After all the information, both on health characteristics and health policy, I have read over the years, I wonder whether the bottom line for a health policy for better health doesn’t come down to two factors: government subsidy for health based on socio-economic score and government levee based on waistline circumference. I know I am making what in political circles would be a ‘courageous’ statement. I am also reluctant to defend the idea to the brink, except that perhaps it provides a useful position to start looking at the ‘what if’.
So let me try to summarize why I think these two features should underpin health policy.
Starting with waistline circumference:
1. it is by and far the easiest test to make among the most important single indicators of health risk;
2. it is clearly associated with the culture of alcohol consumption which creates risks for the population at large, even non-users through road traffic accidents and violence.
3. it falls down as a test where tobacco smoking is involved as many smokers are lean from appetite suppression and / or lung disease. However levels of tobacco smoking is self-reporting and therefore would be a poor test for negative ascertainment. The question might be to what degree helping people quit smoking is more difficult when people realise it is helping them avoid a tax. I will address tobacco policy below.
As to a government subsidy based on SES. In Australia, this evaluation is done on a daily basis through the government’s safety net agency, Centrelink. Centrelink provides unemployment, disability, and aged pensions. All Centrelink beneficiaries receive a Health Care Card. All holders of a health care card should be able to access a package of fully paid health services for themselves and their dependents eg as many GP visits as a GP feels appropriate, and 5 standard visits per year to any other registered health professional eg physiotherapist or psychologist. I tend towards no subsidy being paid for anyone else, for a number of economic reasons around health access which relates to health costs and the cost of health equipment and supplies. In short, widespread subsidies feed inflation. I would even rather see argument made for better pay for lower paid unskilled workers, so that health can be paid for by families.
How would it work.
Going back to a tax levee based on waistline. The policy could start by establishing a levee with 4 levels, say .5%, 1.5%, 2% of taxable income. For everyone who can’t produce a screening report ie hasn’t had a GP health check up that year, they pay a 2% levee. For everyone with a Health checkup but a waist measurement above the ‘moderately at-risk’ levels, they pay a 1.5% levee. Everyone who has a waist measurement under the moderately at risk level, pays only .5% levee. I think there are then a number of levers in this formula for health professionals and other businesses to use to improve health behaviours. For example coaching, fitness, arts, etc products could be developed to help save people 1% levee per year.
Tobacco sales are captured across Australia. The Commonwealth government can report on sale per region. Apart from tax on tobacco, a percentage increase in everyone’s levee can be ascertained by the overall sales of tobacco by region. This would create significant across board mobilisation of regional agency and local government applications to decreasing tobacco sales. Likewise, every tobacco smoker will know that they are directly responsible for the tax level of other people. The social tension this will create will drive tobacco smokers to quit products.
Is this too simply as a health policy. Well it sure doesn’t include all our health needs but it should make a big dent in the hospitalisations based on risk behaviours. Would it cost? It is a more capped system than the current medicare and would help keep GDP expenditure below 10% even in an ageing population.