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Yves here. Reader Christopher J sent a contribution from Down Under, with a long note about his treatment for his first major medical treatment. I thought I would run it as a long-form example of how health care works in other advanced economies. Admittedly, my personal data points are stale, but when I was in Sydney (2002-2004), the caliber of health care was on a par with the US, and even with my paying out of pocket, the charges were about a third of what they would have been in the US. A couple I knew who had the option of the wife giving childbirth in New York City or Sydney chose Sydney because they deemed the care to be better.
One of the big things that allows for America’s health care looting to go well beyond what ought to have been its sell by date is our provincialism.
You can read about the Australian scheme here; the short version is citizens and permanent residents pay 2% of their annual income over a threshold for Medicare; they can then either buy private insurance or pay a surcharge for the balance of their coverage.
Christopher J lives in Cairns, which is a remote city of 150,000 near the Great Barrier Reef.
By Christopher J
I follow your blog most days and have been a part time commenter for well over 10 years now, since I worked for the Bureau of Transport Economics in Canberra.
Here is a story about my first medical emergency. I was born in the UK in 1961 and now live in Cairns after working in the public sector for 30 plus years in the finance and treasury sectors. I currently work for self as handyman and have a partner who also works.
Last September 2018, I gave up smoking cigarettes due to the expense. Heavily taxed to ‘discourage use’, a 20 pack of Marlboros now costs around A$30 – $20 US. And, I reckon my habit was costing around $750 a month, or the cost of an annual river cruise in Europe! I’d given up several times for months or even years, but this was the first time I’d given up arising from anger at how the Federal Government was tackling the problem with a huge tax on, mostly, working people.
After that first month, I withdrew the money I’d saved in cash and bought myself a flash wallet to put it in. Smug I was at the pub around my smoking friends. I found huge improvements in my health. For many years sleeping on my side led to my arms going to sleep as my circulation was constricted by all that smoke residue. After a month or so of not smoking, my blood circulation improved and I found I could sleep again on my side. I told partner we were going to extend all our run circuits by about 800 m and we started to hike up Mount Whitfield, and jog down, about an 8km round trip with an up and down of around 350m, with the trail along the ridge line. I was feeling very fit for my age and was feeling generally positive about my health and well being.
At the end of May, or so, and out of the blue, I found a lump as I was sitting on the bed one morning. This was a Monday about 4 months ago. At the top of my right thigh and groiu area was a lump, not painful, about the size of a small egg.’
How would I feel about this if I was living in Florida or Seattle? Australia has health insurance, but I don’t have any as the insurance is only useful, for example, if you think you might need elective surgery and have the money to pay for procedures through a private hospital. For higher income earners, extra tax is levied where the taxpayer does not have insurance. So, there are a number of for and not for profit companies that market cheap insurance that they know the consumer will never use, as everyone, insured or not, can fall back on the public system when they fall unwell.
Heather and I are more fortunate than most. She still has that rarity in modern Australia, a salary, and me a modest government pension already being paid each fortnight, plus work I do as a handyman. We have money in the bank as well, set aside to finish the balance of the work on our house. So, if I was a US citizen, I would either be insured and able to access care, and all the costs and complexities, or not insured and unlikely to have the funds to get cheaper treatment overseas, or even find out what is wrong.
My immediate questions were what is the lump in my thigh and, if it’s serious (my first thought was cancer), can it be treated? At its rawest, I was confronted with my own passing, years before I thought was my time. For US citizens, the first thought might have been how much money do I have? Is my insurance up to date and going to cover this? I am lucky as the thought of cost or access never crossed my mind.
Nonetheless, I hadn’t been to a doctor in years and didn’t know one who knew me, or my scant medical history. Heather works for an indigenous health care organization that provides primary health care to indigenous and non indigenous clients. I went there and the male doctor I saw sent me off for an ultrasound the same day. No cost, all ‘bulk billed’ to the Australian Government, at rates they set across the thousands of procedures that doctors and specialists perform.
Each time the results came back I was sent off to have more expensive diagnostic procedures. That same week, I had an xray and then a CAT scan. After the scan, my doctor rang the hematologist at Cairns Base Hospital and three days later I was in his consulting rooms as the evidence mounted that I had cancer. Dr Azz is an Australian, but his family is Asian. This neither concerned or surprised me, as our health sector is full of clinicians who have come from overseas or are first generation immigrants. But, for me, he looked and sounded the business.
He told me I had lymphoma, where cancer had infiltrated my body’s waste system. He didn’t know how far it had spread, so he scheduled an ecg to check my heart, a bone marrow biopsy, where marrow is taken from the hip area, to see if it had spread there, and a PET scan to see the extent to which the cancer had spread to other areas of my body. He also said that I needed to have a ‘biopsy’ on the tumor in my thigh and scheduled surgery for that the same week.
I haven’t determined what the cost of a CAT scan is in the USA, but count them, some seven different procedures involving radiologists, heart specialist, surgeons, anesthetists…. All happening with speed in the space of about three weeks, from the time I found the lump to me sitting down for my first cycle of chemotherapy. Even I was impressed at how quickly they’d commenced treatment.
Naturally, there were complications and, after my surgery was completed, I found out that ‘biopsy’ was actually the removal of the tumor, which was then tested in pathology. This surgery left me with a wound that was slightly open and constantly weeping plasma. I took the potential infection issue seriously and dressed the wound twice or more each day and regularly went into the men’s clinic to get the wound cleaned and re dressed. And, they also gave me valuable dressing supplies at no cost so that I could do it myself at home.
Yet, it probably took two months before the wound had closed and healed. It caused me a lot of trouble, particularly during the first couple of chemotherapy cycles as my immune system was very weak. Chemo was relatively okay for me. Not nice having four toxins dripped into your blood over 6 or 7 hours, but the staff were brilliant, I talked to people from all works of life and came out of it alright. I also lost all my hair and have other problems which should all go away over time.
I am scheduled for another PET scan at the end of November, allowing sufficient time for the drugs to fully work their way in and out of my system, leaving my lymphatic system free of tumor cells. That’s the goal.
I never thought about money, mine at least, throughout the whole ordeal No, but I did think of all the public resources involved in my diagnosis and treatment and assessed, as best I could that my treatment probably cost the taxpayer around $100k or so, probably more when you factor in all the capital and technology employed in my cure. I am sure there are some cancer survivors out there in the NC community who live in the US and elsewhere. What were their experiences in meeting the $ cost of cancer treatment?
It gets pointed out weekly in NC that the US has the most expensive health care system in the world with not the best outcomes. So many players, corporate and otherwise, profit from the system there. A just and fair society would have changed things long ago so that a free public health system existed In 2020, as in 2012, there are so many potential losers from a Medicare for all system, that they are all spending like crazy to ensure it never happens. And, outside of a revolution, I am not sure you will ever get it as advocates like Bernie will never be nominated as President, in my very humble opinion.