Tuesday, October 04, 2016

Healthy societies

Most societies believe that health is a human right. Some don’t, and others consider it more of a luxury. It all comes down to how it’s paid for, and that determines the outcomes not just of health, but also the progress of that society.

When I talked about my own healthcare adventure, I said that in New Zealand, “We just get better”, because we do: We don’t get hospital bills, and we don’t pay directly for such healthcare costs because we pay for healthcare through our taxes. As a result, when we have an illness or injury, we can concentrate on getting well, and not focus on how we’re going to pay for it.

I recently saw a Facebook discussion that reminded me of what I used to face. A friend in the USA was commenting on paying off a hospital bill, apparently after many payments. Someone else was looking forward to soon paying off their hospital bill from surgery in December of last year—but was mindful of new expenses to come. Yet another person commiserated, having had to pay a lot for cancer treatment, even with “good” health insurance.

My experience was nothing like theirs. What did those people have to forgo while paying off their medical bills? What things can Americans NOT do because they have to pay medical bills that New Zealanders do not?

This is the problem with a system that relies on people having to purchase private health insurance: The costs are not just in what they pay in premiums, nor is it just the “co-payment” they have to make in addition to their premiums. The problem is that they always have to worry about what happens if they’re sick or injured—what things will they be unable to do or to afford?

The Affordable Care Act was a much-needed reform, making the broken US system work a little bit better. But until the US moves to a single-payer system like the rest of the developed world, Americans will continue to have to sacrifice and deny things—even essential things—so they can pay their medical bills beyond whatever their insurance pays, and they’ll continue to have to worry about how they’ll pay for everything else if they have a major health problem.

I’m not against health insurance as such, but it should be a supplement, not the main way healthcare is paid for. In New Zealand, people with private health insurance can be treated privately and sometimes faster than they can in the public system. If that’s what people want, they can pay for it, but otherwise their healthcare is paid for through their taxes.

The one thing the New Zealand system doesn’t do well is income replacement for people who face long rehabilitation from accident or illness. They may qualify for benefit (“welfare”) payments, but it probably won’t be what they were earning. That’s why those on higher incomes, or who are sole earners for their families, may choose to carry income replacement insurance. This, too, is optional, and it’s the closest the New Zealand system ever gets to the American system—and even that’s not at all close for most people or most of the time.

The discussion I saw on Facebook made me feel sad for the folks discussing their clearly large hospital bills. We don’t have those worries or extra expenses: We really do just get better. I just wish my fellow Americans could, too.

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