JOHN MENADUE. The unfairness and waste of private health insurance and the threat to Medicare. Repost from April 21 2017

History is repeating itself.

Medicare was created by the Whitlam government because of the abject failure of private health insurance or, as it was then called voluntary health insurance. 

As a result of the growth of private health insurance (PHI) since 1999 under the Howard government, Medicare is now seriously threatened. Government subsidies for PHI will take us back to the pre Whitlam and pre Medicare era. 

The Australian government today knows that PHI is in real trouble. But for ideological reasons it wants to prop up what John Howard foisted on us in 1999. That is the reason for the current review. It is like putting lipstick on a pig.

There are 34 insurers with 40,000 variations of PHI policies available. Due to complexities and deliberate obfuscation the public is confused over exclusions, inclusions and gap cover. It is an awful mess and it is not surprising that the public is increasingly sceptical. The former Minister for Health Sussan Ley told us ‘ Everywhere I go, consumers health insurers, doctors and private hospitals tell me their needs are not being met by PHI….Australians are paying too much for health insurance that does not deliver them much value.’

It all takes me back to what Gough Whitlam said in 1969 about PHI. 

“Voluntary health insurance was condemned in the Nimmo report for having become complex to the point of incomprehensibility, charging contributions beyond the means of many members of the community, paying less in benefits than the cost of medical and hospital services, causing serious and widespread hardship through the application of ‘special account’ regulations, appropriating too much of its own contribution income for operating expenses and accumulating excessive reserves.”

What he said then about voluntary/private health insurance is still true today of PHI. It is inefficient and unfair. It is eroding Medicare. And the CEO of NIB has warned us that that is what he wants to see,,’to bring us back to the days before..Gough Whitlam introduced Medicare’.

Yet inefficient and unfair private health insurance is underwritten in Australia through an enormous government subsidy. Private health insurance is subsidized by Australian taxpayers at a cost of $11 billion p.a. The motor industry never got a subsidy like this.

In 2015-16, that taxpayer subsidy was made up as follows:

  • $6.565 b., direct outlays in the budget for the rebate.
  • $1.6 b. tax-free income for those who got the rebate.
  • $1 b. estimate for the benefit of exemption of tax-payers from the Medibank Levy Surcharge.
  • $2 b. for the estimated cost to taxpayers of high costs associated with PHI and particularly unnecessary treatments.

That subsidy should be abolished and some of the money saved should be spent to include dental care as part of Medicare, at a cost of about $6 b. pa. See link Almost 40% of Australians earning less than $75 000 pa cannot afford to see a dentist.

It is important to understand some history to realize the threat of PHI. We have been here before.

The ALP in the Senate in 1968 was responsible for establishing a Select Committee on Medical and Hospital Costs. To head off this report, the McMahon Government appointed Justice Nimmo to conduct an enquiry into Health Insurance. Not surprisingly, both the Nimmo report and the Senate report condemned the inefficiency and waste of private health insurance that I have mentioned.

Those two reports laid the basis and the reasons for establishing Medicare. .

PHI is a grave threat to Medicare but the ALP does not seem to care.

Let me summarise the failings and risks of PHI.

  • It threatens our universal health system through seriously weakening the ability of Medicare as a single funder to control costs. We have seen the enormous damage that PHI has wrought in the US. We are steadily going down the same dangerous path. On present trends, we will have a divided healthcare system. One system will be for the wealthy with a safety net system for the indigent.
  • PHI not only weakens Medicare, but in itself it does not have the market power to match the power of health providers who hold all the cards. On February this year in the SMH, Dr Rachel David the chief Executive of Private Healthcare Australia said that’ private health funds have no control over input costs, which include medical device benefits, hospital accommodation costs, allied health costs e.g. dental, medical specialist gap costs among others’ Without perhaps realizing it she put the case against PHI…its inability to control costs.
  • It favours the wealthy who can jump the public hospital queue by going to private hospitals.
  • It penalises country people who have limited access to private hospitals.
  • It has administrative costs three times higher than Medicare.
  • Since John Howard introduced the PHI subsidy in 1999, premiums payable on PHI have increased by over 150% but the CPI has risen by only 50% .
  • PHI has made it extremely difficult for public hospitals to retain specialists who are attracted to remuneration which is often at least three times higher in private practice and private hospitals. PHI has not taken the pressure off public hospitals
  • There are government-supported trials in Queensland to extend coverage of PHI to general practice.
  • Medibank Private is pressing for PHI holders to get preference in public emergency departments.

If people want private health insurance that is their right. But why should taxpayers subsidize the PHI industry to corrupt and undermine a universal system that is available to all.

The vested interests in PHI never argue their case in public. They rely on private lobbying of ministers and officials.

PHI is like a Trojan horse to lead us away from world’s best practice in health care, a single public payer with services provided by both private and public providers.

This article originally appeared in Health Voices, the Journal of the Consumers’ Health Forum.


John Menadue is the publisher of Pearls & Irritations. He has had a distinguished career both in the private sector and in the Public Service.

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5 Responses to JOHN MENADUE. The unfairness and waste of private health insurance and the threat to Medicare. Repost from April 21 2017

  1. Avatar Mike Yewdall says:

    You are quite right in your assertion that it is purely ideological. Politicians of all shades just have to fiddle with things to create the impression that they are actually doing something. I squirm when I hear one of them say “reform”. Labor seems oddly acquiescent on a couple of fronts at the moment and I can’t help but wonder why.

  2. Avatar Jaquix says:

    Bushwalkner – I read somewhere that the costs you mention, have been quantified and are actually quite low. Remember not everyone with health insurance goes to hospital every year. Removing the subsidy wont mean that everyone will cancel their health insurance.
    I think the Labor party is working on this proposal – after all $ 11 billion is a lot bleeding out of the budget propping up private companies.

  3. Avatar michael lacey says:

    Good article John!

    When you look at neoliberal dogma it makes perfect sense-
    They have hated compulsory superannuation and Medicare since their inception.
    Neoliberals don’t like social spending or our “safety net”. Why? Because when you’re unemployed and desperate, corporations can pay you whatever they feel like – which is inevitably as little as possible. You see, they want you “over a barrel” and in a position to “work cheap or starve”.

    At bottom, Neoliberals believe in a social hierarchy of “haves” and “have nots”. They have taken this corrosive social vision and dressed it up with a “respectable” sounding ideology which all boils down to the cheap labour they depend on to make their fortunes.

    Neoliberals don’t like the minimum wage, or other improvements in wages and working conditions. Why? These reforms undo all of their efforts to keep you “over a barrel”.
    Neoliberals loved “free trade” agreements. Why? Because there is a huge supply of desperately poor people in the third world who are “over a barrel” and will work cheap.

    Michael Hudson in his book Killing the host calls them parasites!

  4. Avatar Lorraine says:

    Thank you John for articulating what most of us out there know to be the case through experience and observation.
    The ALP continue to drop the ball on this, their own creation.
    Like access to good education, good health care is one of the cornerstones to a good life and future for us all.
    What can be done to stop this before it’s too late and I’m back to my twenties without that youth and strength to sustain me.

  5. Avatar bushwalker says:

    You never got around to addressing the critical question; when the PHI is abolished what proportion of taxpayers will continue to pay for PHI? Those who opt out will suddenly need to have their hospital care paid for by State funded hospitals. So how much saved by the subsidy will have to be re-allocated to the states. The now much emptier private hospitals will probably need to be contracted by the states to take the overflow the state hospitals can’t physically handle.

    I don’t think you thought this through quantitatively.

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