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Health Care in the = 21st century
Where are we headed?

Howard’s Medicare

Tony Abbott=

John Deeble=

Reform

"A global surv= ey commissioned for..."

Introduction

Medicare Core Princ= iples

Market Provision

Problems

Propaganda Push=

Facts

Topics of Discussio= n

The Right to Health= Care

"The right to = health includes..."

There is no legal r= ight to health in Australia

"Choices of se= rvices"

What Australians Wa= nt

"Commonwealth = Fund 2002 International Health..."

Australians support Medicare

We don’t want this government’s push to privatisation and the market model

The government is not listening

Romanow Report
 Building on Values: The Future of = Health Care in Canada
Report of the Commission on the Future of Health Care in Canada
2002

Australia’s Rising = Health Care Costs

PHI Rebate<= /font>

Ageing Population

Economic Globalisat= ion

Health at the Global Level

Where to from here?=

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Health Care in the = 21st century
Where are we headed?
Tracy Schrader

Howard’s Medicare
"miserable cru= el fraud”
"scandal”
"total and com= plete failure”
"quagmire”
"total disaste= r”
"financial mon= ster"
"human nightma= re"

Tony Abbott=
health system is a = market
target the ‘needy’ = and ‘disadvantaged’
doctors should be a= ble to charge what they choose
However -
claim to be ‘rescui= ng’ Medicare
“the Howard Governm= ent is the best friend that Medicare has ever had, that Howard Government ministers = are the truest of true believers in a Medicare system.”

John Deeble=
Medicare is not a d= iscretionary Government handout. Nor is it a welfare scheme. It is an insurance system= to which everyone contributes according to their income. They then have a universal right to coverage. That solves all the problems of protecting p= ensioners, the unemployed, other low-income earners, large families and the chronica= lly ill with equity, dignity and less intrusion into their affairs than any alternative.
(“Not ailing, but i= n need of a checkup”, The Sydney Morning Herald, 10 March, 2003 )

Reform
‘Reform’ an oft mis= used word
Dictionaries suggest improvement or rectification of something faulty or inefficient.
Strong moral overto= nes with historical and emotional associations (Richard Evans - Lingua Franca RN A= BC 1998).
Reformation and ref= orm movements with moral and religious driving forces.
Creating a just and= equitable society.
Many reforms today = are based on cost containment and demand management.

"A global surv= ey commissioned for..."
A global survey com= missioned for the Millennium Summit of the United Nations found people around the w= orld consistently rank good health as their number one desire
(The Millennium Rep= ort, 2000: We the peoples: The Role of the United Nations in the Twenty-First Centur= y, United Nations, New York)

Introduction
Health care reflect= s societal values
Dichotomy - health = and health care - shared civic good with community responsibility or an individual responsibility best left to market influences
Australia - support= for Medicare or private financing

Medicare Core Princ= iples
Universal access ac= cording to need not the ability to pay
fairness
compassion
social solidarity

Market Provision
Individual choice a= nd responsibility within the competitive market
Minimal ‘government interference’, safety nets for the ‘poor’
Health care in this= schema is not seen to be different from any other good or service
Tradable commodity<= /font>
Shift costs from go= vernment (public) to individuals (private)

Problems
conflict with multi= ple international accords that define access to health care a basic public he= alth and human rights issue
equity
public interest and= common good
rising costs=
market failure
Medicare popular wi= th Australians, little community support for privatisation

Propaganda Push=
Costs out of contro= l
Can’t afford univer= sal coverage - too expensive
Not sustainable
Private market more= efficient
Ageing population
People who can affo= rd should pay
Gives people choice=

Facts
Publicly funded uni= versal health insurance schemes, such as Medicare, provide the most equitable and cost effective health systems.
The larger the priv= ate sector the higher the total cost of a health system.
Increases in privat= e spending on health are associated with declines in public spending.
In the private mark= et, the wealthy healthy pay less, the less wealthy ill pay proportionately more, = and the wealthy ill get preferential access.
The wealthy pay mor= e if taxation-funded and less if user-pays.

Topics of Discussio= n
The right to health= and health care
Public support for = Medicare
Rising health costs= in Australia
The myth of PHI
The bogey of the ag= eing population
Economic globalisat= ion the saviour
Health at the globa= l level

The Right to Health= Care
Universal Declarati= on of Human Rights (UDHR) Article 25.1
 Everyone has the right to a standard of living adequate for the health and well-being of himself and of his famil= y, including food, clothing, housing and medical care and necessary social services
The Declaration of = Alma Ata World Health Organisation  1978   The Alma Ata Declaration identified = health as a fundamental human right and the health of all people as fundamental = to the attainment of peace and security.

"The right to = health includes..."
The right to health= includes the right to health care. Multiple international accords define access to health care as a basic human rights issue.
Universal Declarati= on of Human Rights 1948
International Conve= ntion on the Elimination of All Forms of Racial Discrimination 1969
International Coven= ant on Economic, Social and Cultural Rights 1976
Convention on the E= limination of All Forms of Discrimination against Women 1979
Convention on the R= ights of the Child 1990
Australia is signat= ory to all these treaties

There is no legal r= ight to health in Australia
Australia is the on= ly liberal democracy and member of the Organisation for Economic Cooperation and Development (OECD) that does not have a constitutional guarantee of human rights.
Section 26(2) of th= e Health Insurance Act 1973 sets out three principles and two commitments relating= to the provision of public hospital services in which legislation should be enacted.
Amendments in 1993 = required all States and Territories to enact complementary legislation to reflect these principles and commitments.
The principles, how= ever, are not enacted in legislation. State and Territory legislation has incorpora= ted the principles but the principles have been qualified.

"Choices of se= rvices"
Choices of services=                                               =                              Principle 1: Eligible persons must be given the choice to receive public hospital services free of charge as public patients.
Universality of ser= vices                                              =                        Principle 2: Access to public hospital services is to be on the ba= sis of clinical need.
Equity in service p= rovision                                              =                  Principle 3: To the maximum practicable extent, a State will ensure the provision of public hospital services equitably to all eligible perso= ns, regardless of their geographical location.
Information about s= ervice provision                                          Commitment 1: The Commonwealth and a State must make available information on the pu= blic hospital services eligible persons can expect to receive as public patien= ts.
Efficiency and qual= ity in service provision                                 Commit= ment 2: The Commonwealth and the States are committed to making improvements in the efficiency, effectiveness and quality of hospital service delivery.

What Australians Wa= nt
Medicare has consis= tently been popular with the Australian people
Little community su= pport for privatisation
Strong support for = government involvement in health care

"Commonwealth = Fund 2002 International Health..."
Commonwealth Fund 2= 002 International Health Policy Survey
When asked what is = the single most important thing that government could do to improve care, Australians were most likely to call for increasing funding for health care or adding more resources.
Australian Survey o= f Social Attitudes, 2003
69% of respondents = were willing to pay more tax to spend more on health and Medicare.
support for governm= ent delivery of health care was overwhelming at >80%. 78% of people who identified = as Liberals and 83% of people who identified as Labor supported government delivery.
International Socia= l Survey Programme (ISSP) survey on attitudes to government, ISSP 1996 Role of Government III
29.3 % of Australia= ns thought the government should spend much more on health; 50.6 % more; 18 % the sa= me; 1.8 % less; and 0.3 % much less.
42.4 % thought it s= hould definitely be the government’s responsibility to provide health care, 51.= 7 % thought it probably should be; 5.4 % thought it probably should not be; a= nd 0.4 % thought it definitely should not be.

Australians support Medicare

We don’t want this government’s push to privatisation and the market model

The government is not listening

Romanow Report
 Building on Values: The Future of = Health Care in Canada
Report of the Commission on the Future of Health Care in Canada
2002
     Early in my mandate, I challenged = those advocating radical solutions for reforming health care – user fees, medic= al savings accounts, de-listing services, greater privatisation, a parallel private system – to come forward with evidence that these approaches would improve and strengthen our health care system. The evidence has not been forthcoming. I have also carefully explored the experience of other jurisdictions with copayment models and with public-private partnerships,= and have found these lacking. There is no evidence that these solutions will deliver better or cheaper care, or improve access (except, perhaps for th= ose who can afford to pay for care out of their own pockets). More to the poi= nt, the principles on which these solutions rest cannot be reconciled with the values at the heart of Medicare or with the tenets of the Canada Health A= ct that Canadians overwhelmingly support. It would be irresponsible of me to jeopardise what has been, and can remain, a world-class health care system and a proud national symbol by accepting anecdote as fact or on the dubio= us basis of making a ‘leap of faith’.

Australia’s Rising = Health Care Costs
Australia’s health = care costs have risen by 18 per cent in the two years up to 2003.
Much due to the PHI= rebate. The greatest rises in expenditure in the healthcare sector have been in the private sector.
The growth in gover= nment recurrent funding has largely been in two areas - private hospitals and o= ther professional services. Private hospitals had the most rapid real growth d= ue to the PHI rebate.
Out-of-pocket spend= ing on health has grown 6.2% in 2003-04 compared to 5.0% the previous year.
In the last four ye= ars (1999–00 to 2002–03), health inflation was higher than at any other time during the period since 1993–94.

PHI Rebate<= /font>
$2.5 billion direct= cost in 2003–04.
Cost of the Medicar= e levy surcharge exemption between $750 - $1,100 million annually.
This amounts to an = average cost of more than $200 from every man, woman and child or around $385 from eve= ry taxpayer in the country.
High income earners= only need to buy a PHI package costing < 1% of their taxable income to make a sa= ving from their tax exemption.
Approximately half = of the present open-ended PHI subsidy goes to the top 20 % of taxpayers and near= ly three quarters goes to the top 40 %.

Ageing Population
Most health costs a= re in the final few years of life whether that life is 60 or 85 years.  Health expenditures are more closely related to the number of years to death than to the number of years since birth.
Major factors creat= ing growth in health service use by people of all ages include greater expectations = of being healthy and the introduction of new technologies.
Other OECD countrie= s already have an age demographic similar to that anticipated for Australia in futu= re decades and have a similar level of healthcare spending.  The UK, Sweden and Germany presently = have the aged demographic that Australia is predicted to have in 2030.<= /td>

Economic Globalisat= ion
Deregulated markets= for goods and services (trade liberalisation).
Liberalisation of d= omestic economies involving privatisation of public services.
Reduction in the ro= le of the State in economic management and regulation.
General expansion i= n the role of the market.
Belief that global = well-being depends on wealth creation that is reflected in economic growth.
Economic growth or = GDP measures only increased economic growth and not the qualitative impact on people, communities and environment. The costs of economic growth and the distribution of the benefits are not taken into account.
Belief in the marke= t can also override evidence of its failings.

Health at the Global Level
The WHO is the prim= ary organisation in international health cooperation.
The WTO, however, i= s now emerging as the most influential international agency with respect to hea= lth.
The influence of the International Financial Institutions such as the WB and the IMF on health= and health care is extensive
The corporate secto= r’s role in health has increased at both the international and national levels. This = is especially so with the pharmaceutical industry.
The pharmaceutical = giant, Pfizer has more staff in its marketing department than is in the entire W= HO.
The ‘new philanthro= pists’ - eg Ted Turner and Bill Gates.
The budget of the h= ealth program of the Gates Foundation will soon equal that of the entire WHO.

Where to from here?=
Australians don’t w= ant to go down the privatisation, market model path.
Show the public tha= t a universal health care system such as Medicare is not only viable but the = most affordable.
Convince and elect = governments to this effect.
Curb the excesses o= f this government.
Advocate for a Comm= ission on Health Care in Australia before any more radical changes to the structure= of Medicare are made.

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