Oz Medicare

G'day all!

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!



  1. I think you are well and truly entitled to have an off day, man you have had a lot to face in the last few weeks. Any wonder you are out of sorts. Give yourself a break,you're the only one that can.

  2. Yep I agree!!Go ahead and have a grumpy even a yell or two!!!This came from my MIL when she was treated!Also when you start Chemo your immunity is stuffed up so you wont be able to wash those fleeces or so Im aware.
    I love your Chemo hat,Ive just finished the one I was working on,hoping to to do a sock head one in Cashmere,in eletric blue
    Great peice on Medicare!!I was talking to a lady at school today whose come through Breat Cancer treatment,she was a +2 level,the treatment was free at the new Cancer place in Perth as a Public patient but another lady was out of pocket $4000 after claiming her insurance.My MIL sat in Centrelinks office and refused to leave until they gave her a health care card and sickness benefits 'cause she couldnt afford to travel to Sydney for her treatment.Its what you know and how to use that info.
    Thinking of you!

  3. Nice precis of Medicare!!!
    Bah humbug about the car though.
    12 boxes of fleece and other nice things?? What fun!!!
    Try to get used to the waiting: there will be a lot. It is strange and unnerving the way your life is pottering along nicely and then whammo, it isn't any more.
    (Now I am forced to hum that Take On Me song by a-ha: thank you very much for the ear worm!!)

  4. Hi Lynn
    thanks for answering my question about Medicare in OZ. Re your grumpiness and your feelings about the road you now have to take -- I remember being at some nursing seminar about childbirth and the instructor talking
    about helping people face the fact that their child is born with a disability. She likened it to being on a plane (that's the pregnancy) and heading off to live in a foreign country (childbirth)after taking language lessons, and reading up on the culture and psyching yourself up and being prepared and all excited only to discover that for some inexplicable reason the plane has landed you in a DIFFERENT foreign country, where you don't know a word of the language and the people are strange and the customs are not what you studied up on and this is not what you prepared for at all. It's as if you've been swept up and kidnapped against your will and now you have to try to adapt and cope.
    I feel for you, although of course I can't even begin to understand every aspect of your experience. Of course having a sulky little car that keeps conking out on you is not helping matters either. Hope it's easily fixed and that it behaves better.
    cathy underscore loughman at yahoo.com --- email me if you want me to bring you a treat from California --- I will be arriving in Melbourne on Monday Feb 1 staying with my sister in Glen Iris before heading up to the Riverina for the rest of the week.

  5. Have you asked the grease monkey if you can get a reconditioned part? Doesn't cost to ask...

    Also, don't forget to talk about the cost of the ambulance (versus ambo subs), when you talk about a trip to hospital.

    As far as fleece processing goes, do you know about Supa Soft? They specialise in alpaca, but advertise regularly in Treadles, and I think they will do fleece too. No idea on costs, sorry, and NAYY. www.supasoft.com.au

    And I hate the idea that we're "not allowed" to be grumpy, especially when you have good reason. Since when has there been a rule that these emotions are "unfeminine" but not "unmasculine"? Grump away, you're entitled ;)

  6. Lynne, I am way behind on blog posts and just read your news today. You are doing the only thing you can do, which is to keep on going.

    Our local fitness center does a Lance Armstrong Foundation fund-raiser for cancer victims and survivors every year and they have a big banner posted that says "Attitude is everything!" At first I thought that was silly, as attitude doesn't cure cancer. But then I realized that the situation is what it is; you can curl up and do nothing, or you can keep moving ahead and make the most of your life as it is. I guess I'd strive for the latter, as you seem to be.

    As for your Medicare system, wow. I am so jealous. The US is sooo messed up. My family currently is without health insurance but there's nothing we can do; the economy is bad, our income is suffering, and here insurance is tied to employment so the self-employed get a raw deal.

    When we had insurance, we were paying between 5-10 percent of our income for it, with a $5,000 deductible! That's a "major medical" policy that only covered serious problems; regular checkups were charged at full price and didn't even count toward the deductible! Now we have nothing and we're still paying out of pocket for doctor visits but with no premiums. That can't go on but in the short run we're saving money; we cross our fingers and hope for good health.

    Not sure why the US is so against universal care but taxes are considered a sin here for some reason. Vermont is very progressive and with any luck we'll institute a state health care system that can be a model for the rest of the country. Soon, I hope.

    As for you, take care and take good care of yourself. I'll keep reading.

  7. Hi Lynne,

    Just remember, you can always come and swap the Barina for the Astra for longer trips; anything'd be better than trying to PT to Frankston. Also - there is great power in grumpiness - harness your pissedoffness for the greater good.

  8. Interesting write-up of Australian Medicare. Quite a few similarities with our NHS - funded by taxes (that is technically what we pay national Insurance for, on top of Income tax), free stuff for benefits etc. recipients.

    Here we don't pay for any GP appt., hospital procedure, tests, operations, anything if we are using the NHS. We do pay for prescription drugs, a set fee, currently £7.20 I think. However there are many people who get free 'scripts, benefits recipients, children etc. Apparently the minority actually pay for them, including me. Ther is some talk about not having to pay for ongoing/indefinite meds, as opposed to one-offs like antibiotics, I'll be surprised if that actually hits the statute books. Make sit worse that in Wales and Scotland they are free for everyone, the power of regional assemblies.

    Lots of places exhorting us to buy medical cover, BUPA being the big player. Exactly the same as Aus in that if it isn't a life-threatening thing you can end up on a long long waiting list, so some people do go private. However for serious stuff the NHS are pretty good and get you sorted out. Can't imagine a system where people can't afford healthcare, we got rid of that last century.


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