Tuesday, 25 September 2007

Australian Sicko

The Australian health system deserves many posts, and for a long while I was pondering how to best approach the subject. I actually had the framework for this post shaped in my head for a week now (yes, that’s how most posts start), but you can blame the recently reviewed Sicko for pushing me ahead with it: it reminded me that the term “medicare” is used and abused both in the USA and in Australia.
You can blame Sicko, but you can also blame our obstetrician. Not that I have much against him or against the service we got from him; on the contrary. The obstetrician we have been using with Dylan has a reputation for being Melbourne’s best, and aside of being on holiday when Dylan decided to pop out everything he did justifies his reputation. Including his bills, which are the subject of this post.
Overall, the obstetrician has pocketed something like $7000 through his engagement with Dylan, along the following breakdown: Fees for the initial meeting (around $200), first bulk fee bill (around $2000), second bulk fee bill (around $3000), charge per visit (around $1500), and the fee for the last meeting (around $200).
Now, I wouldn’t want to be an obstetrician myself – and not only because I don’t want to receive emergency calls in the middle of the night – but if you calculate how much work our obstetrician or his delivery substitute had to perform in our case per dollar, I’m sure you will see that being an obstetrician is pretty close to winning the lottery. Question is, how can he/they get away with it? The answer sounds complicated until you understand the way the system works, which would require some patience.
Although we have engaged the obstetrician as private patients, we did get quite a lot of our $7000 investment back: For the first and last meetings we got about $120 back from Medicare, the Australian public health network run by the government; then for that second bulk fee we got close to $2500 back from Medicare; and the “per visit” charge of $1500 was paid full through both Medicate and our private health insurance combined. Overall, we were only around $3000 out of pocket on the obstetrician (and the actual sum will be reduced even further once we do our tax returns for the year). However, can we really say that we “only” paid $3000 out of pocket? Don’t the rest of the fees, for which we got reimbursed and about which the doctors tell you not to care about because “we” don’t pay them, end up being paid by us just as well through the backdoor of taxes and private health insurance fees? No wonder the private health insurers keep on asking for stupidly high fee rises on an annual basis if this is the way things are!
And that is the point of this post. Private health is being actively promoted by the Australian government because, they say, the public system lacks the funding to provide adequate support for everyone; it is those that pay for private health that “enable”, according to the government, the more lowly public to enjoy public health (on a separate note, a similar and just as stupid excuse is used by the government to justify its funding of private schools). But while saying that, the government is also heavily subsidizing private patients (as demonstrated above in our own case) and also promotes private health insurance by subsidizing 30% of the monthly private health bills.
The results are simple. On one hand, you have a very wealthy obstetrician. On the other hand, you have people receiving public obstetrician support which probably costs the government significantly less than $4000, while those that opt for the private way end up costing the government more than those that go public. Now, I am assuming here that public patients cost the government less than $4000 even though I don’t really know their true cost; however, I find it hard to believe it would be more than $4000.
This, in effect, demonstrates that the Australian government has totally failed its task to fund public health through private health; what it did manage to achieve is the creation of a system which makes key people (e.g., our obstetrician) and key companies (e.g., private health insurers) stupidly rich through the enormous sums of money flowing between their hands.
I have made our obstetrician adventure an example here, but that’s not the only way in which the government has implemented a rather twisted concept: just check out its Medicare Safety Net scheme, where most of one’s health expenses are refunded after a certain expense threshold is passed on a given calendar year – doesn’t this sound like a good motivation for people to go and visit doctors as many times as they can once they pass the threshold? Not that there’s much wrong with going to see one’s doctor, it’s just that the framework is all twisted. Again, the doctors are being made richer, and the people get less for their buck.
My solution is simple: cut the middle man. Remove private health from the equation. No one would go about wishing for private health if nothing is wrong with the public system, and no one would even think about it if the money invested in private health was to be invested in public health. I’m pretty sure even our obstetrician will manage to financially survive the shock to the system.

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