John Menadue. Health Insurance – here we go again!

Feb 28, 2015

The Health Minister, Sussan Ley has just announced a 6.2% increase in private health insurance premiums.  Increases of this order happen almost every year.

Since the Howard government introduced the rebate on private health insurance in 1999, the cost of private health insurance has increased over 150%. Overall prices have increased by less than 50% in this period.

Because private health insurance has not got the will or ability to control prices, it is a ‘price taker’ as economists say, it underwrites large increases in health costs particularly by private specialists. That is why we are all paying more in out-of-pocket expenses. But it is even much worse than that. Private health insurance makes it more difficult for Medicare to control fees.

The private health insurance industry receives a $7 billion p.a. subsidy from taxpayers. This subsidy is far more than the car industry ever received. This is real corporate and middle class welfare. Abolition of the subsidy and at the same time funding a Medicare dental scheme would greatly improve equity and quality of care at no extra cost to the budget.

Abolition of the subsidy would also remove the Damocles sword that hangs over Medicare. Private health insurance has proven disastrous in the US. We must stop sleep-walking down a similar path in Australia.

Private Healthcare Australia runs a quite dishonest campaign. Private health insurance has not taken pressure off public hospitals. By funding excessive private specialist fees, private health insurance has attracted many specialists away from public hospitals. Comparing like with like, private and public hospital costs are about the same. The administrative costs of private health insurance are three times those of Medicare.

But subsidised private health insurance has one particular attraction. It enables wealthy people to avoid the queue for public hospital beds.

A major beneficiary of private health insurance has been private hospitals and one hospital group in particular. That group is Ramsay Healthcare which operates 120 odd hospital and day-care surgeries in Australia and offshore. Like other supporters of private health insurance, Ramsay Healthcare seldom argues its case publicly. It knows that its case will not stand up to public scrutiny.

Instead, Ramsay Healthcare relies on lobbying and political influence like so many other wealthy companies and people in Australia. In the last 14 years, Ramsay Healthcare and Paul Ramsay Holdings gave more than $1.8 million to the Liberal Party. Not a cent was given to the Labor Party. Paul Ramsay left an estate of over $3.4 billion recently. Before his death, he was Australia’s eleventh richest person.

The private health insurance industry relies on lobbying and political influence and not on a publicly defensible case.

The interests of Australian taxpayers and the Australian community would be better served if the $7 billion taxpayer subsidy was abolished and the money transferred to a Medicare dental scheme.

The response of the ALP to the latest round of PHI premium increases shows that it has little idea of what is at stake…. Medicare

See earlier post that I have made on this subject below:

Two days before Christmas and to avoid scrutiny, the hard-to-notice Federal Minister for Health, Peter Dutton, announced a 6.2% increase in health insurance premiums for next year.

We have seen the same pattern year after year with health insurance premiums increasing at well ahead of the CPI.

The Howard Government introduced the Private Health Insurance (PHI) rebate in 1999. Since then the average health insurance premium has risen by 130% while overall prices have risen by less than 50%.

The Chief Executive of NIB put the reason for the latest increase very bluntly. He said ‘the rise was necessary to meet the rising cost of providing health care’. But PHI is a key part of the problem of rising health care costs because PHI funds have little or no power in the market to contain costs. They are price-takers. The power to set prices in the health market is with the providers – doctors and hospitals – and only a single payer or national insurer, as in the UK or Scandinavian countries with national insurers, can and do exercise market power.

Medicare would have more market power to control prices if it was the only single payer. But its power is eroded by the PHI companies. A clear example of this is gap insurance which the PHI funds offer. This gap insurance has underwritten the largest increase in specialist fees in Australia in the last quarter of a century.

If Australians want to waste their money on expensive PHI that is their choice. But I see no reason for taxpayers providing an annual subsidy of $7 billion for PHI that enables the wealthy to jump the hospital queue.

In February 10, 2013 year, I wrote about the rising cost of PHI. See repost below. I have also reposted ‘Health care and the budget deficit in the US’ which shows the enormous damage that PHI has wrought in the US.

Repost (from February 10, 2013)

Last week Health Minister Plibersek approved an average increase of 5.6% in private health insurance premiums from April this year. It is the same story year after year with health insurance premiums increasing at 2% to 3% ahead of the rate of inflation.

There are two main reasons for these increases.

The first and least important reason is that the administrative costs of private health insurance companies run at about 15% to 16% of premiums. Medicare, including the cost of tax collection, costs about 6% per year. Broadly speaking private health insurance administrative costs, including profit margin, run at about three times the administration costs of Medicare.

The second and most important reason for the steady increases in premiums is that private health insurance funds are largely unable to control the price, quality and utilisation of services provided by doctors and hospitals. This is a problem for all insurers, both private and public, when services are provided free at the point of delivery. There is little incentive or opportunity for consumers to exercise power either over  the cost of the service or whether the service is  necessary. The power is with the provider, not the consumer. Economists call this ‘moral hazard’.

But when a country has a single payer or a single national insurer, as in the UK or Scandinavian countries, the national insurers can and do exercise market power. That is why health services in those countries is invariably delivered efficiently and at low cost. . Private health insurance has practically no power to control prices and demand for health services. What is worse, private health insurance in Australia undermines the ability of Medicare to exercise market power.

Evidence on the failure of private health insurance is clear. First, the standard example of private health insurance failure is the high cost and inequity of the US health service. That service provides the worst value for money of any health ‘system’ in the world. Secondly, The Economist, in an article on February 18, 2010, said ‘The biggest factor behind the cost conundrum is that insurers lack market power. Health care providers hold all the cards.’  Thirdly, our Productivity Commission said in 2005 ‘increased levels of private health insurance membership have been associated with a marked increase in the number of services performed and reimbursement for those services”.  Fourthly, in a review in 2003 of private health insurance in Australia, the OECD commented ‘Private (insurance) funds have not effectively engaged in cost controls. They seem to have limited tools and few incentives to promote cost efficient care … Private health insurance appears to have led to an overall increase in health utilisation in Australia …’

Increases in private health insurance premiums ahead of the inflation rate are not surprising. Private health insurance is badly serving Australians and undermines the power of Medicare as a single payer.

This is not to say that Medicare should not be improved. It is a very efficient payments vehicle. But it is much too passive. It was launched and still carries in its name, the ‘Health Insurance Commission’. If it were a proactive public health insurer, it could significantly reduce the malign influence of private health insurance in Australia.

See also article by John Menadue and Ian McAuley ‘Private Health Insurance: high in cost and low in equity’ – reposted today below.


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