No doubt I’m not the first to comment on the fact that Therese Rein had her gallbladder surgery at the Mater Private Hospital. I’m certainly not casting stones, as I had my gallbladder removed at St Andrew’s Hospital in 2004.
Complaints regarding gallstones are often highlighted to demonstrate what’s wrong with waiting lists for public operations. Gallstones can be incredibly painful – it is very difficult to write about pain, because as a number of writers have noted, it literally defies expression. But suffice it to say that very severe pain for about two hours, often at an ungodly hour of the night, which almost nothing short of morpheine or similar painkillers can relieve, is very far from being pleasant, and though the pain is intermittent, it can be very difficult to work because of the loss of sleep and the general feeling of enervation when you have severe gallstones. Gallstones, left untreated, as I’m well aware to my cost, can also lead to some very nasty complications, and in some instances can also lead to things like pancreatitis and worse. Even if that’s not the case, waiting for an op can be quite awful, though the operation itself, if done by a good surgeon, is pretty straightforward in the absence of complications, and can be done by keyhole surgery, requiring only an overnight hospital stay.
Incidentally, if the articles are correct that Rein has had a recurring problem, based on the advice I received, she might have done better to have her gallbladder removed – unless much has changed in the last four or so years, I was told that dissolving the stones surgically doesn’t stop them recurring. But that’s neither here nor there. At the time I had the operation, the wait in Queensland was nine months, and I was able to have the surgery done basically to fit my own convenience in terms of work within a couple of months of the diagnosis. As it turned out, I ought to have had it done earlier (which would have been possible) because between the first ultrasound and the actual surgery, a lot more had gone wrong.
I took out private health insurance when I was 30 because of the inducements offered by the federal government (lifetime rating, and lower Medicare rebate), and I envisaged getting most benefit out of it through rebates on dentistry. But I was fortunate to have taken out hospital cover. However, the whole business of being ill was still expensive – while the hospital’s $500 a night bill was covered, the gap between the Medicare schedule and the fees of the surgeon and the anaesthetist were not, and then there were the gaps in GP bills and radiography costs. I think I worked out at the time it cost 8 grand all up, only about 5 grand of which was covered by either insurance or Medicare. It also sorted out the wolves from the sheep in terms of my employers as a sessional academic – some were happy to keep paying me even though I wasn’t well enough to teach, one reacted so unsympathetically and refused to offer me further employment despite having worked there for four years that I considered taking legal action against them. Certainly it was a much bigger strain on my budget both through the upfront costs and income foregone than it would be for Therese Rein.
Despite the money the Rudd government is pouring into the public hospital system to clear waiting lists, I can’t help thinking the continued support for the private system and private insurers will continue to drive and reproduce inequality. The claim from Howard that private hospitals would take pressure off public ones has to be one of the biggest ideologically motivated con jobs ever. There will continue to be incentives for those who can afford to do so to effectively opt out, and the existence of a two tier system will continue to make it less politically palatable to spend on public hospitals if a significant section of middle class voters believe that they’re some sort of residual safety net for the poor – this is the whole point of universal public provision. Although it’s hardly perfect, that’s why the British NHS is well worth defending, and I was very struck by the argument made by Neal Lawson in The New Statesman:
The purpose of any centre-left government is to use the state to ensure that accidents of birth do not blight people’s lives. The brute luck of not being born rich, bright or healthy demands social action to ensure that all have the resources and opportunity to make the most of their lives.
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If Brown wants to use the gap before the next election to put the NHS on a sound footing he must start by understanding it as a political entity. It is a social democratic bubble in a capitalist society, a place where we feel free from commercial pressures but that can’t avoid being contaminated by market forces and values surrounding it. It is perhaps the key battleground in the ongoing struggle between society and the market.
…
Through our collective voice, we demonstrate the common ownership of the NHS as a site of social citizenship, which we value not just because it makes us well, but because it makes us more equal and puts us in control of our world. Democracy is the means and ends of the good society.
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If Labour cannot popularise the National Health Service as an institution that embodies the values of the left, the notion of solidarity will come under threat of extinction in an increasingly individualised and consumerised world. After all, we should all be equal in our pyjamas.
Great post, Mark.
The NHS as ‘Social Democratic bubble in a capitalist society’ is an apt image!
Yeah, he’s a dab hand with the pen that Lawson fella.
Unfortunately, the Public Health System will always be struggling to be reformed because of the Militant Doctor’s union aka the AMA, who make Kevin reynolds and the CFMEU look like Boy Scouts.
Talk about a Closed Shop.
“Complaints regarding gallstones are often highlighted to demonstrate what’s wrong with waiting lists for public operations.”
I’m thinking the complaints would better serve demonstrating what’s wrong with dietary practices in Australia.
A large percentage of the population is never going to trust the state with its healthcare. Both British and Australian public health shows why. The only way to align the incentives is for the same fees to be paid to both public and private hospitals for a given operation – if people want extras like their own room etc they can pay more for the private option, but there are shared interest in the underlying fees for medical services.
This may sound very patronising and penalising,but gallstones do not happen by accident,and there are even methods non surgical intervention that have been done under medical supervision.The non-medical methods now dumped upon by the lazy end of the ALP elite by not wanting to think for themselves ,but be the empty vassals of medical thought at its convenient worse,will not move towards other medical modalities and the unfortunate term complimentary medicine.Non-invasive treatments without pain do exist either medically or alternatively so I think you got the worst type of treatment and advice.Having lived my life and hear about gallstones occasionally, I think, these matters are not solely a political philosophical problem of bubbles of social democracy,but the ability of individuals to choose and pick out maybe even some terrible justifications,economic,keeping patients in the dark.
“The only way to align the incentives is for the same fees to be paid to both public and private hospitals for a given operation ”
Does this include the ides of raising the fees so the doctors will be happy to do the operation in either system?
If you enforce the reverse ie impose state mandated fees the doctors can always opt out of work in the public system. Do you think it feasible to set fees for private medicine and surgery ? Is it even legally possible?
Juniour specialists need to start in public hospitals and train under supervision but if the senior specilists have a big enough private practice they may not be so co-operative with your plan. The public is then left without the access to the most trained doctors and by extension possibly the better levels of care.
Mark’s implication that there are no out of pockets if you get your operation done in a public hospital, is wrong. This is only true if you don’t choose your own doctor. If people are in a bad car accident and get taken to a hospital for an emergency operation, then they won’t choose their own doctor. But most of the time, operations will be scheduled, and they will choose.
If I need a gall bladder operation, I will be referred to a surgeon by my GP. The surgeon will typically say, “I do my operations in public hospital X and private hospital Y”. If I have private health insurance, he could schedule me in for either one. If I don’t, then I go the public hospital. Either way, I am up for out of pockets on the surgeon’s fees.
Private health insurance allows people to have elective surgery in a private hospital, or be treated as a private patient in a public hospital, and so not wait in queues. And they can have better rooms while they are in hospital. But that is just about it. In fact, since people with private health insurance nearly always choose their own doctor, they are more exposed to large out of pockets than people without it. Which is truly weird, because the purpose of insurance is surely to make people less exposed to financial risk, but private health insurance does the opposite.
If you’re ever rushed to a hospital in an emergency and you’re asked whether you have private health insurance, say no, even if you have it. Since it’s an emergency, you won’t get to choose your doctor anyway, and as a public patient, you pay a cent.
“A large percentage of the population is never going to trust the state with its healthcare. Both British and Australian public health shows why.”
>
Surely that’s a bit disingenuous, Andrew, when for many operations you’re getting the exact same surgeon and anaesthetist whether you’re under private, or public, and it’s simply the day of the week or sometimes (but by no means always) the venue that changes.
There are very few fully private surgeons, etc. in Australia, so the difference – at least in this regard – is largely illusory.
Just out of curiosity, what would you define as a large percentage, anyway?
Obviously written by an Englishman.
âA large percentage of the population is never going to trust the state with its healthcare. Both British and Australian public health shows why.â?
Oh yes, and what might US “public health” demonstrate?
Frankly, if the right ever ever pushed a genuine rollback of medicare, they’d find themselves a fringe group within a month – hardly bothering the EAC on poll night.
I’d abolish the 30% rebate to private insurers tomorrow. If you want private, go private, dont suck on the public teat.
Naturally, private patients should get medicare rebates like the rest of us. I dont actually mind paying my “penalty rate” medicare levy. But why am I subsidizing someone to opt out?
Oh, and sorry to hear of those travails, Mark. Didnt know! Hope all is well now.
But that is just about it. In fact, since people with private health insurance nearly always choose their own doctor, they are more exposed to large out of pockets than people without it. Which is truly weird, because the purpose of insurance is surely to make people less exposed to financial risk, but private health insurance does the opposite.
If you’re ever rushed to a hospital in an emergency and you’re asked whether you have private health insurance, say no, even if you have it. Since it’s an emergency, you won’t get to choose your doctor anyway, and as a public patient, you pay a cent.
Thanks, Spiros, that is how I have seen the system working but I wasn’t sure if I was correct in my perceptions, as it seemed so counterintuitive that private insurance actually makes things more expensive.
And we taxpayers subsidise people to take it. Grrrrr.
Yep, gets my vote for the worst, most inefficient piece of social policy in Australian political history.
Plus, of course, the “rebate” merely increases the price of the insurance, dollar for dollar in most cases. Like flushing tax dollars down a toilet.
I agree with you there, but I’d also increase the medicare surcharge, especially for high income earners if they don’t have private cover. Its pretty clear that medical costs are increasing at a much higher rate than inflation, and for those who decline to insure themselves but could afford it, they should pay more to the public system to fund the increasing costs.
I think that in many cases its not a problem of doctors refusing to work under the public system at the current rates, its that the government doesn’t allocate sufficient funds to pay the doctors for all the operations they could be doing.
btw is anyone else having problems with submitting two comments in a row? I get an error about not filling out the name/email fields, but they’re not visible when effectively logged in.
Yes, as I said, Chris, Im quite happy to pay a surcharge as a high(er) income earner.
But frankly, I wonder whether it is in any way true in Au that “declining to privately insure” passes costs to the public system.
Private patients still get the same medicare rebates (ie no real public savings there) – and are then charged more on top. Plus the research is pretty clear that the “reducing the public queue” argument has proved empty. Many privately insured got absolute minimum coverage when the penalties came in, and end up in public hospitals when surgery is required regardless. Just a different billing system.
I think the stronger evidence is the 30% rebate merely takes scarce health dollars out of the health system, gives it to private insurers, who then piss 14% of it up against a wall (compare with 4% admin costs on public), and charge the consumer the entire amount they received from the public treasury.
Net health gain zero.
I don’t see anything wrong with this. After all, so many ALPers send their kids to private schools, why not their gall stones to the private hospitals? And just like the ghastly public schools, the public hospitals are also financed and managed by the states. La Rein is thus quite justified in throwing a NIMBY on this one. You Go Girl!
I had foot surgery two years ago, and without hesitation I opted for the private path. My bulk-billing, suburban, martial-arts sports doctor really knows his stuff, and referred me to one of the best sports surgeons in town. You’ll often see hobbling AFL players cornered by TV crews outside his practice.
As Mark has noted, it becomes a cast of hundreds and you end up paying bills for people you didn’t know existed. Would I do it again? Absolutely. The surgeon was worth every cent of his paranoid, poncey, professionalism. He and the private hospital were particularly efficient, and yet not sparing with the attention. The foot will never be perfect, but it’s close. I was out of pocket ~$3500, but I think it was worth it to have a great outcome with no follow-up required.
Meanwhile the guy who sits across the cubicle at work snapped his achilles during a lunchtime half-court press. He went through the public system. He had different doctors and disappointing care to the point where it got infected and had to be re-snapped, cleaned out, and then re-attached. Recovery time wasted ~ 6 weeks. All free, but I suspect you get what you pay for. Most of the time.
I expect I’m comparing the two extremes of both systems, but there you are.
Whence does this flaccid pussyfooting “social democratic” malarky spring? Back in my meat and potato salad days, it was known simply as “socialist.”
Which is to say, the policy was explicitly designed to prop up an allegedly “private” industry with public monies; and it effectively achieves that goal.
It was not designed to improve public health outcomes, nor to relieve stress on the public system. Thats pretty much why it doesn’t.
So not policy failure, per se, but rather, it was an industry policy rather than a health policy.
I think it we get the aims of the Howard government policy clear, we can have a better debate.
And basically, I find the idea that by sticking with a system designed to help all I am letting society down – well, rather bizarre!
LeftyE@11 and Chris@15:
I agree totally about abolition of the Private Healthcare rebate and increase of the basic Medicare Levy (a flat 3% for everybody might be about right).
Reasons:
1. Decent medical care should be available to all, equally, and should be provided on a not-for-profit basis. The profit motive encourages both attempts at over-treatment/use of more expensive treatments, and simultaneously reluctance of insurers to finance these treatments. Until commercial law is revised so that the interests of patients (“customers”) and employees are prioritised over those of shareholders, private insurers should not be involved in paying for medical care.
2. Healthcare is a natural monopoly. Everyone needs it, and demand for the important stuff is not very elastic. A single, properly run, non-profit provider could work just fine. If it doesn’t, change the management until it does. Advertising and reduplicated administration by multiple “competitors” is wasteful and inflationary. Since they all chase each other down to the lowest common denominator of service and maximum profitability, the apparent “choice” is phony.
3. While the Gap remains, the concept of insurance is a sick joke, in any case.
4. LeftyE is utterly right about the wrongness of public subsidy for private enterprise. Even more so when it is competing with a public provider. The Levy surcharge is a Howardite social-engineering atrocity. Why should anyone be forced to support some other Australian’s choice for private healthcare while neglecting their own? This sick scheme should be dismantled, along with the rest of Howard’s putrid legacy.
5. We should nationalise the private insurers, tame the AMA, and set the Medicare Levy at a rate that actually pays for the quality of care that we want.
I’m glad you got a good health outcome Craig; seriously, thats excellent. I could tell you the opposite from childbirth experiences among friends (eg private anesthetists playing golf, compared with public rostered specialists 24/7 at our public hospital) – but its not really the point.
Im happy for anyone to make their choices – the policy issue is about how those choices are funded.
If I need a gall bladder operation, I will be referred to a surgeon by my GP. The surgeon will typically say, âI do my operations in public hospital X and private hospital Yâ?. If I have private health insurance, he could schedule me in for either one. If I donât, then I go the public hospital. Either way, I am up for out of pockets on the surgeonâs fees.
I’m not sure that’s always true. A pal of mine recently had a hip replacement as a public patient and although he ‘chose’ his surgeon, he didn’t have to pay anything. (He was 8 months on the waiting list.)
I think you’ll find that many doctors work in both the public and private system. In the private system they get paid more for the same work due to gap fees and additional payments by the insurance companies. So in effect the private patient work is cross subsidising the public work (which is fine by me).
The availability of no-gap cover is probably helping a bit from the user of insurance point of view, but I don’t really know how widespread the adoption of it is. And I’d be concerned about getting into a US HMO type situation where medical procedures are declined on financial rather than medical reasons.
I think it would be better to abolish the medicare levy for everyone and incorporate it back into the normal tax rates. The existance of they levy fools people into thinking that the 1.5% or so that they pay funds the health system (ie that they’re paying their public health insurance fees), whereas in reality it comes nowhere even close. About the only thing it achieves is to allow foreigners working in the country to avoid paying more tax (as they need to get private health insurance anyway and not covered by medicare, they’re exempt from the medicare levy).
“So in effect the private patient work is cross subsidising the public work (which is fine by me).”
True, but that factor should be balanced against the medicare contribution (which I have no prob with) and 30% rebate (which I do) for a total health cross-subsidy figure.
In a net sense, the public purse is subsidising private choices, to the detriment of the public health system.
Basically: id like to see a genuine market in private health; and a health rather than protectionist industry policy approach to the sector.
I assume thats not a particularly radical position, but post-Howard, who knows?
LeftyE: well I could have gone into the public system and I doubt it would have cost a lot less to perform, it’s just that the state government & Medicare would be paying for it, not me, Medibank Private & Medicare.
The coalition policy is as much about coaxing people to pay for some of their hospital care rather than let the state governments carry the tab. It does that by giving patients a choice that’s worth getting their wallets out for. Sorry to hear your choice didn’t work out so well, but at least with a private system you can choose not to make that choice again. In the public system you have no choice other than which hospital’s ER room to park yourself in.
It’d be nice if the state had enough money to pay for everyone to go to a public hospital, but it doesn’t, and won’t (although I think most would back an increase in the Medicare Levy). The alternative is to relieve pressure on limited public means by encouraging private co-payments. This is about the best system for doing that.
At least in this country our medical expenses aren’t really legal expenses by other means like they are in the USA.
Fair enough Craig – and I guess Ive said my piece.
Just to clarify though – our choice of public hospital for childbirth worked out very well.
The negative story I referred to above were from friends of ours who went private. eg no anesthetists on hand when they needed them.
Patrickg – Private health insurance coverage hasn’t been below 30%, even without any subsidy. And there is always self-insurance on top of that – people just paying private hospitals themselves.
The point is not that you have high-risk care once in public hospitals; it is that you cannot get in when you want to get in and cannot get add-ons that are not medically essential but make an unpleasant experience slightly less so, such as your own room.
I’m certainly not going to limit my power to get the medical services I need when I need them to a vote every three years.
Although a recent study found that when it comes to having heart problems its now better to go to private hospital than a public one, because the public ones are under enough financial pressure they are doing less tests. Just a few years ago I’m sure the situation would have been reversed with the public hospitals better for emergency like cases because they have more experience. Not that you generally get to choose
in emergency situations
Andrew, this:
is nowhere near the same as this:
Your argument is at best disingenuous, and at worst deceptive. You do not have enough information to equate the proportion of the population who hold (some form of) private health insurance with the proportion of the population who are “never going to trust the state with … healthcare”. You’re going to need to try again, perhaps without the free market blinkers on.
Alister – Fair enough, ‘never’ was a bit strong. But that was data from the whole period since Hawke introduced Medicare, roughly 50-50 Coalition and Labor governments. So during a quarter-century of universal healthcare coverage, at least 30% were not prepared to accept the state as the sole provider of hospital care.
And we are seeing the same underlying problem happening again. The government has conflicting objectives; they believe that spending needs to be contained to keep inflation down. Frankly, if I need a hospital stay I don’t care about inflation.
There are strong theoretical reasons why governments won’t reliably deliver healthcare in the way some people want, and extensive empirical evidence as well.
And as we have seen, when the cost of private health insurance drops even more people take it out – suggesting that the underlying preference for private health is well above 30%.