The NIB chief executive is at it again, grabbing headlines with his desire to scrap Medicare – which would coincidentally mean his company and other private health insurers would become much bigger and his already-fat salary would skyrocket.

There’s nothing new in Mark Fitzgibbon talking NIB’s own book.

He was doing it two years ago, wanting a return to pre-Medicare percentages of private health insurance.

And, no doubt, he’ll keep doing it as Australia’s present unsustainable two-class health care system totters towards a crisis, as private health insurance coverage continues to shrink.

Political reality after the effectiveness of the 2016 “Mediscare” campaign means the Morrison government immediately and totally disavowed dismantling Medicare.

But the growing problem of preserving the private health insurers – the sheltered workshop of Australian capitalism – is not going away.

Mungo MacCallum has posted a nice history of the Coalition’s conflicted loyalties when it comes to private health insurance. That conflict makes it impossible to face up to the problem of young people rejecting the inequity of the two-class system.

The latest quarterly private health insurance statistics show 55.5 per cent of Australians didn’t have hospital treatment cover on March 31.

That’s up from 54.5 per cent the year before and 53.1 per cent six years ago – despite the tax cattle prod the government uses to try to force people to sign up and taxpayers subsidising insurance premiums.

The reason for the steady shrinkage is that younger people aren’t entirely stupid.

With weak wages growth, expensive housing and education debts, they understand the meaning of this graph that shows which age groups are getting the benefits from health insurance – the old.

Realising that “doctor of your choice” means nothing when you land in hospital as an emergency patient, the young are voting with their wallets. As the second graph shows, there’s not much interest in those expensive premiums, in subsidising the Boomers, below 30.

The result is an unhealthy pyramid. And remember, few of those Boomers collecting the benefits are paying taxes, even while the franking credits roll in.

There also is a philosophical question of why a particularly rich country like Australia doesn’t have a first-class hospital system for all.

Faith in the public system varies considerably between states.

Only 41 per cent of Victorians and Queenslanders are privately insured, while 54 per cent of West Australians and Canberrans pay the premiums.

With a universal health care system, taxpayers across the board pick up the tab.

And, unlike the private health insurance industry, 14 per cent of what goes in is not eaten up by profits, tax, marketing and the cost of running the recirculation of money from premiums to hospitals and specialists.

Meanwhile, Mr Fitzgibbon’s company is doing quite nicely. When announcing an 18 per cent lift in its interim results in February, NIB upgraded market guidance for the full year’s result due next month. Underlying operating profit is expected to be at least $195 million.

Imagine what it might be if everyone was forced to take out private insurance.