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.

Of all of the posts here I have yet to read one by someone who sounds like they knows what they are talking about. I have recently been in hospital for a major operation to place a patch over my diaphragm, and since I don't have private health insurance I was public. And no matter what those like Frank_Blunt try to make it out to be, public is the least desirable option.

I was bumped no less than three times due to emergency cases coming in while Private hospitals are only required to take emergency cases when there is no other option available. Public hospitals are required to complete all surgery by 4:30 pm to clear the theatre and ready the surgical staff for any emergency cases (which happen more frequently than most think). Because of this time limit even if there are no emergency cases, if a scheduled operation goes long those in after are bumped as well. Private hospitals can continue operating as long as they wish or as long as the surgeon is able. After the operation stay in the ward is the shortest time possible, with some cases being sent home the next day due to the lack of beds. While this is similar to private hospitals, in private there is not such a huge crush of people looking for a limited number of beds.

Public health care is a shambles, the people working within the system while being some of the best in the industry are let down by the way the system is structured. So no, this one is going to get private health insurance even though I come well under the Medicare levy limit. I and many of the other people I know who are on public have had enough and will be on private from now on.

Frank,
what can I say.I can't immagine what it must feel like surrounded by all those budgers and people using up all those tax $ even if they do form the majority of Australians.

Everytime Medicare is threatened the majority of ordinary people say no.
I would respectively suggest you get a dictionary and look up the meanings of words like 'Welfare' Health is not Welfare its a Public services. Are schools welfare? is the army welfare.

You appear to be upset with the AMA and the various colleges and their control over Drs and private industry manipulating for a greater profit. Come the revolution comrade it will all change.

The PBS is only broadly speaking part of the medical system.
But it is controled by a Federal Commision seperate to that which controlls Medicare.

Hospitals are (currently) a state authority.
As you failed to address any of my points i assume you just want people who agree with you....what ever it is.
The key word for this site is debate. To do that you need facts and reasoning sorry Frank in this case you're exibiting neither.
Bye

Frank,

the private sector particularly in pathology is positioning it self to take advantage of what will happen when the baby boomers start to require health care, for example in the last few years of a persons life is when they will have the majority of blood tests.

The private sector is positioning for the best financial result.

you critise the PBS scheme, I have had contact with americans and how they deal with the drug prices in America, people travel to Mexico to buy their yearly supply of medications.

There are in Australia many lucky people who do not require expensive medications or a few who are wealthy enough not to be bothered by the cost, but resent the fact that they pay taxes which in theory are suppose to help the poor.

Examinator,

Sheesh, it's a bit rough accusing me of not debating. I'm doing my best.

Let me restate a few positions.

1. I think there are good reasons for splitting the health system from the welfare system. Public expenditure on medical treatment is growing at an unsustainable rate, much of it going to people who can afford to pay for their own medical care and much of it going to people who choose to keep themselves in poor shape.

2. The welfare system needs to be able to accommodate people who are struggling to pay for the costs of living, including their medical expenses. Absolutely. However, the welfare system is not designed to cater for all of the people, all of the time.

3. Protection of the medical industry has overseen the growth of a bloated, inefficient industry. At the same time the health status of millions of Australians has got worse. Not a good system. The wrong industry is being protected.

4. There is no more reason for states to run hospitals than there is for them to run dockyards, banks, telecoms, or electricy utilities.

5. We have to reconcile the desire of people to keep themselves in poor shape and the State to pay to keep them going.

You write 'everytime Medicare is threatened the majority of ordinary people say no.' Of course they do, they're on a good thing, they're not paying anything for their medical bills; they'd love it if the State paid for their groceries as well. However, by the looks of it, it's not doing them or the country much good.

I agree schools are an essential public service, as is public health infrastructure. I don't believe surgeries, hospitals and pharmacies are.

I think you've missed my point about needing to mark the boundary between what's a public health responsibility and what's a private health responsibility. My feeling is that the pendulum has swung too far. The State is, unreasonably, being asked to pay for more than it's share of the illhealth bill.

Frank you said,

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1. "I think there are good reasons for splitting the health system from the welfare system. Public expenditure on medical treatment is growing at an unsustainable rate, much of it going to people who can afford to pay for their own medical care and much of it going to people who choose to keep themselves in poor shape">

This may appear at first to be correct yet if you compare the Australian health care expenditure to that of the US, Australia spends much less on health per GDP than the Americans, the american private system does not cover the majority of americans (I use to know the stats).

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3. Protection of the medical industry has overseen the growth of a bloated, inefficient industry. At the same time the health status of millions of Australians has got worse. Not a good system. The wrong industry is being protected>

Inefficient, mention that to any person who works on the wards and they will have your guts for garters.

There has been a large shift over the last few decades, firstly hospitals use to only have a small percentage of critically ill patients(which are the most expensive) and a large population of recovering patients( which helped subsidise the cost of the very ill).

Now what has happened is that medicine has become a production line, admit, treat as quickly as possible and discharge, for example today if you are admitted with a heart attack, you will likely be discharge within 3 days, compared to spending a week or more in hospital a decade or two ago.

Many procedures that use to require and stay of 4days to a week, now take place as a day procedure.

So where is the inefficiencies in that?

Oh! by the way increase throughput means increased costs. Public Hospital admission and discharge rates have increased without an increase in bed numbers or staff.

Thanks James

By inefficient I mean that the aim of a health system should be to have healthier people. That's not happening.

I'm sure, as you say that the doctors and nurses are working flat out. However, despite hospital medicine becoming vastly more efficient in the terms you express, it's not efficient enough to cope with demand.

Making medical care the be all and end all of public health policy supports the ambulances at the bottom of the cliff model. If people were keeping themselves fit and healthy to the best of their ability, they'd still be walking around on the top of the cliff and the doctors and nurses would be sitting around at the bottom twiddling their thumbs.

The metabolic dysfunctions would disappear, bones would get back into alignment and people's mood would improve.

Some doctors are making a rod for their own back. Their customers ignore their advice. They keep coming back. The doctors can't help themselves and keep treating people who don't want to do the things THEY need to do to restore poor function to good.

Some doctors provide poor advice. They reach for the pad at the drop of a hat. People become dependent on the service and keep coming back for another fix. In reality it's a good lurk if you can get someone on to blood presure tablets for 40 years. I'm not sympathetic to this type of doctoring.

The fact that the State keeps paying the bill for poor medical practice is another source of inefficiency.

A lot of doctors are reluctant to co-operate with the fitness profession, which I think is probably the profession the State should be protecting. It's time to gradually wean people off the medical system and swap them over to the fitness system.

Your last couple of sentences are interesting. If the industry were becoming more efficient costs should be coming down. They're not. That's the effect of protection.

Frank,

"Your last couple of sentences are interesting. If the industry were becoming more efficient costs should be coming down. They're not. That's the effect of protection."

Frank there perhaps a perverse, converse paradox at play in relationship to costs.

I have a very simple model that demonstrates that by reducing the average length of stay from 5 to 3 days, costs per patient treatment falls, yet average daily costs increase, but because more people can then be put through that hospital bed the overall costs increase. Simply because more people can be treated.

The first 48-72 hours of admission to hospital are the most expensive period, this is because of number of reasons, such as treatment and investigations.

By reducing the average length of stay by 2 days, the number of admission increase by about 25% and the overall cost in a public hospital increases by around 33%, however if the same thing were to take place in a private hospital it would be an increase in profits by 33%.

So for public hospitals treating more patients, increases costs, for a private hospital it is an increase in profits.

'So for public hospitals treating more patients, increases costs, for a private hospital it is an increase in profits.'

That's very interesting James. My partner was told after having our baby that the Hospital had a deal with the insurance company about a 4 day stay after birth. Luckily she was keen to go home after three, but I still think patient care shouldn't be influenced by some deal between a hospital and an insurance company.

Usual Suspect,

In the US there was a practise where people were discharged early from hospital and the hospital and insurer split the difference.

This meant increased profits for the hospitals and subsequently shareholders.

I do not know if you have seen a corporation flow chart, but in the private health care sector the most important person on the flow chart is the PM, followed by the Health Minister etc I think the CEO makes about third or fourth place. Doctors rate about fifth or sixth place, patients do not begin to rate until level 15.

Oh shareholders are more important than patients.

There is a lot of cynicism flying around on this thread. Perhaps a recap on some fundamentals wouldn't go astray

Health care is not free.

Most of us pay for some level of cover through the tax system. About half of us choose to pay again through private health insurance.

As far as the public system goes, we do pretty well here in Australia. You will always be picked up off the street after a car accident or a heart attack, and taken to a (pretty good, by most standards) hospital to be fixed up.

But if you need surgery that is not of an immediately life-threatening nature, you might have to wait awhile.

Private health insurance isn't a substitute for the public system, it is in addition. Private hospitals are built to take care of patients who are prepared to pay for choice, convenience and timeliness. If you remove this option, or price it out of the market, the full burden falls back on the taxpayer.

At which point, the decisions become significantly more difficult.

The question becomes how long are (we all) prepared to wait for that bypass surgery? or the knee reconstruction? or the vasectomy? And what about cosmetic surgery following that car accident? Does that rate higher or lower on a scale of importance than, say, IVF?

Allocation of taxpayers' funds to the competing needs becomes a nightmare. Whose problems get priority?

Clearly, the more money you throw at it the better the service. But how much will the taxpayer willingly put into the pot?

Here's a hint. With the population aging, two things happen. Firstly, there are fewer taxpayers as a proportion of the population. Secondly, those fewer taxpayers will be required to support the growing legion of old folk, who - by definition - are a bigger per capita drain on the system.

And they all vote.

So you get an increasingly aging population, increasingly voting for the younger folk to pay more taxes to fund the system that changes the bedpans.

Think about it.