19 August 2009

Australia in the American health debatcle

Watching the health care debate raging in America isn't a spectator sport, because America's choices affect us all. Although the Australian government negotiates best price with drug companies, the 2004 Free Trade Agreement had as a major push from the US, the end of that policy, seeking to make Australians pay what the drug companies want just as Americans do. Why? As a lobbyist said, for a “fairer, more transparent process for the pricing of medicines.”

Fairer, more transparent health care:
"The most controversial aspect of reform is the idea of government-run insurance, known as the "public plan" or "public option." According to a recent NBC/Wall Street Journal poll, 47 percent of those surveyed oppose the public plan while 43 percent support it."
Future for reform uncertain, PBS NewsHour, Aug 18, 2009

Only last week, an American I know was telling me that he hopes he doesn't "go Communist like you are in Australia". This was after telling me that he can't afford health insurance, and needs to work though he's sick to save enough money to blah blah blah. His job: selling to the US military. He's usually in Washington lobbying.
"Yeah I'm Australian as well. Medicare is awesome and I also have private health insurance to get the extras like massages and stuff. I fail to understand why the US doesn't just implement a system like ours. Actually I understand exactly why, the US is run by corporations and full of douchebags that would sell their grandmas to get the chance to screw someone over for a couple of extra bucks."

The oddest part of this freakout in the US about socialism and communism is that they're both words that just mean, as Barack Obama summed up, Bogeyman!

How the public option can work
Americans are being frightened away from choice, but only choice will give the transparency and reduced costs that are so long overdue. And it is Australia that Americans should look at when they consider the public option, not the UK—because in Australia, we do have choice. A great deal of choice between private and public, and a combination of the two. Most Australians choose the government option, and then for some surgery, might choose private. We don't have doctors foisted upon us. We do get procedures done on time, and certainly don't typically have to wait like the Arizonian with breathing problems I know who was told he had to wait two weeks to see a doc.

Our medical costs are shared, and are not exorbitant. Our drug costs are reasonable, and aren't breaking the back of the country. We even have listed and unlisted drugs, meaning that you can buy some that are subsidized by our taxes, and some that are not. Age and income are a consideration, too, inclusively, not leaving older people out in the cold, as some of the fear-mongers are warning. The Australian system gives people dignity. It is a shared responsibility that is no more perfect than any human construction can be, but the basic model runs so well that no politician dares to talk of taking the public option away.

The biggest difference between Americans and Australians is in the character of the people. Australians are too complacent. We don't live in the fear and dread over the financial cost of getting sick or having an accident, or having a baby. Australians don't go bankrupt from having a baby. Public choice works. I know because I'm typical and like most Australians, use both but mostly use the basic public option, just like most other people. I have my choice of doctor (of course!), and have had one operation in a private hospital and recently spent a week in a public hospital, where I was given the best of care, especially by a nursing staff that was superior to that of the private hospital (though, typical with our terrible state government, a terrible feature of the public hospital was the recently privatised food service, which not only shipped the food from a location two hours away [stupid and dangerous - hospitals with no independent food supply and working kitchen are useless in disasters and disease outbreaks] ) but considered fresh fruit and vegetables two foods too far. They did have pears though, so hard that they could have come from a munitions store). So much for nutrition.

Of all the uses that Australians' taxes go to, our health system is probably the most approved of.
"Medicare has been popular with the general public since its inception, but is disliked by many in the medical profession (possibly because it caps their fees and thus income). Many among the conservative side of Australian politics would like to reduce its coverage, but have found it too popular to tamper with thus far."
Medicare (Australia) Health Private Doctors' Scheme System
What's the US military?
"The Republicans need to stop denigrating the troops. They keep saying that the government can't get anything right. How about the biggest government project of all -- the United States Armed Forces?"
Cenk Uygur, Is the US Military a Socialist Institution?, Huffington Post, August 6, 2009
Millions of Americans have socialist health care provided by the military – provided for those in uniform, the retired, families – and even, in the case of Walter Reed Hospital, for instance, officials elected to office? It would be interesting to see what the reaction would be if, instead of Veterans' hospitals and military health care, the command was: Go private!

Two red herrings smelling up the debate: co-ops and tort reform

Co-ops instead of the public-option choice - a sleight of choice

These are now being mooted as the solution, but co-ops have been around for many years. Group Health, the model in Seattle, has been around since 1947. So by all means, co-ops can add to the mix, but they are no substitute for a publicly-funded choice.

Tourists for health now, tort reform for dessert - later
Increasingly, health tourism is a factor in American health care, from buying drugs to getting operations. People who can't afford those options are stuck with a system that doesn't work. It is true that tort reform would help Americans to get health costs down.

"Yet the congressional leadership has slammed the door on solutions to the one driver of waste that is relatively easy to fix: the erratic, expensive and time-consuming jury-by-jury malpractice system. Pilot projects could test whether this system should be replaced with expert health courts, but leaders who say they want to cut costs will not even consider them.

What are they scared of? The answer is inescapable -- such expert courts might succeed and undercut the special interest of an influential lobby, the trial lawyers."
– Philip K. Howard, Health Reform's Taboo Topic,
Washington Post, July 31, 2009
It would be great if tort reform could be included in American health reforms now, but the proposers know that this is just a tactic to jam reform now. Republicans didn't when they had the majority and the opportunities.

That damaging suing mentality has now infected Australia too. It's a strain and we need tort reform too. But that's beside the point. We still have affordable health care in Australia, and a more equitable society (here's hoping that word doesn't offend).

But why listen to an Australian? Here's someone better: Erin O'Neill, Columbia Daily Tribune.
"The Aussies have fashioned themselves a very nice, if not perfect, health care system. It merges the benefits of a government-run universal insurance and care scheme with the flexibility and choice of private insurance rather successfully."
Follow Aussie example on health system, August 11, 2009

More opinions and resources:
  • What the US can learn from Aussie health care, by Alan Mascarenhas, Global Post - "Here’s a damning statistic: Australia spends 8.7 percent of its GDP on health care and covers everyone, irrespective of their employment status. The U.S., meanwhile, spends 16 percent of its GDP on health care — far more than any other industrialized country — yet 47 million of its citizens lack health insurance while millions more are underinsured."

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