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Figure: international EM, Medicare, medicine in Australia, private health insurance, socialized medicine
FigureA rose is a rose is a rose is a rose. So wrote Gertrude Stein, initially in 1913 and subsequently in modified states over the next several decades. Many have debated the meaning at the heart of the phrase, but she used it in many instances as a way of exploring semantics; it forms part of a law of identity, where the use of a name confers automatic imagery and understanding in the mind of the reader.
Today I lay on the EMN-column table the term “socialized medicine.” First, two facts that you are probably all over: Australia has socialized medicine, and socialized medicine is a bit of a dirty word in the United States.
I cannot speak for the latter, but I can posit some theories from working inside the Aussie system. Somehow socialized has been equated with socialism, which itself has been confused and matted together with communism, and we all know communism is a failed paradigm and dead politico-economic philosophy. Ergo, the same must apply to socialized medicine.
Socialism, of course, has softer defining terms than communism: the things that matter are owned and distributed by the public rather than in the hands of private ownership. Marxist theory has it that socialism is somewhere in the liminal space between the overthrow of capitalism and the realization of communism.
In Favor of Socialized Medicine
But, if I may, let me speak a few words in favor of socialized medicine. The interchangeable terms for socialized medicine are “universal health care” and “public safety net.” Without going into the mildly tedious history of it, we have only had it since 1984, and it is bankrolled through the federally tax-funded Medicare system (an approximate two percent levy on a resident's taxable income). But we also have a thriving private sector, which caters to those who have taken out private insurance (about 44% of the population), making it a hybrid scheme.
Interestingly, the two systems have buddied up and helped each other during tough times, such as the pandemic, with hospital beds being leased to the other for capacity and dividing and (occasionally) conquering the tricky increases in workload. The private system is still partly underwritten by the government; the costs are shared for every patient who goes through the system.
Australian health care is far from perfect. And when I say far, I mean the sort of distance where you still cannot see its horizon even when you squint. We have a hamstrung standoff between state and federal funding (often allowing both to put their hands over their ears and say it's the other one's problem). We have cost-cutting to the point that the system is groaning under the writhing human weight of emergency department presentations.
We have the government undercutting doctor's fees in the system so that the costs can shift back onto certain patient demographics. Inefficiency and complacency can seep in when no incentivizing fees are paid to health workers. Public outpatient clinics in hospitals are drowning, some with unacceptable wait times. The system has a long way to go in how we manage the disenfranchised, the underprivileged, the vulnerable populations.
All Treated Equally
But what we do have is the safety net. Nowhere is this more obvious than in EDs. Nobody is turned away, certainly never for financial reasons. Even those who are not Australian residents or covered under Medicare are treated equally. I find the latter fascinating. When “undocumented” patients arrive needing care, the clerical staff is required to tell them the costs, but we always follow it with a wink. The bills are never pursued.
One of the greatest conflicts currently facing humanity is equity, and at least our system goes some way toward that. And overall health outcomes? They also benefit. The macro indicators are favorable with a sturdy hybrid system.
Some of the Australian numbers speak for themselves. Life expectancy? 82.9 years. Infant survival rate? 2.5 deaths per 1000 live births. Maternal mortality rate? Six per 100,000 live births. Australia also has the lowest cancer mortality rate in the world, partly a result of a robust nationwide system that provides not just universal health care but benchmarked standards among all health care sites.
So, yes, we have a way to go, but socialized medicine is unarguably the greatest strength we have to provide the most equitable health for a population, even in a country where the wildlife is intent on killing us.
Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novels Tiny Uncertain Miracles (available Nov. 3) and Dustfall, available on her website, http://michellejohnston.com.au. She also contributes regularly to the blog Life in the Fast Lane athttps://litfl.com. Follow her on Twitter@Eleytheriusand read her past columns athttp://bit.ly/EMN-WhatLiesBeneath.
