When anyone can use a world-class public health system for a token contribution to the real cost, a voluntary insurance plan to encourage more Hong Kong people to use the private sector is bound to get a mixed reception. Criticisms of the proposal officials are putting out to consultation include that it is not bold enough to put off an impending health care crisis, that people won't pay higher premiums to cover the elderly and chronically ill, that it is not attractive enough to convince younger people to join, and that frequent claims by the chronically ill may push up premiums. Regardless, the government has no other alternative short of compulsion to get more people who can afford it to shoulder some responsibility for their health care costs. With the elderly expected to account for a third of the population by 2041, recurrent government expenditure to maintain the same service quality is estimated to increase by 6.5 per cent every year, from HK$52.4 billion to HK$285 billion. Services will become increasingly "rationed" - or made less accessible - either by lengthening queues or fees. The government expects about 1.5 million people to be covered by a voluntary health insurance scheme, which will cost the public purse more than HK$4.5 billion a year in subsidies and tax breaks. Private health insurance policies will have to meet government criteria, including a so-called standard plan for which people with pre-existing conditions will be guaranteed acceptance for insurance cover and annual renewal. But premiums for all policies would rise by about 9 per cent to an average of HK$3,600 per year. The criticisms take a short-term view, while health insurance covers a risk that peaks in the last few years of life. It is only to be expected that younger and middle-aged people have to be convinced to cover themselves against possible events that seem remote. Previous consultation and polling has confirmed the obvious - that compulsory insurance lacks public support. Ultimately, however, it is the only effective answer if younger Hongkongers expect the same level of health care service in their old age. Until officials and lawmakers come to terms with this, the government must redouble its efforts to educate the public in the virtues of taking out health insurance if the voluntary scheme is to accumulate a viable pool of premiums to fund benefits.