Get-off-your-butt money!

As the era of “sit-down money” for Aborigines ends, the Australian General Practice Network has proposed a new scheme to give “sit-up money” to the obese.

The AGPN wants over-weight patients referred by their doctor to an accredited weight-loss program to receive a $170 government-subsidy to cover 75 per cent of the cost.

The federal government and opposition have agreed to consider the proposal.

Little wonder. According to Melbourne University Associate Professor David Dunt, the cost of treating obesity-related chronic conditions, such as Type-2 diabetes, accounts for nearly 70 per cent of allocated Commonwealth health expenditure. When diabetes leads to end-stage kidney disease, patients require renal dialysis. In 2005-06, public hospitals admitted more patients for renal dialysis than for any other reason.

Because so many unhealthy Australians are requiring costly, complex, and recurring treatments, investing in preventative measures to address the obesity crisis seems like a good idea.

But can and should Medicare be paying for this?

Taxpayer-funded health systems like Medicare were designed to deliver relatively cheap and basic care to people who contracted an infectious disease, or who were injured in an accident. The idea was to share the risk of misfortune equitably between the rich and poor, and ensure the cost of ill health did not ruin the less wealthy.

But thanks to modern medicine, Medicare is increasingly saving people from themselves. Once, if you ate poorly all your life, you died of a heart attack in your 50s or early-60s. Now you can escape the consequences of your lifestyle because open-heart surgeons can unclog your arteries.

This means that today there is less reason than ever before to take care of your health, regardless of the enormous social cost, particularly when healthcare is largely “free”. While ever Medicare foots the bill and protects people from the consequences, this will not encourage people to modify their lifestyle.

However, social policy experts recognise that unless there are consequences, people will not change their behavior. They also recognise that the best way to promote positive social outcomes is to link entitlement to social welfare to good behavior. Hence, people are no longer paid unemployment benefits unless they fulfill mutual obligations and actively look for work or agree to work for the dole.

The same idea of encouraging personal responsibility is behind the federal government’s intervention in Northern Territory aboriginal settlements. Fifty per cent of welfare payments have been quarantined because the free flow of “sit down money” led to socially destructive behaviour - primarily alcohol abuse - in these communities.

But there is a reluctance to extend this approach to health. This is largely because we continue to think about healthcare in terms of protecting people from misfortune, even though Medicare clearly no longer functions this way.