Australian Politics and Policy - Senior, 2019a

Australian Politics and Policy
wasn’t until the period after 1945 that mechanisms for widespread sharing of health
care costs were developed with increasing levels of government involvement.
Worldwidethedevelopmentwasalongtwopaths.Onepath,inBritainand
the Nordic countries, was for governments to take the prime role in funding, and
in some cases providing, tax-financed health care for all. Many other European
countries relied more on mutual benefit societies, which slowly extended their
reach to become not-for-profit health insurers. The USA, by contrast, relied on
insurance provided by for-profit companies. Some countries’ policies were guided
by the principle that whatever one’s means, health care would be accessible to
everyone on the same terms (‘universalism’) while others directed health care
funding more at the poor or indigent, using means tests.
Much is written on the difference between these funding systems. There are,
indeed, important differences: in particular America’s reliance on for-profit
insurance has resulted in that country having high-cost health care and in many
peoplebeinguncovered.(AsaproportionofGDP,America’stotalhealthcare
costs, private and government, are the highest of all OECD countries, and almost
double the OECD average. 10 ) But there are also important similarities in different
countries’ policies, the strongest being people’s choice, generally backed through
political processes, to share health care costs with one another, through some form
of insurance, private or public.
Whatever our ‘left’ or ‘right’ political orientation, our acceptance or otherwise
of the outcomes of competitive markets, and whatever our general norms on
sharing, for health care we tend to be communal in our values, and we seek
mechanisms of sharing and redistribution.
Individuals may believe that because they have good education and the reserves
of accumulated savings they can weather most economic contingencies, but when
itcomestohealthcaremostpeoplehavelittleknowledgeoftheirrisks.Nomatter
how fit we are, life-changing illness or accident can occur at any time.
ForourhealthcareneedsweareinwhatphilosopherJohnRawlscallsan
‘original position’. 11 When people are asked to choose the rules which should
govern the distribution of wealth and income in a society, but when they don’t
know what place they will occupy in that society, they are in an ‘original position’.
In such situations people tend to favour rules that result in some degree of levelling
–aredistributionfromthewell-offtothenotsowell-off.
At first sight there seems to be a simple way to fill this need: if people seek
tosharetheirhealthcarecostswithoneanother,thentheyshouldbefreetodo
so through private insurance or through mutual societies. But such laissez faire
arrangements fail to meet community needs.
In the comparatively unregulated markets of general insurance, where we
insureourhousesandcars,marketscanworkreasonablywell.Insurancefirms,
10 OECD 2017.
11 Rawls 1971.
608