A Health Policy for Australia’: response #3

There are many aspects of A Health Policy for Australia: reclaiming universal health care that I could debate, but this would be missing the point. It is a brilliant paper that covers all the important matters with great skill. It is a great place from which to start the next revolution in health care.

I particularly like the ideas about having a single health insurance scheme. Bob Evans, the justifiably well-known Canadian health economist, described why the Canadian government eliminated most private health insurance and established nationwide government health insurance during the 1970s. He said that Canadians have a strong sense of social solidarity, and ‘they believe everyone should be equal when it comes to matters of life and death’. Most Australians would share that view: when they were asked in 1997 whether they wanted a private health insurance rebate or preferred the money to be spent in public hospitals, 80% chose the latter. A similar statistic has been reported in surveys in other countries.

That said, I can’t resist one minor criticism. The authors say ‘it would be politically naive to expect any government to fill the place presently occupied by direct payments and co-payments (currently around 20 percent of all health care expenditure, or $2 000 a household).’ This is seemingly in conflict with the idea, clearly expressed elsewhere in the policy paper, that no government has any money: it is merely the custodian of the people’s money and it should therefore do what the majority would like it to do. Given the overwhelming evidence that user fees reduce equity (no matter how complicated the ‘safety nets’ may be) one might conclude that most Australians would support a reduction in user fees if they were given the opportunity to be sure about the facts.

Dave Barrett, one of Canada’s most respected former politicians, said recently that health user fees are what Bob Evans called them many years ago: a dumb idea that has been discredited again and again but just won’t die. ‘What Dr Evans does not understand, those of us who were in politics often enunciated dumb ideas because we thought we could get votes with it. I did it myself. I had to pay the benefit or the penalty of it on occasion. User fees are a dumb idea; they do not work. Just as plain and simple, all the research shows that. Not that that stopped me from using dumb ideas again and again, and I was a victim of my own policy on occasion.’

So my minor criticism is that we should not allow the defenders of social injustice and economic irrationality to excuse themselves by saying they have the responsibility to avoid being politically naïve. We should never give them a chance to use our own words against us.

I respect a drugs industry lobbyist who says he or she believes there should be more user-payment because this would improve industry profitability, or a rich and healthy person living in a gated community who says user fees appropriately punish the poor. I have no patience with people who say they have private health insurance ‘to take the pressure off the public system’ and I am worried about suggesting that it is politically naïve to do the right thing. We need no more than a government that has a degree of integrity and a basic understanding of health financing. We had such governments in the past, and we should not give up hope that we will have another in future.