Before cutting private health insurance rebates, the government should hear older Australians who rely on cover as a safeguard against delay, uncertainty and worsening health.

Before making changes to private health insurance rebates, the Australian government must listen to the thousand of older Australians who aren’t seeking luxury or privilege but simply trying to protect their access to timely healthcare.

As the government considers changes to the private health insurance rebate in April 2027, I ask that they listen to the thousands of older Australians whose voices are often missing from this debate.

They are older Australians who aren’t wealthy, who aren’t looking for special treatment and who don’t see private health insurance as a symbol of privilege. Many have carried insurance for years because they believe it offers some security if their health deteriorates.

For them, private health insurance isn’t about avoiding the public system, it’s about uncertainty and the fear of what may happen if they lose access to timely care.

The debate about the private health insurance rebate is often presented as a choice between supporting private insurers or investing more in Medicare. It’s understandable that governments must consider how public money is spent, but it’s also true that Medicare must be protected and strengthened and that Australians deserve a simpler, fairer and more accessible health system.

However, there is another part of this conversation that deserves greater attention.

Many older Australians hold private hospital cover not because they want luxury, but because they live with chronic illnesses, ongoing medical conditions and the realities of ageing. They know that healthcare isn’t just an economic policy discussion – it’s appointments, specialist consultations, monitoring, tests and the anxiety of wondering how long they might wait if they need treatment. They’re not trying to jump the queue, they’re trying to ensure that when their doctor says treatment is needed, they have a realistic pathway to receiving it.

This is also why it’s important to remember why the higher private health insurance rebate for older Australians was introduced in the first place. It was never intended to be a reward or a privilege. It recognised a practical reality that older Australians use hospital services more often, face greater healthcare costs and are more likely to need treatment as they age. It also recognised that helping older Australians maintain private health cover would reduce pressure on Australia’s public hospitals by enabling those who could access private care to continue doing so.

Those reasons have not disappeared. If anything, Australians are living longer, more people are managing multiple chronic health conditions and public hospitals continue to face increasing demand and lengthy waiting times. Before removing support that was introduced to recognise these realities, it’s reasonable to ask what has changed. If the circumstances that justified the rebate still exist, or have become even more significant, why should the policy be abandoned before an alternative is in place?

This is where lived experience is important.

Many of the decisions affecting older Australians are made by people who haven’t yet reached the stage of life where managing chronic illness, attending regular specialist appointments and navigating the health system can become part of everyday life. This isn’t a criticism of younger policymakers. Age alone doesn’t determine understanding or compassion, but it does raise an important question: are the experiences of older Australians being properly heard when decisions are made about the health system they depend on?

A health system isn’t only about funding models, it’s about the people who rely on it.

There is an argument that government support for private health insurance should instead be redirected into strengthening Medicare and expanding services such as dental care. This is an important argument, but there is also a question that must be answered.

What happens in the meantime?

A stronger public system is a goal for the future, but Australians living with health conditions today must make decisions based on the system that exists today. They see the waiting lists and they know the pressure on hospitals. They also understand the challenges facing specialists and the public health system.

For many, private health insurance isn’t a choice between public and private values, it’s a personal safety net in a system where they don’t feel they can afford to take the risk of being without it. If fewer older Australians can afford to keep their private cover because the rebate is reduced or removed, many will have little choice but to rely more heavily on the public hospital system and that raises an important question, not only for older Australians, but for every Australian who depends on timely access to healthcare. Will public hospitals be ready to absorb that additional demand and will waiting times improve or become even longer? These concerns are already being expressed by many older Australians who fear they will be forced to give up private health insurance despite continuing health needs.

This is why the debate about reducing rebates needs to be approached with great care. It shouldn’t assume that every older Australian with private health insurance is protecting a privilege because many are simply protecting their health.

If governments decide to reduce support for private health insurance, then Australians should be able to see a clear and immediate benefit: shorter waiting times, better access to specialists, stronger Medicare and meaningful improvements in areas such as dental care.

Most Australians would welcome a health system where private insurance was no longer necessary because the public system could provide more efficient care for everyone.

However, until that day arrives, policymakers need to recognise the reality faced by those who depend on private cover. Before removing support that previous governments recognised was necessary for older Australians, the government should be able to demonstrate that the circumstances which justified it have genuinely changed. Until public hospitals can consistently provide timely access to the care older Australians need, private health insurance will remain not a luxury, but an essential safeguard for many.

A compassionate health system must be able to hold two ideas at the same time: Medicare should be strengthened and older Australians who currently rely on private health insurance should not be left without security while those improvements are being made.

Older Australians aren’t asking for privilege.

They’re asking not to be forgotten.

The views expressed in this article may or may not reflect those of Pearls and Irritations.