Medicare for All (Australians)

Since we’ve been looking at things down under in our last few posts, and since death panels are all the rage right now, and since we’ll be looking at power and change next year in the Illahee Lectures, let’s tie all three together by looking at health care – something that’s probably going to change in some way, after various power brokers twist – uh, metamorphose – it into something we may or may not recognize.

The rest of the developed world has some form of single-payer health care, and the rest of the world pays less for it as a percentage of their economy than the United States.  But our system is the envy of the world, right?  Top notch.  The very best.  Number one.

Actually, according to the World Health Organization (WHO), we’re number 37, right below Costa Rica, but a notch above Slovenia.  All together now: USA! USA!

But maybe the WHO is a some kind of socialist “new world order”outfit, trying to take away our freedoms.  So let’s look at a few other indicators.

We’re number two in health care expenditure as a percentage of our economy, shelling out 15.2% of our gross domestic product (and rising), right behind the Marshall Islands, a U.S. protectorate (and a remote island nation, where you’d expect everything to be expensive), and ahead of Micronesia, another U.S. protectorate (and a remote island nation, where you’d expect… hey wait a minute!).  But what about comparable developed economies, like Switzerland, France, and Germany? Their health care expenditures take up only 11.4, 11.2 and 10.7 percent of GDP, respectively.

But what do these socialized medicine pikers get for rationing their health care spending? Well they rank #20, #1 and #25 in terms of overall health care rankings according to the WHO, far ahead of the U.S.  Hmm….

OK, what if we look at something the WHO can’t manipulate in an index, something that virtually all public health experts say is an excellent indicator of over public health performance, like life expectancy?

And the winner is… not the United States.  Japan comes in number one, but Switzerland ranks number eight, France number three, and Germany number twenty-two (too much sausage and beer?). But we’re right behind Germany at number twenty-four!

So why are some of us fighting so hard to protect our “world class” health care system, (other than the fact that “some of us” like insurance and pharmaceutical companies are doing just fine with this system)? Maybe it’s not our health care system we’re fighting for after all, but our “freedoms.”  Or rather, our freedom to choose. Or more to the point, our illusion of the freedom to choose. You can’t really make an informed choice when the game is rigged, and our game is rigged to the eyeballs (just try decoding your insurance statements after a minor medical procedure).

So how does a country with a health policy something like what President Obama originally proposed come out in terms of rankings? Let’s look at Australia, which has universal health care, (they call it Medicare!) but encourages citizens to purchase private health insurance if they’d like to. The main concern in Australia is that everyone is covered one way or another.  Australian Medicare is paid for with a 1.5% tax (yes, we said the “T” word) plus another 1% surcharge (just couldn’t say it twice in the same sentence) on higher income earners.

You still have choice, as we witnessed a few weeks ago. A friend in Melbourne came down with a sore throat, and rang her doctor – the same doctor she’s being seeing for over 15 years – and got an appointment for 2:15 pm the next afternoon. We dropped her off at her doctor a little before 2:15, and she suggested we get a cup of coffee next door. We chuckled at her naivete.  She’d be lucky to even schedule a doctor in the U.S. on such short notice, and wouldn’t SEE said doctor for at least the standard 45 minute doctor’s-waiting-room-penalty period.

She stopped by the coffee shop at 2:30, all done, before we’d finished our lattes. We were astounded.  Surely this wasn’t normal?  She assured us it was.  But sometimes public health care was less than ideal, she said.  And in those cases you could opt for the private route.  For example, a few months ago her little boy had been diagnosed with enlarged tonsils.  The public health system would have paid to have them removed, but only after a battery of tests, which would have involved a waiting period.  The parents didn’t want to wait. It was obvious what should be done.  So they went private and had the tonsils out.  The total cost?  Drum-roll… $2000. Try buying an aspirin in a hospital in the U.S. for that price.  One can’t be sure, but it seems likely that the existence of “the government plan” in Australia is at least partly responsible for keeping that tonsillectomy at a reasonable cost.

OK that’s a great anecdotal story about a lucky outcome for a friend in some socialist nation (Australia, whose last president was lock-step in tune with George Bush on just about everything). But how does Australia rank statistically in terms of over-all health care? Uh, several notches above the U.S., at number thirty two. In terms of life expectancy? Number two.  How about health care spending? Way down at number twenty-nine, at 8.8 percent of GDP, far better than the U.S.

Better health outcomes. Same freedom to choose (actually, more freedom). Forty percent cheaper.

Maybe we should think about this middle road, with government and private health care systems co-existing.  It’s not a radical change, really, (for citizens anyway) but it may be a change that we can believe in, since it seems to work elsewhere.  The question is, do we have the power to change?

In the mean time, be afraid, be very afraid. Or we could end up like the health care hell-hole that is… Australia!

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