Wednesday, February 8, 2012

Propping up private heath insurance unfair, inefficient

Despite the untiring efforts of Julia Gillard and Tony Abbott to make themselves seem poles apart in their policies - he/she is hopeless, I'm really good - the ideological gap between the two sides has never been narrower.

If you look carefully, that's true even in one of the few remaining points of ideological difference: the funding of healthcare, particularly private health insurance.

When John Howard resumed leadership of the Liberals in 1995, he abandoned their long-standing opposition to Labor's Medicare (and Medibank before it). But that didn't stop him using a succession of carrots and sticks to get people back into private health insurance.

When Labor returned to power in 2007, it lost no time in seeking to water down those incentives. In its first budget it raised the income thresholds at which middle- and high-income earners became liable for the additional, 1 per cent Medicare levy surcharge if they didn't have private insurance.

In its second budget it sought to means test the 30 per cent health insurance rebate, reducing it for higher-income earners and removing it for those even higher up. Labor seems to have wanted this as part of its efforts to pare back all the middle-class welfare Howard introduced to health and social security payments.

But the measure was knocked back by the Senate, mainly because of the implacable opposition of the Libs. Labor has sent the bill back to the Senate every year since then, only to have it rejected.

This week the newish Minister for Health, Tanya Plibersek, is conducting discussions with the independents and the Greens in the hope of having more success this year. Strangely, if the Greens join forces with the Libs to block the bill one more time, it will be because they profess to believe it doesn't go far enough.

Plibersek has sought to demonstrate the unfairness of the rebate with figures showing that while just 12 per cent of couple taxpayers earn more than $160,000 a year between them, they account for 21 per cent of the couples benefiting from the rebate - worth, typically, about $1000 a year. For single taxpayers, the 14 per cent earning more than $80,000 a year account for 28 per cent of the singles getting the rebate. It's a concession for the well-off.

The health funds and the Liberals oppose the means test because, they claim, it would lead many people to abandon private insurance.

Leaving aside the question of why that would be such a bad thing, this is a weak argument.

Treasury's calculations show that only about 0.3 per cent of the 10 million people with insurance would quit. And it's not hard to see why. Higher earners are essentially compelled to hold private insurance by the Medicare surcharge. And Labor's plan actually involves increasing the size of that stick.

It's clear Labor's motives are to make the system a little less unfair and save the budget a little money (its means test would reduce the $3 billion annual cost of the rebate by about $700 million) without harming private insurance.

So, just as the Libs now accept the legitimacy of Medicare, so Labor now accepts the legitimacy of taxpayer-subsidised and enforced private health insurance. One of the few remaining ideological gaps has greatly narrowed.

The pity is that, as John Menadue and Ian McAuley explain in a new paper published by the Centre for Policy Development, subsidising private health insurance doesn't only advantage the better-off (including yours truly), it makes healthcare more expensive than it needs to be.

Healthcare costs to the community - whether funded by the taxpayer or privately - are already growing rapidly and are set to keep outpacing most other costs, becoming by far the greatest pressure on government budgets.

That makes healthcare the greatest source of pressure for rising taxes. Nothing wrong with that - provided we get value for money. But that's just where private insurance lets us down.

Howard's subsidy of health fund premiums was really a vote-buying election promise and a gift to the well-insured Liberal heartland. He tried to justify it by claiming that getting more people into private insurance would relieve the pressure on public hospitals.

As all the experts predicted at the time, it didn't work. It shifted patients from public to private, but it also shifted doctors from public to private, leaving public queues little changed. It did, however, subsidise the better-off in their efforts to jump the queue.

As anyone who's done high school economics could tell you, the benefit from a government subsidy of the price of something is shared between the buyer and the seller. The health funds have become a lot more profitable than they used to be.

All arrangements that separate the true cost of something from what you appear to pay for it at the counter encourage overconsumption, overservicing and overcharging. That's true of Medicare as well as private insurance.

But unlike private insurance, Medicare has countervailing advantages. Being a single national payer, it has lower administrative costs and, more to the point, greater ability to counter the market power of healthcare providers.

Our many private health funds have little ability - and little incentive - to counter overservicing and overcharging. It's a well established principle in health economics that those countries with the greatest reliance on private insurance to finance healthcare have the most expensive healthcare - without a commensurate improvement in their health. The United States is the classic case.

Using carrots and sticks to prop up private insurance not only subsidises a two-class health system, it delivers its greatest benefit to the incomes of medical specialists. Great idea.