Socialized Medicine in Australia
Sydney Hospital (cc photo by tobym)
An Australian who follows American political debates closely weighs in with a description of the joys of socialized medicine as practiced in the antipodes:
We have a wonderful balance here in Australia. If you need health care and can’t afford it, you can get it. Everyone can get it. There are a multitude of doctors who bulk bill. And you can use the public hospital system. But if you have a little more money, you can choose the extra cover. The government doesn’t decide what access I have- they just set a level of access, and everything beyond, I have to pay for.
Is that “rationing”? Perhaps. But at least we all have access to pretty good basic cover. At least a major illness will not bankrupt us. But, at the same time, if we have access to the extra funds, we can use them and pay for extra cover. [...] I am thankful for a system in which I can access a basic level of care regardless of my income, where I can choose to spend additional funds if I have them available, and where I have both public and private hospital options. For that, I’m happy to pay an extra $1.50 tax for every $100 I earn. It’s worth it.
I think these are really important points. Conservatives seem extremely worried about the possibility that the United States will implement rules that prevent people from paying for health care out of pocket or from acquiring private insurance. But no such proposals are on the table. A system that combines a government guarantee of coverage for certain things with governmental unwillingness to pay for certain other things doesn’t preclude the possibility that people will choose to pay for them. Here in the United States we have public schools and people also take violin lessons.
43 Responses to “Socialized Medicine in Australia”
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July 17th, 2009 at 2:30 pm
Conservatives seem extremely worried about the possibility that the United States will implement rules that prevent people from paying for health care out of pocket or from acquiring private insurance.
Of course, many of them know better, and are faking concern for political or pecuniary reasons. In fact, I actually wonder how many really believe this.
July 17th, 2009 at 2:30 pm
I’m pretty sure I heard Glenn Beck screaming in a high pitched voice that Australian speakers of the Parliament must flee to the U.S. in order to get health treatment. GET OFFA MY PHONE!
July 17th, 2009 at 2:36 pm
Here in the United States we have public schools and people also take violin lessons.
Matt doesn’t know about this, but some people also opt out completely and send their kids to expensive private schools.
July 17th, 2009 at 2:43 pm
My estimate is zero (among the politicans, activists, and lobbyists that is, not among the sheeple they bamboozle.) Excuses != reasons.
July 17th, 2009 at 2:44 pm
I couldn’t agree more, but is this what is being discussed though. This sounds more like a catestrophic plan?
Interesting anectode: I played baseball this weekend and a guy from the other team had to be taken away in an ambulance because he broke (or severely tore) ligaments in his arm throwing in a ball from the outfield. First thing everyone said was “hope he has insurance.” It does show the absurdity of our system. Does this guy deserve to get ‘major league’ surgery repair? Maybe not, but it seems riduculous that he could go bankrupt by having just an ‘adequate’ surgery from participating in a relatively riskless activity.
July 17th, 2009 at 2:48 pm
I haven’t heard Australia mentioned a great deal in the US health care debate (which I follow with interest despite, or perhaps because of, being British). Government-run healthcare seems to be portrayed by the American Right as an effeminate European policy (or worse – Canadian!), unsuitable for a free nation.
But would an “Australian Approach” to healthcare sound more reassuringly independent and manly to Harry and Louise? I can’t quite judge whether stereotypes of the Australian Outback and sportsmen and so on are sufficiently developed in the US for this to be an option. Are they?
(though this is an uncharacteristically sorry day for Australian sportsmen, eh Cricket fans?)
July 17th, 2009 at 2:50 pm
peep: They don’t really opt-out completely, since they still pay for public schools in their taxes.
And if you want to push the analogy, the health care reforms are somewhat more like what it would be like if there was a slightly eccentric nationwide voucher program. There would be credits funded out of taxpayer dollars (although only for lower-to-middle income people instead of universal) and people would have the choice of going to public or private run schools, and there would be various regulations imposed on the schools regarding cost and enrollment and a basic minimum standard for the curriculum.
And with “single payer” education, you’d still be free to go to public or private schools, but instead of being given vouchers, the government would just automatically foot the bill up to some point, after which you’d have to pay out of pocket.
July 17th, 2009 at 2:58 pm
It’s so cute the way you give them the benefit of the doubt. They know what’s being discussed, they know that people will be allowed to purchase whatever level of coverage they want over and above what is set as the basic level of coverage.
They are lying. They are lying liars. If they ever tell the truth about a proposed policy it is on accident.
July 17th, 2009 at 3:01 pm
@Duncan,
Many, possibly most, Americans can’t tell the difference between and Australian accent and an English one. I’d venture that the typical red state American thinks of Australia as Britain with kangaroos.
July 17th, 2009 at 3:01 pm
peep: They don’t really opt-out completely, since they still pay for public schools in their taxes
True, but my comment was mere gratuitous Yglesias-mocking and not meant to be taken seriously.
July 17th, 2009 at 3:05 pm
Even with government-funded healthcare there would always be a market for private, supplemental insurance for things a basic plan won’t cover. Somewhat like the Medigap plans. And the overclass would presumably always prefer its own, private insurance.
July 17th, 2009 at 3:15 pm
peep: And I would have just made a one-liner correction, but I was intrigued by the idea of health care-style education and delved into that.
July 17th, 2009 at 3:25 pm
@Duncan:- Just hope Punter wouldn’t be back with a double in the second. Grow some backbone Poms and give Freddie a fitting farewell.
July 17th, 2009 at 3:33 pm
Considering the likes of Mike Pence and Steve Austria, I think there is a good chance that there are a couple dozen true believers. They really are not mentally equipped to understand any of this. I’m not aware of any Senator who falls in that catagory, though.
July 17th, 2009 at 3:37 pm
Are they covered for all types of large reptile bites, or just crocadiles? We have a lot of gators here, and I’d hate to have to sew my own arm back on.
July 17th, 2009 at 3:56 pm
I’m originally from Australia & I’ve often wondered why the Australian system is not mentioned as a good option in the health care debate.
Everybody gets basic health care (pretty good, but does have co-pays) and you can get extra insurance if you want. I got supplemental private insurance through my work, but it was also advertised on TV for individual (healthy, young) private citizens.
July 17th, 2009 at 3:56 pm
You have to remember, though, that while the absolute health care quality of the rich may not decline, their relative health care quality may decline thanks to increased access among the poor. If you live to be 85 and your gardener lives to be 70 under the current system, and if you live to be 85 and your gardener lives to be 74 under some kind of universal coverage, then effectively you’ve lost four years of your life in terms of your superiority.
July 17th, 2009 at 3:58 pm
Again, DTM wins. Conservatives only care about profits for huge corporations, and the poor can all die.
July 17th, 2009 at 4:07 pm
Is that a statue of some HMO president in front of the hospital?
OINK!
July 17th, 2009 at 4:15 pm
“At least a major illness will not bankrupt us.”
Just pray you don’t get lung cancer.
Report from Cancer Council of New South Wales
http://www.femail.com.au/deniedtreatment.htm
July 17th, 2009 at 4:33 pm
Nice selective quoting, Dave123. Preceding graf:
Well done, you. [golf clap]
July 17th, 2009 at 4:39 pm
@15
Australian Doctor: You call that a scalpel? (pulls out machete) THIS is a scalpel!
(Just wait until you see the Australian idea of a catheter…)
July 17th, 2009 at 4:41 pm
“many don’t seek proper treatment because they think it’s futile.”
And do you think that perception came out of no where? People just decided one day that lung cancer was a death sentence. Of course not, it came from high death rates. For example,
So basically you have a 85% to change to die within 5 years if you get lung cancer in Australia.
http://www.nswcc.org.au/editorial.asp?pageid=1119
More than 7,000 Australians die from lung cancer each year.
July 17th, 2009 at 4:57 pm
Or in the US. Are you misinformed or are you engaged in deliberately misinforming others?
July 17th, 2009 at 4:57 pm
Fun how always just the ilnesses where the us is doing a bit better are getting picked
. Overall, i am afraid the rest of the developed world is doing much better.
There is something highly unethnical about the idear that different people should get different levels of healthcare.
From my outside viewpoint, US debates have a scary tendency to twist their heads so long that they forget inequality is a negative externality capitalist economies produce, not some virtue. Healthcare is one of those points, where inequality becomes unaceptable.
July 17th, 2009 at 5:16 pm
do you think that perception came out of no where? People just decided one day that lung cancer was a death sentence.
I dunno– perhaps the “SMOKING WILL KILL YOU DEAD WITH LUNG CANCER” health warnings?
July 17th, 2009 at 6:04 pm
“Or in the US. Are you misinformed or are you engaged in deliberately misinforming others?”
Fair enough, I was wrong.
July 17th, 2009 at 7:33 pm
Our health system is OK here in Australia. Especially if your a pensioner. In the latter case basically everything is free (no serious need for private cover). In the case of younger people it is advisable to get private cover, for what medicare doesn’t provide (like dental care, physiotherapy, and alternative therapies).
Private cover also allows one to have a choice of doctor at the (public) hospital and also a private room. Also, it covers a lot of more basic procedures such as arthroscopic knee surgery. This is covered by the public health plan also, but the advantage for private insurance patients is that you can go to a private hospital and not have to wait a couple of months (can get it done in a couple of weeks). But, just like private plans in the US, they are stingy and you always have out of pocket expenses.
Now for the quality of care – from my experience it is very very good – I have been to both private and public hospitals and there is no huge contrast between the two. We have modern facilities and well trained doctors. I once saw my own member of parliament (high ranking btw) use the public hospital, and waited in line just like everyone else.
The best thing about the system, IMO, is the fact that I know of not a single person who worries about health care in terms of costs. This is because I can’t think of anyone who has been bankrupted by health care. A close friend of mine had a baby who had a disfigurement in the scalp (was out of shape), and needed corrective surgery. They did not have private cover. After consulting with three neurosurgeons the doctors decided to operate to fix the disfigurement. My guess is that the operation cost in excess of $50,000. They didn’t pay a cent.
By having the private insurance plan on top of the “basic” (its hardly basic IMO) plan, there is less stress on the health system as a whole, and there are thus tax rebates for people who opt into private cover.
July 18th, 2009 at 12:36 am
Though I’m generally a proponent of so called “Socialised” medicine, in point of fact Australia is NOT a good case study.
The reality is that over the past 10 years various governments dramatically underfunded the health-care system, to the stage where is bordering on collapse.
Contrary to what is written, it is almost impossible to find a specialist doctor who bulk bills (unless you are a pensioner), and hospitals are so understaffed that rates of medical error have exploded.
This however is not an inherent problem with the system, it i the result of people not being willing to pay (in taxes) for the medical care they want (and need).
July 18th, 2009 at 1:12 am
A few Australian anecdotes, for whatever they’re worth:
* When my wife was a child, her mother developed life-threatening renal disease and was told that she had a year to live. She was a widow with five children and read gas-meters for a living. By the time she passed away, two decades later, she had I gather been through kidney operations, several heart bypasses, and finally removal of her kidneys, followed by a period on dialysis.
Total out of pocket cost: zip.
There’s no way she could have afforded insurance for any of this. Without Medicare (introduced as Medibank by Gough Whitlam’s Labor Party in the 1970s), she would have presumably died much sooner, probably within months, and would never have seen her kids grow up. They would have been farmed out to God-knows-where and I doubt that they would have ended up the successful professionals that most of them are. (Free university education played a part in this too.)
* When I fell and hit my head some years ago and had some headaches, I was booked in for a CAT scan straight away, just to be sure. No charge.
I second md’s point: no-one I know here has ever worried for a second about financial difficulties from health-care costs. To the non-American First Worlder, the American health-care debate, at least until recently, looks like a bunch of guys arguing about whether heavier-than-air flight is possible, all the while oblivious to us over here flying first-class. Weird.
July 18th, 2009 at 1:37 am
Also, shouldn’t this post have been titled “Worthwhile Australian Initiative”? Just asking…
July 18th, 2009 at 5:22 am
The sad part is that conservatives really don’t care whether people have health care or not. They only care that they continue to make money or, if they are elected officials, that there contributors continue to make money so they can continue to win elections. It really is that simple and that sad.
July 18th, 2009 at 5:55 am
Given supporters of the public plan are trying to claim cost control as an argument, the Australian PBS system might be useful supporting evidence:
http://www.medicareaustralia.gov.au/provider/pbs/index.jsp
July 18th, 2009 at 7:41 am
Well, I’m more concerned about being forced to purchase care. We’re going to be taxed for inane purchases like more F-22s than the military wants and unconstitutional spy programs and the like.
My problem is with a House bill mandating that I purchase health care or be subject to an income tax increase. I think the political aristocracy wants universal care whether I want to consume health care or not. I pursue health in my own way.
Why is it just to force me to consume a product I don’t want?
July 18th, 2009 at 9:15 am
Let me count as another Aussie putting in a shout for our system.
One other feature of our system is that the private plans seem to be much more heavily regulated and in particular are largely not permitted to exclude anyone for pre-existing conditions. My wife found out some years ago that she has a mitral valve problem that will almost certainly need surgery sometime. In order to allow us to choose her specialist (difficult in our public system), we then – AFTER DIAGNOSIS – took out private insurance, which we had not had previously. I get the impression that this would have been impossible in the US at any price, but here, no problem. There was a waiting period of 12 months before we could claim anything related to her heart (during which we had the public system to fall back on, so that was no financial worry), and other than that, no questions asked.
Exactly as described already – basic, high quality comprenesive care available to everyone, with more available on the top for those who wish to pay for it.
By contrast, when I lived in the US for a couple of years I had to go to some lengths to get any insurance at all, simply because I am a skinny chap and was considered to be underweight. I had not, and to this day have not, had any chronic health disorders other than childhood athsma which has been quiescent for decades. Compared to what we are used to in Australia it was a bad and rather frightening joke. The end of comment #30 above is both priceless and accurate.
July 18th, 2009 at 9:21 am
Re: My problem is with a House bill mandating that I purchase health care or be subject to an income tax increase.
So what? You are subject to all sorts of mandates and requirements. You aren’t allowed to go out in public in the nude so there’s an mandate that you buy clothing. Your home and business is required to have proper sanitation and you are taxed to pay for sewers, garbage pickup etc. If you can’t deal with the requirements of living in an advanced cilivilzed society then you should retiure from it an go live as a solitary hermit in the wilderness where you can do things your own way.
July 18th, 2009 at 9:30 am
My thoughts about healthcare is who is going to pay? In Australia you don’t have the immigration problem like we do here. If someone comes from Mexico and has a child here, and they barely make it to the emergency room, they are a citizen and will receive medicade for as long as they need it. We are feeding, clothing, providing medical, dental, gas cards, etc. to able bodied people who are draining our system. What if you just kept spending money from your account without replenishing your resources! Eventually you would be broke and worse, be in major debt. Do I want anyone to go hungry? No! Do I want to support the druggie, the lazy able bodied American/immigrant? No! I want to spend money educating people and if they receive medicade then they can volunteer or put in hours to receive it!!! Get off getting anything for FREE!!! FREEDOM isn’t FREE!!!!! It is paid for in blood and most receiving haven’t served this county in any way!!!!
July 18th, 2009 at 1:47 pm
Prof.Chomsky was on Democracy Now awhile ago and mentioned Aussie health care as one of the best around.Nobody writes about here.
July 18th, 2009 at 2:11 pm
Basja wrote:
Kudos Basja – concise and so accurate.
July 18th, 2009 at 2:30 pm
My thoughts about healthcare is who is going to pay? Who’s paying now, usthots?
July 18th, 2009 at 7:55 pm
I’ve often wondered why the Australian system doesn’t get more mention in the US, since it seems to fit perfectly into the American psyche.
One principle of the Aus system, is that the public insurance covers non-elective health, while the private insurances usually cover more things that are elective, a higher portion of some things such as physio, the cost of a private room or the selection of your own doctor while in hospital and other things that are considered above a minimum standard of care that everyone should be entitled to.
Selection of doctor is what most people pay for, since its possible to be assigned a registrar who has never performed an operation before, if you’re a public patient. The other thing most people like about private insurance is the shorter waiting times for specialist care.
Its worth also mentioning that our pharmaceutical costs are significantly lower than the US – although the US tried to force their stupid system down our throats a few years ago when we were trying to get an FTA signed. Most Australian’s figured accepting US health care policy was a much larger cost to bare than anything we might have gained from trade through an FTA.
July 19th, 2009 at 11:07 am
I’ve often wondered why the Australian system doesn’t get more mention in the US, since it seems to fit perfectly into the American psyche.
Because we are an insular people who are taught from early childhood to believe that we live in the greatest country on earth. We are so much better than everyone else that we should not only avoid change, but we should also actively reject it, lest it brings us down to the level of the inferior foreigners. Everybody envies us and wants to be like us, so what they could possibly have to teach us?
The insurance and medical industries have exploited this American propensity for self-aggrandizement to their advantage. There is a significant population in the country that refuses to believe that we could possibly be inferior to anyone else and will never hear it, no matter how obvious it may be. At that point, you’re not just debating healthcare, but drilling into the core of what gives us our identity and sense of who we are as a people.
July 20th, 2009 at 3:03 pm
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