Make no mistake about it. The battle to preserve Australia’s mix of public and private health care will be joined in earnest this week.

How much are people prepared to pay? Illustration: Jon Kudelka

At stake is a worsening of the shaky health of our public hospitals.

At stake also is a direct cost impact for almost half the population who have private health insurance and an indirect, or delayed, impact on those who rely on public hospitals for treatment.

Labor’s attack on private health insurance through this year’s Budget will force substantial numbers of people to drop or downgrade their insurance coverage meaning many, many more people will be seeking treatment at public hospitals.

Longer waits in Accident and Emergency Departments, longer waits on lists for surgery lay ahead if this attack succeeds.

Nothing holds the potential to increase the stresses and strains on our hospitals more than the changes to private health insurance rebates contained in the erroneously named Fairer Private Health Insurance Incentives Bills, which are expected to be debated in the Senate this week

Every decision Kevin Rudd has taken since coming to Government will make our public health system worse – making a mockery of his oft-repeated promise that he had a plan to “fix” the nation’s public hospitals.

There is no doubt that the health sector is paying a high price for Labor’s reckless spending over the past nine months which has the nation spinning into massive debt.

The Government has targeted many areas of health to claw-back savings, but the targeting of private health insurance rebates carries the added factor of ideology – Labor hates private health insurance - and this is a serious direct attack upon it.

It is also a trashing of numerous promises both Mr Rudd and his now Health Minister Nicola Roxon made before the last election - to both the public and the insurance sector - that Labor would not change these rebates paid to those who take out private health insurance and in so doing relieve the call on public hospitals.

The phasing down of the universal 30 per cent rebate, in three stages, to 20 per cent, 10 per cent and eventually to zero for those earning over $75,000 (singles) and $150,000 (families or couples) will mean 1.7 million Australians will immediately face private health insurance premium increases of between 14 and 43 per cent.

One million people are likely to drop or downgrade their insurance cover forcing premium increases for all who maintain insurance.

In seeking to cut the rebate to so-called higher income earners the Rudd Government will hammer low and middle income earners with higher prices.
It’s worth noting that a million people – one million Australians, probably many of them elderly – earning less than $26,000 a year make the struggle to pay for private health insurance.

Does it want them to also opt out of private insurance and join the queue at our public hospitals?

If so what impact could all this have?

The private health sector estimates it could transfer 75,000 treatment episodes from private to public health care.

Public hospitals will have to accommodate an extra 190,000 bed days at a cost of $200 million.

Four million allied health services would no longer be covered by insurance costing another $200 million.

Two million dental care treatments for which private insurance would have paid $100 million would also no longer be covered.

If those estimates even partially come to pass, it creates a huge hole in the $1.9 billion in savings Rudd Labor estimates it will make by changing the rebates.

It will also push our public hospitals further toward breaking point.

Reductions in Medicare rebates for cataract surgery and various other treatments, caps on the Extended Medicare Safety Net and the 2008 Budget changes to the Medicare Levy threshold all have implications for adding to pressures on the hospital system – the one that Kevin Rudd said he would “fix” by June this year.

The Coalition will oppose the private health insurance rebate cuts when they come before the Senate this week.

The savings needed by this Government to the nation’s bottom-line can be achieved in other ways.

The Coalition has proposed an increase in the excise on cigarettes that would more than cover the $1.9 billion in savings projected from the rebate changes.

Rudd Labor does not have to further threaten our public hospitals which its State Labor Governments have so dramatically mismanaged for far too many years.

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36 comments

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    • Rationalist says:

      06:40am | 17/08/09

      Peter, I don’t think Labor hates private health insurance but nevertheless, I think you are pretty good guy! Good luck with politics, someone will need to be around for when the Rudd Government gets old and smelly.

    • Josh says:

      06:53am | 17/08/09

      It’s about striking a balance. We all know you Libs hate Medicare and want everyone on private health insurance, regardless of whether they can afford it or not, and we know how well that’s working for the US…

    • alan says:

      07:32am | 17/08/09

      Peter, The question should be - why does the Liberal Party love private health cover so much?  It doesn’t help people much when they go to hospital and cop a bill of thousands of dollars, even though they have the cover.  Are you tr ying to say that public hospitals shouldn’t treat middle income patients for free, even though they’ve paid taxes all of their lives?  What I want   to know is which insurance companies are financing the Liberal Party?????? They dictate Lib party policy on health!

    • alan cotterell says:

      07:37am | 17/08/09

      Rationalist, it doesn’t matter how old the Rudd government becomes, it could never smell as bad as the Howard government, or our current opposition!

    • G says:

      07:59am | 17/08/09

      I’ll place my trust in Labor for universal health care thanks - your lot have done it’s best over the previous 10 years to make a system that divides for the have’s and have not’s, looking only after the top end of town.

      “It’s worth noting that a million people – one million Australians, probably many of them elderly – earning less than $26,000 a year make the struggle to pay for private health insurance.” 

      - Liberals don’t care about these people and in any case they’re protected by the means testing anyway (thanks to Labor).  And I dare say this 1 million are far more in need of extra medical insurance due to specific health concerns - therefore it’s a cost they need to prioritise anyway. 

      However there are countless millions like myself who are lucky to see a doctor once a year (and that’s only to get a medical cert. for some days of work) why should we have to pay an inflated rebate to subsidise all of the rich bastards earning over $150,000.

    • Tim Chapman says:

      08:25am | 17/08/09

      A sure sign of desperation is overblown rhetoric. And it is an exaggeration to say that the ALP ‘hates’ private health insurance.

      I, nevertheless, hate paying for something that should be free and universal. I hate the fact that people who can afford it can get better treatment than those on average incomes.

      Peter makes it clear that this sort of inequality is fundamental to his party. And even the moderate system left in place by the ALP is not good enough for him.
      So, you can probably guess how I feel about the Liberal Party as well.

    • Bec says:

      08:52am | 17/08/09

      I don’t see why the health insurance industry has to rely upon its members getting tax breaks to sustain it.  Here’s a handy hint - if people are unwilling to pay without the tax breaks, you’re doing something wrong and the industry is unsustainable.

      Car, life and other insurance types manage to survive without them, why not health?

    • David says:

      09:04am | 17/08/09

      The architects of Medicare [ S & D ] stated that Medicare will not work while fee for service medicine exists and this is the root of the problem . Private care is available to a few but they still whinge about the exorbitant fees the specialists demand . Medical investigation and care has become very expensive and is outstripping everything else . Australia cannot afford this current situation while everyone wants to be the healthiest corpse in the cemetery !
      We don’t have enough people paying their fair share of tax .
      I say get politics out of the equasion before this country becomes
      the Keating prediction .
      There are too many greedy professionals around and they don’t care .

    • Eric says:

      09:03am | 17/08/09

      “I, nevertheless, hate paying for something that should be free and universal.”

      Well if you’re not going to pay for it, who is?

      The only things that are free and universal are air and sunlight. Everything else has to be paid for with human labour.

      “Free” healthcare isn’t free; it’s just being paid for by someone else.

    • Joe says:

      09:26am | 17/08/09

      Peter it is very unfortunate that the AEC’s have decided to favor the Labor Party in their redistribution of QLD’s federal seats. Last time we saw Mal Brough loose out tho this. I hope that you can hang on even though they have really tried to shaft you.

    • Angela says:

      09:41am | 17/08/09

      Peter Dutton is totally out of his depth with Nicola Roxon as his opposite number. 
      This is rubbish for a few reasons.  While the rebate will be subject to a means test, the penalty for not holding private insurance over a particular income level has been increased.  Therefore, people who can afford private insurance still have a financial incentive to maintain it.
      More importantly, large private health insurance sectors lead to inflated health costs overall.  This is not what we need with an ageing population and rising rates of chronic disease.
      Thirdly, why should the tax payer subsidise private insurance interests to such a massive degree?  Giving the money directly to private hospitals would be much more efficient and the whole community would be better off.  If private health insurance companies cannot produce a competitive product without massive public subsidy then they need to review how they are doing business. 
      Lastly, these subsidies have failed to achieve their express purpose of alleviating pressure in public hospitals.  In fact, they hae contributed to it by luring specialists away from the public system into a more lucrative private system.

    • DJG says:

      09:56am | 17/08/09

      Private Health Insurance? Private my arse. Government policy by the previous Lib Govt. propped this industry up in a disgraceful manner. I note they didnt step in to prop up Labour Unions falling numbers with a 30% subsidy funded by the tax payer, coupled with a 2% penalty loading for every year over 30. I myself have (under sufferance) Mutual Community Premium. It costs a mozza. I would rather pay all that into the public health system, because that is where i have wound up following two life saving procedures in the last 5 years. I thought Peter Duttons piece had the intelectual rigour of a 3rd year High School student. Universal Health Care for all should not be an unachievable goal in this country. We do not want a two tiered system based on peoples income.

    • R.E.L. says:

      10:21am | 17/08/09

      Medicare should only be for those who cannot afford private health insurance. Those who choose private cover should be able to opt out of the Medicare levy. Why should some people pay twice?
      Who else recalls the late Kerry Packer checking into a public hospital on his Medicare card several years ago? Why should the average income earner have to pay for someone who earns millions?

    • fehowarth says:

      10:24am | 17/08/09

      It is not a matter of hating private health funds.  The problem is that private funds do not deliver for all.  The evidence is in the actions the previous government took to badger people into private funds,  If they delivered, this would not have been needed.  The opposition whenever it gets the opportunity do whatever they can get away with to undermine Medicare, leading to a poorer overall health system.  The government should do all in its power to ensure that the base level of health care in this country meets the need of the whole population.  If people want frills, they can chose to join a private fund.  The government need not be involved in these funds. I firmly believe after being reliance on the public system for the last few years, having 4 operations and accompany a partner who suffer a number of strokes, the public system is not all bad.  We hear about the failures but probably 97% have good outcomes.  We have to ensure that the system continues to grow and improve, not destroy it.  The number of beds in comparison to the past, does not mean a thing.  Many procedures that required ten or more hospital beds, today are done in a day.  The hospital is not needed for many.  The system needs to ,meet the needs of today, not 20 years ago. All the comments in the media seem to be about hospitals.  Hospitals are only a small part of the health system.  Health is also more than about doctors.  In many necessary health services, doctors only play a small part.  We need to judge the system by today needs, not those of the past.

    • Bitten says:

      10:36am | 17/08/09

      If you aren’t willing to invest in your own and your family’s health, you’re a scunge plain and simple. I pay and I earn $35,000 pa. I simply prioritise my expenditure more responsibly than the whining majority of ‘Aussie battlers’. I don’t think my health is your problem - why do you not extend the same courtesy to me?

    • JB says:

      10:50am | 17/08/09

      What’s the heart of this issue? Who’s going to pay for health care.

      Everyone knows the problem of health is caused by State Government mismanagement, yet the Federal Government receives the political blame ~ It is always about “More Federal Money”.
      Let’s strike the real issue - Rudd should take leadership on this front and not delay further from his initial deadline. As Tony Abbott has said frequently in recent times,the power to take federal responsibility in this respect will not increase the political bigotry and callous stubborness already shown over this issue but rather make it so much more transparent. If Health isn’t fixed than there can only be one government responsible and political party responsible. Want it fixed, than it’ll take just one vote to change it.

    • Frank says:

      10:58am | 17/08/09

      My wife and I have private health cover, the highest level of cover available.  Like many others we were faced with what to do when we retired from the workforce, our main source of income disappears and is replaced by self funded pension.  Should we cancel our private cover at a time when we might need it most?  A difficult decision, but like most others I suspect, if you have cover already it seems too big a gamble to cancel it.  So we stay with the comforting thought that whilst it is expensive at least we are assured that if the need arises we are covered. 

      Well after a few years that need surfaces and major surgery is required and a few hospital stays are required and infections are encountered.  The treatment and service we receive is first class, couldn’t be praised enough, but what a shock when we found what wasn’t covered by the health fund and what was excluded by the safety net.  Thousands of dollars in out of pocket expenses is a nasty shock when you suddenly realise, perhaps naively, that full private hospital cover with zero excess doesn’t actually mean that at all.  It does mean that all direct hospital accommodation and care costs are covered, but all other procedures, ECG’s, operations, radiography, pathology, doctors, surgeons, anesthetists etc are only covered for the difference of the Medicare rebate and the scheduled fee, usually 15% of the scheduled fee. 

      The actual fees charged are much higher than the scheduled fee and there are many hidden services that are waiting to surprise you and you have no control over.  Pathology testing of tissue samples at $600 a time. Insertion of PICC lines at $700 plus a time.  The balance, the ‘Gap’, that I have to pay is often much more than the scheduled fee.  Wait one moment though, there is the safety net, that means that once I get over $1111, Medicare will pay 80% of the out of pocket expenses.  But I find this only applies to services received out of hospital.  So the majority of the out of pocket costs are excluded and despite being faced with large out of pocket expenses, I never make the safety net because most of these items are classed by Medicare as in-hospital services.  Ironically, the private health fund regards these same services as out of hospital services and as such are only at best covered for the scheduled fee gap and in some cases for example like MRI’s, not covered at all by anyone.

      So I find that despite paying a high premium for health insurance for the last 30 years, when the time comes, my share of the bill excluding the basic hospital room cost, is over five times more than the health insurance company pays and more than medicare pays.  Fortunately, we were in a position to cover these costs, but many others in a similar position may not be.
       
      Now tell me, what sort of insurance only covers for between 5-10% of actual cost? 

      The private health treatment is wonderful, but the private health insurance system is not providing what it is touted as providing.  By the way our health fund is one of the most popular in Australia so don’t think that we made a bad choice.  There is a fair chance that it is the one you are insured with as well.
      Peter Dutton, the health insurance rebate is not the real issue here.  The way the system is working as a whole is the issue that should be addressed.

    • Lee-Anne says:

      11:45am | 17/08/09

      I am one of the pensioners who has private health insurance through necessity. I struggle to find the monthly payment but do so because I was told by my local public hospital ( dental ) not to come there anymore as I have special needs and they can’t help me. So now I need to find $1000 for private health insurance ‘gap’. I have all dental work without local anaesthetic (not by choice) but tremble at the idea of having extractions without any anaesthetic.

      Liberals took the money out of public dental years ago. I can still remember Peter Costello standing on budget night and saying it. So as far as I can see Liberals don’t care about people from low socio economic backgrounds. As for equity and people exercising choice in this fair market economy, hogwash! How can you make a choice and have equity if you don’t have the money to pay in the first place?

      What is Rudd going to do about it and when ?

      I just hope we don’t go down the road of USA, where it cost E$500USD month for ‘decent health insurance.’

    • Greego says:

      12:29pm | 17/08/09

      The Liberals simply want to put children back down the mines!!!!
      The sky is falling!!!!
      Is this piece honestly the best from the “new hope” of the coalition?
      Health is possibly the most complex area of government with huge technological advances, increased demand from lifestyle illnesses and the restrictions of a 19th century governance structure. Overlay this with the impact of human death and suffering and it’s adds up to an issue demanding better outcomes from new thinking and creative solutions to emerging and existing chalenges, all needed yesterday.
      Now the grief of the election loss is past they should have got over denial and even worked on acceptance. Really, this is the best opinion piece possible after all this time?
      No wonder Rudd looks relaxed and comfortable in the Lodge….....

    • DJG says:

      12:38pm | 17/08/09

      Bitten. Why do you want to pay a private for profit insurer? Why not have your Medicare levy go into the Public system. If you only pull $35K a year thats fine. I am a $100K + and do not mind one iota, paying the same percentage of my income into a Public system as your good self. Whilst i will pay more in cash terms, it is equitable in terms of percentage. This makes for a healthy society. Health of our fellow humans should not be market driven.

    • John Gilbert says:

      12:48pm | 17/08/09

      JACK G/Coast
      Peter Dutton is like a gramaphone needle, His goverment did nothing while in power, oops sorry they blamed every thing on the states,
      Peter Dutton will not hold his seat at the next election.

    • Peter says:

      01:33pm | 17/08/09

      The reason I hate private health insurance Mr Dutton is simply because you pay them lots of money and you get little back. After all, that’s what profit is - making a lot more than you pay out. So having a private health sector means we pay more for health care. Protecting private interest profit at the expense of the general populace is simply dumb politics. Let’s hope Dutton never gets to make public policy.

    • RobJ says:

      01:46pm | 17/08/09

      “Health of our fellow humans should not be market driven. “

      Hear hear,

      You see if Labor HATES private insurance it’s clear that Liberals believe that EVERYTHING has to be a money making exercise. Their blind faith in the ‘Market’ is laughable.. The very same ‘Market’ that gave us tobacco and lied and lied for years and years about it’s effects.

      Now tell me Peter Dutton, how much do the free market drug companies contribute to research for a cure or vaccine for malaria, the BIGGEST killer compared to Govts and not for profit NGOs?

      Here’s a better one Peter Dutton, how much do free market (the free market that you love) pharmaceutical companies pay to research male pattern baldness (a condition that hurts NOONE) compared to say, let’s see…......MALARIA?

      Oh, and tell us about all the research done by private hospitals when compared to the Royal Women’s Hospital or Royal Childrens Hospital.

      I ask, why don’t you hate private health insurance? Why? Because as per usual Liberal MPs are all about looking after the BIG END of TOWN!

      By the way I’d never heard of you before you posted this topic, do you think you could have disclosed your position in the Liberal opposition early in your post to save me wondering why you are such a biased partisan character?

    • Kym Durance says:

      02:25pm | 17/08/09

      At $2 billion a year we can well aford to get rid of yet another example of middle cass welfare. A good chunk of it went to appease the “worreid weell’ and administrative costs withn the PHI industry.

      It was a vote garnering exercise and it has run its course

      The assertion that the ALP “hates” Private Health Insurance is infantile. Might make for a mediocre headline but does nothing for Duttons crediblility or credentials on health or economics for that matter.

    • RobJ says:

      02:41pm | 17/08/09

      “Let’s hope Dutton never gets to make public policy. “

      Regardless, policy will be made by politicians and they will always consider their re-election when making such policy. I don’t like any of them from either side, politicians are politicians regardless of the party they represent.

    • AJ says:

      03:42pm | 17/08/09

      “The battle to preserve Australia’s mix of public and private health care will be joined in earnest this week.”

      Hmmmmmm, an odd statement, to say the very least.  This makes it sound like our system needs to be defended in a Gettysburg-esque clash.  The question I would like both sides of Parliament to ask themselves is: ‘Do we currently have a perfect health system?’.  The answer, inevitably, is no.  So, how do we improve it?  Mr Dutton and Ms Roxon seem rather unwilling to engage in a debate about the fundamentals of how health services should be provided in this country, although at least Ms Roxon has provided us with a minimal framework for what the government believes would be an improvement.  The Coalition, yet again, has missed out on its ability to be an alternative government by being nitpicky about costs and savings and provides no meaningful change to the system itself other than a token tobacco excise increase which, it should be noted, may very well be co-opted by the Government.

    • Jessica says:

      03:59pm | 17/08/09

      Excellent article, Peter. I have had private health insurance all my life and had the misfortune of visiting a friend in one of Qld’s public hospitals recently. Thanks, but if I have a medical emergency I’d prefer to go to the Wesley and be seen immediately rather than sit for hours in a grotty waiting room in a grotty hospital. I pay for that, and I am happy to. However, this broken promise is yet another example of Rudd et al attempting to gouge more out of those who he thinks can afford it, and redistribute the wealth to others. Funny, in a sense, since Rudd’s family is worth hundreds of millions of dollars.

    • Julian Thomas says:

      08:42pm | 17/08/09

      I would love to pay Health Insurance but wait, I already do Medicare Surcharge and levy etc, increasing premiums and age penalties, no thanks, get rid of medicare and introduce low premiums and I think of joining “private health” once it really private and not a subsidy hybrid

    • Lorraine Hillier says:

      11:03pm | 01/04/10

      confused we are aged pensioners thinking we may need although healthy at the moment in the future extra medical private health cover dont know which company can best help us

    • Rae Edwards says:

      03:46pm | 15/10/10

      Health insurance costs can be enormous. I always advise to invest in a low cost term life insurance to cover final expenses and any existing medical bills that heath insurance does not cover.

    • Alissa says:

      10:25pm | 20/10/10

      In a study published in the The Journal of Agriculture and Food Chemistry, researchers found that the level of one flavonoid in organically grown tomatoes was almost twice as high as that in tomatoes that were conventionally grown. I’m not sure about you but this makes me wanna check my Insurance Quote. Also this may give people who choose organic vegetables and fruits in order to avoid pesticides yet one more reason reason to spend the extra money on organic produce.

    • Noel says:

      02:37pm | 30/03/11

      Good article and I would agree with Peter on this, yes Health insurance is very expensive and sometimes we get little back.  However I think we need to look at the bigger picture , I have noticed recently the country’s only listed health insurance provider NIB Health Insurance seem to have made a big push by targeting major employers that offer insurance cover to employees such as the coal mining industry. This is important to target as the government previously have let down this industry and the coal mine health care system was affected. I think our own people who risk their own lives should be protected and insured. Recently we have seen lots of disasters around the world and these people’s families need to be properly insured.

    • Jack Trip says:

      02:57pm | 13/07/11

      I don’t see the issue here. Forcing more people into private insurance at more expensive rates will simply help grow the massive insurance lobby, which in turn funds political campaigns and most likely secrets money to some politicians on the sly. What’s wrong with that? Oh, wait, you’re not a politician? Well, in that case you’re hosed, mate!

      Jack
      http://www.accidentinjurydirect.co.uk

    • TonyaLEACH says:

      12:39pm | 19/08/11

      Have no enough money to buy some real estate? Don’t worry, because it’s achievable to get the credit loans to solve all the problems. So take a term loan to buy all you require.

    • Willa33STRICKLAND says:

      09:06am | 23/12/11

      If you want to buy a house, you will have to get the business loans. Moreover, my father commonly utilizes a short term loan, which occurs to be really firm.

    • Chris Chinniah says:

      02:14pm | 01/05/12

      The cut in the rebates on the private insurance will force countless people to flock to public healthcare instead, and thus the government must be prepared for the consequences.

 

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