MRI's are very expensive: usually well over $1200 in the US, often closer to $2000 (and maybe more where higher local incomes can be tapped for additional profit). But in Australia, you offer your card and that's it. No co-pays: peace of mind. It does not matter whether you are getting an MRI or a heart-lung transplant. It is all covered. No surprises and 'no worries.' Aussies (and, if only out of courtesy, practice saying 'Auzzies' instead of 'Aussies") say this a lot: "No worries, Mate!" And they really mean it. You also hear them say, "Not a problem," and "no dramas," and they really aim at this in every aspect of life. "No worries. She'll be right! Just leave her to us!"
If your daughter didn't need any special diagnostic scans, then your office appointment with the doctor is likely to end with, "Bring her back tomorrow if things don't seem to be improving." Did I hear right? "Tomorrow?" Of course! "And when would you like to bring her in...?"
Maybe the problem gets worse that night and so you phone the doctor. Worst case, the doctor's answering service will take your details and the doctor will likely call you back soon. Her or his understanding of how you communicate about your child is reflected in your contact with that familiar voice. You are scared (of course) and so is your child. The doctor might suggest going to the hospital, saying, "I'll meet you there." Simple. You are never far from your doctor's care: more peace of mind. When you get to the hospital, your daughter is taken in and given an initial exam - the results phoned to the doctor who is en route. From that moment onward, you and your family are 'in the system' and wherever that particular situation will take you, there is a seamless connection at every step of the way. Why? Because everyone is working for the same system – the same 'company' if you will. It's like managed care that really cares. And no one in the process is motivated by money. You will get whatever you need. And at every stop along your journey, everyone will know the same details - and everyone involved will know each other. Peace of mind.
Maybe your child's problem requires that she stay overnight at the hospital. Things happen. If that's the case, you will probably be offered a bed right next to hers so you can sleep there, too! Extra cost? Don't even worry about it. It's all covered. I'm saving the money part for the end, but no matter what you have heard, wait for the kicker, please!
So another childhood emergency has been resolved. One time our daughter, who was about six or seven, ran down a hallway with her little brother (who was perhaps three or so). As luck would have it, he ran right into the edge of an open door. Blood, big gash, you know the drill. It was mid-evening. I cleaned the wound and brought it together with a butterfly bandage (I am not a doctor but have worked in medical situations). Then I called the doctor and told him what I had done. He asked a few questions about the size and depth of the wound because there was a question as to whether stitches were needed, of course. He concluded that if the wound came together cleanly, that he would also use a butterfly, and so he said we'd done the right thing and that was that. Was he afraid that there would be a small scar and that we'd sue him for his practice? Or his house? No, apparently not. We spoke like two adults talking it over, and concluded that we were on the same track. Can you imagine what this scene would be like in the US? Here, no doctor could assess and approve home treatment like this – yeah, that liability paranoia yet again.
In the U.S., as soon as you make that initial phone call to your doctor, then your medical providers are on the liability hook. And the only way off is to do everything possible within the guidelines that govern medical practice in your state. Allow a parent to clean and close a wound as I had done? Very risky. That risk is what we all pay for, over and over and over again. It's not that our system is subject to constant bilking by 'frivolous' lawsuits – in fact, despite what the corporate right tells you, such excessive lawsuits only account for about 1% of our medical overhead. The real economic 'hold-up' comes with everyone's fear of the possibility of a liability issue. We are paying exorbitant medical insurance premiums – and the doctors are paying far more – to feed the beast of fear. Like the fear that there may be a terrorist plot in every senior citizen's skin moisturizer when they fly to see their grandchildren in .... Peace of mind? Sorry, not allowed.
AMERICAN MEDIA COVERING FOR BIG PHARMA AND MEDICINE-FOR-PROFIT
I was very disappointed when CNN's Dr. Sanjay Gupta spoke with Michael Moore about the film, Sicko! Sanjay Gupta has been one of my heroes: when he is sent to a disaster in a far off country to report for CNN, he often scrubs up and begins performing his specialty, neurosurgery. He is human, down to earth and unpretentious and has helped many (millions perhaps) Americans better understand medicine and medical care. But when he spoke with Michael Moore, it was as though he had been bitten by a very nasty bug. When Michael Moore emphasized that in every country that practices universal health care, there is "no charge" for whatever treatment is need, Gupta started repeating with rising crescendo, "Yes, but they pay for it in higher taxes!" The discussion went back and forth. For some reason, Moore would not give Gupta the ready answer that I am about to give you, and Gupta pressed Moore as though he wanted him to 'admit' that so-called socialized medicine was actually not 'free' at all!
In fact, folks, both were correct. In Australia, everyone pays for the national health care. Well, everyone, that is, except old age pensioners, the unemployed, single (supporting) parents, the disabled, those whose incomes are below taxable levels, children (of course)... and all those who do not pay taxes on income that is 'under the table' (a common occurrence in Australia). This leaves primary earners in every family and those who make a decent living wage to pay for the health care for an entire nation of 20 million people. How can this be possible? If something like (and I am completely guessing here), twenty per cent of Australians (those adults who pay tax on reasonable incomes) have to support the entire healthcare system for everyone in the country, how much do they have to pay? In what way was Dr. Gupta right that Australians are paying for their health care system because they pay extra tax?
OK, you've been patient (and so have I). But I am finally ready to tell you the absolutely disgusting truth: covering all Australians from preemie babies to complex transplant patients, to HIV/AIDS sufferers, to long-term hospice care and preventive medicine for every Australian is paid for by the relatively small population who pay income taxes in the form of a surcharge. The Medicare Surcharge is still just as it was when I left there with my family in 1995. It has not been raised, then, in more than twelve years. And the amount of the surcharge or 'levy' as they call it, is: 1.5% of the taxable income of every taxpayer.
Let's do some simple math. If a single individual or a family of ten or more earns, say AUD$50,000 per year, the Medicare Surcharge will levied as follows: 1.5% of $50,000, or $750! That's $750 per year. That's it: no hidden extras, no co-pays, nothing! If you earned only $25,000, then you'd pay a Medicare levy of $375 per year; if you earned $100,000, $1500. Divide the numbers above by 12 to find the amount of an Aussie's monthly healthcare expenses: $750 is equal to $62.50 per month. $375 per year = $31.25 per month, etc. If you'd like to confirm these figures, follow this link to the Australian Taxation Department's Medicare Levy Worksheet This worksheet will also introduce you to several possible ways to reduce even this small surcharge by 50% or 100% if you fall into a 'qualified' category.
For this single, annual payment into the Australian government's single payer health care system, not only will you have covered all of your family's healthcare needs for an entire year, but you will have also covered your 'share' of what is needed to pay the health care of all those who did not earn enough to contribute for themselves. And who is it that doesn't earn? Remember? It is all of those in the population who are at most risk; those who are most likely to have extensive healthcare needs and so consume the highest per capita share of the healthcare dollar. So, that is the 'kicker' - the entire system of universal health care is run on a tax surcharge of 1 ½% of each taxpayer's taxable income.
There are several important differences between the Australian and American health care industries that contribute to the workability of Australia's universal health care system.
- Australian doctors – especially in small towns – simply expect and require somewhat less income. While Americans rationalize that, for example, top surgeons need to earn more than $500,000 per year – and sometimes a million or more – "because they had to go to school for a long time," you would find Australian surgeons have less inflated notions of the worth of their work, and yet still live very well by any standard. It is frequently said that the most talked about subjects at social events attended by American doctors are real estate and investments. Not medicine. What does this say about the economics of American medicine?
- The Medicare system in Australia is a 'single payer' system. That means that the government can negotiate drug prices with drug manufacturers, where the Bush government has made this illegal as regards our Social Security system.
- Resources used in Australian medical treatment are state purchased and state maintained. Thus there is no competition among, for example, MRI facilities to have the very latest gadgets and gimmicks.
- Where insurance companies (which reputedly use about 33% of every dollar that subscribers pay in on bureaucratic costs, compared to about 8% in our own Medicare system) extract a dollar profit from every service that they provide their policy holders, the public health system in Australia does not have to build this overhead into their operating budgets.
- Likewise, where U.S. managed care corporations make a profit on every medical service that they cover, the Australian government is not trying to make a profit on providing health care for you or your children. They are simply trying to cover the medical needs of the Australian public.
Are you angry yet? Do you feel ripped off by the enormous effort you have to expend to get medical insurance for your family, only to face enormous co-pays, nursing expenses, convalescence expenses and the high cost of prescription drugs – and oh, did I forget to mention that all prescription drugs are also covered by the Australian Medicare surcharge? Are you angry that, increasingly, the appearance of serious illness in your family will most likely lead to your health insurance being dropped by your company? Are you angry that you may not be able to afford insurance at all if you are regarded as 'too' old, diabetic, or if you've had heart surgery or cancer?
I SUPPOSE YOU'VE HEARD ALL THE SCARY STORIES?
Not everyone in Australia uses the Medicare system of universal health care. A high percentage of taxpayers maintain private health insurance – and are then excused from having to pay the Medicare surcharge (which shifts the burden of support even further toward the lower end of the economic scale). Ironically, we might say that despite the fact that most Aussie taxpayers pay into the single payer system, the full benefits of the system are disproportionately used most by those... who actually need it! I will wait while you turn this over in your mind. Everyone pays, but those who can afford it tend to buy private health insurance. Wonder what they get that the free health care people do not? Let's look at that.
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