The United States is struggling to replace (or avoid replacing) a hodgepodge of state health insurance laws and programs with a somewhat more standardized system based on the Patient Protection and Affordable Care Act of 2010 (PPACA).
Australia is trying to supplement its own fragmented hodgepodge of support programs for people with disabilities with a new National Disability Insurance Scheme (NDIS).
To me, it’s interesting to see how much health policymakers who hop around with kangaroos and koala bears upside down have in common with our health policymakers.
The NDIS is supposed to help about 410,000 Australians who have a “permanent disability that significantly affects their communication, mobility, self-care or self-management.”
Australian officials have budgeted 1 billion Australian dollars to develop the program and hope to start testing it in a few locations in mid-2013.
Participants are supposed to get quick access to services that could improve their ability to function, such as therapy aimed at helping people with autism or Parkinson’s disease. Participants also will get help with finding and using government services and community-based services, officials say.
Another goal is for Australia to shift an ad hoc disability program funding system to a new, standardized system based on actuarial projections.
Australian Prime Minister Julia Gillard has talked about requiring states to contribute about 21,000 Australian dollars in funding per person per year and supplementing that amount with cash from the Australian federal government.
The program goals in the documents on the NDIS website seem amazingly similar to PPACA goals, and quite pleasant in an abstract, governmental way. What kind of Grinch could object to replacing rationed supports for people with disabilities with personalized supports based on each individual’s own goals and aspirations?
When officials describe the weaknesses of current Australian programs for people with disabilities, they sound as if they could be describing the U.S. system. Officials note, for example, that “even within a jurisdiction, people deal with a multitude of programs and agencies, few of which coordinate or share information,” and that “funding for service providers uses outdated models and comes with unnecessary compliance burdens, stifling innovation.”
The floweriness of the predictions about how the NDIS will affect Australians’ lives is also striking. Once the NDIS is up and running, “people with disability and their carers will have peace of mind that the individualised care and support they receive will change as their needs change,” program managers promise.
But, at least for me, an American, figuring out what benefits the NDIS managers are really promising is more difficult than figuring out what the PPACA implementers are promising.
I don’t know if states and the U.S. Department and Health and Human Services (HHS) can deliver on the PPACA promises, but I can make up a list of what agencies think PPACA will provide. I’m cribbing some of my description of what I think the NDIS is supposed to provide from Australian media accounts, I’m not sure, from the NDIS site, what the program is ultimately supposed to provide, other than endless, personalized peace of mind.
John Walsh, a consultant, told the Australian Financial Services Council in July 2011 that he thinks the NDIS will not crowd out private insurance arrangements, because private disability insurance programs usually replace income. The NDIS will not be an income replacement program.
Regardless: It might be interesting to watch to see what goes right, and wrong, with implementation of the NDIS, to see if any of the lessons learned there could lead to ideas about what to do and not to do in the U.S. disability, health and long-term care insurance markets.
Today, we get into endless, bitter, partisan fights over policy because we’re trying to predict what the future will look like.
Wanting to know how a big policy change will affect a country with 300 million people is understandable but not very realistic. It’s hard to know how a 5-line Microsoft Word macro will work in real life, let alone a 2,000-page law.
If only we could just hire Australia, New Zealand or, say, a really brave Canadian province to test all of our big new policy ideas before we try them in the United States, just to get a reality check.