[ramparrt]

The Australian system is far from perfect but does come some way to solving this. It is effectively 2 tiered:

1) Public Medicare, the publicly funded system available to everybody. 2) Private insurance, paid for by the individual and tailored to their needs.

To pay for the public system everybody pays a Medicare levy as part of their income tax. The levy is coarsely means tested. If you have private insurance then this levy is reduced somewhat.

The real critical differentiation between the public (Medicare) and private offerings are that any services deemed as elective in nature (ie, non life threatening conditions such as surgeries to treat injuries, etc) can be completed by the public system but there is a wait list which can often be quite long. If you have private insurance then you can get in very quickly with the surgeon you want.

Having private in no way restricts your usage of the public system so there is no downside to having private except that it costs more. There are also fee structures in place to encourage people to take up private when they're younger and the saving on the medicare levy.

As I said, it's far from perfect, but the 2 tiers offer a high level of customized cover for people willing and able to afford it while offering an acceptable level of cover for those who can't.

[bigger_cheese]

One thing I don't like about the Australian system is I think it is wasteful in someways. For example under my private cover I'm subsidized for ~$300 a year in optical expenses (split between lenses and frames).

From anecdotal conversations I know there are many people who purchase a new pair of glasses every year just because the system is basically set up to encourage this which smells like very wasteful consumption to me. I don't need a pair of glasses every year. I have gone through 3 sets of glasses in 15 years.

If I wanted to I could opt to exclude optical from my cover and save some money every month but then I'd worry about what happens if I lose my glasses or sit on them and I'd end up out of pocket so I keep paying for optical cover I don't use and feel like a sucker every year for not taking advantage of subsidized glasses.

Same thing with trips to dentist I know people who insist on general dental (unnecessary cleaning etc) because they are subsidized so they "need to take advantage to get their money's worth".

[robbiep]

I suggest you stop thinking about it as a benefit and think about what it actually is, which is insurance. My travel insurance is cheaper if I don't cover any lost property, but what if I need it? Anecdotally many young travellers who head overseas 'lose' their $1500 DSLR or their 6 year old macbook when in South America in order to make use of their $300 travel insurance

[bigger_cheese]

Agreed exactly why I pay for it. The fact it is advertised as a benefit probably contributes to this.

My insurer has gone as far as cold calling me last year "I notice you haven't been claiming any of these benefits, would you like to review your policy."

[robbiep]

Having worked in both Public and Private Australian systems as a Dr, and as a Medical Student in the US, I agree with your comments - we have a 'reasonable balance' of a system that does a reasonable job of allocating resources in a reasonable manner. As you say, nothing is perfect and in anything as complicated as healthcare there are going to be inequalities and problems... But even on the healthcare investment side, our Government has made some really intelligent decisions and built some beautiful facilities recently. It is rare that I work in a hospital that has not had a major renovation within the last 5-10 years (or about to undergo a rebuild)

[ricardonunez]

This sounds in some ways similar to Mark Cuban's solution.

Here's the post: http://blogmaverick.com/2017/03/08/some-thoughts-on-fixing-o...