The Long March To Private Health
The Age
Thursday September 28, 2000
``The 30 per cent (health insurance) rebate is effectively a subsidy to the private health insurance industry and is larger than the budgetary assistance for the mining, manufacturing and primary agricultural industries combined." -- Professor Stephen Duckett, former head of the Commonwealth Department of Health
IT'S NOT as if the Howard Government is even particularly concerned about the health of the rich. What the government is really on about is the destruction of Medicare.
All the rest - the monumental abuse of the micro-economic reform process, the undermining of the integrity of the tax system, the redistribution of income and health resources away from the poor - is simply collateral damage on the government's long march to a privatised health system in which Medicare will be retained as a mean, residualised service or public charity for the poor.
The government is doing no favors for the rich. The health model it is hell bent on replicating is alive and well in the United States. The US spends twice as much as Australia on health and yet has poorer outcomes in terms of infant mortality, morbidity and longevity than most advanced industrial countries.
The US health industry is run for the benefit of the pharmaceutical industry, doctors, private hospitals, lawyers and the insurance industry.
For the individual, most of the cost of medical interventions comes in the last couple of years of life. Even those Americans in the most comfortable class during their working lives and who have had access to the most opulent private insurance, are generally uninsured and dependent on government Medicare at the end of their lives when they need the health system most.
And yet, not only have they paid private health insurance during their working lives, Americans actually paid more in taxes to finance Medicare (aged) and Medicaid (poor) public health programs than Australian taxpayers pay in order to provide a universal public service that, at least until 1996, was designed to cover the whole community and still covers a far larger proportion of the population than the restricted US public health system.
The well-off in Australia should be under no delusions. Apart from the mega-rich, and those lucky or unlucky enough to come to a premature, swift or sudden end, most of the middle class, who may think private health a la Howard is a wonderful way to beat the health queues and their obligations to the poor, are likely to find themselves heavily dependent on the public health system and whatever this generation of taxpayer is prepared to stump up in the last years of their long retirement.
What's their best bet? Pray that the next generation of taxpayers and politicians are wiser and kinder than them? Or will they find, as in the US now, that they have created a monstrous network of vested interests impossible to shift. America may be able to afford to spend 13 per cent of GDP on health. Australia, which presently spends 8 per cent, can't. Even Kerry Packer is likely to be worse off if the health industry is allowed to boost its income by $30billion a year.
Even for the rich, the best chance of civilised end is in a system where everybody is prepared to make the public health universal and the government's first priority, because everybody understands that is the system where they are most likely to end up.
The proposition seems simple enough. But we are expected to believe it is beyond the grasp of Kim Beazley's shadow cabinet or the electorate. Julie Smith from the Australia Institute has shown that while the Howard Government has been starving public hospitals of funds and has chopped the $100million dental health program, which was specifically directed to the poor, it has provided some $3billion in tax expenditures for private health insurance, including an estimated $150million for private dental insurance.
Beazley says he won't abolish, let alone means-test, the rebate because health funds lack the mechanism to assess members' incomes. Rubbish. Hasn't he heard of the ATO?
The universal Medicare system was the most electorally popular program of the Hawke-Keating government. It still is.
If Beazley can't defend it, he has no business in politics, let alone leading the ALP at the next election.
© 2000 The Age