prices down, which will result in more reasonably priced health insurance policies, too, while maintaining and even improving quality.

Currently in Australia public health funding is provided through the taxation system, income tax and the medi-care levy and state taxation.

The next problem is that it is then funded by both the federal and state governments.

The state governments dish out the funding in a piece meal fashion, and use a carrot approach, where hospitals that meet bench marks recieve extra funding. Mind you the bench marks are set by the various health departments, and often are totally unrealistic and unachievable, because of years where funding has been kept below the inflation rate, and the decrease in available public hospital beds.

However what drives public hospital budgets into the red, it where they are funded to treat 1,000 patients for example, but wind up treating 1,100 patients.

The major costs of a patient are incurred within the first 24 to 72 hours of admission.

Decades ago, public hospitals had a small number of acutely ill patients and a high number of convalescening patients. Today this ratio has been reversed. Which increases costs, so improved effeciency increases costs.

A paradox occurs where the actual costs per patients decreases, because of shorter stays, yet the overall cost to the hospital increased because more patients are treated and the average daily cost per patient increases, because their stays are shorter.

Today both the Vic and NSW governments want public hospitals to make efficieny savings, this is after decades of attempts at cost reductions.

I guess both these governments think that you can get blood out of a stone.

cevilia, thanks very much for your posts. i don't have time to look carefully at this, but i'll make a few comments.

first, i have no doubt that the dutch system is better than the u.s. system: there's not much that is worse! i know there are many good health care systems around the world which have a private element, which avoid the free-market looniness of the american system. i take your word that the dutch system is highly successful and highly regarded, and take as good sense the safeguards you say the dutch system includes.

but, that is not an argument that the dutch system is preferable to the current australian system. it may be, but i don't accept it as true without someone making the argument. humphreys definitely doesn't make that argument, he simply assumes it, all the while chanting "competition". humphrey's failure to even recognise the argument needs to be made, the whole tone of his post, exposes him as a monotonic ideologue. he is not simply obtuse, he is totally untrustworthy.

i don't have time to dig up and review the arguments, but there are obvious ways in which free markets and competition do not apply well to health care. paul krugman is great on this stuff. Here, for example:

http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/

i *like* australia's medicare (and i liked it more before howard and his thugs tried to destroy it). it seems to me to work extraordinarily well. that doesn't mean i'm not willing to consider improvements and alternative systems, that the private element is automatically bad. but it does mean i'm not going to pay much attention to anti-government ideologues like humphreys.

Agree with Bushbasher.
Notice the author didn't mention the US. That's because the US system proves that competition leads to higher costs, appalling service and a totally inhumane system.
This is typical right wing clpatrap from a typical right wing ideologue.

Having lost 18 days and nights total drugged up to vegetable state in an ICU ward of a local public hospital in February and December 2008 against my will, for 'asthma' of all things, I would suggest that the employment of casual agency 2nd yr nursing students who can barely speak English and are not yet capable of adjusting the dials on an oxygen meter might be quite adept at reducing the number of living specimens taking up hospital beds. More privatisation would no doubt help to free up more hospital resources to allow more efficient financial adjustments.

Although I have paid over $5,000 p/a for my so-called 'health' insurance by way of tobacco tax over these last three years on Newstart Allowance since struck down by that mosquito bite from Ross River, I don't consider the treatment I was provided in 2008 to be good value for my money, and hope that there might be an 'opt-out' option in this competitive solution, both for the provision of such deadly services and for the thousands of dollars I have paid for stuff all help and my two lucky escapes to survive that incompetence that pervades the private and public health sectors when I've been drugged up by force and stuck in a bed with unknown fools and mentally disturbed sicko's from the casual staffing pool roster playing school-yard games with my life.

I agree it's time for a new Medicare. But beyond that there is precious little from there.

As usual with most CIS offerings this starts with a biased summary then followed by highly contentious(unprovable as an absolute) ideological assumption as an immutable then proceeded from there.

Next it delivered a pre-emptive emotive spray declaring that only Bureaucratic ideologues and closest COMMUNISTS disagree with the assumptions.

I would take issue on all points. I am none of the above having a successful career in private enterprise.

University teaches to state one's proposition then discuss it giving criteria, assumption (justifying them) then add examples and other proofs. Then arguing to the conclusion. At ALL times remaining OBJECTIVE.

The a fatal assumption here is the irrefutability of the dogma. e.g. the absence of one extreme form of management automatically mandates the extreme of the other. It doesn't!

The Article gave no evidence to disprove its flawed status.
Conversely one could give clear evidence that the current 'feral Capitalism' is practised in a terminally distorted environment making the prerequisite level playing field a nonsense. Without this, the silent hand, the market is so distorted as to fails to deliver the necessary impetus to force competition.
That is, if the primary purpose is service delivery at the cheapest price. Consider the abuses of Telstra, the neglect of privatised water and power here and in several other countries.

One could reasonably suggest that the majority of the increasing costs is BECAUSE of feral Capitalism . Drs unions, pharmaceutical companies shenanigans, et al.
One can further suggest that without controlling them ANY management model is fighting a losing battle. Particularly the for 'profit first sector.' On close analysis this whole argument is thus doomed to failure .
In short it is a superficial, biased blurb ( paid ) by the already subsidised private health insurance industry, the pro business at any cost lobby and conservatives.
BTW I support no party dogma just good ideas which because of dubious preconceptions are generally lacking from CIS

The arguments against privatisation are essentially of this form:
1. socialism has never worked anywhere it has been tried
2. everyone knows that
3. therefore we need more socialism.
http://mises.org/story/3793

Exterminator, some people either have short memories or do not really understand their subject.

Around 1997 certain state governments beleived in the mantra that the private sector would be able to run hospitals more cost effectively and effeciently, so they privatised some hospitals, which later proved to be more expensive, I think the website that had details of this is now non-existant.

No health care system is perfect, there are a number of questions we need to ask.

Firstly, is health care to be available all, regardless of income?

Secondly, how are we going to achieve this?

In many countries around the world follow the American system, including middle eastern countries, if you have money, you get health care, if you dont, the disease process would follow its natural course.

for example Seano who posted previously about spending time in ICU, in the States this would have bankrupted you if you do not have health insurance, and in other countries it is highly likely Seano would not have survived the asthma attack, if Seano was not able to pay for health care.

For all of you who think that the American system is based on competition, consider this; out of pocket costs are lower in america relative to total health care spending than most OECD countries. Insurance companies or the govt (which is the largest insurer in America, covering one quarter of the population) pay for ordinary GP visits. Insurance is meant to protect you against catastrophic expenses, not regular check-ups. That is why health care is so expensive in America. NO competition.
Singapore, which spends only 4% of GDP on health care and has one of the most efficient, fair and good quality health systems in the world has more competition and a public safety net. Some stats: almost 50% of spending on health care comes from the govt in the USA, almost 70% in Australia and just 30% in Singapore, but Singapore as better health outcomes and more competition.

All this talk of competition, has me imagining hospital representatives attending motor vechile accidents, to sign up the consumers to use their services, or maybe giving ambulance drivers kickbacks to bring patients to their hospital.

You are having a heart attack, imagine trying to make a judgement of the pros and cons about which health care provider you should use.

Hi bushbasher,
Yes it would be helpful if Humphries clarified his argument, I’m just trying to understand it the best I can.
Thanks for the article by Krugman, I read it with interest- but he is pointing out that relying on the free market ONLY will not work, so how is this relevant to Humphreys’ point? Humphreys, as far as I understand it, does not advocate that we should just rely on the free market. E.g., he says:
” Regulations can be put in place to ensure that health firms do not discriminate against high-risk customers.”
“…agree to have their $3,000 go directly to the government “new Medicare”.”

You like Australia’s medicare system and I think there is a lot to like about it too. In fact I would prefer this system IF I could be convinced that it could work and if it promised to be future-proof, but I find it hard to imagine how this system could survive an increasing greying population if there are so many problems with it today. It’ll be harder to manage if we, in the near future, have a bigger population and proportionally fewer earners.
And we’re also struggling with a dental health system of third-world standard, something that Medicare still hasn’t proposed a solution for.

I see more merit and future in a universal, regulated free market medical insurance system than in Medicare provided health-care. It would get rid of the queue-jumpers, too.

However, if we go ahead with the patching-up of Medicare, a good start might be to stop handing out rebates for private health insurance, and direct this money to Medicare. I believe close to 4 billion dollars was spent on rebates last year. Dumping the rebates altogether would be better than means testing. And we would need something like Medisave.

James, thank you for reading my diatribe on p4. I neglected to mention the overall pattern I've noticed over four occasions in 2000, 2002, 2004, and 2008. The privatisation I noticed in 2008 where unqualified and careless casual staff from private agencies are left in charge of a patient's life was around throughout that period, according to one friend I knew in 2001 who was casually employed by her agency as a nurse at a local public hospital in Perth.

However I remember the first time I presented at the emergency ward during an asthma attack in 2000, and I felt lucky to be immediately led to a cubicle with a chair and an oxygen system, with a monitor attached to a little sensor that I attached to my finger to watch my blood/oxygen level rise from the mid-70s (dangerous) back up to the 90s (safe) over a few hours that night, and gratefully discharged myself before breakfast time that morning.

2002 was the same helpful and efficient experience. Then in 2004, I encountered a very obstinate nurse who tried to force me onto ventolin instead of oxygen. Once left alone in another cubicle that had an oxygen system in place, I was able to change to the oxy and recovered by morning once again.

In 2008, I called three different public hospitals to ask if I might utilise an oxygen tank at their premises during the asthma attack, and was told that they could not promise me anything unless I presented, so I got in the car and made it to emergency, on faith.

That was the last I remember. They drugged me sensless for five days, and held me captive in the ICU for another five. Luckily, I survived by bluffing my way out, threatening the registrar with legal action at one point.

More privatisation will save more dollars but IMHO after what happened twice in 2008, cost human lives. Not because I didn't have the money to pay for the hire of the oxygen tank, but because they were too stubborn to give it me.

I think the issues are not being contested at the foundation of the problem, and I note the propensity of some to want to steer the debate towards arguments of the mechanism of profiteering alone.

For those who allege a COMMUNIST agenda, I would say this. If the relevant scum continue to assert a right to deny appropriate access to medical and legal based on costs, then very likely there will always be trouble.

If Medicare is handed to the "private profiteers," on top of reasonable costs they will apply their own over inflated opinion of themselves plus their exorbitant lifestyles, and then still want big bonuses and a chunk of profit as well.

I am in favor of a hybrid system, with regulated salaries and regulated bonuses for those who use OUR money to make MORE money so that, EVERYONE gets full health care, not just those who can afford it.

In the 1st instance, I do not begrudge a talented hardworking doctor or financial services person making a quid above the norm, so long as their increased income does not come at the expense of say the Original Australians AND low income earners NOT receiving treatment like everyone else.

So, if the FAT CATS can make so much loot that everyone gets appropriate treatment, and currently they do NOT, and still make a surplus, then within reason they are deserving of their higher incomes and bonuses.

But that is not what is happening. The FAT CATS have become lazy, greedy and stupid, as evidenced by the global financial crisis, and again, from the outback, to dental, just to name a couple of sore points, people are suffering much as they do in the 3rd world.

Set the bar higher *Mr Wudd* and make them perform.

PeterHume and all
PH I don't think you were referring to me. If you were I have to ask
What part of "the absence of one extreme DOESN'T automatically presumes the other extreme" don't you follow?

The absence of feral Capitalism doesn't imply Communism/socialism or any other ism, just a need to focus on the objective, medical care for everyone including the poor.
Not like CIS ideological stance, Business profit first.
(just in case you missed it) Companies don't vote and not every one can own enough shares to make a difference.

I offered no alternative simply because privatization of medicare doesn't address the real issues i.e. medical care for every one.

Have you seen what a cockup the specialists market is? It serves those who can pay full stop.

Come to the wrong end of town and hear the majority. Public hospital waiting lists are ridiculous.

Been to a dentist lately? They charge substantially over the insurance rebate! Try the public health system for dental needs.

What ever the insurance co's pay the drs. will charge extra. This, currently can cost $100s-$1000s depending the service. Even with max private insurance two majors in any year can really screw the average man over badly.

Conclusion We need a new Medicare.

BTW There are other business models worth of consideration.

"There are other business models worth of consideration."
One maybe your local travel agent if you plan medical requirements ahead of time. Costs of overseas medical and dental services can accommodate the expense of return airfares if you know where to go, and the poor service of public hospital treatment in Australia may have lower probability of further damage, but there are risks in anything with health care. Buyer beware.

Beware to have it over and recovered before returning. The most memorable welcome home party I remember was in 2005 when I was medivacced back to Perth with fairly serious abdominal and head injuries after a traffic crash. Six stitches in my stomach from the overseas hospital starting to itch on the plane, and that Saturday afternoon I presented at the usual public hospital to ask for professional help in removing the 18 day old stitches.

Nobody would do anything at all until my records arrived from overseas, and from what I gather, the courier from the airport was off duty on weekends, and so they could do nothing for me until Monday. This was a Saturday. I accepted the admedistrivia, and said that I could probably remove the plastic stitches myself when I got home, and on hearing that they locked me up in a mental asylum for the night as my homecoming to Australia.

A week later, still with those blasted six stitches in my tummy, I went to another public hospital early one morning, waited until after lunch until a quack turned up with a 'student' and demonstrated on my abdomen the removal of plastic stitches, twice. I watched closely and pulled the remaining four out myself when I got home. There's still a small piece of plastic inside me around where the buckle on my belt would hitch up, but after blatant incompetence and negligence like that, I'd solemnly suggest to anyone who needs hospital care to visit your travel agent and fly to a civilised hospital.

To those who prefer the current system, under my proposal the worst possible outcome is that you stay on the current system. So no problem. If the government provider was the best, everybody could stay there, and they would be no worse off.

If somebody decides to move, surely they should have that right? The only reason to object is that you simply assume the bureaucratic approach will always be better, and then you assert your right to force others to follow your preferences.

To those referring to America, that is not relevant to my proposal. The American system is a world apart, and has many problems associated with the fact that their government encourages healthcare to be managed through employment contracts, and has many restrictions on competition. I don't think that is a good approach... but irrespective of that debate, it has nothing to do with my proposal.

To those who object to competition, under my proposal you can just stick with the government's "new Medicare" and be no worse off. If no other competitor provides better health care, then nobody will change and we'll still have the current system. If the government provider really is the *best* then you have nothing to fear from competition.

But the evidence in support of competition around the world & through history is so vast I find it strange that people are actually asking me to explain it. To start with, if nothing else competition allows greater diversity. The pro-bureaucracy types might hate diversity, but I think it's important to recognise that people are different and have different preferences/needs in life.

The link between competition, higher quality and lower price is unambiguous. When sectors are protected from competition the pro-bureaucracy types always insist they are doing things as well as possible, and oppose competition. When competition is introduced, outcomes improve. This is true for agriculture, for telecommunications, for heavy industry, for education, for airlines, for restaurants, for supermarkets, for bakeries, for shoe-makers, car-makers, hairdressers, etc, etc

BTW, competition does not mean radical free-market reform. A radical free-market position would have no government involvement... but my proposal includes massive government redistribution ($3000/year health subsidies) and a government provider. Some free-market people have attached my proposal as being too "soft". In any other sector, my proposal would be considered radical left-wing government intervention.

When people worry about the free-market approach their concern is usually with making sure poor people can afford the goods & services & ensuring a minimum standard. My proposal does that. The only reason to object to my proposal is if you have a ideological love of government monopoly.

To those who say that everybody should have infinite healthcare... once you invent an infinite money tree, then we'll take you seriously.

And to those who insist the solution to health policy (and every other policy) is simply for the government to spend more, that outcome simply isn't viable. Under the Howard government health spending increased by about 6% per year... and this explosion in costs is set to continue over the coming decades due to the aging population. If we do nothing to fix our health & pensions systems, by the middle of this century we will need a GST of 25%, just to pay for our current system. That includes no new initiatives. Just the current system. If you want to add new initiatives, then we would literally need taxes higher than communist East Europe had before they collapsed.

The "just spend more" approach does not work. We need to find ways to "spend smarter"... and allowing multiple providers to compete for our custom is a good way to encourage smarter thinking. Trusting bureaucrats & politicians to some day become perfect is not a good strategy.

Some people have a very low rating of the central govt; running health care. A govt run system has got to be cheaper to run than a provider full of share holders. You can't go past medibank private for health insurance.
This system should be expanded with more members and lower fees.

This is an argument that has no end, because the basic question is flawed.

Should the citizenry be entitled to universal health care, funded from taxation?

The immediate answer - "yes, of course, and it is the government's responsibility to provide it" - is a warm and fuzzy response, neatly divorced from reality.

This much is obvious when we ask the next question, "what do you mean by universal?"

Does that mean everything. Preventive, curative, palliative? Does it include varicose veins as well as setting broken limbs? How about teeth-straightening for teenagers, or collagen injections for those scared of middle-age? What about IVF, or ACL surgery?

And what part does waiting-for-surgery have on the right to universal healthcare? Can I sue the government if I have to wait so long for my bypass operation that it is too late to restore me to health - assuming of course, that I live that long?

There are also market forces present in the supply-side of the equation. If we remove the capability for qualified doctors to buy their BMWs, what other incentives shall we introduce to persuade people into the - necessarily - long and complex learning process to become one?

In a very real sense, the cost of the US system is underpinned by demand inflation. People expect more and more each year from their healthcare. They read the magazines, that tell them how medical science moves on, and expect the new technology to be instantly available to them, ignoring the facts that these machines cost money, as does the training that goes with it.

At the same time, the practitioners are in fear of making mistakes for which they can be sued, which results in i) massive over-servicing and ii) ever-escalating insurance costs.

We will always have an imperfect system, in that it will never please all the people, all the time. But any "solution" needs at least to be based in a modicum of reality, and stripped of irrelevant ideology.

John Humperies writes about the 'Government monopoly"

Well one only need to look at what is happening to the prices for gas and electricity, and water, water hasn't been privatised yet!

There will be an energy crisis in the future, prices will skyrocket, before private investors will build extra power stations, and the prices will not come down.

In the current Private Health sector, private patients are transferred to public hospitals once the private health insurance, nolonger covers them.

On the website that John claims is communist, there is an article on Succesful Sociopaths

"By definition these people are at least temporarily very successful in society. They achieve their success by socially unacceptable means and at the expense of the community and its citizens. As Robertson et al pointed out in 1996 a number of entrepreneurs seem to have these characteristics."
http://www.uow.edu.au/~bmartin/dissent/documents/health/sociopathy.html

"Care and profit compete directly for the health care dollar and those who can bring themselves to compromise on care will be most profitable. This problem has been recognised for 2000 years."

So John are prepared to stake all that you own, including your super, plus all consultancy commissions.

I am, plus I will work for the rest of my life for a charity, if I am wrong.

So John are you trying to sell your model to the federal government?

I think we had this argument before, back in the 70's? We decided on Health Insurance Commission as it was known then.

We had the Commonwealth bank and government involvement kept finance costs low. They privatised CBA and now there is no competition. They all suck us dry.

The same with health, competition will not happen, There will be collusion.

It works ok now, not so bad. I would prefer to stop paying baby bonus to rich people and improve health with savings like that.

" ... To those who say that everybody should have infinite healthcare... once you invent an infinite money tree, then we'll take you seriously. ... "

That's right, we don't have an infinite money tree. There are a finite number of people with an amount of health isues which we can predict with a reasonable degree of certainty based on historical data ..

(which should be centralised - i.e how many times have you been to a doctor to have them ask the same stupid questions which have already been asked by several other doctors over and over?)

(or for them because of time constraints inappropriately not to consider your overall medical history becoz they don't know what has already been recorded - and this the digital age beyond the new millenium)

!LAUGHABLE!

.. and a fixed amount of contributions which upon investment can render a fixed amount of funds which in turn

BY WAY OF IRON FISTED REGULATION of the mathematical economic equilibrium can provide a certain amount of health services at a particular standard.

What people must decide fundamentally at this point in time is whether or not medicine is a fundamental Australian Human Right or just another excuse for in this case money grubbing doctors to profiteer?

I work with people who come from countries that do not have a health care system similar to Medi-care.

Basically it means that if you cannot afford to pay for health care, you don't get any. In some of these countries, children get polio and have a very limited life. In Australia the last outbreak of polio was in the 50's or 60's.

In Hong Kong, once if there were two people requiring a ventilator, the richest one won, no matter how old. If you were young and poor, you'd miss out.

As I have said; "No health care system is perfect."

The question is do we still want to make health care available and reasonably affordible to all Australian's or do we want to close off access to health care for those who cannot afford it.

Well who would want the American system, which costs more to deliver less.
When NIB demutualised the CEO paid himself $1million management fee and is in talks with American health insurance funds.

The largest health insurer is Medibank Private the next biggest are HBA, HBF which have ties to overseas insurance companies. If the large insurers weren't profitable then there wouldn't be overseas interest.

The sad fact is that sick people are generally not in a position to pay for their health care. If they weren't sick they could work to pay for their health care.

It has to be more complex administratively to get everyone to chose a private health fund and pay them $3000 to pay to the health fund.

This what I think will happen.

Public hospitals will be corporatized.

Medi-bank will be privatised.

Australians will have to take out private health insurance and there will be very little reduction in taxation, mainly because our politicans enjoy pork barrelling and putting their names on the plagues.

The people who get in early with the privatisation of Medi-bank (care) will do very well, and mums and dads investors will be thrown the crumbs.

Private trust funds will do very well, mainly because they distance certain people from scrutiny.