Health Care

[Hesh1956]

I'm curious as to how my friends (you too Kim... JUST KIDDING!) in the southern hemorrhoid get your health care.

It's currently a big issue in the US with President Obama pushing hard to change how Americans get their health care.

Currently if you are under 65 years of age and if you have health care insurance (something like 47,000,000 Americans do not...) you are a customer of a health insurance company. These companies may or may not be for profit companies.

Health insurance policies are generally sold as part of a "group" package/discount. As such the vast majority of Americans get their health care as a benefit, often with a co-pay from their employers. Small companies may not offer health insurance and their employees either have no coverage or have to buy an individual policy often at very high rates.

If you lose your job you have the opportunity to pay the entire premium on your own for 18 months (COBRA) and then the policy terminates if you do not find employment with an employer who will cover you or purchase an individual policy.

Also in the states if you have a pre-existing condition insurance companies may choose to not cover you in some or all respects and they in fact do this pretty much as a rule.

Anyway if you get sick here and even if you are insured often the insurance company will dictate what kind of care that you receive. You can fight with them and attempt to change things which is possible but when you are already sick it's not something that you really want to have to do...

So that's what we have and IMHO it completely sucks... One of the three greatest causes of death in the US is medical intervention... If you are hospitalized for more than 7 days there is an 80% chance that you will catch a staff infection from the hospital and the lack of cleanliness.... Often folks die from these infections or complications arising from same...

So my friends how does your health care system work, who runs it, are you happy with it, what's it cost you and how is it paid for?

Many thanks.

[Allen]

It's something that has really puzzled me since moving here. Coming from Canada and having universal health care, where everyone is treated equal is a far more democratic way of allocating tax payers funds, and taking care of people who need it. Also a much more efficient way of using those funds, when you aren't running two systems that are effectively providing the same service.

I don't have private health care here, so we pay as is required by the public system, and get reimbursed a portion from the government when we use the system.

Friends do, and have had to use it recently for various aliments and operations. Prior to requiring the care, they were all for Private Heath cover, under the assumption that they paid their excess of say $500 and all was done. Everything else was taken care of, and no worries.

In each of the 3 cases of these friends using their health cover, it has turned into a fight with the insurance company trying to be reimbursed for out of pocket expenses, and in the end, they find that besides the excess that they have to pay, their is a long list of other costs that aren't covered, but are never discussed when you take out the health cover in the first place.

Another selling point of private health care here is that you get to pick your doctor and hospital, to some extent, and get immediate service. In some cases this may be true, but in the real world, these people had to wait just like the rest of us. Hoping to be able to get in for their operation in a few months.

All these friends now are canceling their insurance, as the cost of $200 + a month, plus the service (or lack of) and the extra costs don't add up to good economic sense for them.

[Bob Connor]

Our private health insurance costs around $280 per month which covers the whole family.

That includes dental and optometry and physio.

If you have private health insurance here you will also get a rebate from the government at tax time. Sort of as an enticement to take out private health insurance.

If you do not have insurance and need treatmet or surgery under the public health system you will not have a choice of surgeon plus there are generally long waiting lists. The follow up treatment may be with a registrar (qualified doctor who is training to be a specialist, in conjunction with the specialist)

If you have private you have the choice of surgeon, specialist and hospital and generally your treatment or surgery will be in a timely fashion, with regular visits from your specialist of choice.

I have monthly treatment for Multi Focal Motor Neuropathy with Conduction Blocks (similar to MS) which consists of infusions of Intragam
- essentially other peoples immune systems - the cost of which is $7,500 per month. I get this treatment under the public health system even though I am insured and the government foots the bill.

So you can use both systems to your advantage but choice of specialist is the critical point here methinks.

The basic premise of the Medicare public health system is that everyone will get treated free. They may have to wait and not have their doctor of choice but they will get treated.

[Paul B]

Further to what's already been said; if you get hurt and find your self in the emergency room you get the treatment you need and the docs aren't too concerned about the cost. You just show them your Medicare card and sign the form, if you don't have your card on you they worry about that later.

[Hesh1956]

Thanks Allen, Bob, and Paul - this has been very interesting to me.

So in a nutshell would it be accurate to say that all Aussies are covered by "Medicare?"

Taking it further it sounds like Medicare coverage may have some waits for some kinds of treatments and there are some limits to where you can go and who you see but everyone is covered - is this correct?

It also sounds like there is a market there for supplemental, private insurance that is optional. Having this coverage gives you more choices in who to go to and may reduce some waits.

It's amazing to me the cost of the supplemental insurance Bob. In the sates to insure a family of 4 AND include dental and optical would be well over $1K per month. And even with a private policy here the insurance companies impose very restrictive measures on their clients. For example only one shitty (and ugly) pair of glasses every 2 years with some companies.

There are lots of stories here too about a patient needing a new procedure that the hospital may have had great success with but the insurance companies refuse to pay for it because it's new....

Well thanks for the info.

[Allen]

That's it in a nutshell Hesh.

Sounds like our $200 - $300 mark is a bit of a fire sale then.

I suppose I'm a bit of a Socialist when it comes to making vast profits from things like Health Care, water, telephone, and electricity. I know I'm not going to change the world, but I'm working on being a "Grumpy Old Man"

[joel]

I can't really comment from first hand experience. I've only spent a total of three years of my adult life as a stinkin' civvie. Defence personnel get everything free (non-elective that is) and much faster than everybody else, insured or not. Knee operation? How's next week? Brain scan? We'll have you done day after tomorrow. We often complain about the excessive 1 whole hour wait to get to see a doctor . Well, they have been short staffed recently.

My wife and I have taken out private health insurance through Defence Health for her and the two kids at around $180 a month for everything. Chiropractic, physio, optical, dental, hospital, podiatry, and more. We have a certain spending limit per type of care per year and once that limit is reached we pay full fee. e.g. For chiropractic the wife and kids go once a month and its covered by insurance, but any more than that exceeds that limit and we pay the full chiropractic fee. We even got a grand back from the wifes laser eye surgery. Overall, its a good deal and it's actually saved us money as we were already using many services before we were covered.

But we've also used the public system to our advantage as well. We had our daughter on public and private waiting lists for an operation, and just took the first space that came up (private in this case. 6 months vs. 3 years waiting lists). But for our second daughters birth public all the way. Same level of care, same facilities. Private just offered a private room for which we had to pay the excess, and my wife needs social interaction, so the private room was not a good idea.

Our system gets a fair bit of criticism in the press, but when I look oversees to other countries systems, I know where I'd rather get sick. Here.