The Sydney Morning Herald published a colourful opinion piece by Lisa Pryor on full-fee paying local students in Australian universities (1). The gist of her article was that the full-fee paying option allowed students of lesser academic ranking (and by presumption, ability) to "bribe" their way into university. Pryor states and I quote:
"The problem with full-fee paying students is they are engaged in institutionalised bribery...
The real threat to values is the triumph of money over fairness, which full-fee payers represent. What is the point of drumming into kids an ethos of egalitarianism and the fair go at school, if we are going to teach them as soon as they leave that it is okay to bend the rules so long as you can afford it?"
On this point I agree fully with Pryor. If there is such as thing as "Australian" values, then egalitarianism and meritocracy are a key part. There is an intrinsic unfairness to the fact that for those students who cannot enter a program on academic merit alone, a large sum of cash will guarantee placement.
Nevertheless, I can see the reasoning of the universities in this regard. Unless there is a significant shift in public policy with increased funding to tertiary education, external sources of funding are required. An ideological position of "pure" meritocracy would either require a contraction in positions, and/or higher tuition fees for all students.
In the example of full-fee paying international students, we do not consider that these students are "taking local places". Not only do their tuition fees fully fund their course, but they also help subsidise the remainder of the university. This "export" of tertiary education has become an important sector in Australian trade with a 123% increase in the international student population between 1997 and 2002 (compared to an 20% increase of local students) (2).
A discussion of full-fee paying university positions
Let us assume that:
Now, given that there is no intrinsic objection to non-publicly funded education, the second question is whether private positions are acceptable within a public institution. Given the paucity of "private" tertiary educational institutions in Australia, this would seem to be a necessity. Furthermore, the fact that the highest quality and most prestigious universities in Australia are public rather than private institutions (in comparison to the United States) should be a source of national pride.
There are no obvious examples in primary or secondary education that we can draw upon, but perhaps, an analogous situation can be taken from the health system. On the whole, most people do not find it objectionable that there are patients with private health insurance in public hospitals. Indeed, there are clear benefits to the system as privately funded patients (i.e., their insurer) not only fully pays for their stay, but the small profit that the public system makes reduces the public funding load for everyone else.
Extrapolating this into the tertiary education system, I believe that there are indeed benefits in having full-fee paying students in public universities.
What are the objections to full-fee paying students?
I can see a number of specific issues problems with public universities accepting full-fee paying students:
Entry by lesser academic merit / advantageous financial merit
The first is discussed in the aforementioned opinion piece by Pryor. The current system allows economically advantaged students a "bypass" into what is essentially the same position if they do not meet the entry criteria by academic standards alone. This is perhaps particularly odious when full-fee paying students change into a HECS-HELP (3) funded position after "getting their foot in the door". Clearly this is inequitable.
The stance of the universities, however, is represented by the following University of Melbourne 2003 Senate Inquiry Submission who reject this notion (4):
With regards full-fee paying students doing well in their tertiary studies, the conclusion made by the University is spurious. I could equally claim it supports the notion that the University demonstrates academic favouritism to full-fee paying students.
The submission states further:
However, the "second best solution" as detailed above is diametrically opposed to the "best solution". Moving down that pathway is a validation of the existing system. The University is trying to walk down both sides of the street; trotting out the best (but politically unpopular) solution and killing it in the same breath with a flawed but politically acquiescent position.
Government funding into privatised positions
This issue goes to the heart of social equality. It is not only an issue in tertiary education, but also primary and secondary education as well as health. When someone has the socioeconomic advantage to be able to choose the "non-standard" option, should public money be used to support that choice?
I believe that public money should not be used in this fashion. For example, we may give social benefits to someone who is unemployed but it would be ludicrous to give that same benefit to someone who is not only employed but wealthy. Nevertheless, the incumbent conservative Federal Government seems to not agree with a progressive increase in funding of non-government schools at the expense of government schools since the mid-1990s (5).
In the context of tertiary education, we have the FEE-HELP scheme (3). States the Government policy:
What is unstated in their "support for students" section of the policy paper is that this so called "inequity" is of the government's making, by setting rigid HECS-HELP quotas and encouraging universities in offering more "full-fee" funded positions. It seems to me that a clearly better solution is that any funding that would have been given through the "FEE-HELP" scheme to be applied to the HECS-HELP, i.e., by either reducing the cost of publicly funded university positions or by increasing the number of publicly funded positions.
I believe that students accepting a full-fee paying university position should do exactly that; be full-fee paying and to do so up front.
Nevertheless, I can see the reasoning of the universities in this regard. Unless there is a significant shift in public policy with increased funding to tertiary education, external sources of funding are required. An ideological position of "pure" meritocracy would either require a contraction in positions, and/or higher tuition fees for all students.
In the example of full-fee paying international students, we do not consider that these students are "taking local places". Not only do their tuition fees fully fund their course, but they also help subsidise the remainder of the university. This "export" of tertiary education has become an important sector in Australian trade with a 123% increase in the international student population between 1997 and 2002 (compared to an 20% increase of local students) (2).
A discussion of full-fee paying university positions
Let us assume that:
- There will not be any substantial change in government funding for tertiary education;
- and that some form of "privatised" tertiary education in public universities is a necessity for the economic viability of the universities (insofar as maintaining current standards).
Now, given that there is no intrinsic objection to non-publicly funded education, the second question is whether private positions are acceptable within a public institution. Given the paucity of "private" tertiary educational institutions in Australia, this would seem to be a necessity. Furthermore, the fact that the highest quality and most prestigious universities in Australia are public rather than private institutions (in comparison to the United States) should be a source of national pride.
There are no obvious examples in primary or secondary education that we can draw upon, but perhaps, an analogous situation can be taken from the health system. On the whole, most people do not find it objectionable that there are patients with private health insurance in public hospitals. Indeed, there are clear benefits to the system as privately funded patients (i.e., their insurer) not only fully pays for their stay, but the small profit that the public system makes reduces the public funding load for everyone else.
Extrapolating this into the tertiary education system, I believe that there are indeed benefits in having full-fee paying students in public universities.
What are the objections to full-fee paying students?
I can see a number of specific issues problems with public universities accepting full-fee paying students:
Entry by lesser academic merit / advantageous financial merit
The first is discussed in the aforementioned opinion piece by Pryor. The current system allows economically advantaged students a "bypass" into what is essentially the same position if they do not meet the entry criteria by academic standards alone. This is perhaps particularly odious when full-fee paying students change into a HECS-HELP (3) funded position after "getting their foot in the door". Clearly this is inequitable.
The stance of the universities, however, is represented by the following University of Melbourne 2003 Senate Inquiry Submission who reject this notion (4):
"The University rejects the idea that enrolling full-fee paying students undermines the merit principle. The ‘clearly in’ score required of HECS students reflects supply and demand for a limited number of places, not merit, or any minimum ability to required to complete a course. All full-fee paying students meet minimum entry requirements, as do other students admitted on lower than the ‘clearly in’ score, such as those in equity programs. Many students admitted under the full-fee program would be eligible for a HECS place at another course within the University, and all of them would be eligible for a wide range of courses at other universities. In 2002, the academic performance of the commencing students in domestic undergraduate full-fee places exceeded that of students in HECS-liable places. Australian full-fee students were more likely to pass all their subjects, and to receive a first class honours grade. The strong academic performance of full-fee students demonstrates that the selection process in no way compromises academic standards."Here, I reject the University of Melbourne's "rejection". Specifically, they have avoided the point. It is clearly acknowledged that entrance into an Australian university is based on supply and demand. Arguable, this is the case for most human endeavours. However, the ranking of the potential university entrants is based on academic principles while the acceptance of full-fee paying positions is not the case. I would propose that it is a matter of common sense that there would be a clear positive correlation of socioeconomic advantage for those students who accept a full-fee paying position compared to those that don't.
With regards full-fee paying students doing well in their tertiary studies, the conclusion made by the University is spurious. I could equally claim it supports the notion that the University demonstrates academic favouritism to full-fee paying students.
The submission states further:
"The best solution is not to abolish the full-fee paying places, but to end the quota system that creates the original mismatch between supply and demand. This is what the University proposed in its submission to the 2002 Nelson review. A second best solution is to extend income-contingent loans to full-fee paying undergraduates, and we support the government’s proposal to do this. The Minister has suggested that the $50,000 limit on loans under the FEES-HELP program be increased, and we strongly support an upward revision."I agree with the "best solution" in principle. The rigid quota system and inadequate tertiary education funding is what drives universities to seeking full-fee paying students in the first place.
However, the "second best solution" as detailed above is diametrically opposed to the "best solution". Moving down that pathway is a validation of the existing system. The University is trying to walk down both sides of the street; trotting out the best (but politically unpopular) solution and killing it in the same breath with a flawed but politically acquiescent position.
Government funding into privatised positions
This issue goes to the heart of social equality. It is not only an issue in tertiary education, but also primary and secondary education as well as health. When someone has the socioeconomic advantage to be able to choose the "non-standard" option, should public money be used to support that choice?
I believe that public money should not be used in this fashion. For example, we may give social benefits to someone who is unemployed but it would be ludicrous to give that same benefit to someone who is not only employed but wealthy. Nevertheless, the incumbent conservative Federal Government seems to not agree with a progressive increase in funding of non-government schools at the expense of government schools since the mid-1990s (5).
In the context of tertiary education, we have the FEE-HELP scheme (3). States the Government policy:
"Students paying full fees for an undergraduate course do not currently have access to an income contingent loan scheme. This means that a qualified student who is offered a full fee paying place but who does not have the means to pay up front or can not take out a commercial loan can not access a place. This is inequitable."I reject this assessment that it is (i) inequitable, and that (ii) government assistance through a deferred "income contingent loan scheme" is the correct solution. The Federal Government is moving the goal posts and forcing the public and the universities into a new status quo.
What is unstated in their "support for students" section of the policy paper is that this so called "inequity" is of the government's making, by setting rigid HECS-HELP quotas and encouraging universities in offering more "full-fee" funded positions. It seems to me that a clearly better solution is that any funding that would have been given through the "FEE-HELP" scheme to be applied to the HECS-HELP, i.e., by either reducing the cost of publicly funded university positions or by increasing the number of publicly funded positions.
I believe that students accepting a full-fee paying university position should do exactly that; be full-fee paying and to do so up front.
A proposed "fair" model that includes full-fee paying students
I believe that I have demonstrated that there is nothing fundamentally wrong with a partial privatised system but that there are many inequities to the current system. The following are a list of suggestions that I believe will make the system more fair:
1. Separate the admissions pool for private vs. public students
You can apply for any one course either through the publicly-funded system (where you are ranked and compete with other students on the "public" list) or you you can apply through the full-fee paying system (where you are ranked and compete with other students on the "private" list). That is, if you apply and are not offered a publicly funded position, you cannot "weasel" into the course by giving the university a large sum of money.
2. Relax the strict quota system that the universities are placed under
Universities may offer "x" number of places to prospective students under the quota. Naturally, there will always be a shortfall. The current system is such that the universities cannot then offer further publicly-funded positions in subsequent rounds (this is the basis the universities use to claim that their full-fee funded positions are "fair"). Clearly, it would be much fairer if the system allowed the universities to fill their publicly-funded positions with publicly-funded students!
3. Full-fee paying students must not be able to "convert" partway into publicly-funded position
I believe that when you start a university course as a full-fee paying student, you are entering into a social contract with the nation. Arguably, if someone wants to change courses, they should have access into either a publicly-funded or a full-fee paying position. However, I think that it is clearly unfair for a full-fee paying student to then subsequent enter a publicly-funded position in the same degree.
4. Full-fee paying students must be just that
It seems illogical for a full-fee paying student to receive public funding for their studies. Surely, any such funding would be better spent on more publicly-funded positions.
References
- Pryor L. First lesson at university: have the cash, can jump the queue [opinion]. The Sydney Morning Herald. 3 March 2007. [Link]
- Lukic T., Broadbent A., Maclachlan M. International higher education students. Strategic Analysis and Evaluation Group, Research Note No. 2, May 2004. Australian Government, Department of Education, Science and Training. [Link]
- "Support for students", Our Universities: Backing Australia's Future, Policy Paper. Australian Government, Department of Education, Science and Training. Last updated: 16 November 2006. [Link]
- Submission to the Employment, Workplace Relations and Education References Committee. Inquiry into Higher Education Funding and Regulatory Legislation 2003. The University of Melbourne. Submitted: 14 August 2003. [Link]
- Australian Government funding to public and private schools. Australian Education Union. April 2004. [Link]
16 comments:
Hi Michael,
One simple question I have in this debate is this. If a simple man (not a rich man) seeks to makes the sacrifices necessary to put his kids through college, should the education be deprived to his kids?
In other words... the simple man is willing to pay full price, subsidizing the "fully deserving kids" who get into the institution who get there without paying anything out of their parent's pockets. Should a system be devised that prevents a parent from sacrificing for the benefit of his kids? I hope not.
Firstly, understand the Australian system is vastly different to the American system.
In Australia (and most of the Western world), tertiary education is heavily subsided by government; i.e., tertiary education is public. Everybody pays for tertiary education by way of taxation so "who get there without paying anything" is terribly inaccurate.
The rationalisation is that tertiary education (just like secondary and primary education) is a social investment; the nation as a whole benefits on many levels with having highly educated people.
As such, entry into a public institution should always be meritocratic. The number of places in any one course should reflect expected demands required for the future of the nation.
If a simple man (not a rich man) seeks to makes the sacrifices necessary to put his kids through college, should the education be deprived to his kids?
If his kids are ONLY able to enter by means of money and not merit, then the answer is an emphatic yes if it means displacing another student in a public institution. No one is stopping this parent from enrolling their child into a private university or a unversity abroad.
Regards.
Well, in this case I do not think the Australian model serves as a good example. Or at least the model you propose is not a good example.
In your example, the students would be admitted based upon "merit". There is nothing ensuring the "merit" student is motivated to learn and is not, only, engaging in education in order to delay having to deal with the real world. As long as the government is willing to foot the bill and provide the meal ticket, education is the path to follow even if there is no motivation to advance society through education.
Think of it this way. Who is going to make a better Doctor? The average intelligence, motivated student or the above average intelligence, unmotivated student who just wants to party? Surely you saw examples of the partier during your studies.
This is a complicated subject. I doubt there is a perfect answer to the question debated. However I am fairly certain that an unforgivable "merit only" system will not yield the best results. It is better that the system requires some sacrifice, somehow, for entry.
I realize that what I am in favor of would allow snot nosed, foreign, rich kids to enter the course of study. However this does not mean the standards of education need be lowered. If the snot nosed rich kid can't pass the tests, he flunks out. Besides, if snot nosed rich kids' parents are willing to pony up the full, unsubsidized price for the education, they subsidize the education of the "merit" based students.
If there is enough demand for the course of study that supply can not meet demand, then expand the availability of the courses. Just do not lower standards and make the snot nosed rich kids' parents pay for the expansion with unsubsidized tuition.
Or are you trying to artificially limit the availability of medical services through limiting the availability of study to become a medical doctor?
Sorry, but I don't see your argument at all. In fact, they seem entirely spurious.
Again, the Australian University system is probably very different from the American system. Anyone who is a "partier" and not actually applying themselves in their studies will fail. Simple as that. Unlike the American system where you somewhat float around for your first 1-2 years of university, in Australia, you directly enter a course and most courses are difficult from the beginning.
So yes, entry should be based on merit to stay IN a course, it is based on merit as well.
For publically funded positions, it should depend on the expected needs of the nation. It is illogical for the government to train more dentists or doctors or lawyers than what is needed. If you want training outside of the public system, then as before, there is no reason why you cannot apply to a private of foreign university.
Rich foreign students are outside of the system. I mentioned this in my article since they cannot work within the Australian workforce. In essence, Australia is simply "exporting" education which is what we are good at.
Regards.
I do not buy your argument that there it is illogical to train more doctors, dentists or lawyers then are needed.
That is called central planning. If it is OK to central plan education, then it should be OK to central plan how many pickup trucks are manufactured or how many acres of corn are grown.
Let market forces determine how many doctors and lawyers are needed just like market forces determine other aspects of the economy.
Of course the American system is not much better. While I am unaware of any quota on the number of lawyers turned out, there is a false scarcity created by limiting the number of Doctors educated. We can thank the American Medical Association for that. In the meantime many rural areas are not serviced by the artificially low pool of Doctors because those educated prefer to pursue more lucrative employment opportunities.
Another aspect I object to is that when a quota system is entered into, and then filling the positions in the quota is based upon merit only, who is going to be the "merit" student? Won't it happen to be the students who grew up in the best neighborhoods and attended the best elementary and high schools?
To me it seems unfair that, since all the education is paid for by the taxpayers in Australia, that an "average" citizen should be expected to pay taxes to support the system when his own children will be denied the benefits of the system.
Yes it would be wrong to allow a student access who has no chance of succeeding. But when "merit" is used as the sole deciding yardstick to determine elegibility, the yardstick needs to be closely scrutinized.
I've had a couple of slow days here that coincided with my being able to find WiFi hotspots. It may be a few days before I am able to get back to this conversation.
As before, it is illogical for the government to train more professionals that it thinks it needs. Quite simply, the PRIVATE system will pick up the slack around supply and demand. It is a matter of efficiency. If you train more doctors or lawyers, etc., than what Australia needs, then there is nothing that is going to stop the international movement of labour. Australia is a free country. It would be stupid for the Australian government to train the United Kingdom's future doctors because there are no jobs in Australia.
As for the meritocracy, I am happy for anyone to suggest any other alternative that is not fundamentally unfair.
Again, the Australian system is quite unlike that American system. The best universities are public (i.e., on merit, you don't have to pay [much] on point of entry). Many of the best schools are ALSO, public schools. In essence, a low socioeconomic background is not an overwhelming barrier to good education. Alternatively, socioeconomic advantage is also not a ticket into law or medicine or the other "highly desirable" professional courses.
Of course, people who are from a wealth background are likely to have more opportunities. That is a natural consequence of living in a capitalist economic system. However, an egalitarian Western society would seem to demand high quality public education such that the best opportunities are available to anyone with ability.
As a point of reference:
The "Ivy League" universities in the United States are essentially barred by their extremely competitive entry criteria to anyone of socioeconomic disadvantage unless they are exceptionally bright.
On the other hand, the best universities in Australia (e.g., University of Sydney, University of NSW, Monash University, University of Western Australia, etc.) are all public universities. Anyone who does well in their high school examinations (something that is primarily based on academic ability and cannot be "bought") has an excellent chance of securing a government funded position.
To me it seems unfair that, since all the education is paid for by the taxpayers in Australia, that an "average" citizen should be expected to pay taxes to support the system when his own children will be denied the benefits of the system.
I don't see why it is unfair at all. These are public goods. I will never use 99% of the public libraries or parklands, etc., in Australia as I do not live in that part of the country. Does that make it "unfair" that I have to pay for them through taxation? Or what about paying for "schools" if I don't even have children?
These are social goods and social services. Everyone pays their fair share through taxation so that certain things which cannot be adequately or equitably provided by private enterprise is accesible to EVERYONE.
Education is a nation's investment into their future and evidence is that it almost always pays off in the long term. If the average citizen is better educated, they also tend to have better health, make better choices and are more economically productive.
Yes it would be wrong to allow a student access who has no chance of succeeding.
That is not the point. The point is that the government can provide "x" number of positions. What is the fairest way of allocating those positions?
Regards.
I guess I do not know enough about the Australian system. If the "private" university system still allows a genuine alternative to merit based public universities then I do not have any real objections to merit based systems.
What I object to is any real "quota" system that artificially maintains a scarcity of Doctors like America's system seems to do.
I also object to my understanding of your own viewpoint, as when you stated: "If you train more doctors or lawyers, etc., than what Australia needs, then there is nothing that is going to stop the international movement of labour. Australia is a free country. It would be stupid for the Australian government to train the United Kingdom's future doctors because there are no jobs in Australia."
This could be stated of any occupation. For example, if Australia trains more truck drivers then are needed, they too could move to the United Kingdom (or more probably, the United States since I have met Australians driving trucks in America). If more Doctors are trained then "are needed" (who decides how many are needed?) then the excess supply would drive down the cost of medical care as doctors lowered their prices while they scrambled for patients. Perhaps private medical practice is not a reality in Australia, however if more Doctors existed then the supply of jobs, the existing pool of Doctors might be willing to work for less in order to gain employment in the pool of public service medical positions available.
I see no reason why Doctors should any more be insulated from competition in the labor market then should a truck driver, carpenter, waitress or any other occupation.
By the way, as far as lawyers go, no artificial limitation on this occupation exists in America. As a result, we have more then enough of them. Too many in my judgement. If Australia still has a need for lawyers and the taxpayers of Australia want to save some tax dollars, how about us Americans filling your "quota" of lawyers from our excess supply? We can bundle them up and have them shipped to you overnight. Grin.
Your arguments fail simply because doctors are a highly valued commodity in the world wide labour market (arguably unlike, truck drivers). Furthermore, medicine is a highly internationally translatable skills. Being trained in Australia, there are few limitations that stop me from working anywhere else in the Western world. An excess of doctors (and that limit is determined by the economy) simply means that people go overseas.
For a publically funded university position (i.e., where the Australian government pays for most of the cost), it is illogical for them to train more doctors than the forseable economic need of the country. At some cross over point, it no longer becomes economically sensible for the government to be paying for more doctors if there is no market for them.
As before, the Australian government then would simply be training (specifically, PAYING for the training of) doctors for another country's deficit.
Medicine is a service industry and its supply does not influence demand to any great extent. That is, having more doctors doesn't mean that there is more "sickness" to go around. That is mostly static (or if the nation's health improves, LESS so).
Again, the Australian health system is very different to the US where it is mostly private. In Australia, health is for the most part free at point of contact (i.e., the government is the payer) unless the doctor chooses to bill privately (and the patient chooses to pay privately).
Regards.
As an example, bankrupcy from medical costs is unheard of in Australia, irrespective of the socioeconomic background of a person.
My understanding is the bankrupcy from medical costs is relatively common in the United States.
Regards.
You seem to be motivated to insulate your occupation from competition. As long as the lines are long enough in your occupation for your services, you are in favor of it.
You also belittle my own occupation. I will note that my occupation faces foreign competition including Australian citizens driving trucks in America. Perhaps what needs to happen is that America starts producing enough Doctors to drive down wages for Doctors in Australia?
Get my point? No occupation should be insulated from competition and that includes Doctors.
????
You seem to be motivated by insisting your own fallacious point of view.
I am talking about government paid training positions. It would be stupid for the GOVERNMENT to train more doctors, truck drivers, plumbers, etc., than what it thinks is needed for the economy. It would simply be putting money into capital where it wouldn't be needed. In the case of doctors, if the government trained an oversupply, they won't simply be training future unemployed doctors. They would be training another country's future doctors which again, is a waste of public money.
If someone wants to train despite not getting a government position, then they can go down the private pathway.
This is all entirely beside the point of the original article which is about the fairness of having full-fee paying students (i.e., a private student) in a public university.
I disagree.
You are in favor of a system that restricts availability of services.
With restricted supply, your income is assured. Obviously you would not be in favor of a system that would, due to supply and demand, limit your income.
You are making absolutely no economic sense.
Let me make sure that you actually understand what I'M talking about.
I'm not talking about restricting any number of jobs in any career pathway. I'm talking about the the government PAYING for training.
If the government thinks that it will need 100 chairs to furnish a new building complex, would it make sense for them to buy 200 chairs?
If Australia Post models that it will need to hire 100 extra postal workers to cover the needs of a new suburb, does it make sense for them to hire 200 extra postal workers?
If the government models that the health needs of the community are such that there is the need for 100 extra doctors, does it make sense for them to train (i.e., completely pay for the training) of 200 extra doctors?
The answer is NO. What happens if there are 100 extra doctors? Those 100 are either unemployed, underemployed or they move overseas, all of which are a very bad investment for the government. If would be like the government buying 100 chairs that it doesn't really need, and even worse, the excess chairs spontaneously disappear and furnish a new British building.
Furthermore, your whole "cost" thing is bunk. Remember, Australia like the rest of the Western world has universal health care which means that the government pays the bill. Whether there are 100 doctors or 200 doctors, there are going to be the same number of sick people so the government pays the same for health. The only difference is that each doctor costs up to $AU 200,000 to train and if they aren't actually providing any additional services to the nation, then it was a waste of money to train them in the first place.
The situation is different in the US where basically all doctors had to pay privately for their own studies so it costs the government nothing extra for more to train. It also costs the government nothing if they move overseas. However, this also means that each doctor "recoups" their own investment by charging quite frankly, ridiculous prices.
The cost to see a GP in Australia? If they bulk bill (i.e., directly bill the government), then it is FREE. If they charge privately then the gap is usually around $AU 20. About 70% of all GPs bulk bill.
Somewhat off the topic, but even medications in Australia are vastly cheaper than in the US thanks to "universal" health care. Irrespective of how expensive your medications are, once you hit a safety net (of about $AU 1500 per calendar year) for the whole family, then all further medications are free.
An somehow our health expendicture is still 30-40% less than the United States as a proportion of GDP.
You keep trying to ask me to defend the American medical system. In my opinion, the American medical care system is pretty well indefensible.
I will offer one defense of this system however. The American system also suffers from restricted availability of medical service providers due to the American Medical Association.
However, even if medical service providers were forced to deal with unrestricted, freemarket competition it would not cure what ails the American system. It would only be an improvement. Let Doctors face the same competition as truck drivers and waitresses face.
I do not know a whole lot about the Australian system. What intrigues me about it, from what I know from you, is that it seems to offer a mixture of public and private providers. Perhaps the Australian system if it was adopted in America would be an improvement. However it does not seem to be perfect either.
Evidently, Australian health care providers also seek to constrict the availability of their services so as to guarantee society provides them a healthy standard of living.
I want to guarantee good Doctors a healthy standard of living. However doctors in America seem to enjoy too healthy a standard of living at the expense of the ordinary citizen.
It seems to me that the Australian system is designed so that it prevents profits for the medical care industrial providers but ensures a standard of living for doctors through limiting supply.
Perhaps the Australian system provides economical medical care even to the most remote elements of Australian society. I can only speak from the American experience.
In the American experience, if more doctors were trained, more doctors would be motivated to accept a reasonable standard of living to serve rural areas. However due to limited supply of services most trained doctors concentrate in urban areas where they can make more money.
Any managed supply with unlimited demand equals unreasonable wealth.
Chris
(a doctor in australia - Hi Michael I found you web page on Kit's brower)
I just read this conversation which seems to being straying but still:
1) the actual training restriction in Australia is in the healthcare system not the university, (especially in specialist training). Training doctors requires experienced senior doctors and access to patients. If there was no restriction in university output the graduates would either; have no-one to continue their training or the standard of training would decrease.
2) Sadly not all are equal. Medicine is not truckdriving or waitressing, it is not a free market. It IS desirable to have our best and brightest looking after our health. If medicine were a free market we would let anyone offer services and the market would determine which surgeons were great healers and which were scalpel-murderers.
Back on topic Michael talks about undergraduate medicine,
firstly, in the market competition is desirable because survival of the fittest and leanest achieves better outcomes, ie cheaper better services and products. The currency of competition in undergraduate medicine is merit, and this achieves better outcomes, ie more talented and successful graduates. THAT is a free-market.
We have free education in Australia for all, The secondary school in our most populous state which consistently achieves the highest high school exit-exam scores is public.
Regarding David's original point, a simple man should NOT be able to sacrifice for the benefit of his kids.
That is for his private benefit, not for the publics benefit. Should the children of a lazy man be disadvantaged? Is it fair for a young person lack the advantages of another because of the family they are born into?
This silly argument essentially insinuates that there is deserving money and non-deserving money.
there is also no reasonable argument regarding motivation. lazy dumb rich kids and lazy smart poor kids will both make poor students. However a naturally gifted lazy kids will at least absorb a little more.
Regarding the government subsidizing restricted numbers Michael should explain more bluntly;
-Because we believe in equal merit based opportunity we must at least provided some places with public money (consider it scholarship sponsorship).
-The maximum places the community (government) should pay for is equal to it's projected need.
-a doctor is a >$100 000 product.
-doctors that leave for overseas is essentially a >$100 000 loss to the community - a waste.
Mobility in medicine will always be the case. Rural medicine in Australia is also severely underserviced. However we live in the most urbanised country in the world, the vast majority of population live in the large costal cities.
Doctors do not leave the cities because they are being asked to leave their homes, their families, friends etc. You are trying to suggest the optimal solution is to flood the market with supply to make doctors desperate enough to abandon their current lives to support themselves. Actually the real distortion in the market is that since medical care is largely free here (a good thing) then there is not scope for demand (ie renumeration) in rural areas to rise to compensate doctors to relocate their lives. and FYI I have not worked in one of the major cities for 5 yrs).
In summary I believe there is a place for private funding in university places in some courses for Australian students, but not in medicine.
Long live cross-subsidies.
Healthcare is community-charity, not business.
i dont see why there is only an uproar about fee paying students. these students actually have to fulfil all the criteria of entry anyway. how about the rural students? they can actually get in with lower marks. a lot of the people getting into a rural place arent even disadvantaged - they have full access to everything they need for a full education. even if they are disadvantaged - if at the end of the day it is only merit that counts then none of these rural spots should exist.
Post a Comment