U.S. healthcare reform

Image via Wikipedia

I'm very interested in the current debate in the U.S. on Obama's proposed health care reform.
I decided to look up the subject on Wikipedia.
To my surprise there's no mention of Australia. Why Australia? Because we've had what Obama is proposing for the U.S. for over thirty years.

Want a first hand opinion of what it's going to be like? Ask me.

We in Australia certainly had a fierce debate on the issue before the reforms were introduced.
The only issue now is whether it should all be dismantled or not.

Our system is called Medicare (see Wikipedia system for details)

So here's my personal experience of Medicare.

The GP
I have a choice when going to the doctor. I can opt for a practitioner that 'bulk bills" or not. Bulk billing means my doctors fee is partially subsidized by the government. I pay a fixed amount while the doctor claims the balance directly from the government.
If I visit a doctor that doesn't bulk bill, I can go to a medicare office and claim a fixed portion of the bill (not a percentage) back from the government.

The Hospital
We have public and private hospitals.
Public hospitals are funded by the government and there is no cost charged to the patient.
Private hospitals charge whatever they like.
Public hospitals have emergency wards that are always full of patients waiting for treatment. Most of these patients are people who cannot afford or are not willing to attend a bulk billing clinic. Therefore a triage system operates. This means that if a patient is categorized as non-emergency case, they might wait for days to get treatment by a doctor.
The emergency ward system is also complicated by the shortage of available beds in hospitals.Even if you are seen as an emergency case, treatment still awaits the availability of a bed in that hospital.

Surgery
Surgery is also subject to the triage system. It is also subject to a value based assessment process. That is, if you are young, working and supporting a family, you go to the top of the waiting list for surgery. Old people are placed at the bottom of the waiting list. It's not uncommon for older patients to wait years before they receive surgery.

Administration
The government being concerned by the negative news of long waiting lists in hospitals, imposes performance targets which are rewarded with financial bonuses if met by the hospitals. Recently the news headlines were full of stories of hospitals that had made "mistakes" in the administration of these statistics. Many hospitals were involved, all claimed ignorance and innocence of these "mistakes". Waiting list statistics no doubt have been fudged.

Health Insurance
For those who choose to pay for health insurance, the choices for treatment are much better.
Patients can opt to go to a private hospital or a public (Medicare) hospital.
The problem is that public hospitals depend to a large extent on the revenue of patients who have health insurance. This means that these patients are able to bypass the triage process and get access to a hospital bed that is available for private patients. The system works like this, public hospitals have allocated beds for private patients and public patients. Even when the public patient beds are all occupied, even when there are people on waiting lists waiting for a bed, there are empty beds in hospitals waiting for private patients to occupy them.
You might ask yourself, why don't private patients attend private hospitals instead of taking up beds in public hospitals? Cost!
The health insurance system is structured so that nobody ever gets 100% coverage of medical/hospital costs. There is what is known as the gap. The gap is what a patient with private health insurance must pay after the insurance covers most of the cost but never entirely all the cost of medical treatment. Given the option of which hospital to attend, even though a patient has private health insurance, they will opt for the cheaper option.