By Marie Shieh
The Kansas City Star, May 27, 2017
President Donald Trump, I heartily agree with you when you told Australian Prime Minister Malcolm Turnbull, “You have better health care than we do.”
You see, I have been both a patient and a doctor in the U.S. and Australia. After working and studying as a family physician in the U.S. for almost 20 years, I landed my dream job working in Australia in 2015. I love working within this excellent health care system where doctors and patients are supported by a program called Medicare. It is similar to American Medicare but covers every Australian of every age for most health care costs.
Patients pay a small out-of-pocket fee, based on income, for things like medications ($7-$30), doctor visits ($0-$30) or X-rays ($0-$40). As their primary care physician, I can decide to charge a copay (children and seniors are always free) or stick with the basic Medicare reimbursement. For example, I might not charge patients I feel might not return for a follow-up visit. The choice is mine. Unlike working in the U.S., I never worry about bringing people back to the office to be sure they are getting the best care.
My Australian patients are not afraid to come see me and get tests done. They can visit physical therapists, dietitians, exercise physiologists, diabetes educators, chiropractors, podiatrists and osteopaths. I do not worry about patients not being able to afford an electrocardiogram, blood tests, radiology tests or medications like I did in the U.S. I can send my Australian patients to the hospital and emergency room, and unlike in the U.S., they are not afraid to go for fear of medical bankruptcy. The hospitals here are of excellent quality.
My Australian patients get care when they need it, not when they can afford it. By contrast, my American patients would routinely avoid care and treatments for fear of cost, leading to complications and extended sickness.
Australian Medicare provides high-quality, compassionate care to the elderly and disabled, which allows my patients to live with dignity at home, not in nursing homes. Take two of my patients, an elderly couple: The husband is 90 years old and the wife 81 years old, with mild dementia. They receive regular home visits from nurses who conduct assessments and dispense medication. They might get a cleaner every two weeks if they cannot get down to scrub floors or bathtubs. And speaking of bathtubs, they get handrails installed for a substantial discount, to keep them safe from falls. These common-sense measures keep patients healthy and cut down dramatically on hospital costs.
My Australian patients with advanced or terminal illness get home visits from me if they are too weak to come to the office. They receive palliative care in their homes, on par with the best treatments I have seen in U.S. hospice care.
Compare this to my experience as a patient in the U.S. I had my first baby in 1992 while in medical school. Even though I carried insurance and enjoyed a normal, unmedicated delivery, we got hit with a bill that was five times our monthly rent. Instead of enjoying our first weeks home with our new son, we spent that time haggling with the insurance company and being threatened by a collection agency. On top of that, our son wasn’t covered for the care he received right after being born, and we received a bill for the newborn check, none of which was covered by our insurance. This would never happen in Australia.
President Trump, you were right. We do have better health care here in Australia. Don’t you think Americans deserve the same?
Marie Shieh, M.D., is an American physician who now works in Australia. She was born in Salt Lake City and raised in Kansas City.
follow-up interview with Dr. Shieh: