I'll be taking most of my information from the latest report on the subject by the nation's leading health economist, Dr Stephen Duckett, of the Grattan Institute, but drawing my own conclusions. Loading Private health insurance is caught in a "death spiral" for two reasons. First, because the cost of the hospital stays and procedures it covers is rising much faster than wages are. Duckett calculates that, since 2011, average weekly wages have risen 8 per cent faster than general inflation, whereas health insurance premiums have rise 30 per cent faster. Why? At bottom, because the health funds have done so little to prevent specialists raising their fees by a lot more than is reasonable. Federal governments have gone for years meekly approving excessive annual price increases. Second, as with all insurance schemes, those policy holders who don't claim cover the cost of those who do. The government's long-standing policy of "community rating" means all singles pay the same premium, and all couples pay about twice that, regardless of their likelihood of making a claim.

This means the young and healthy subsidise the old and ill. Which would work if health insurance was compulsory, but to a large extent it's voluntary. So the old and ill stay insured if they can possibly afford to, while the young and healthy are increasingly giving up their insurance. The Howard government spent the whole of its 11 years trying to prop up health insurance with carrots and sticks. These measures stopped coverage from falling for a while but, with premiums continuing to soar, have lost their effectiveness. Illustration: Andrew Dyson Credit: Over the year to last December, the number of people under 65 with insurance fell by 125,000 (particularly those aged 25 to 34), while the number with insurance who were over 65 increased by 63,000. So here's the bind the funds are in: the more healthy young people drop out, the greater the increase in premiums for those remaining. But the more premiums increase, the more youngsters drop out.

The funds' talk of being in a death spiral is intended to alarm the public into insisting the government bail them out by imposing more of the cost on taxpayers or, ideally, on young people. But before we panic, we should ask why we need the continued existence of private insurance. Loading After all, our real insurance is Medicare and being treated without direct charge in any public hospital. If the taxpayer-funded public system is less than ideal, it could be a lot better if the $9 billion a year the federal government tips into private insurance and private hospitals was redirected. To some people, the big attraction of private insurance is "choice of doctor". But this can be illusory. It's usually your GP who does the choosing – to send you to one of their mates or their old professor. In any case, if people want choice, why shouldn't they be asked to pay for it without a subsidy from the rest of us? Ah, but the real reason I must have private insurance, many oldies say, is to avoid the public hospitals' terrible waiting lists for elective surgery. That's a reasonable argument for an individual, who can do nothing to change the system.