John Deeble, one of the architechs of the Medicare system was in the papers yesterday suggesting that thousands of people are going to drop their medical insurance.

Well why wouldn't they, they're not stupid.

This is what the edifice that Deeble helped create looks like.

If you pay thousands of dollars in health insurance, when you go to hospital you get an account, part of which the insurance company pays, the rest you pay yourself.

If you don't insure yourself you go to a public hospital for free.

Hello!

A system designed so that people who are less well off could gain access to medical treatment (particularly hospitals) became a system accessible by everyone, regardless of their means. It's become a universal right, not a privelege.

The State Governments don't send out accounts. They're going broke trying to meet demand.

It's time Medicare was scrapped and replaced by a welfare model, completely divorced from the health system. People unable to pay their hospital bills could go to Centrelink and plead their case.

They could choose to pay their account by instalments, or enter a Health Contributions Scheme (like HECS) where they start paying when their income reaches a certain point, or it's taken out of their estate.

For a lot of people, choosing to keep themselves fit and healthy would be their best insurance.

The person who thought up community rating was another dill. For health insurance to work it has to be a compulsory, first party insurance, rated against risk. The fitter and healthier you are the lower the premium. The current system subsidizes poor lifestyle choices, not good. Plus, our family of 2 pays the same premium as a family of 6. Hello again!

John, you're fiddling around the edges. Put away the slide rule. Go back to the drawing board.

Frank,

recently there was a program on SBS titled health care around the world and the primary question asked by the interviewer;

"Has health care sent anybody bankrupt?"

Countries that were visited were the UK, Japan, Germany and I think Thailand.

The most common thread was the health care was not profit driven and government control on costs.

Despite the hype health care in Australia is not free, we all pay taxes and part of the reason for collecting taxes is to fund public infrastructure.

I have yet to see "Sicko" but I doubt if it will contain anything I do not know. The American health care system is the most expensive in the world and and Hillary Clinton wants to introduce a medicare style system in the states.

You say the having to pay for health care is a good incentive to keep healthy. Research shows that those that can afford private health care are the ones in the best of health. so in reality the wealthier you are the healthier you are.

Basically in America if you are poor your life expectancy is about the same level of our aboriginals.

James

Success has many fathers, failure is a bastard.

Poverty and poor health are bastards with the same parentage. With some exceptions the great majority of people in Australia do have a say in how fit and healthy they are.

Abraham Lincoln said something to the effect that most folks are about as happy as they want to be. Same thing goes with their health.

John Howard showed us what it takes to keep healthy, starting with a 40 minute brisk walk every morning. He doesn't smoke, isn't a big boozer and watches what he eats. I don't think that has anything to do with how wealthy he is.

As the population becomes progressively unhealthier the cost of illhealth care will escalate. It's not free. The investment in keeping yourself fit and healthy will stay about the same; just a bit of time and effort.

At the core of this debate is what is a public health responsibility and what is a private health responsibility. I don't think my piles, hacking cough, reflux, high blood pressure, crook back, insomnia and lack of energy are a public health responsibility.

What Deeble et al did was well intentioned, but it has progressively become a system being rorted by the many rather than being there for the few. It's caused a massive shift in the perception about what is a public responsibility and what is a private responsibility.

Successive Australian governments have created the foundation for good health - fresh water, deep drainage, heath inspection, immunization ... People are choosing not to build on that foundation.

Too many people are choosing to keep themselves in poor shape with the expectation that the State will pay the bill for the maintenance. What next, Carcare?

While the State is protecting the medical and pharmaceutical industries to the tune of $60B a year, the health of Australians is getting worse. It's not a good system.

Frank,
You are confusing cause and effect by linking Medicare with the level of public fitness.

Pharmaceuticals are a separate program.

Either your views are based on ideology or ignorance either way I don’t believe you have fully considered the consequences of which you are raleing.

The program James was referring to was very enlightening. Our system faulty though it may be rated 15th in the world those rate better are more generous.

The greatest users of our medical system are the middle to lesser well off.
Where would your cut off be? $50-60k?
Consider these examples of such a family without Medicare:

• Child birth could be prohibitively expensive and if there was problems extraordinarily so.

• Say a penniless hoon caused a prang where all members of the family needed varying degrees of hospitalization, medical and pharmaceutical care. Suppose too one was seriously injured or one developed complication. The reasons may be many and varied. Including a screw up in hospital. Then there’s post hospital treatment. The bill could conceivably $100,000s.
• Heart operations and/or transplants in general. (not necessarily due to life style) conceivably $2-300K.
• Some on going specialized medicine for the above could be in the $100’s of dollars per script (the way it is in the US).

There pensioners get a yearly allowance one it goes each script costs. HMO’s can decide what, where and how long a patient is treated. Health insurance in the US is up to 3times more than here and then the limitations may still cost a bomb.

Consider the extreme little girl Cathy Latizio 6, she was a victim twice. The last being an 80 something old man. She would have to sue him (clog the courts with expensive cases), and would she get enough? She has had several operations and will probably have a lifetime of medical needs. Her parents are average wage earners (welfare?). Even the money from press stories won’t suffice for her to have reasonable life?

I think you need to do lots more research and thought before your view can be taken seriously.

Examinator, Medicare is a welfare program. Treat it as such. Don't confuse it with the product that the welfare is being used to buy.

Welfare programs, like the dole, pensions, child support ... assist people to purchase a whole range of things, including medical services. We need to apply the same strict welfare provisions to the purchase of medical services, otherwise it's open slather.

Medicare has become is a sit down program, providing welfare for everyone, particularly those who sit down all day. It's unsustainable.

It's not the middle class and less well off that use the bulk of the services, it's people in poor physical condition. I don't think you can run away from this obvious fact. The State hasn't caused this condition. It's not responsible for the effects of it.

OK, it appears that people who are in good physical condition seem to be better off. Maybe there's a lesson here. I gave it last night in the example of John Howard.

Of course you're right to point out the costs associated with medical care. This is what happens with any industry protection program, it becomes bloated and inefficient.

The burghers of Footscray and Brunswich would be mightily aggrieved if they ever found out that the money that went from their pockets with the reduction of tariffs on TCF ended up in the pockets of doctors in Toorak.

What, for all intents and purposes looks like a subsidy for consumers is, in reality, industry protection.

As for pharmaceuticals, of course they're part of the medical system.

The Australian government pays out a couple of billion dollars a year for cholesterol, glucose and blood pressure lowering drugs, because people are too lazy to keep themselves in good nick.

Just because our system ranks 15th or whatever on some medical league ladder, doesn't mean it's a good one. It's not. The protection of the medical industry is diverting money from our own pockets and from other essential services and infrastructure projects.

Of course my view are based on an ideology. Who's ideas aren't?

'What, for all intents and purposes looks like a subsidy for consumers is, in reality, industry protection. '

Very much so. The private health system is a license to print money. The government pays 30% of premiums and coerces people via the medicare levy surcharge to take out insurance in the first place. Let the product stand on it's own merits and see who buys it I say.