In 2004, I’d just finished a novel and by way of celebration had taken my family for an extended visit to Australia, where I was born and raised.
I didn’t expect that trip to save my life. But I’m convinced it did, because of Australia’s “socialized” medicine.
I retreat to my garret when I write a novel, especially toward the end. I stop going anyplace, wear sweat pants all day, neglect personal grooming. Back in the Sydney neighborhood where I’d lived for many years, I was re-entering the civilized world, and was on the way to a salon for an overdue haircut when I passed the BreastScreen van, parked in the main street.
The fact that they were getting an unbelievable deal on my Australian care didn’t stop Anthem’s gatekeepers routinely declining to pay every single bill.
This mobile service offers free mammograms, no appointment necessary. It wasn’t until I saw that van that I realized a mammogram was one of the things I’d forgotten to do. I was a year overdue, according to the guidelines for women my age, so I stepped into the van, got squished and zapped by a pleasantly efficient technician, who told me a radiologists’ report would be mailed out in a week or so.
Two weeks later, I was in a Sydney hospital, discussing treatment options for my invasive stage II cancer. According to testimony by Senator John Barrasso (R-WY) at last Thursday’s health-care summit, I should have been heading for the airport at that point. Like his unnamed Canadian state premier with the heart condition, I should have been hightailing it to the U.S., to avail myself of “the best health care in the world.”
No thanks, Senator. I elected to stay in Australia. We had ample U.S. insurance; cost wasn’t an issue. I simply wanted to remain in a humane, rational system where doctors treat a person as a patient, not a potential plaintiff, and where the procedures ordered for me were the ones shown by hard science to produce the best outcome for the most people.
Australia adopted universal health care in 1984. Since then, life expectancy for women has increased to 83.5 years from 78.7 (for males to 79.1 from 72.6), while spending on health care has risen less than 1 percent, to 4.4 percent of government outlays (in 2008-09). The scheme is funded by a levy of 1.5 percent on taxable income, and all political parties, even the most conservative, support it.
Costs are controlled by excellent preventive care (example: had I still lived in Australia, a card telling me I was due for a mammogram would have been mailed to me when I turned 50: “Happy Birthday—go get zapped”), hard-nosed bargaining between the Australian government and Big Pharma (the same drugs are much cheaper there than here), and a commonsense legal system that discourages frivolous malpractice suits (the loser generally has to pay the other side’s court costs).
Some doctors choose to go all in with the system, accepting the government’s idea of a fair fee, which is then paid directly out of state coffers. Others choose to set their own higher fees and attract patients who are willing to pay the difference after the Medicare reimbursement. While every legal resident of Australia is covered by Medicare, many Australians also choose to buy reasonably priced private insurance to cover such gaps, avoid waits for elective surgery, and pay for private hospital care. Since we had our U.S. insurance, I chose to “go private” for my treatment, but I soon learned it didn’t mean much. I could have paid nothing and still chosen to see the same excellent oncologist in the public system. As a private patient I got to see him in a room with nicer chairs, and I had a better view from the chemo suite. My U.S. insurer, the now notorious Anthem, also got billed a fraction of the costs it would have had to cover for the same services in the U.S. (My oncologist, who at that time chaired the international association for his specialty, charged the U.S. equivalent of $120 for an unhurried exam and consultation.)
But here’s how sick the U.S. insurance system is: The fact that they were getting an unbelievable deal on my Australian care didn’t stop Anthem’s gatekeepers routinely declining to pay every single bill. While I concentrated on getting through treatment, I would hear my husband, on the phone at odd hours because of the time difference, arguing for the reimbursements due to us. After resubmissions and appeals, they all eventually got paid, some with interest, because of the unjustified delays. But the stress is something to which no family in a medical crisis should ever be subjected.
Once, when my Aussie mother visited me in the U.S., she developed bronchitis. Even though the diagnosis was plain, the doctor felt obliged to send her for a costly x-ray. We had to waste half a day in waiting rooms, while my mother kvetched, loudly and mortifyingly, that “this would never happen in Australia.” When she saw the price for her antibiotics, she almost fainted. “I’m keeping this,” she said, pocketing the receipt. “It’ll give them a laugh, back in Sydney.” “Well, Mum,” I said, suddenly feeling defensively American, “someone has to pay for it, even in Australia.”
“Of course,” she replied calmly. “In Australia, we all pay for it. And those who’ve got more, pay more.”
Now there’s an idea. Can somebody please cc the Republicans?
Geraldine Brooks is an author and former foreign correspondent for the Wall Street Journal, where she covered the Mideast, Africa and the Balkans. Her recent novels include the bestseller, People of the Book, and March, which won the 2006 Pulitzer Prize for Fiction. Her non fiction works include Nine Parts of Desire:the Hidden World of Islamic Women.