Photo by Flickr user littlephil
Photo by Flickr user littlephil

Last week, I contracted gastro.  It wasn’t fun.  My digestive system decided it hated me, and staged a coup.  I’ll spare you any of the more vivid details, because they really aren’t pleasant.

So, after being sent home from work on Tuesday and not improving through the night, I called my local General Practice at 8am on Wednesday.  “Erin, was it?” the receptionist asked.  “Where do you live?”

“Ultimo” I told her.

“Oh, that’s a shame, ’cause we just had a cancellation for 8:15, but I don’t suppose you could get here in time.  How about 10am?”

That was fine with me.

“Dr. Naomi E. isn’t in today, do you mind seeing Dr Naomi G?” she asked.

I assured her I didn’t mind at all, and drove the (very) short distance to the GP at 10am.  Truth be told, I probably could have made the 8:15 appointment, as Ultimo and Glebe aren’t that far apart, but I was thankful for the extra sleep.

You see, my doctor is so close to my house, and so accessible, that not being able to see her on less than 2 hours notice was an aberration.

(By the way, I love that there are two Dr Naomis at the practice).

When I got to the surgery, I noticed a new sign:

We have a number of new staff,
And as they may not yet know your name,
Please be sure to inform them when you arrive.

I wanted to take a photo with my iPhone, but there are strictly no phones allowed.

When I was called into my appointment, a few minutes late, Dr Naomi G. sat with me and talked with me about what was going on.  She listened to my concerns and my symptoms.  She asked about my life: what I did for work, in my spare time, and asked was I stressed.  She assured me not to worry, that it was probably nothing, but she wanted to run X, Y, Z test.

“I see you saw the other Naomi last time you were here, and you got a referral to see your specialist” she said.

“Have you made an appointment yet?”

I hadn’t, which I shamefully admitted.

“I know life is really busy, but I think you need to make this a priority,” she told me.  She wasn’t admonishing me, she was just reassuring me that taking a day’s sick leave was ok, and that this isn’t something I should postpone for the sake of busyness.

After my appointment, I went to the front counter.  My bill was for $60, for a half-hour appointment.  The government would pay about $42 of it (I think).  I could have given them the forms, and the government would have paid my rebate directly into my bank account, but I wasn’t organised enough to have already provided my bank account details, so I had to take it to the local medicare centre.

I’ve only been going to this GP for a little while.  Before, when I didn’t earn as much money, I couldn’t always guarantee I had the $60 up front.  So I went to a doctor that “bulk bills”- a doctor who charged only as much as the medicare rebate, and got the money direct from medicare.  There are lots of them, and it meant I never had to worry about having enough money to see a doctor.

But I got a better job, and a bit more money, and I decided I could afford the gap in order to get better quality care.  That was an option.  So I asked my brother, who is a medical student, if he knew of any good places, and he told me of a local GP with an excellent reputation, so I tried to book an appointment there.

As I work full time, naturally I tried to get a Saturday appointment.  No, they told me.  They only had a limited number of Saturday appointments, and they prefered you to have a one-hour, first-time appointment, so you can get to know your doctor.

So I made a mid-week appointment, took the requisite time from work, and sat down with my new doctor.  She asked all about my life.  Not just about my health background, though she certainly interrogated me on that.  She asked about my job, my personal life, my uni work.  She wasn’t being nosy, she assured me, she just wanted to understand what kind of pressure I faced, so she could keep an eye on me.  I told her about my history of problems with my stomach.
“You know what,” she said.  “Rather than just giving you a referral to your gastroenterologist, I’d rather you came back in, for a shorter appointment, so I can really understand the history of your stomach condition.”

Again, I made the appointment, and took her through the long history of testing and treatment that ultimately resulted in a Fundoplication– an elective surgery at a private hospital, which occurred when I required it, with the doctor I chose- almost 10 years ago.  And in that single appointment, for which my out-of-pocket costs were less than $20, she became familiar with my whole history, and was able to provide wise guidance as to what I should do next.

This isn’t really a revolutionary story.  I’ve no doubt many of my Australian friends have similar tales.  But it is an example of the excellent balance that can be struck when talking about government-sponsored health care.

There’s all this talk in the United States, mainly from conservatives, about how woeful a public health care insurance option would be in the United States.  They talk about “socialized Medicine”, and use “Canada” and “France” as curse words.

And they speak of the government getting between you and your doctor.  The government paying a proportion of my fee in no way “gets between me and my doctor”.  I have lived in the US with really good quality health care coverage*.  But I have never, ever had a doctor like my current one.  She knows me, she cares about my health in a holistic way, not just in diagnosing a particular problem.  She wants to know about my past, and my lifestyle, and integrate it into her understanding of my health.  On my third visit to her, I broke down into tears about something not directly related to my health, and she listened, and said that it was probably affecting me more than I realised.  She gave some advice about how I might deal with me problems better, and assured me that any time I needed her, she was there.

We have a wonderful balance here in Australia.  If you need health care and can’t afford it, you can get it.  Everyone can get it.  There are a multitude of doctors who bulk bill.  And you can use the public hospital system.   But if you have a little more money, you can choose the extra cover.  The government doesn’t decide what access I have- they just set a level of access, and everything beyond, I have to pay for.

Is that “rationing”? Perhaps.  But at least we all have access to pretty good basic cover.  At least a major illness will not bankrupt us.  But, at the same time, if we have access to the extra funds, we can use them and pay for extra cover.  Oh, and if a particular treatment isn’t available here, the government will pay for us to have it overseas- a fact Glenn Beck grossly misrepresented in his recent rant (Do Australians go to the US for certain treatments? Yes.  But he neglected to mention the fact the federal government provides funding for that).

I am thankful for a system in which I can access a basic level of care regardless of my income, where I can choose to spend additional funds if I have them available, and where I have both public and private hospital options.  For that, I’m happy to pay an extra $1.50 tax for every $100 I earn.  It’s worth it.

*I actually remember going to buy glasses, and as our health care scheme wasn’t on the standard approved list, so they had to go and call my insurer.  They came back with a slightly dazed look, having never heard of a premium that covered so much!

Cross-posted to the USSSoc Blog.

7 Responses

  1. Love it! Erin, thanks for sharing this. I have faith we’re gonna figure out all of this health care stuff soon. It really does seem like the time is right.

  2. Whether I’ve been in a position to afford to pay a gap or not, my favourite GPs have both been bulk billers. Where the disparity between quality shifts in Australia, I think, is not so much who you choose to go to generally, but who you choose to go to for specialist treatment. And whether you can find a bulk billing specialist at all. Without being in a fund or having the means to pay for a gap, ongoing specialist treatment and medication is pricey. BUT when I say pricey, I mean in comparison to my free GP visits. AND seeing as I’ve been seeing them both for some time, I can pretty much call them up and talk over the phone to them if I need advice, and this is free. So I don’t know how my definition of “pricey” would translate in terms of American perceptions of expensive healthcare. My guess is that it probably would still be considered pretty low cost for the quality of care.

  3. sorry missed a sentence in the middle there – I meant to add in that I see two specialists regularly.

  4. Right on, Erin!
    I get perfectly great quality health care with my disability in the country. The amount of surgery and therapy and high rotation of equipment when I was born up until probably early high school. If this were the in the U.S. I’d say my parents would have been heavily in debt and possibly nowhere near paying it back.

    Even despite that, all my bulk biller doctors and nurses have always been great and understanding with everything. I wouldn’t even consider our basic medical cover under Medicare to be in any way “basic”. It covers so many small, yet important factors.

    I really don’t know why people would rather see individuals to entire families crippled with an abomination of medical expenses they can’t pay rather than providing their people with adequate, across-the-board health care.

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