Recently MercatorNet ran two articles on the much-discussed prospect of Obamacare. Both articles centred on the possible ethical implications of a government-run insurance scheme. One piece concentrated on the idea flagged by the ubiquitous Sarah Palin, that Obamacare raises the prospect of so called “death panels” as a response to rationing of hospital resources. The other refuted the death panel notion and pointed out the ethical implications of not introducing some form of insurance for the poor who are uninsured.
However, neither told us too much about how the scheme would actually work.
It seems to me as an Aussie observing from a distance of some thousands of miles — and perhaps an even greater cultural divide — that if President Obama does manage to pass his health bill, it will certainly help those presently too poor to take out insurance. But it will hardly be the revolution in thinking necessary to ensure all Americans get good health care all the time. From an Aussie perspective, Obama’s proposal looks pretty tame — hardly the stuff of catastrophic social revolution that some Americans seem to think it will be.
So what is it about Australia’s system that is so superior — as one of my critics demanded? What allows the Australian commentariat their lofty, perhaps smug, assessment of the “American mentality” as evidenced by the vigorous opposition to a rather limited health care bill? Who says we have it right and the Americans have it all wrong?
Almost everyone in Australia, that’s who.
Australians are quite convinced that our universal Medicare system is better that anyone else’s –- and certainly the American one. Even the term “American-style-health-care-system” is code in the media for “the-worst-thing-that-could-ever-happen-to-us”.
During the election campaign of 1993 the Liberal leader of the day, Dr John Hewson, a “dry” economist, ran on a policy of introducing a consumption tax and watering down the universality of Medicare to a system not dissimilar to Obama’s proposals — an opt-in system. Not surprisingly, he was soundly defeated. At the time pundits assumed it was the promised introduction of a goods and services tax (like Britain’s VAT) that caused his defeat.
It was only later, when John Howard was elected three times after introducing a consumption tax, that the same pundits realised it was the watering down of Medicare that had done Hewson in. The election of 1993 is still known as “the Medicare election”. That was opinion poll number one on Medicare. Poll after poll has confirmed the popularity of Australian Medicare. Even Prime Minister John Howard, a vigorous free enterprise conservative, realised that although private insurance might have place in the mix, Medicare as a universal system was untouchable.
The virtue of universality
In Australia, public health insurance is not an “option” to be opted out of. Everyone who has an income over a certain threshold pays a tax levy, although the levy does not fund the system entirely. It works because it is universal. The principle of universality is what drives Australian Medicare. It spreads the costs. Everyone, rich or poor, is entitled to it and has a stake in it. So it raises the general level of medicine. What the rich get, the poor get.
The best example I can give of that is my mother-in-law, a pensioner. She had several major heart operations performed by the same surgeon who had operated on Australia’s richest man, Kerry Packer. Consequently most people, myself included, actually prefer it when they are hospitalised
The big difference in Australia is that we have to opt in to private insurance. Having private insurance doesn’t even mean one gets better care — sometimes the care is worse in private hospitals — but it takes the pressure off the public system. Private insurance is useful for “extras” – like fixing my kids Dracula-like teeth. Having private hospital insurance means that you will have elective surgery, like a knee replacement or a minor hernia or cataracts, done more quickly. But it doesn’t mean that the same doctor might not do the same operation if you were a public patient in a public hospital.
Nor does it mean preferential care for life-threatening problems. In fact, because the major teaching hospitals in Australia are all public hospitals, we get better care there.
A lifetime of public hospital care
I have had difficult experiences in 27 years of dealing with the consequences of having three children with a life-threatening disease. These have confirmed for me the benefits of Medicare. People are often surprised when I tell them that over that period I have not paid anything for all my children’s medical care.
And the amount they have required over the years is staggering. They have all had numerous hospitalisations, up to a dozen times a year, every year. They have an endocrine syndrome and when they were young they had at least weekly blood tests for a huge range of things. In hospital they often had blood taken almost hourly. In fact it was the cost of pathology that convinced us to go “public”. Originally we were private patients, but we received bills for their pathology that we couldn’t afford to pay. The hospital simply readmitted them a public patients.
The paediatric endocrinologist patiently explained to us that we would continue to see him and all the other specialists at the children’s hospital whether we were private or not. In fact, he told me later that he tried to talk parents of seriously ill kids out of private insurance all the time, because it only added to their mental and emotional burdens. I can attest to that. One thing my husband and I have never worried about in our struggle with our children is money — unlike my American cousins, who are forced to hang onto poor-paying jobs so that they can get medical insurance. And yet they still struggle to pay their medical expenses.
Until recently, the number of Australians uninsured, ie, without any extra private insurance, had fallen below a critical mass and the industry was virtually on its knees. The publicity surrounding Howard’s own health minister who complained that his expensive private health insurance was leaving him huge gap bills didn’t help that situation. The government was forced to introduce a system of rebates for anyone who had bothered to take it out.
This incentive has proved quite popular because it mean that families and ageing couples can afford some extra insurance. So now I can pay for minor things like fixing my kids’ Dracula-like teeth and get my husband’s hernia operation done quickly
Our brother’s keeper
We don’t live in a medical paradise in Australia. There are plenty of stories of hospital overcrowding and women having babies in the emergency room toilets. But if you are really sick, not only are you well looked after, you don’t have the headache of finding the money.
Australia also has good universal ancillary services like free universal childhood immunisation and a pharmaceutical benefits scheme, which means drugs are subsidised and, after a certain threshold, are free. Compare that to my American cousin Denise, a mother of five who can’t access front-line drugs for her condition because she can’t afford them.
The supreme irony of the American situation is that for all the talk of free enterprise and paying one’s own way, it is not the destitute poor who can’t get medical care. They can generally get Medicaid. The people who have a tough time in the US are the working poor and the unemployed who have paid taxes throughout their working lives. Surely when they are sick the government should recognise their tax contribution?
America has some of the best doctors in the world. I have met quite a few of them working at the Children’s Hospital in Sydney. I have lived under both systems. In America, catastrophic illness plus no insurance can equal an early death. If Americans want good medicine for everybody, not just the few who can afford it, they have to be willing to pay for a universal scheme. Medicine is too expensive now for the state not to become involved.
To be frank, most Australians are bewildered by the vehemence of the American Right’s response to the so-called “public option”. After all, Obama’s bill is only that — an option. It does not mean real universal health insurance as we understand it in Australia.
For all our cultural similarities, the talk of “Communism” about what seems, on this side of the Pacific, a very modest proposal to ensure that the working poor and unemployed can continue to stay well does seem a mite exaggerated and indicative of some of the less admirable qualities of our great friend and ally.
If the Americans can fund a war in Iraq they should be able to have decent medical insurance for their people. To do that they must take off their ideological blinkers, stop blathering about socialism, and realise that in a civilised society we are to some extent our brother’s keeper.
Angela Shanahan is an Australian newspaper columnist.