So the co payment is gone, so where to now because the problem of our unaffordable, unsustainable health system has not.

So what about a much fairer system then, one that rewards people who at least try to live a healthy lifestyle.

I feel the time has come whereby all treatment for self inflicted illnesses are no longer funded by the tax layers generosity (medical conditions excluded of cause) because let's face it, we can't continue to help everybody and why should those who live a healthy lifestyle and pay to visit the doctor while those who choose to ignor all the warnings get free medical.

My suggestion is for anyone with a self inflicted illness when receiving treatment gets charged a co payment, because let's face it, a pack of fags, or a carton of grog accounts for plenty of $7 co payments, and they choose to indulge, not the tax payer.

Sure, many tax payers also have self inflicted illnesses, so they too should pay a co payment because it's the best way to encourage a healthy lifestyle, to hit the pocket of the offender.

As we venture ever closer to the point of unstainainabillity, we must make the hard choices and decide when and where to make the cuts because we can't continue to expect the pro active, well disciplined to continue supporting those who seemingly refuse to help themselves. So people can then decide to continue with their unhealthy lifestyles, and a co payment,or they can change, but they can't expect the tax payers to continue supporting their unhealthy choices.

I see you are disappointed that Abbott's hugely unpopular co-payment (and almost all of his other 'promises') have been 'axed' rehctub?

Your ideas have been floated before, by people who think their lives are perfect and they are a cut above the rest of society in all ways.

As people over 65 constitute the most expensive users of the health system, for simply having one or many 'old age' health problems, I would suggest it is this age-group who should be paying more for their health care,
What do you think?

Thank you, Rehctub,

I sincerely hope that indeed this health system will not be sustained.

While there are exceptions, the rule should be that people pay for their own medical expenses - whatever is agreed between them and their doctors and other health-providers. Alternately, one could take a health insurance, one that is truly private unlike the hoax we currently have. As these are not available in Australia, I am about to take a new international health insurance from overseas, then ditch my Australian one.

Needless to mention, I refuse to accept even one cent from the Medicare thieves - and I hope that any of you with conscience will follow suit.

Back in the simpler days of the 60, I paid 3 shillings a week, [from about 20 quid], for full hospital medical benefits, for a family of 3.

Of course we did not do cat scans & a host of other expensive tests, with multi million dollar machinery, on every one with a cut finger back then.

We will have to cut back on this level of expenditure, or our medical costs will soon exceed our GDP.

At the same time, I have been waiting far too long just to see a specialist, for a diagnosis.

This is one where the answer is really a lemon. We can't afford to do, what we have recently learnt how to do, for everyone, particularly for free, but who decides where to draw the line. Some older people particularly get so much treatment, for so little advantage to them, or society, it shouldn't happen, but on whose decision.

Currently it appears the program is to not see people, & hope they die before bitching too loudly. I doubt there is an answer. It looks as if we will keep over spending until we crash & burn.

The government cannot have their cake and eat it too.
The medicare levy was introduced to pay for the health care system.
Maybe with the increase of health cost this levy should be raised maybe especially for smokers or the obese.
My neighbour paid his taxes all his life and at 75 had a heart attack which required six weeks in hospital. Despite private health insurance he was still out of pocket $50,000 requiring him to remortgage his house to pay for it. This is not acceptable.

Get used to it ponde, it is where we are, & will have to go.

It is not unfair that people should have to pay for what they use. You don't expect the taxpayer to buy you a new car do you, so why a new/repaired heart? Of course crazy ideas like the NDIS has the disabled expecting such luxuries, but it is not going to happen.

It is only unfair if we give the same treatment your neighbour paid for, to every yob who has wasted their money, & has none to pay.

Public medicine will have to go back to setting breakages, sewing up wounds, & minor surgery like tonsils & appendix removal. No society can afford to keep sticking replacement hearts lungs & livers in everyone, & particularly not those who have destroyed theirs with lifestyle.

Just be thankful that we have lived in the lucky era when such things were possible, if only for a couple of decades.

Nice try Suze, but might I remind you that I have CLEARLY SAID a co payment for SELF INFLICTED illnesses.

Perhaps you could go back and read my opening post so you can see, or are you simply choosing to ignore that fact.

The blunt reality is, we can't continue to tax the healthy living, so as to provide free medical for those who abuse their bodies.

As for me being perfect, not even close, but I did help raise two law abiding children (now adults) without assistance from the tax payer.

The other point I would make is that so many of the recipients of gifts from the efforts of others are not only ungrateful, but they have the hide to think it's an entitlement.

Sorry, those days are over, so best you get used to it, unless of cause you think we should leave the mess for further generations to clean up, in which case go for your life but please refrain from trying to make me the bad guy.

Here is a straw in the wind;
Someone in the financial world has warned that interest rates could go to zero.
Now if that isn't something to worry the self or partial self funded
retiree I don't know what is.
In fact in Europe interest rates have gone negative.
Think about that you put money in the bank and THEY ask YOU how much
interest YOU will pay THEM !

No sure it has come to individual depositors yet but does apply to commercial depositors.

I see nothing coming that will prevent us going the way of Europe in
the economy. I suspect the politicians have been told this but as
they do not want to know they sit like King Canute a cry out Growth,
Growth Growth that is what we must have.

The entitlement brigade is in for a hard time. Think how they will
scream when the pension get cut in half.

rehctub, this is already done to some extent withh things like cigarette taxes. But copayments, discouraging early intervention, are a false economy.

And you've no real evidence that our health system is either unaffordable or unsustainable.

___________________________________________________________________________

Bazz, that's not what negative interest rates actually are. Governments charge banks to park money, but the banks don't charge customers negative interest rates.

It's not a disastrous policy but it is a stupid one. A bigger government deficit would bring all the economic advantages and would benefit the public more. And there's one very imoortant way we're unlike most European countries: our government has unlimited credit (because we own the RBA). We need not fear debt.

Alright then rehctub, who decides where we draw the line for 'self-inflicted' diseases?
With smoking, will we expect full payment for all medical procedures for all smokers?
Or will we only expect it from those who , say, smoke more than 5 a day?
How will we police that?

Wouldn't everyone say they don't smoke, or they just gave up?
Would we then need full payment of all medical expenses for everyone who EVER smoked?
Would we expect payment before the medical procedure?
If they couldn't pay, would we expect doctors to just let them die in worst case scenario?

With the obese, where will we draw the line there?
Will we penalise all those who are, say, 10kg overweight?
25kg? 30kg?
Who decides that figure?
If they can't afford to pay extra will the doctors be expected to let them die?

Of course, we wouldn't stop at just smoking and obesity either.
We would need to penalise anyone who drank alcohol, drove a car, flew in airplanes, climbed mountains, rode bikes etc, and any other unhealthy or dangerous pursuit that might cause (not course- that's a different meaning) the taxpayer to fork out for extra medical expenses.

In your Funtime world, it would surely be fatal to be poor.....

Imagine the cost of Medicare if men went to the doctor as frequently as women do. Given that men do the lion's share of the dirty, disgusting and dangerous work about it is strange that they visit the doctor far less.

Or if doctors, especially women doctors, tested men as much as they test women. Male doctors arrange more screening tests for women and women doctors arrange a far higher number again.

But just wait a bit, the feminists would have it that women have poorer health and require more medical treatment because of the 'patriarchy'.

While the doctor should be an effective gate-keeper against over-use of medical services (and Medicare), that is not working where women are concerned. The 'whys' need independent study to advise solutions. Or alternatively, if men are not seeing the doctor enough for screenings, encouraging them to do so would result in better health outcomes for them. However, differences in the advised health screenings may still not explain the apparent far higher consumption of medical and ancillary services by women, particularly by otherwise healthy women.

Well I guess that depends on the men out there in the community OTB.
We can't just drag them in to the GP kicking and screaming.

There are plenty of advertising campaigns warning people to see their doctor re diabetes, smoking, drinking, bowel cancer, prostate cancer, STD's, obesity and breast cancer on TV and in the newspapers, as well as sending bowel cancer testing kits to all people over 50 in the country.

In all GP surgeries there are GP's who have special interests that they advertise, such as men's health problems. My husband sees his GP regularly and has a multitude of yearly tests to check his health every year, as do I.

Every person should be proactive about their health, and if they don't, it is not because of a lack of resources or help for either gender, but merely a personal choice.

Believe me, there are also plenty of women out there who also live with their heads in the sand....

Yes a vexed question Suse.

I have a neighbour sent home from emergency 3 times after a gall stone "ATTACK", because she wasn't sick enough to operate yet. Guess they wanted her so sick it would require 14 days of hospitalisation as it ultimately did.

Then we get doctors refusing bypass surgery to a smoker, but sticking not just one, but a second liver in people who destroyed theirs with alcohol/drugs.

How about the ambulance hounding a single parent for payment when it was a school who called the thing, but continuing to pick up drug overdose dropkicks, many times, despite no payment of the bill.

It is about time we applied the Darwin principle with people who try to kill themselves with their lifestyle, so lets not replace livers, but refuse bypass surgery. Refuse one, refuse them all. Doctors should not be arbiters.

Suseonline,

Agreed that everyone should be proactive about their health, which implies that they do the very best they can for themselves by eating a balanced diet with portion control, make physical movement part of their day and participate actively in life around them. These behaviours, well known and proved, will grossly reduce their need for medical intervention.

However you should not be blaming men (or indeed women) for being socialised into being low or high consumers of health services. -Which was implicit in your reply. If that explains why women frequent doctors and men do not, then it the syndromes are worthy of research and solutions.

The other issue that needs to be studied is the very poor tolerance of any discomfit and especially pain by the community (and I suspect very much so for women who go to the doctor more). Not saying that people should endure significant pain, but some pain and discomfort are a natural part of life. Taking women for example, they have been conditioned by advertisers to demand analgesics even in the expectation of pain arising.

How to get women to be less 'self-aware'(sic) and self-obsessed is the question. Turning off those nags on the TV who encourage that behaviour is a good idea, but government needs to do more to challenge the hidden persuaders with facts to de-bunk. The pain and cough 'relief' shelf space at Woolies is far too long, indicating the obvious problem.

I would like to see the primary health care model trialled with practice nurses as the first stage in clinics. The higher trained nurses are more than capable of that and observations can be made and advice given.

I also believe that Queensland's maternal and child welfare clinics (from Bjelke Peterson's era) were very effective and saved money (both sides, government and patient). Particularly where social/contact groups - with a nurse or two sitting in - are part of it. Just provide the space and tea facilities.

Here in WA we already have nurse practitioners seeing patients, and not GPs.
It certainly saves money for the health system.
Unfortunately, we have many Doctors, mainly the older male ones, who feel threatened by losing some of their influence on patients, so it is an uphill battle.

It's nice to see you so concerned about women's health OTB, but I think you will find there are plenty of men out there having their fair share of over the counter medications too. They love their cold and flu meds.
I can't say I have found much difference in the genders in that respect.

Ask any nurse and they will tell you that the biggest problem with pain are young, to not so young, adult males!

Talking of health adverts on TV, I would say the most prolific ones lately, well after 9pm anyway, are the ones for men's sexual health.
It seems they have no problems looking for help in that department!

Suseonline,

You can play sex politics if you like but the thread is about costs to Medicare so it is worth teasing out some already known facts.

There are plenty of research proving considerably higher consumption of analgesics by women in the West. Why that is so is not completely understood. There are adverse effects, so health authorities are right to be concerned.

It would not be surprising at all if similar results were being found with (say) cough mixture and antihistamines. Again, there are adverse effects.

It is also a matter of fact from HIC analyses, that women visit the GP and specialists more often than men and much more than might expected even making allowances for women-only conditions. Similar comments can be made about GP-directed testing of women - far higher than men and women doctors ramp up the testing of women even higher.

Analysis of sick leave credits by employers - the federal public service for instance - have consistently shown that women employees use their leave soon after it becomes available. That hold true where there are no dependents and no pregnancy. Yet men build up their credits, using them only where necessary, for anticipated serious problems later in life, or serious injury.

Thinking about it from a population perspective as Medibank should, what are the medical and non-medical contributors to the differences? Could it be as simple as advertisers targeting women, especially via those women-oriented talk shows on The Box?

never really worked it out too fully however I would of thought that someone assisting their death by smoking would cost less overall than keeping someone in a nursing home for 20 years. Just a thought! Just think of how many knee and hip operations as well as diabetes medicine, blood thinners etc are avoided by the death of smokers.

Talk about sex politics OTB, you should be the leader of that party!
Where are your stats for those assertions OTB?

Using analgesics as directed is very safe actually.
Using cough medicines is useless....they don't work, except maybe from the alcohol helping you sleep.

Women are certainly more pro-health than men, no doubt about that.
As there are still more male doctors around than female, I doubt there is a conspiracy to ignore men's health in the GP surgeries.

Certainly the GPs are on a constant alert to look out for prostate cancer and bowel cancer in men at present, according to all my male relatives and patients.
Have you had yours checked lately OTB?

The only ones who ignore men's health are men themselves.
Certainly there is one good way to save health dollars, and that is to have regular blood tests at least, at the GP surgery. Early detection and prevention is the key.

Suseonline,

That was a shallow, senseless reply.

You say you are a registered nurse providing community services. Yet you are unaware that misuse of analgesics is a serious problem in Australia, ranking as the third most common form of illicit drug use, behind marijuana/cannabis and ecstasy use, and ahead of cocaine and heroin.
[Public Health Association Australia, policy 2010]

Just quoting from Victoria, non-opioid analgesics (such as paracetamol) are the third most common drug involved in ambulance attendances, following alcohol and benziodiazepines.

-The last mentioned drug, which is only available on prescription, contributed to 56 deaths in Victoria in 2010, representing almost 17% of the total number of drug-related deaths investigated by the Coroners Court of Victoria in that year.
[Australian Drug Foundation]

Of course government should be concerned if women and girls are being targeted for higher drug sales, both prescription and over the counter.

Paracetamol is not an illicit drug.
As I said above OTB, using analgesics as directed is very safe.
Like anything else, if you over-use them, then they are dangerous.
Any fool knows that though.

Certainly over-use of alcohol and illicit/prescription drugs do represent a huge expense to the public health system, especially with adult males, with resulting car accidents and violence in the community.

Suseonline, "Paracetamol is not an illicit drug"

Are you trying to be obstructive or what? As I advised I took that from the Public Health Association Australia's policy 2010 update and from the Australian Drug Foundation. Illicit refers to the (mis)use of the drug, which is common and has serious health effects.

Your 'any fool knows that' is a frivolous, ill-considered and ill-advised remark. What the hell is going on with that crew you work for that they are not up to speed on any of this?

..Here in WA we already have nurse practitioners seeing patients, and not GPs.
It certainly saves money for the health system.

yes Suze and it doesn't help having to service the needs of remote communities, some with as few as six members, all from the public purse.

As for your return serve on self inflicted illness, its an argument for the sake of having an argument and of cause a change like this would require expert input to set parameters.

BTW, self inflicted illness can not be categorised with 'risk taking' which is what you are suggesting.

Of cause non of us are obliged to heed the warning signs and we are all entitled to bury our heads in the sand, its just that some of us prefer not to.

1)So the co payment is gone, so where to now because the problem of our unaffordable,
< unsustainable health system has not.

2)I feel the time has come whereby all treatment for self inflicted illnesses are no longer
< funded by the tax layers generosity

Posted by rehctub, Thursday, 19 March 2015 5:46:46 AM

In the 1990's the Federal Labor, of Hawke and Keating reduced the numbers of university places for medicine, a paper suggested the we would have too many doctors and that would cost too much.

Instead what happened was not an excess in doctors but a shortage.

Anyone who is saying the our health care system is unsustainable is engaging in a scare mongering tactic.

Secondly, in America such tactic as a pre existing condition has been used to deny people treatment, one case, was a woman who once had thrush and developed cervical cancer, who was denied treatment by her health care fund.

On ABC radio there was a comparison made between the UK system and the American for profit sector and how a person with mesothelioma was treated. In America the patient received around a million dollars in treatment that added about another 6 weeks to their life span.

In the UK the program said that the person would not receive such invasive high cost useless treatment.

So what you're saying Wally is that there's no real problem treating someone say in their late 80's who is either grossly obese or a chain smoker with lung cancer or even an alcoholic absolutely free of charge while on the other hand charge a healthy person $60 for a health check simply because they work and earn what's considered an average wage, even though that average wage is not excessive as is $66K a year.

We already live in a society where those who contribute the most to our healthcare system receive the least, while at the same time we have many who live on fast food, smoke 50 cigs a day and drink heavily, (often home brew as it's cheaper)who receive free treatment frequently and cry fowl when they are asked to forgo just $7 to see the doctor for a self inflicted problem.

Boy do we need someone in charge with a big stick approach so those who carry the load can at least do so knowing their contributions and efforts are not in vein.

I have private health insurance for my family which costs us a fortune,$800/month. So why should a chain smoker/alcoholic or obese junk food addict receive free health when we are the ones being pro active?

My family are not the ones placing strain on the system, we are the ones helping to prop it up so the least those who don't care can do is pay about one tenth of what I pay.

What ever happened to user pays?

Self inflicted or not, they should be crying fowl – any policy that discourages early intervention's a turkey.

rehctub, our public hospital system is not free!

It is funded by taxpayers, and other activities that public hospitals can charge for.

If you look at the aetiology of disease, and I use smoking as an example. Smoking rates are decreasing and perhaps the peak of diseases caused by smoking may occur within the next decade or two.

There is a lag between, the cessation of an activity and the diseases that that activity may cause.

It must be remember that governments use to actively promote smoking, the medical profession also promoted smoking in the past.

<What ever happened to user pays?
Posted by rehctub, Tuesday, 24 March 2015 4:31:36 AM

In America's user pays model, the cost of health care is the leading cause of personal bankruptcy.

Most third world countries have a user pays model, which leads to people loosing their houses and if they can't afford to pay, then treatment is withdrawn and the patient generally dies.

The biggest cost driver is not the patients, but the doctors, especially the specialists.

Your specialist, more that likely has business interests in a number of pies, such as private hospitals, radiology services and pathology. The specialists will know which procedures and tests give them the highest return.

Take for example the ENT surgeon who also sells hearing aids. Audiologists on their make an extremely nice living

Once an inappropriate treatment is commenced on a patient (such as dialysis) it becomes extremely difficult to stop it.

The question is why is it not allowed in Australia to have truly private medicine.

The so-called "private" health insurance is not private at all: part of the payment comes from Medicare and there is no way to stop that payment even if you want to forfeit it. Moreover, Medicare would not even accept the money back, so even if you don't want to take a cent from the government, they force it on you anyway.

I would rather take the "visitor" health cover which is not subsidised by the government, but alas they won't give it to Australian citizens, only to those who hold certain visas. This forces me to either pay it all out of pocket, or obtain an extremely expensive international health cover from overseas.

If only they would allow those with dignity to pay or insure their own medical expenses, there would be more than enough left for those who are not ashamed to take from others without their permission.

<The question is why is it not allowed in Australia to have truly private medicine.
Yuyutsu, Tuesday, 24 March 2015 11:27:59 PM

If you really want to have Private health, then I suggest moving to America or if the Coalition stays in power waiting a few more years for them to destroy medi-care.

As America's private health care system demonstrates, it is the most expensive way to fund health care. With the US paying around 18% of GDP compared to Australia's 9.5% of GDP.

The American costs only covered about 75% of the population, with the other 25% either under funded or without health care cover.(until Obama's health cover plan)

Whilst the American private health care is the most expensive for patients, it is also the most profitable for doctors, the CEO's of health funds, hospitals ect.

<If only they would allow those with dignity to pay or insure their own medical expenses,
<there would be more than enough left for those who are not ashamed to take from
<others without their permission.

Firstly there is nothing stopping you from paying for your own medical expenses.

Using the second part of your argument about "permission" I guess you drive on the roads. Roads that parts of the taxes I pay, helped to fund our public roads. In fact many of the services that you use today were initially funded through taxation and even now taxation subsidises some of the operating costs.

Dear Wolly,

America (USA) is hardly an example for anything - it's a mad place, obsessed with violence and with the highest per-capita rate of incarceration in the world. EVERY international health insurer, including American ones, has a standard policy for the rest of the world and a much more expensive policy if one wishes to include the USA in their cover.

The ability of poor people to afford health services is not in contention and I did not even suggest scrapping the Medicare levy which is somehow meant to provide it. What I wrote about is the ability of others to insure themselves against the worst health-care scenarios.

I already pay for my own medical expenses, but most of us cannot afford those extreme (but rare) conditions which produce medical bills in the $100,000's - and that's where insurance is required.

In Australia one cannot even obtain an insurance with an excess over $500 when one is happy to pay for all but the most extreme conditions.

Even for those extreme conditions, why can't one pay a higher premium so that their insurer pays it all rather than the state? This is available not just in America, but in nearly every other place except this stupid country.

Paying your own fees ensures that the doctors are loyal to you, the patient, and serve you alone, their only patron. It also ensures that your private medical information is not passed on and kept by people whom you cannot trust. If more people did so, the competition as well as the simplicity and avoidance of red-tape would also bring about a reduction in their fees.