And many people don't like them, but I found it interesting and just wondered what others thought.
This exchange appeared on a different forum between a UK guy (in italics) who had cancer last year and now lives in Oz and a lady over here:
If this month or this year you or I need to spend a bit extra on X, we can use some savings, or else we can compensate by spending a bit less on Y or Z, without having to go without essentials like food, heat, clothes etc. When I asked about "low income" I didn't mean "average household income". I meant "a lot lower than average household income so that any significant extra expenditure creates a real problem" - ie the sort of person to whom it would never occur to use the expression "I am happy to pay a bit extra for..." about anything. Think single parent on NMW, and you'll realise that their finances and yours aren't really comparable. I am not entirely sure what you mean by describing your household as both low income and average income in the same paragraph - as I understand those terms, they are contradictory, so you must mean something I haven't understood.
I am also not making light of your cancer, or Mrs Gen's difficulties either. I know they have been painful and scary and generally a very big deal for you as a person and the four of you as a family. But *financially speaking*, they are not in the same league as a severely disabled child who needs professional healthcare every day for the whole of their life. Your care has not cost, as far as I understand, as much as several large houses, for example.
In the US, a severely disabled child can quite easily cause the parents to go bankrupt. The *financial* effects on an adult of developing something expensive and incurable - maybe polycystic kidney disease requiring dialysis 3 times a week, or something like that - can also be catastrophic. What I keep wondering, whenever you are extolling the virtues of the Australian system, is what happens to Aussies who need, or whose children need, healthcare in the "mind bogglingly expensive" category - like Ivan Cameron, to choose an example of someone with whom I imagine most NP will be familiar. But when I try to ask this question, I never seem to be able to put it across in a way that gets me the details I am looking for.
If you can explain to me if, and if so then how, the Australian system provides for those whose healthcare needs are beyond the capability of any private individual to pay for, and beyond the maximum on their health insurance policy, or whatever, without ruining them financially, then I will be much more interested in it as a desirable system.
I am NOT trying to have a go at you. I am asking for information, because I really want to know the answer.
In the last two years I've had cancer and been treated for arthritis plus Mrs Generali has had pneumonia and I'm extremely pleased that I wasn't forced to go through the NHS
The way it works is this.
I am well and I work. I have two choices:
1. Get health insurance which I must pay for myself. My employer cannot provide this. (Mine costs $240/month for a family of 4).
2. Do not get health insurance and pay extra income tax known as the Medicare levy which is 2% of my income above the $18,200 tax free threshold (known as the Personal Allowance in the UK I believe).
I now get sick and need to see a doctor. First stop is a GP. Who do I see? I now have a choice. Medicare will pay $37.50 to any GP I see so I can see one which charges $37.50 and not end up with out of pocket expenses or I can see one that charges more and pay the difference. Generally speaking I would choose the former although I have used more expensive doctors. Generally a more expensive one gives you more time and the offices are nicer.
The GP tells me he thinks that I have cancer and I need to have some tests to find out. The tests cost $200 of which Medicare will pay $70. The extra $130 must come out of my pocket and it is against the rules for insurance to pay. If I am super poor then I am receiving welfare and am expected to pay this cost from my welfare cheque. (There are exceptions to this, for example if you have to have a lot of tests or are ex-military).
Oh heck, I have cancer. I need an operation. What to do? As I am insured I get my operation done privately at nil cost. Davo, my uninsured cousin, would have the same operation done by the same person in the public hospital at nil cost. He will probably wait a week or so longer and won't have as nice facilities.
Then we both need radiotherapy. We both go to the public hospital and have radiotherapy at nil cost paid for in both cases by Medicare.
We then need physio as a result of our treatment. Normally physio isn't covered by Medicare but is covered by private insurance. However, as our need for physio is caused by a serious illness we get a 6 week physio program paid for in part by Medicare. Medicare pays all but $20 for each session, unlike the GP visit the extra payment is specified not the subsidy.
The difference between the UK and the Aussie system is that:
1. When we receive welfare we understand that some of that money will have to pay for medical treatment
2. Waiting times are between negligible and nil
Health care will always need to be rationed as there isn't an infinite number of doctors, nurses and hospitals. The only question left is how to ration it. The NHS seems to use a crazy system of rationing by queue based on political imperative. We use a system where we are encouraged by the tax system to self-fund for the most part and encouraged by the health system to use only as much health care as we need.
If my kid was diagnosed with a terrible disease then my insurers and the Medicare system would treat them at little or no out of pocket cost to me. Drugs needed would either be partly or wholly subsidised and health care would probably be provided through the private hospital system depending on where the facilities to treat are available.
One of the things that really annoys me about the UK public health debate is this ridiculous false dichotomy that is raised that you can have the UK or US system. If the NHS really is the envy of the world then why doesn't anyone else copy it?
Out of interest, with the NHS, a lot of the things you do have to pay for (prescriptions, dental work, eye tests...) are free for children regardless of parental income. Does the Aussie medicare system have a similar "children for free" ethos, or does it cost the same for kids as for adults?
Kids get some stuff free that adults pay for, get some extra subsidies and pay the same on some stuff. For example, my daughter 'needs' glasses (TBH I think they're a nice to have not a need). Medicare paid for her eye test and health insurance got her a pair of glasses. If we'd had no insurance she'd have had to pay for the glasses although the eye test would have been paid for still. That is exactly the same deal as me.
Funnily enough, opticians split into two sets over here: posh ones selling Ray Bans etc and normal ones. The normal ones all manage to sell you two pairs of glasses (one normal one sunglasses) for exactly the amount of money that your health insurance will cover. What a coincidence! Once you break down the health insurance and payouts than I probably spend a bit over $1,000 in a year where I don't get sick of the insurance company's money. 3 of us wear glasses plus I get The Boy sunnies. Then Mrs Generali and I get a few massages each year. Plus dental.
It is a criminal act as someone caring for a child to deprive them of medical care. If you spend the money on beer instead the courts will take a very dim view in the same way as if you bought cigarettes rather than food for a child.
I found that informative. Everyone knows that the NHS needs to be reformed somehow - most people are very fond of it and rightly so, but it was set up at a time in history and hasn't evolved as needs and the way we live has changed, along with advances in medical ability.
So often the choice appears to be between the American system and ours, surely there has to be a better way to provide medical care?
NHS - bit of a long thread
This exchange appeared on a different forum between a UK guy (in italics) who had cancer last year and now lives in Oz and a lady over here:
If this month or this year you or I need to spend a bit extra on X, we can use some savings, or else we can compensate by spending a bit less on Y or Z, without having to go without essentials like food, heat, clothes etc. When I asked about "low income" I didn't mean "average household income". I meant "a lot lower than average household income so that any significant extra expenditure creates a real problem" - ie the sort of person to whom it would never occur to use the expression "I am happy to pay a bit extra for..." about anything. Think single parent on NMW, and you'll realise that their finances and yours aren't really comparable. I am not entirely sure what you mean by describing your household as both low income and average income in the same paragraph - as I understand those terms, they are contradictory, so you must mean something I haven't understood.
I am also not making light of your cancer, or Mrs Gen's difficulties either. I know they have been painful and scary and generally a very big deal for you as a person and the four of you as a family. But *financially speaking*, they are not in the same league as a severely disabled child who needs professional healthcare every day for the whole of their life. Your care has not cost, as far as I understand, as much as several large houses, for example.
In the US, a severely disabled child can quite easily cause the parents to go bankrupt. The *financial* effects on an adult of developing something expensive and incurable - maybe polycystic kidney disease requiring dialysis 3 times a week, or something like that - can also be catastrophic. What I keep wondering, whenever you are extolling the virtues of the Australian system, is what happens to Aussies who need, or whose children need, healthcare in the "mind bogglingly expensive" category - like Ivan Cameron, to choose an example of someone with whom I imagine most NP will be familiar. But when I try to ask this question, I never seem to be able to put it across in a way that gets me the details I am looking for.
If you can explain to me if, and if so then how, the Australian system provides for those whose healthcare needs are beyond the capability of any private individual to pay for, and beyond the maximum on their health insurance policy, or whatever, without ruining them financially, then I will be much more interested in it as a desirable system.
I am NOT trying to have a go at you. I am asking for information, because I really want to know the answer.
In the last two years I've had cancer and been treated for arthritis plus Mrs Generali has had pneumonia and I'm extremely pleased that I wasn't forced to go through the NHS
The way it works is this.
I am well and I work. I have two choices:
1. Get health insurance which I must pay for myself. My employer cannot provide this. (Mine costs $240/month for a family of 4).
2. Do not get health insurance and pay extra income tax known as the Medicare levy which is 2% of my income above the $18,200 tax free threshold (known as the Personal Allowance in the UK I believe).
I now get sick and need to see a doctor. First stop is a GP. Who do I see? I now have a choice. Medicare will pay $37.50 to any GP I see so I can see one which charges $37.50 and not end up with out of pocket expenses or I can see one that charges more and pay the difference. Generally speaking I would choose the former although I have used more expensive doctors. Generally a more expensive one gives you more time and the offices are nicer.
The GP tells me he thinks that I have cancer and I need to have some tests to find out. The tests cost $200 of which Medicare will pay $70. The extra $130 must come out of my pocket and it is against the rules for insurance to pay. If I am super poor then I am receiving welfare and am expected to pay this cost from my welfare cheque. (There are exceptions to this, for example if you have to have a lot of tests or are ex-military).
Oh heck, I have cancer. I need an operation. What to do? As I am insured I get my operation done privately at nil cost. Davo, my uninsured cousin, would have the same operation done by the same person in the public hospital at nil cost. He will probably wait a week or so longer and won't have as nice facilities.
Then we both need radiotherapy. We both go to the public hospital and have radiotherapy at nil cost paid for in both cases by Medicare.
We then need physio as a result of our treatment. Normally physio isn't covered by Medicare but is covered by private insurance. However, as our need for physio is caused by a serious illness we get a 6 week physio program paid for in part by Medicare. Medicare pays all but $20 for each session, unlike the GP visit the extra payment is specified not the subsidy.
The difference between the UK and the Aussie system is that:
1. When we receive welfare we understand that some of that money will have to pay for medical treatment
2. Waiting times are between negligible and nil
Health care will always need to be rationed as there isn't an infinite number of doctors, nurses and hospitals. The only question left is how to ration it. The NHS seems to use a crazy system of rationing by queue based on political imperative. We use a system where we are encouraged by the tax system to self-fund for the most part and encouraged by the health system to use only as much health care as we need.
If my kid was diagnosed with a terrible disease then my insurers and the Medicare system would treat them at little or no out of pocket cost to me. Drugs needed would either be partly or wholly subsidised and health care would probably be provided through the private hospital system depending on where the facilities to treat are available.
One of the things that really annoys me about the UK public health debate is this ridiculous false dichotomy that is raised that you can have the UK or US system. If the NHS really is the envy of the world then why doesn't anyone else copy it?
Out of interest, with the NHS, a lot of the things you do have to pay for (prescriptions, dental work, eye tests...) are free for children regardless of parental income. Does the Aussie medicare system have a similar "children for free" ethos, or does it cost the same for kids as for adults?
Kids get some stuff free that adults pay for, get some extra subsidies and pay the same on some stuff. For example, my daughter 'needs' glasses (TBH I think they're a nice to have not a need). Medicare paid for her eye test and health insurance got her a pair of glasses. If we'd had no insurance she'd have had to pay for the glasses although the eye test would have been paid for still. That is exactly the same deal as me.
Funnily enough, opticians split into two sets over here: posh ones selling Ray Bans etc and normal ones. The normal ones all manage to sell you two pairs of glasses (one normal one sunglasses) for exactly the amount of money that your health insurance will cover. What a coincidence! Once you break down the health insurance and payouts than I probably spend a bit over $1,000 in a year where I don't get sick of the insurance company's money. 3 of us wear glasses plus I get The Boy sunnies. Then Mrs Generali and I get a few massages each year. Plus dental.
It is a criminal act as someone caring for a child to deprive them of medical care. If you spend the money on beer instead the courts will take a very dim view in the same way as if you bought cigarettes rather than food for a child.
I found that informative. Everyone knows that the NHS needs to be reformed somehow - most people are very fond of it and rightly so, but it was set up at a time in history and hasn't evolved as needs and the way we live has changed, along with advances in medical ability.
So often the choice appears to be between the American system and ours, surely there has to be a better way to provide medical care?
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