Is it time for MindCare?

With strong public support for public insurance schemes such as Medicare and the NDIS, Sebastian Rosenberg proposes a similar insurance system for mental health called MindCare…

The decision to now support a Medicare-style levy to pay for the new National Disability Insurance Scheme is partly fired by the difficult budget situation.

However it is also inspired because of the Australian community’s proven support for Medicare. Few policies or programs have the universal support Medicare enjoys, with Australians fully realising that if we all chip in, according to our earning capacity, we can all share access to one of the world’s best health systems. Australians treat access to quality health care as a shared public good and have placed real value on the role of Medicare since its inception in 1984.

The Government is pretty sure we will feel the same about DisabilityCare. A new shared public insurance scheme, based on a hypothecated tax or levy, designed to provide long overdue access to quality disability services to the whole Australian community. Australians seem to prefer a situation in which they can clearly identify how their taxes will be spent and the vehicle of a levy permits this. Together with the community’s response to the undoubted moral imperative, the Government thinks the community will back this proposal wholeheartedly and, even judging by the talkback radio vox pops, they are probably right.

One of the key issues raised about the current proposal is that a half a percent rise in the Medicare levy will only generate $3.2bn, less than half the $8bn it is estimated the NDIS will cost annually to run. The balance it is said will be found from general revenue and the states. We do need to be clear that the Medicare Levy only raises a small proportion of the total Commonwealth expenditure on health, about $10bn out of total of around $60bn.

Even so, I believe that this theme of public insurance, such as Medicare and now the NDIS warrants further investigation. The NDIS is being established to address the disconnected, underfunded lottery that has been disability services in Australia over many decades. It is acknowledged that the focus of the NDIS will be on helping people with permanent disabilities. Many of these people have no prospect of functional independence and will require lifelong support. This will necessarily exclude the vast majority of people with a mental illness whose conditions are episodic rather than permanent. Of the 410,000 people estimated to be covered by the NDIS, only a tiny fraction is likely to be people with psychiatric illnesses. As has been demonstrated by our former Australian of the Year, Professor Pat McGorry, with proper mental health care, particularly based on early intervention, even people with low prevalence disorders such as schizophrenia and bipolar disorder can be treated and are able to recover to live fulfilling lives.

I therefore propose a new public insurance scheme, to be funded by a further half a percent levy on Medicare, to be known as MindCare. It will generate $3.2bn per year dedicated to growing the existing expenditure on mental health care in Australia, to finally address one of the most unfair and glaring gaps in what is otherwise a world class health system. The large deficit in mental health spending in proportion to the burden of disease is widely understood. New investments in mental health have been sporadic at best and not particularly generous, leaving our service system woefully underpowered.

It would be interesting to gauge public sentiment in relation to MindCare. While community surveys have repeatedly made it clear that Australians value mental health and are aware the system remains in crisis, would they be as willing to hypothecate away their hard earned cash as they seem to be in relation to DisabilityCare?

Can I also propose a way to pay for all this? The health budget is under greater scrutiny than ever before, as witnessed by the recent report of the Grattan Institute. Prime Minister Gillard says all options are on the table.

There have been recent efforts to curb public health spending by implementing a means test on the private health insurance rebate. Why don’t we go further and finally address what Jenny Macklin called one of the worst pieces of public policy ever implemented. Let’s abandon taxpayer subsidies for private health insurance altogether. In their January 2012 piece published by the Centre for Policy Development, John Menadue and Ian McAuley systematically debunked all the key points raised by proponents of the rebate, demonstrating that the policy is a huge budget burden, has massive administrative costs, has not eased the pressure on public hospitals, has not improved choice and does not reward self-reliance.

Australians have shown their clear preference for public insurance arrangements. Despite the rhetoric of choice and self-determination, both Labor and Liberal governments have forced the community to take up private insurance or be faced with considerable financial penalties (ironically payable via an additional surcharge on the Medicare levy). This is un-Australian. The subsidy paid by the Government to the private health insurance industry is around $5.5bn each year and growing. If people want to pay for their own private insurance well and good but let’s not use taxpayer funds, better directed to the public health system, to prop up private insurers.

Medicare, DisabilityCare and shortly no doubt DentiCare. I know it’s not a competition but people with a mental illness and their families are sick of waiting while every other body part and malady is considered more worthy.

Good health care is expensive. Mental health care is significantly underfunded. A national scheme of public insurance is the most efficient and publicly popular method to generate new funds and new services. Isolation is the enemy of good mental health. This kind of scheme is part of what holds a society together, making it more than just an assembly of individuals.

It is time for MindCare.

Sebastian Rosenberg is a Senior Lecturer at the Brain and Mind Research Unit, University of Sydney