Two Tiers (Part the Second of n)

"In a country well governed poverty is something to be ashamed of. In a country badly governed wealth is something to be ashamed of."

Confucius

"And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me."

Matthew 25:40



"The degree of civilization in a society can be judged by entering its prisons."

Feodor Dostoyevsky


"The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped."

Hubert Humphrey

Dr Dork notes a quintessential contrast in what he perceives of the US and UK systems, and of those exponents and critics of their approaches to healthcare.

The NHS is disparaged as “socialised medicine”, as if that is a failing unto itself. Of course, private companies driven by shareholder profits would not exactly be more compassionate, one thinks, in attempting to distribute a limited resource unable to keep pace with demand.

The US provides well, but at great direct financial cost to its users. Dr Crippen, of interest, pointed out the frighteningly high correlation between medical costs and personal bankruptcies in the US. Yet, as far as Dr Dork can infer from his US colleagues, the system is underpinned by a “socialist” Medicaid network.

Australia is a mixture of these two approaches. Here in Oz, we have traditionally operated primarily as a public healthcare system for the most part. In recent years, there has also been increasing growth in a separate private healthcare system. Rather than funding by largely employer sponsored insurance, as in the US, ‘private’ healthcare is funded generally by paying insurance premiums oneself. The exception to this rule is occupational health problems, wherein the cost of treatment (whether via the public or private system) is funded by the employers insurance.

This system is inherently possessed of two tiers of care level – in many areas, but not all. The public system struggles to meet demand in many areas. Emergency departments get overcrowded. Waiting lists for elective surgery are sometimes ridiculously long, and numbers are politically obfuscated. Only in the private system can you choose your doctor, choose your hospital, and not spend several months on firstly a waiting to be seen list, then a waiting to be treated list.

However, for acute, devastating injuries and illnesses, public hospitals are, arguably, much better equipped. Larger and better staffed ICUs, for example. Medium level staff always onsite.

One important annotation to the ‘private’ system is that health insurers in Oz are not-for-profit. There is no CEO earning $30 million in bonuses. There are no shareholders demanding cuts in coverage to boost their stock portfolio.

As mentioned in his previous post, Dr Dork is cogitating out loud on the two-tiered system in which he operates. This is further groundwork.

There is more to the story than this précis. Arguments for and against each approach. Dr Dork would love to hear from others experienced in multiple healthcare systems, as health provider or patient.

To echo the sentiments of Dr Crippen, in large part, Dr Dork is open in his bias: he believes healthcare is a right, and not a privilege, in any civilised society. Tax-based support of the public system in Oz is positively biased to place costs moreso on the wealthy who do not self-insure than the poor (the Medicare Levy).

It becomes, one could say, essentially an argument of efficiency and management, of finite resources confronted with ballooning demand, as our knowledge of the health sciences grows, and our populations age demographically, and live longer lives. Neither approach seems sustainable in the long term.

More on this at a later date. Your opinion is welcomed.