Today I am a different one of the Seven Dwarfs. Today I am Grumpy. I think it is because the little car we've been lent has a terminal case of leaking water pump and the cost to repair it is somewhat more than I expected it to cost (over $500 vs the expected $100). $500 is a lot to fix a car but if it isn't fixed, it can't be driven more than about 25km in one hit and I was looking forward to driving up the hills and across to stuff on the other side of town. DH assures me some of it can by done by PT but that is tedious - eg 45 minutes into town on one train, 45 minutes out again and then a 2-3km walk to the plant nursery I'd like to visit. Then I'd have to lug plants back home again walking and PTing.
(Some not very restful water to calm me down - the Pacific Ocean just south of San Francisco)
So I've had a couple of requests to talk about Medicare in Australia. Our Medicare is nothing to do with the US version. I am going to call it Medicare from here on, not Oz Medicare or Medicare AU. Remember this is for Australia only. Another caveat? This is *my* experience of Medicare, it is not an official thing. I know a bit more about it than the average bear because I used to work for an income protection insurer so I had to know how to read Medicare statements (to see what treatment/tests our clients were getting). If you want to know more about how Medicare runs, check the website.
Medicare provides health care for all Australians and permanent residents of Australia. We get a card with our name and a Medicare number on it. Kiwis also get Medicare benefits (as do Aussies in New Zealand under a reciprocal arrangement). Medicare does not provide health care for those on visas or illegal immigrants - they need to have private health insurance. Most medical care is free if you have a health care card (ie have a very low income, are unemployed, on a government pension, etc). The rest of us have to pay an extra fee - a co-pay in American terms.
Medicare has scheduled fees for various medical tests and procedures. Each thing a doctor can do or each type or surgery or test or anything medical has an item number. That number is associated with a scheduled fee. For example, a CT scan has an item number of 56807 and a scheduled fee of $560. If I am on a health care card, it should not cost me anything to have a CT scan. But I am not on a health care card so I paid $659.90. For whatever reason, Medicare does not repay me the scheduled fee, no I get back $490.90.
Last week I had $1,200 worth of medical tests. I had to pay up front. Yikes! I took the receipts to a "local" Medicare office. They repaid about $900. That money went into my bank account.
When I go to the doctor, s/he charges a fee. The local GPs (general practitioners or primary care physicians in US terms) charge about $45 for a visit (usually about 10 minutes). I pay $20, the government pays the rest. Longer visits cost more. I usually pay up on the spot, and the doctor's staff charge Medicare the rest (sometimes by swiping my card, sometimes by taking an imprint, depends on the surgery).
Say later on today, I am rather silly and get run over by a bus whilst crossing the road. The ambulance takes me to Monash Medical Centre (the local public hospital). My care there is free. Ongoing care for things related to the accident are free. If I say I have private health cover on top of my Medicare cover, I get access to things like my own room, etc. I don't necessarily get better health care, I just get access to "upgrades." I may still have to pay something towards the upgrades.
How do we pay for all of this? Through that most dread, foul word (for quite a number of Americans and some Australians) TAXES! Oh yes, my fellow Aussies, our taxes pay for this government largess. I pay an extra 1.5% for Medicare cover and I cannot opt out. If I don't earn very much, I don't have to pay the 1.5%. If I earn more than a certain amount, I start paying 2.5% instead (unless I have private health cover - another story!). Most of us are happy to pay this money because we see it as being right and proper and necessary for people to have access to subsidised health cover, particularly the elderly and the poor.
Where Medicare falls down is when it comes to "elective surgery." This isn't stuff like cancer treatment or appendix operations, it is stuff where it isn't immediately life threatening. Say you fall over the cat and wreck your knee. After you get it all checked out, you need a knee reconstruction. You go on a waiting list. You can wait a couple of years on that list, particularly if you want a certain hospital or a certain surgeon to do that operation. To avoid this, people take out private health cover, if they can afford it. It means that you can go to a private hospital and get your knee fixed a lot quicker. It just costs you and the insurer. You will still have out of pocket expenses. Eg if I wreck my knee falling down the stairs, under the plan I have I will have to pay $500 and $50 a day towards my private hospital cover as long as I go to a hospital in the insurer's network of preferred hospitals and providers.
Note that if you are willing to go to a different or maybe a country hospital, take potluck on the surgeon you have *and* pay a small amount of money, you can get the problem fixed more quickly even as a public patient. DH had a small issue that he had to wait for 2 weeks to get into day surgery in a small country hospital 50km out of Melbourne. It cost him $50 for the general anaesthetic, the surgery and the aftercare. A bargain!
If I have a heart attack, my care is free at a public hospital. But if I only have angina and need coronary artery surgery, I go on a waiting list to have angioplasty at a public hospital. If I want to get it fixed quicker, I can get it done at a private hospital if I am willing to pay $$$$$ or have private health cover and will pay $$$.
I hope this outlines how Medicare works in Australia. It provides subsidised or free health care for all Aussies (and Kiwis). It is paid for by taxes and a levy on high income earners. It looks after us. We can take out private health insurance on top of our government cover if we choose.
In other news, Nathan and a friend are ripping up carpets and sanding floors at our house today. I discovered that I have something like TWELVE boxes of fleece awaiting my pleasure! Some has yarn in it as well. Yikes! It is a pity there is noone who processes fibre here in Oz cos it might be easier to get it processed than try to do it all myself. I haven't played with the fleece yet to see if it needs rewashing or anything.
(Not quite useless but very pretty lights that I took a shine to for some reason.... jellyfish lamps!)
Now to work out why I feel out of sorts. Maybe it's because I WANT MY CHEMO! I want my chemo so that I don't die. I can feel the lumps I have, it is hard to find bras/etc that do not rub on it and remind me that I have a Major Issue. Chemo might start at the end of next week. The appointments for my various tests have been made, well all bar one and that one might be in Frankston. The little car, if not fixed, will not make it to Frankston, and taking PT will mean a bus, a train and a bus, if any buses go in the right direction. Plus one test is going to be at 7:30 in the morning! I am awake most days by then but this means showering and getting out the door early. No breakfast either cos I have to be fasting. Ah well, I signed up for it full knowing what I'd have to do!
Or maybe today I am just grumpy. I can't figure out what I want. Normally I have some degree of self-awareness. I want to fill the gap in me that this diagnosis has created but there is nothing that can fill it - not the best wishes of friends and families, not a teddy bear, not Stuff, not anything but me working out what the hole is and how to fill it. What is it that I am looking for?
I think I am looking for a future, a future without worrying whether I have a future. There's plenty of little things to worry about without worrying about Big Things. I don't need the extra worry. Two months ago I was bold and carefree, ready to take on the world. Now I am having to take on me. That is much harder!