 The State of Health Care
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Jan. 21st, 2012 @ 08:43 am 
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Yay, SOPA/PIPA are dead for now! That's awesome.
Imagine how much better life in America could be if the good people of the country could be stirred to speak up this way about trivial issues like health care reform, as well as vital matters like internet access?
I'm not saying that SOPA/PIPA weren't important, by the way. But America's current health care "system" is literally killing people, and metaphorically killing the American economy in very real ways.
I'm not going to go into details about that, but what I am going to do is talk about my recent experiences with the Australian health care system, and invite Americans to compare this tale with their own experiences and expectations in the USA.
On the 27th of December, I slipped on the stairs and, it turns out, broke my leg in three places.
We went off to Sir Charles Gairdner Hospital, I think the biggest emergency (and teaching) hospital in the city. (The other major one is Royal Perth; there are smaller hospitals dotted around the suburbs, of course, but those are the big ones. (Charlie's is the one nearest our house.))
We arrived at the emergency room at around 8:30 or 9am, I think. There were one or two people in the waiting room, but after a brief interview at the triage window, I was taken inside for examination, having been designated Fast Track.
Fast Track means your case is not critical, but *is* simple; when there's a free spot, you're taken to another room, inside, where doctors treat you promptly. From the times I've been there, usually everyone in Fast Track has some kind of painful, yet not life-threatening injury. If your case is likely to be more complex, you go to Observation, where there are many more doctors, and many more beds, and they're going to work out what exactly is up and how to treat it. (If you've arrived with a broken bone, or anything similar, there is a well-established protocol for how they're going to treat it.)
There's a big poster in the waiting room about their targets: the designated performance target for the Emergency Department is to have 85% of patients either admitted to the hospital or discharged from Emergency within four hours of arrival. Underneath, they write in how they're doing; when last I saw the board, they were at something like 76% overall, with 96% of patients who weren't admitted to hospital being released within four hours.
So. If you turn up at the busiest emergency room in the city, if your problem doesn't require hospitalisation, you've got a 96% chance of getting to leave inside four hours. If you do require admission, you've still got a 76% chance of being out of Emergency and in the hospital proper within those four hours, even taking into account time they may spend observing you and whatnot to make that decision.
Note that this does not mean that, if you require serious medical care, you are denied it - it just means that if it's not something that can be treated quickly and turfed out, the patient should be admitted to the hospital proper.
This is what happened to me. X-rays of my leg showed that I had snapped both my tibia and fibula just above the ankle joint, and the fibula again just below the knee. This qualified my injury as an "unstable fracture", which would require surgery to treat. A visit from the orthopaedic registrar followed. The ortho reg explained the surgery to me, and I signed some paper formally acknowledging my informed consent to the process, and I was wheeled out of Emergency to the fifth floor.
Sadly, I didn't get a private room - the hospital was under a fair amount of pressure for beds, as the private hospitals to which many private patients might have been transferred were all largely closed for the Christmas holidays.
Still, I was put into a room, a Jones Pillow was fetched to hold my ankle well elevated, and there I was in hospital.
It was three days before I had surgery - an ORIF procedure can't be done before the swelling has gone down, because you need enough loose skin to be able to close the incisions again. During those three days I was given gluten-free food that was really quite edible, and a steady supply of pain relief medication from friendly and pleasant nurses.
While I was waiting, I had a visit from a lovely woman from Occupational Therapy. She was there to discuss my equipment needs - what I'd require to be able to go home, and live my life safely. Around Thursday, I think it was, someone from OT went to my house to survey the situation - measuring distances, herself hopping from toilet to sink to couch, and suchlike, to calculate how exhausting it would be and what would be necessary in a given day.
Several of the people who passed through stays in my room were from outside the city - they'd been injured in deeply rural areas, and flown to Perth for treatment.
On the Friday I had surgery. I was wheeled to the OR's anteroom. Surgeons came over to introduce themselves, then the anaesthetists - two qualified doctors and a bashful-looking student. A few minutes later, I was taken into the OR itself, where more people introduced themselves - nurses, from the surgical an anaesthetic teams, mostly, giving me a sense of who this crowd of strangers was.
There were friendly, reassuring comments at my visible nervousness, people warmly telling me that it was okay, they did this every day, they knew this was strange and scary for me but it was totally normal for them, I'd be fine.
And then I was put under, and I woke up back in my room on the fifth floor.
Back there, the nurses supplied me with more painkillers, through the initial phase of post-surgical pain, than I would have thought possible. I had slow-release oxycodone, quick-release oxycodone, paracetemol, ibuprofen, and some tablets that I don't know what they were that you put under your tongue and wait to dissolve. They taste horrible, but they take effect really quickly, and are on a separate cooldown from the rest.
Thanks to this raft of medication, I was almost never in very much pain at all. Most of the time my freshly-drilled-into bones were a faint, easily-ignored ache in the distance.
On Sunday, it was decided by the doctors that I could go home. But, as the woman from hospital administration who came to see me explained, the physiotherapists and Occupational Therapy were refusing to sign off on my discharge.
"Yes, they talked to me about that yesterday," I said. "They want to make sure I'll be safe. They're coming later this morning to make sure I have the equipment for home, and the physio is going to be making sure I'm able to move around like I need to."
And so they did. The OT and physio brought a mobile wooden platform, so that I could, with assistance and supervision in the hospital setting, practice using a walking frame to hop up a low step - because there is a low step to be navigated in order to enter my house. Once I'd managed that properly, they assembled the equipment I was being assigned to take home with me.
This included:
- a seat with rails and so on to go over the toilet
- a shower chair
- a walking frame
The only thing they weren't supplying was a wheelchair. The hospital only provides those if you can't move without one at all, because they don't really have enough to do otherwise.
After that, all that was left was to wait for my medication bag. This was a plastic bag the size of a small pillow, containing a sharps container, thirty Clexane needles, and boxes of my anti-inflammatories and various painkillers.
Once that arrived, I was officially discharged. An orderly came to wheel me down to the hospital doors, while Dean, who had come to collect me, pushed the trolley loaded with the equipment and my bags, and so on.
A couple of days later a letter arrived, giving me the date of my next appointment at the orthopaedic clinic. I went to that, and got my stitches removed and a shiny new cast applied. In a few weeks I go back again, and get the temporary screw removed.
All of which amounts to a really quite excellent standard of care, I'm sure you'll agree. But would it bankrupt me? How much did I pay for all of that, you might wonder?
The answer: Absolutely nothing.
Not a cent. I was not presented with a bill, in person or by mail. Not even for the bag of medications to take away with me. No-one asked for anything except my name, my date of birth and my Medicare number.
And if you're American, don't be mistaken about what it means to have Medicare here. Medicare is not some special subset of care for old people, or poor people, or whatever it is there. In Australia, everyone has Medicare. Everyone. If you are a citizen or permanent resident of this country, you have Medicare. (If you're a tourist, the emergency room will take care of you anyway, by the way.)
How is it funded? Easily enough - when additional money was needed to pay for Medicare costs, the government introduced the Medicare Levy, which is paid alongside income tax, but is separate, because the Medicare Levy is only paid at all once you get above a certain income threshold. Effectively, the wealthy, who can afford and often have private health insurance, subsidise health care for the poor.
When this was introduced, the general reaction of the Australian population amounted to: "... That's fair."
The fact that the Australian government has a vested interest in health care costs has a raft of added advantages. Various medications that are sometimes necessary for people's survival, but which are very expensive, are subsidised by the Pharmaceutical Benefits Scheme; there are drugs which cost thousands of dollars a month, but which Australian patients will pay perhaps thirty dollars a month for - or less, if they have a pension or low-income Health Care Card. (Most of my meds are covered by the PBS; now that I'm on a pension, they're three or four dollars a month, where before they were over thirty.)
So if, for example, you're unemployed, the government further subsidises any health care costs you may be incurring.
Meanwhile, Medicare has a heavy market power with which to negotiate drug prices with the companies that manufacture them, which helps keep the costs down in the first place.
As of the latest statistics I can find, as a percentage of GDP, Australia spends 9.5% to America's 14.6%. Per capita, we also spend much less money in straight dollar costs. And our costs aren't rising as fast.
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| From: | ![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png) nellie_meg |
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January 21st, 2012 03:45 am (UTC) |
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"I'm on a pension"
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For non-Australians, "I'm on a pension" could need some explanation. In some countries, RSA for instance, the only type of state pension is the old-age one. Some employers, including govt ones, pay what's effectively a sickness pension, but it's usually called something else.
(Shortly after we arrived in Australia, we were amused to see in the newspaper a "Wanted" ad asking for a pram for a pensioner. In the context of "pensioner = OAP", this was highly unexpected, hence the amusement.)
if the good people of the country could be stirred to speak up this way about trivial issues like health care reform,
Oh, trust me, Americans have. The problem is that health care reform bills never seem to go anywhere in congress, or get gutted and revised into useless shadows of themselves.
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| From: | sami |
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January 22nd, 2012 02:05 am (UTC) |
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... which the American people, as a group, let happen.
You *could* hold your representatives to account. You could call them and write to them en masse. Hell, you could, in theory, form grassroots movements, like the Tea Party but less stupid, to do the biggest thing that would fix your country's politics: push for campaign finance reform, push like hell to reduce the power of lobbyists and corporate interests.
But that doesn't happen. American democracy is sold to the highest bidders every day. It's frustrating as hell to watch even as a non-American, but elected representatives aren't going to fix it until the American people make them. After all, no politician is going to kick away the ladder that put him into power, while he's still standing on it.
The thing that really broke my heart in the last four years is the degree to which the American people let Barack Obama, and themselves, down. Here was a candidate with massive popular support, vast crowds chanting, "Yes we can."
And then after the election, it seemed like everyone sat back and waited for him to fix things. The Republicans set out to block the hell out of everything he tried to do, and the American people let them, and the Obama Administration has been struggling uphill in the snow both ways to do anything worthwhile at all, and people blame Obama for that.
That slogan was a we, not an I. Obama made a pact with the American people, that together, he and they could fix things, and the American people did not hold up their end of the bargain.
![[User Picture Icon]](https://v2.dreamwidth.org/254881/16290) |
| From: | willow |
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January 22nd, 2012 07:39 am (UTC) |
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The thing I find most astonishing in all that? Is doctors and nurses taking time to tell you their names, and ask yours. And an OT going to your home to ensure you were going to be alright. Wow, am I bitter (or alternatively too exposed to issues in the USA).
**offered hugs** I am glad you had a positive experience after physical trauma though. That's marvelous.
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| From: | sami |
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January 22nd, 2012 12:28 pm (UTC) |
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Thanks. ♥ I'm doing better than I'd have thought I would be, three weeks ago.
With the OT stuff, Dean reminded me of the other part of that - if my house hadn't been safe (it has stairs to all bedrooms, but I can get up them safely by careful, housemate-supervised/assisted crawling) and I'd had nowhere I could go to *be* safe (my parents live in a single-storey house), then the OT people made sure to tell me that they would arrange appropriate accommodation for me.
All of this, writing the post especially, has sort of made me aware of how much Australians take our public health care system for granted. You have to understand, we have a general impression that the system isn't really good enough. That public health care in hospitals and so on kind of sucks.
It really, really doesn't, it's just that when you're in hospital, it doesn't really matter how hard they're trying and how basically excellent the standard of care is, the thing is that you're miserable and in pain and everything seems like it's made of hate and failure.
But our system is pretty good. The real tragedy is that America's apparently isn't half as good, for half again as much money.
I'm behind on journals and stuff. I hope you're doing well. **returned hugs**
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