Before one can engage in a sensible debate about health we need to accept some facts about how provision is handled. Before that one has to let go of a starting point that almost every compassionate person, myself included, has begun from. It's my naive first view, and it was this: "All healthcare should be provided free of charge to everyone".
If it sounds callous to say this is naive then as soon as we look at some real life scenarios we begin to see the problem.
1) Funds are limited. We are faced with choices. At the extreme it's between, say, cosmetic surgery to remove a mole, and a life-saving heart op. OK, we all opt for the heart op. Immediately the first word of our naive position has been broken down. Choices must be made. We presently use waiting lists as a tool for making heartbreakingly difficult decisions about who gets the healthcare we want them to have.
2) Incentives count. Altering the cost of behaviour has an effect on it. Fewer people smoke now the cigarettes cost so much. It is a cost for the behviour. Obesity has been described as an 'epidemic' by some reinsurers. Swiss Re has a great report on this. If it were possible to provide a financial disincentive to being very, very, overweight - then fewer people would do it. To what extent should we as a society underwrite risky behaviour - like the man who had to be rescued twice by our Navy on the high seas. This undermines the second part of the naive position.
Once you accept that there are limits, the next question is how best to fund health. The report for the Health Funds Association logically suggests that to get middle to upper income earners to pay for more of their own healthcare some tax breaks would need to be offered. This thoughtful report by Kim von Lanthen is better and broader than past narrow calls for Health Insurance to be tax deductible. Yet sadly that was the basis on which the report was dismissed recently.
Critically no tax break would be offered with added obligations - i.e. for middle and upper income earners to pay for much of their own healthcare. This is a much bigger thought than 'lets give the rich 39% of their medical insurance premium back' which would not alter much at all.
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