Why Medicare Select is the best option for consumers

Our aim to have the CIMID Health Plan enrolling consumers from the beginning of 2010, and commencing discussions with the Commonwealth in the new year.

Interestingly, Australia actually has a history of competing health plans, which predated the 20th century’s infatuation with public sector managerialism and supply-side service provision.

Friendly societies in the 19th century were competing health plans. Australians in towns and suburbs across the country joined a society of their choice, with a local focus through a lodge, which contracted with GPs, hospitals and pharmacists for capitation-based services. GPs contracted to a lodge provided unlimited treatment for a member, on call, irrespective of how well or ill they were.

From 1900 to 1950, the left and right fought a long battle against the friendly societies’ place in the health system. The left wanted a state-run system, and the right wanted a practitioner-driven system. The friendly societies were caught in a pincer movement, and were gradually killed off. Chifley’s National Health scheme sounded the death knell. After that the friendly societies were reduced to their current ignominious status as insurers and finance houses.

Rediscovering this history is an important part in contemporary health reform, because without a knowledge of this past, we cannot imagine that ordinary citizens can actually form own health plans. We have been so ingrained with the ethos of managerialism through the last century that we think self-help and mutual aid cannot create the institutions that might best serve our needs. But what’s even more significant is that self-help in health maintenance and chronic illness management is now recognised as the key to good health care practice - if only we had good systemic arrangements that supported and reinforced self-care.

We think the Commonwealth should be explicit in seeking to encourage and enable aggregates of health consumers, based on cultural or philosophical or religious preferences, to form their own health plans within a competitive framework. This would mean, for instance, an Indigenous communities-based health plan, a Catholic-based health plan, a New Age complementary medicine-based health plan, a sports health plan, and so on, to provide genuine consumer-based competition with genuinely different “products” to choose from.

Existing private health insurers, who offer identical products at identical prices to a public that is justifiably not interested in their products, would have to reinvent themselves dramatically to compete with genuinely community-based health plans of this kind.

Rediscovering this history, and developing innovation in consumer self-organisation, are essential parts of the process of enabling Australians to own major change in the health system by understanding it as a return of health care to “our” communities, away from control by bureaucrats and providers.

Medicare Select is a framework in health reform that is compatible with these dynamics. At last we have something in health reform that is worth debating.