}

Tuesday, August 23, 2016

We just get better

The photo above is of me holding a copy of the bill I received when I left the hospital last week. The joke is that the paper is blank. The reason it’s a joke is that we don’t get a bill. Instead, we just get better.

Like most developed countries, New Zealand has a single-payer healthcare system, perhaps better known in the USA has “socialised medicine”. So, when we leave hospital, we get instructions, maybe some prescriptions, and that’s it: We do not get a bill, and we have nothing to pay for our hospital stay.

This is not to say that it’s “free”, however, because we pay for our healthcare through our taxes. We’re all well aware of this fact, and we all support this arrangement. Most New Zealanders don’t have any form of private health insurance mainly because we don’t need it.

Some Americans like to declare that a national healthcare system like New Zealand’s are “bad” because they “ration” healthcare. That’s utter nonsense, and I’m a typical example of why that is.

They say that because things like surgery are done according to need, that is, the sickest are treated first. That’s not a radical concept, and it’s one we support. But even most elective, non-urgent surgery gets done in a reasonably timely manner.

What happened to me is typical. I was seen by a doctor who determined there was a problem, then I was sent to the hospital where I was evaluated and treated and sent home all within four days. And, my case wasn’t urgent in the same sense as someone who had just had a heart attack. If the sort of “rationing” that American commentators claim exists actually existed, I’d have been sent home to wait for the procedures that, in fact, I received promptly. Our reality beats their fantasy every time.

I did some rough calculations of the costs my procedures in the USA. This was difficult to do because everything is listed as ranges. Moreover, it’s difficult to work out what “extras” might be charged for, like drugs dispensed, consumables uses in my angiogram, three consultations with cardiologists, two with cardiology staff, two with pharmacists, and one with a nurse who deals with after care.

Nevertheless, looking at what I could work out and using only the non-insured rates (since they more accurately reflected the costs), by a VERY conservative estimate I’d have had a bill for $US18,370, though it could easily have been five or more times that amount depending on things like location. At today’s exchange rates, that works out to NZ $25,130.16 at a bare minimum. Instead, I paid nothing directly.

There were charges that I do pay. First, I’ll be billed for the trip in the ambulance, which I believe is now about $100 (it’s going up and I don’t know the new price). If we’d made a family donation to St John, the ride would have been free. I also had to pay for the doctor’s visit (which is subsidised by the government) and also $30 (today about US$22) for the ECG performed there, though had it not been urgent, I could have had that done for free elsewhere, too.

My prescriptions were harder still to compare. Based on what I found on prescription price comparison sites, I worked out what seemed to be typical prices. They all added up to about US$83, which today would be about NZ$113. I actually paid $25 (today, a bit over US$18).

Many Americans have prescription plans in their health insurance, and we have something like that: A government agency, Pharmac, buys our most common prescriptions in bulk, negotiating the best price. The most important drugs are fully subsidised (also called "fully funded"), meaning there’s no direct cost to patients, and some are partly-subsidised, meaning there is a charge for the drug to cover the difference between the manufacturer’s price and the Pharmac partial subsidy.

In my case, all the drugs were fully subsidised, however, the chemist (pharmacy) charges $5 per drug processing fee. This fee, set by the Ministry of Health, is the same regardless of whether the prescription is for three months or one month, which is why most people get a three-month prescription at a time—it makes the cost of the medicine negligible.

So, I had extensive hospital treatment for which I received no bill, the ambulance is run by a charity and I will pay about $100 for that, and I had to pay some routine expenses at the doctor plus a dispensing fee at the chemist. All up, I’ll be out of pocket maybe a couple hundred dollars for what would cost—at a bare minimum—over $18,000 in the USA.

I know that many Americans would argue that because they have health insurance, they don’t pay the full amount. The truth, though, is that they do pay for healthcare through their insurance premiums, and their taxes also go to the healthcare industries one way or another, in addition to whatever they pay out of their own pockets. The difference is that in countries like New Zealand, it’s simpler, more direct, fairer, and you don’t have businesses doing nothing more that clipping the ticket as patients are being treated. By that measure, our healthcare system is vastly superior to that of the USA: It’s virtually impossible for a New Zealander to go bankrupt because they get sick or are injured.

As I think I’ve made abundantly clear, the quality of the care I received was outstanding. I cannot possibly compare it to the USA (or any other country) because I haven’t experienced healthcare in any other country in decades, nor hospital care since I was a child, and things have changed a fair bit since then. So when I talk about how great the healthcare I received was, it's a declarative, not comparative, statement. Even so, I bet it was at least the equal of anywhere in the USA.

We don’t have “free” healthcare in New Zealand—in fact no one does. But the way we pay for healthcare through our taxes, and the fact we don’t get a hospital bill, makes ours a fantastic system. I simply can’t imagine living any other way.

We don’t get a bill, we just get better.

Update: The bill for the ambulance arrived.

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