Posted by http://www.theage.com.au/daily/981223/leaders.html on January 20, 1999 at 17:58:18:
Editorial Opinion 23 December 1998
Medicare has served us well
There are problems in funding health care, but abolishing universal cover won't
resolve them.
MEDICARE has never been popular with the private health-care industry,
which blames its continuing financial problems on Australia's system of universal
health cover. But private insurers and private hospital operators, like the
coalition, have had to accept the basic fact of Medicare's overwhelming
popularity in the electorate. For almost a decade there has been talk of the need
to stem the flight away from private health cover, yet nothing - at least in public -
about abolishing Medicare. But this week the Australian Private Hospitals
Association radically shifted the focus of debate, by proposing a voucher system
that would allow people to opt out of Medicare. The association's executive
director, Mr Ian Chalmers, insists that no one would have to pay more than they
do now for basic care, because consumers could either spend their voucher
through Medicare or transfer it to a fund of their choice. But Mr Chalmers'
argument evades the basic point: the Medicare that would survive under such a
system would no longer be a system of universal cover.
That system has served this country far more effectively than its critics allow.
Australia spends 8.4 per cent of its gross domestic product on health care, and
still manages to provide universal cover. Compare this achievement with the
situation in the United States, which spends more than 14 per cent of its GDP
on health care but where 30 per cent of the population have no health insurance,
and thus no access to affordable health care. The problems associated with
public health care in Australia are well known - the blowout in waiting lists for
elective surgery in public hospitals, and the temptation to overservicing that is
inevitable in a system such as Medicare, which combines universal cover with
the right of doctors to set their own fees. But despite these problems Australia
remains a better provider of cost-effective health care than the richest of the
OECD nations; and it provides that care without having to resort to a
centralised, bureaucratic system on the model of Britain's National Health
Service in the 1940s and '50s.
The question is whether reversing the flight from private health cover - whether
through Mr Chalmers' voucher system, or through means-testing access to
Medicare, as the president of the Australian Medical Association, Dr David
Brand, has urged - is likely to resolve the root problem of funding health care in
Australia.
Medicare's critics commonly assume that the answer to this question is yes. But
the Productivity Commission - not an agency normally regarded as sympathetic
to the philosophy underpinning Medicare - reported last year that between 1989
and 1996 the drop-out rate among younger, healthier fund members had been
responsible for only 9 per cent of premium increases for the older, higher-risk
members who remained. A much bigger factor was the increasing proportion of
privately insured patients being treated in private hospitals, which was
responsible for 19 per cent of premium increases. The commission's figures
suggest it is a misleading oversimplification to claim that the cost pressures on
public hospitals are a result of people abandoning private cover, and so
overloading the public system. Those pressures result from a decline in spending
on public hospitals in real terms by state governments during the early 1990s.
The hefty increases in private health-insurance premiums, in turn, result chiefly
from the fact that people who can afford to avoid the under-resourced public
hospital system increasingly do so.
Medicare and the public system, however, continue to be the choice of 70 per
cent of the population. Medicare's popularity was acknowledged by the
coalition when it pledged during the 1996 election campaign to retain the system
if elected. That pledge was not retracted during this year's campaign, and the
Prime Minister, Mr John Howard, this week responded to Mr Chalmers'
proposal by reaffirming the commitment to Medicare. Universal cover has
become an entrenched part of Australia's health-care arrangements, and even
newly re-elected governments are likely to distance themselves from the sort of
radical change urged by Mr Chalmers. A better prospect for governments
hoping to retain popular support might be to tackle the real problems facing
public hospitals, by devising with the states a mechanism to ensure that the
hospitals' funding needs are met. If public hospitals are better resourced, it will
ease the pressures on the private health-care system, too.
Safer waterways
Voluntary policing of power skis is not the best way to curb the hoon element.
TO MOST who use our waterways, power skis are no more than the noisy,
sometimes annoying toys of a minority. But in truth they are a powered vessel
and just as lethal as any other when misused. They have claimed a small number
of lives in Victoria in summers past and, tragically, will probably do so again.
Moves by power ski distributors and clubs to patrol Port Phillip Bay themselves
in an effort to rid our beaches of the hoon element reflect broader community
concerns about some users of these machines. It is right that they be banned
altogether from most beach areas and their use be permitted only in limited
circumstances. It is also appropriate that the use of such potentially dangerous
vessels be strictly regulated. The State Government has to date baulked at
licensing power skis, in spite of the vocal disdain for them voiced by the
Premier, Mr Jeff Kennett, and the recommendation of a 1995 inquiry to that
effect. Any move to improve the behavior of power ski users is to be
applauded. However, volunteer enforcers patrolling our beaches are unlikely to
prove effective. Instead, stricter policing and regulation of these machines by
police and local authorities should be encouraged.