Our rotten healthcare system.

[born-again-biker]

Can someone please explain to me how our healthcare system is NOT a complete and total scam?
And how did we come to accept the structure and terms of the system over time?
We must be on the wrong drugs.

A case study:

Daughter no. 1 needs small operation on her ears to remove fluid. It's not life threatening, but it is effecting her hearing. She's a bit "shouty" to say the least.
NOT a big deal. NOT a lengthy procedure. NOT brain surgery. This procedure is carried out by ENT's everyday.
It typically takes between 30 to 60 mins to complete and requires about 40 mins of general anaesthetic.
It's a ROUTINE procedure with low risks.

So....
Monthly insurance premiums: $150 (which apparently buy me four fifths of fuck-all)
Excess to make a claim: $500
Pre-surgery costs: $400 to $500
Actual surgery: $950
Anaesthetic: $850
Private Hospital admission: $1400

Total: around $4200 (this doesn't include the $150 we pay every single month.

Total out-of-pocket after Medicare and Private Health rebates? About $2500 !!

I have learned that the ENT specialist is charging about double the "scheduled" fee for this op.
Why is this not regulated properly???

The anaesthetist is charging wayyy more than our health fund is prepared to cover.
Why is this not regulated properly??

So, we made enquiries about admitting her to the public hospital for the same procedure.
They told us the wait time will be 9 to 12 months. Great.
I'm not going to disclose the total amount of income tax I pay every year, but lets just say it's a lot.
(and lets not forget GST and the medicare levy)
What does it buy me? A 12 month wait for my daughters hearing.

We faithfully pay private health insurance premiums every month. "Insurance" is supposed to cover (FULLY cover) a claim event. Like when your house burns down they replace it with a new house, not one third of a house....yeah?

It seems to me the private system is a well designed rort that makes doctors/specialists/radiographers and insurance co. shareholders rich.
The government doesn't give two shits about the public system....and the private companies are the equivalent of the fox let-loose in the hen house.

So what should happen in a fair, regulated and well funded system??
We should pay premiums every month to our health insurer and then when the time comes for a claim, you pay a small REASONABLE excess (say...$150 ?) and then that's it. Everything is covered.
Why? Because that's why you pay premiums every fucking month regardless of weather you make a claim or not !!!!

And don't even start me on paying extras cover for Dental...I'll blow a gasket)

(Little pit pissed-off about it all....does it show?)

 

[Haakon]

This is because all those health system dollars are being funneled into the private health insurance system. The money ends up in private sector profit taking instead of wholly spent on the health system - hence the public system is starved.

The private system is in the business of not paying out - hence the markups, cost and delays. Imagine how fast the public system would be if it got all those private sector profits?

In short, fuck you Howard. Private health insurance is a scam and blatant wealth transfer from the poor to the rich.

 

[Calvin27]

Wow you just realised private heathcare is a scam?

Not going to go into details, but the solution is simple. Don't buy into the private healthcare system and pay your medicare levy surcharge instead. Dollaroos will go to fund public health instead of lining insurance pockets.

FYI my densitst who happily charged $120 out of pocket for a routine check and clean, charges $280 if you have PHI. For free market liberals, the liberals sure don't like free markets.

+1 To screw you Howard, another sell out on his growing list.

 

[c3024446]

What kind of policy is $150 p/m? Must be a bare bones one. We fork out $315 p/m for top hospital, family, after a 26% rebate.

 

[yuley95]

This is because all those health system dollars are being funneled into the private health insurance system. The money ends up in private sector profit taking instead of wholly spent on the health system - hence the public system is starved.

The private system is in the business of not paying out - hence the markups, cost and delays. Imagine how fast the public system would be if it got all those private sector profits?

In short, fuck you Howard. Private health insurance is a scam and blatant wealth transfer from the poor to the rich.

This. A million times this.

Not wanting to minimise the experience of the OP but the public system is pretty fucking amazing and would be totally fucking amazing if the gov would direct all their funding there rather than subsidising a private system that is abused as described.

And fuck you Howard for designing a tax system that forces people to take out priavate health insurance once you earn over a certain amount. Artificially inflates the rate of take up.

 

[born-again-biker]

What kind of policy is $150 p/m? Must be a bare bones one. We fork out $315 p/m for top hospital, family, after a 26% rebate.

You're implying is not the system?
Is just that I'm not paying enough money?
$150 p/m because we don't pay for "extras", just hospital.
I don't even want to pay that, but Little Johnny Howard made sure i'd get screwed at tax time if I don't pay it.

 

[Zaf]

Removed by user

 

[c3024446]

You're implying is not the system?
Is just that I'm not paying enough money?
$150 p/m because we don't pay for "extras", just hospital.
I don't even want to pay that, but Little Johnny Howard made sure i'd get screwed at tax time if I don't pay it.

Ours doesn't include extras for that price. What does your policy actually cover? It sounds like one of those junk policies that cover nothing except removing the surcharge requirement.

 

[c3024446]

Oh, and you should be able to see another specialist to see if they will do it cheaper.

 

[Haakon]

I don't even want to pay that, but Little Johnny Howard made sure i'd get screwed at tax time if I don't pay it.

I'm earning enough (and because we're selfish evil DINKs...) that I get screwed at tax time too. But being the grubby socialist I am I'd rather spend more and have it spent on the public system. Its a society we live in. I pay for your kids daycare as well, that's just the way it works.

Libertarians and neocons can get fucked. Health and social support services are essential public services, not a source of profit.

 

[johnny]

Everyone one those doctors, as a consultant, are almost fifteen years in the making for the specialist qualification.

MBBS is a 6 year undergrad and a 4-5 year post-grad (depending on the UNI), and that gets you to residency, basic RMO doing rotations.
For most specialty programs, you then have at least two years worth of RMO work before you can apply. Once there, you have to make it through the specialty program, for a FRACS and FRANZCA there are another 5-6 years on their separate registrar programs (competitive years at that!!) and also include a fellowship year before qualification, and some very expensive exams to sit over that time...and college fees...and liability insurance and public indemnity...and study. That's before you even mention the shift work those two specialties are notorious for.

So usually, even if you started your training early, and depending on the specialist program you enroll into, you'll be late twenties to mid thirties before you're fully qualified and achieve any solid earning potential, and the first thing it goes towards is clearing a substantial debt for the training you've done. They then have their triennial reassessment to maintain qualification, the college fees don't end.

Most of them have worked many years in the public system before going into private to help clear debts and set up superannuation as well. I don't know any doctors who have gone into the profession for the money, that's not to say they don't exist, but I don't know any.

If you don't want to pay private, go through the public system. Personally, a $2500 out of pocket and being able to choose my own surgeon is a price I'd pay happily. I don't begrudge the system, there's a good mix of private/public sector in our system and it makes sense. I'm more pissed that nobody has gone back and fixed the PBS, because that gatekeeper system has become so fucking bloated and doesn't allow for bidding. There are substantial costs that can be saved with a few sensible tweaks to that, and nobody is doing it.

^^^This.

Secondly, and without going into what Howard did as I'm a dolt on that stuff - I'm not a fan of saying that regulation will fix everything. I'm no free-marketeer come-what-may, but the government telling private industry what they can and cannot charge for stuff is a dodgy space (again, I'm not an economist or market specialist, just an internet bigmouth).

Also keep in mind, as the population ages, demands go up on the healthcare system, which increases demand/prices (or so I've heard on the radio when the pros are discussing this issue, anyway).

 

[johnny]

I'm earning enough (and because we're selfish evil DINKs...) that I get screwed at tax time too. But being the grubby socialist I am I'd rather spend more and have it spent on the public system. Its a society we live in. I pay for your kids daycare as well, that's just the way it works.

Libertarians and neocons can get fucked. Health and social support services are essential public services, not a source of profit.

I struggle with this, mostly because I agree with it and am happy to pay taxes to help others out when they need it.

But I'm also for small govt and libertarian social values as well.

I'm so confused.

 

[Haakon]

^^^This.

Secondly, and without going into what Howard did as I'm a dolt on that stuff - I'm not a fan of saying that regulation will fix everything. I'm no free-marketeer come-what-may, but the government telling private industry what they can and cannot charge for stuff is a dodgy space (again, I'm not an economist or market specialist, just an internet bigmouth).

Also keep in mind, as the population ages, demands go up on the healthcare system, which increases demand/prices (or so I've heard on the radio when the pros are discussing this issue, anyway).

Regulation has its place. Free markets will sell poison baby milk formula if you let them, as well of course that there will always be a part of the population who needs to be protected from themselves... Just the way it is.

Dictating prices in an open market is another matter. I'm just saying there are some basic building blocks of a healthy functioning modern society that should not be in private for profit control. Health, public transport, electricity and water etc. Etc. These are the things that make for a happy healthy society, in which an economy can really flourish when its not being held back by a poor and unhealthy and isolated community too busy just trying to keep it together.

The issues Zaf points out are largely borne of the american corporate approach to education and the health system we have... We as a society should be investing in these people, not punishing them financially for wanting to help people...

Fuck it, Australia is just too dumb and gullible. Time to move to Norway.

 

[Tubbsy]

Time to move to Norway.

You know how much day care you'll be subsidising there, right?

 

[Haakon]

You know how much day care you'll be subsidising there, right?

Yep. Not as much as here... They keep the profits from their resource boom and spend it on social programs and invest it in the country's future. They dont let American oil companies offshore all the money.

 

[Haakon]

Anyway, I had PHI for years and when it came to really need it when I had hip surgery they found some loopholes and found ways to not pay me. $6K out of pocket. I still feel conned and stupid for ever having had it in the first place

"choice" is largely a fantasy for health providers. Most people who need serious health services cannot be making "choices" at times when they are least equipped to do so. And who really knows what they're asking anyway? No one lines up a bunch of orthopedic surgeons and interviews them to make a choice...

 

[Tubbsy]

Yep. Not as much as here... They keep the profits from their resource boom and spend it on social programs and invest it in the country's future. They dont let American oil companies offshore all the money.

Hmmm, that's still 'you' doing the subsidising. You don't get to pick and choose which parts of society are being bolstered by your particular tax dollars.

However it is a good point that Howard and Costello pissed Australia's sovereign wealth up the wall through middle-class welfare and committed to decades of gas exports at now-pathetic prices meaning locals pay through the nose for an abundant resource.

 

[johnny]

Regulation has its place. Free markets will sell poison baby milk formula if you let them,

Heavily regulated markets do the exact same thing, though. China’s melamine scandal as a case in point.

I’m not against regulation per se, and I agree with pretty much all of your sentiments in the rest of your post. As I said, I have no actual knowledge in this space, just gut feeling. But I know there are no easy answers for complex issues such as these.

 

[rangersac]

As others have said the $150 p/m is bloody low for family cover so I'm not surprised the OP is getting screwed. However I agreed with the sentiments of it being a shit system. Having lived in the UK for a long time every paycheck had a solid sacrifice to the NHS, but the benefit was that you knew that when something went wrong you weren't going to be forking out. That is the definition of insurance to me. Mind you, we had one child in the UK, and one in the public system here, and the Australian experience shat from a mile high over the delights of the Paisley maternity ward. There's also been several surgeries for the wife and kids which have gone generally swimmingly, although the major frustration is you never seem to know exactly how much you are going to cough up.

The bottom line is if you get a bit sick here you fork out a minimal amount, or if you are really in trouble everything is covered. Everything in between is going to cost, which is pretty fucked really.

 

[johnny]

My wife and I went through an unenviable experience early this year and I can’t tell you how well we were taken care of by both the public system and private companies in the healthcare arena.

Genuinely a lump in the throat experience just thinking how kind and charitable everyone involved was. It’s not always bad.