Keeping Medicare Universal: Medicare must be kept universal if the program is to improve
6:30 Feb 16th, 2012 | 0 notes
It seams strange having to discuss this, but means testing the Private Health Insurance Rebate (PHIR) has brought up questions as to the validity of publicly funded universal health care in Australia. Tim Wilson of the Institute of Public Affairs (who’s motto I think should be, ‘Government. Eww!’) stirred up just such a question on this weeks Q&A.
Let’s be clear: Australia’s financing of healthcare is very messy and inefficient. The 53% of us who purchase private health insurance (PHI) remain insured under Medicare (Australia’s universal public health system), meaning more than half the population is insured twice, but only ever enters the health system as a public patient or private patient at any one time. Similarly, doctors have an incentive not to reduce waiting times in public hospitals, because higher waiting times may drive people to the private system (with shorter waiting times) where they are payed more.
Several solutions are pushed by the ‘Government. Eww!’ people. One is an opt-out of medicare after purchasing PHI. The result is that once you enter the PHI market, you forfeit your right to use Medicare (and presumably the need to pay for it) for everything except emergencies—assuming that we don’t fumble that exemption like the Americans did for a while. The downside is that the people left using Medicare (those who can’t afford PHI) don’t generate enough revenue to pay for the same quality of care the system currently provides with everyone paying, leading to additional funding having to be drawn from other parts of the budget, or a decline in the quality of treatment.
A more radical proposal is a voucher program. You can probably guess where this is headed, because ‘Government. Eww!’ love voucher programs. The idea is to give everyone a cheque instead of directly sending those funds to public programs like Medicare. With said cheques, people choose where to place their money; in the private health system, or the public health system—whichever serves their needs best. The potential is for people to flock away from the public system into the private system, with the worst case scenario being the dismantling of the public system all together. You then have to hope that your cheque covers all of your health costs in the private system, or be left footing a bill that you never would have had under Medicare.
The problem I and many others have with these proposals is that they remove the universality of Medicare. While this may not always be done with malicious intent, it creates an environment where our attitudes towards this public program drastically diverge. At the moment, every man, woman, and child in this country is invested in Medicare. This is not only because we are all paying for it, but because we all have a claim to its use—we know it is there if we ever need it, free of charge, no questions asked. Removing the universality of Medicare breaks this mindset. All of a sudden, we are not all invested in making sure the quality of Medicare services are kept high, that the treatments delivered are the best available, or that new and creative solutions are found to the systems flaws.
Overnight, Medicare would turn into something ‘only poor people use’. Much like Centerlink conjures up images of ‘dole bludgers’ and ‘welfare queens’ despite the agency’s role of providing student support, the pension, the Family Tax Benefit, legal aid, grief counselling, and disability support; so too will Medicare become a target for disparaging remarks, and the first port-of-call when politicians start spouting off about the need to ‘remove the culture of dependency’.
New methods need to be found as to how we finance healthcare in Australia. Beyond adjusting the PHIR, we could adjust the system so that PHI covers only ancillary care, and not medical or hospital cover. There are many changes possible and with more debate, more solutions will arise. However, we must not forget that we must all be in this together. Dividing Australia into ‘haves’ and ‘have-nots’ in terms of healthcare will only weaken a strong public program. If we are to lobby for a better Medicare, we must all be invested in its success.
