It's a question many Australians are asking when confronted with their private health insurance payments these days: why are the premiums so high?
The answer is complex, but many in the health sector put it down to basic maths, ABC News reports.
That is, there are too many older patients in the system — expensive older patients that utilise more resources — and not enough young people to balance the ledger.
And during COVID-19, the situation has worsened, with an uptick in older patients taking up insurance but younger people questioning its overall value.
Those in the sector believe reforms are needed in this month's federal budget to improve the three main levers the government uses to encourage health insurance uptake.
These are the Medicare levy surcharge, the private health insurance rebate and lifetime health cover loading.
These three schemes are supposed to act as a carrot and stick approach to encourage those who can afford private health cover to take it up.
But, over time, critics say a combination of low wages growth, premium rises, government tinkering and social changes have made these incentives ineffective.
They say the levers, in their current forms, are locking young people out of private health instead of encouraging them in.
Debate about reforms has become more important after COVID-19 restrictions led to an explosion in public hospital waiting lists for elective surgery in the eastern states.
As Rachel David, chief executive of peak body Private Healthcare Australia explains, nearly two-thirds of elective surgeries are done in the private system.
"If people are in need of essential non-emergency surgery like a hip replacement and they choose to get it in the private sector, it will free up space on public waiting lists," she said.
But basic policy can set a single person back about $1,000 a year, with more costly policies for households.
Consumer Health Forum chief executive Leanne Wells said many consumers did the sums and realised it was cheaper to pay the surcharge, rather than than actually taking out health insurance.
Or failing that, younger people took out a basic or bronze-level policy to avoid the tax, but still relied on the public hospital system for actual treatment.
"It's a bit problematic," Ms Wells said.