Sunday, July 1, 2012

American Health Care Is Stupid

Yes, you read that correctly. I know you were expecting the title to be "Australian Health Care Is Weird" because that be more in line with the overall tenor of this blog.  But this is one area that I think Australia has a few things it could teach its bigger, fatter cousin to the north.  And I'm not talking about China.
Obamacare, obamacare, obamacare!
In Australia, whether you're a permanent resident, a naturalized citizen, or a citizen by birth, YOU HAVE BASIC HEALTH INSURANCE.  Automatically.  For FREE!

All you have to do is walk in to your local Medicare office (or Mediocre if you're a smart-ass like me), fill out a form, and get a plastic card with your name and your Mediocre number embossed on it.

Then, anytime you feel yourself coming down with a broken leg, a brain tumor, ADHD or the Spanish Flu, you can make an appointment at any local family doctor of your choice (called a General Practitioner or "GP"), pay a few dollars and get it checked out.

If the "GP" has enough turnover to employ an office staff, then they might do something called "bulk billing."  That means you pay only the $20 or so co-pay for the office visit, and the doctor sends Mediocre a bill for the rest.  Otherwise, you pay the full bill, then later take it in to the Mediocre office yourself and get most of it refunded back to you.

Now, let's say you have a serious condition that requires a specialist.  Acne, for example.  Then, your GP would write a referral to a specialist, a Dermatologist in this case.  (If you have Lizards, he might refer you to a Herpetologist.) With that referral, most of your costs incurred with that specialist are covered by Mediocre.  But if you are content to pay out of your own pocket, you are perfectly at liberty to see any specialist anytime as much as you want without a referral.

Sounds like a Hypochondriac's Utopia, doesn't it. Well, it has some down sides too.  Because it's almost free, it is sometimes over-used by idiots who smoke, drink, eat and screw themselves into poor health.  Consequently there can be lengthy waits to get an appointment at a GP, get into the hospital, or to finally have that brain transplant you've been so desperately needing.

Also, Mediocre stipulates how much Mediocre money a doctor can receive for their mediocre services, and often this is below the doctors' costs.  As in America, the cost of health care has risen dramatically as scientists have invented ever more expensive ways to not die a little longer.  Consequently, most doctors only have enough time in your appointment (average length: 1 hour in the waiting room, 14 seconds in the "surgery" or examination room) to give you a randomly-generated prescription for some pills that may or may not make frogs grow out of your armpits.

In other words, "free" health care is no exception to the maxim that you get what you pay for.

That is why in Australia you also have many opportunities to purchase "private" health cover which gets you into the medical fast-lane, better hospitals, smarter doctors with better English skills and TWICE the amount of time (28 seconds) to give you a prescription for something guaranteed to make you go away and not bother him anymore.

Private health insurance in Australia costs about a tenth of what health insurance costs in the US.  It also covers "unnecessary" extras like dentistry, hand-washing before surgery, and boob-jobs.  Though what exactly constitutes "necessary" medical procedures is the subject of intense debate in pubs and bars across Australia.

Shouldn't America adopt a similar system?  Perhaps not.  Australia has just eight or nine states or territories (we're not sure if Christmas Island and the Cocos Islands count), and just 22 million residents. It's quite a different thing to administer a Mediocre-type system across 50+ states and 300 million people.  There is a strong argument in favor of running these things on a State level under Federal laws.  Except if you live in Arizona.  In that case there's a strong argument in favor of moving to Colorado.

Another problematic issue is this.  If someone is paying for your medical care, can that person reasonably have some say in what you can and can't do that may affect your health, and consequently your medical costs?  I personally think that would only be fair.  But good luck banning all the things that could put you in the hospital!  Food, drink, drugs, tobacco, sex, sitting, standing, working, playing, walking, driving; virtually every aspect of life eventually comes under government control if we follow this line of reasoning.

But there is a solution!

My solution to the quandary of a single-payer health care system which does not simply reward idiots and bums while punishing healthy people with higher taxes is this:  Free basic health care with a slight twist.  If  you drink, smoke, do drugs, overeat, don't exercise, are overweight, have unprotected sex, or are really, really accident-prone, you pay for the privilege and freedom of doing as you please with an extra co-pay for each voluntary behavior that increases the burden on the health care system.

When we examine the extraordinary costs of providing emergency-room care for the poor and the cost of interventions that would have been cheaper to fix sooner, then the single-payer system is the cheaper option by far, as long as you don't inadvertently reward behavior that makes people sick.

But in the end, as all of us will, you will eventually die.  In Australia, it will almost certainly be in the jaws of a shark, crocodile or wombat.  From this perspective, America's obsession with Obamacare seems a silly, silly, silly, silly silly thing to worry about.

Find out more.  Understanding Australia's Health Care System:


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