Thursday, July 06, 2006


Aussi Medicine: Socialized and Working Fine

This comes from:


America’s medical system sucks, at least for consumers. The insurance industry loves it, the phameceutical manufacturers did it, and so do many doctors... However, there are functional alternatives that the US needs to consider. I don’t know how these will be considered, unless backers of alternative systems somehow manage to buy enough lawmakers to get things changed.

Good Health Care, Aussie Style

By Susanna Rodell

July 6, 2006 by the Providence Journal

Whenever the lament goes up about the awful health-care system
in America, there's a predictable response: Yes, we have our
problems, but this country still has the best health care in
the world. To those who still think this is true, I'd like to
introduce Billy Badger, of the Australian state of Tasmania.

Dr. Badger (a Ph.D., not a medical doctor) inhabits the office
next to mine at the University of Tasmania. He is a professor
of German. He is also the brand-new father of a baby girl.

Billy has no private health insurance. He and his wife,
Christina, have relied entirely on the public system for
prenatal care, for the birth, and for postnatal care of baby
and mother. I asked him to describe the experience.

"We had no idea what to expect," he told me. Both parents were
healthy and had never as adults set foot in a hospital. Upon
finding out they were expecting a baby, they went to a doctor,
who directed them to the maternity ward at the Royal Hobart

At the Royal, Hobart's big public hospital, they were given
the choice of three systems: 1) They could go to a birthing
center, run entirely by midwives. 2) They could go to a doctor
at the hospital. 3) Or they could stay in the hospital and use
a system called KYM, which stands for Know Your Midwife: At
prenatal visits they would meet all the hospital's midwives,
so that whoever was on duty when the time came, it would be
someone familiar. Christina and Billy chose the KYM system.

At first monthly, they visited the hospital's maternity unit
and had checkups with midwives. As the pregnancy advanced, the
intervals between visits were shorter, becoming weekly in the
last month. They saw an obstetrician at their first visit and
at the 20th and 36th weeks. If the midwives had seen any
problems, the couple would have seen a doctor more often.

"We were never kept waiting at any of these appointments for
more than five minutes," Billy said. "There were five or six
midwives in all, and they were all pretty good. It was like a
family; you had a community feeling."

On the day that Christina went into labor, she and Billy went
to the hospital, at first to a PAC, or Pregnancy Assessment
Center. This was a two-bed hospital room with a bathroom
attached, where Christina was monitored until the staff judged
her to be fully in labor. Then they went to the birthing

The suite consisted of a large room with a double bed, a table
and chairs, and its own adjoining bathroom. "It was
comfortable," said Billy. "It was clean enough in a hospital
sense, but also homey enough."

Here the midwives kept an eye on the couple but also tried to
stay out of the way unless they were needed. The birth was
straightforward. Emergency equipment was available, just in
case, and a doctor was also present, but a midwife eased the
baby into the world as Billy stayed in bed with Christina.

"You didn't necessarily get the feeling you were being watched
or intruded on," Billy said. "It was more like we were doing
it, and they were there to help." For example, after the birth
a midwife lifted the baby's legs and said, "Have a look and
see what you've got" -- rather than telling them the child's

"After that they left us pretty much alone," Billy said. "The
baby was obviously all right, so they just left us for about
an hour." Any time they needed help, it was nearby.

Billy, Christina, and the baby stayed together in the suite
for five days, just getting to know each other and calling on
the staff when they needed a little help with establishing
breast-feeding and giving the baby her first bath.

"We could have stayed for up to two weeks if we had wanted,"
Billy recalled with wonderment. The food was good, too -- a
special menu, since the couple are vegetarians.

When they decided to go home, the staff encouraged them to
stay another night if they felt at all unsure. The staff also
said that the new family could come back and stay a few more
nights, if needed, up to the two-week limit.

When the family left, they took with them free diapers and
baby wipes. Whatever was needed, said Billy, "if you didn't
have it, you got it."

After the family was home, midwives visited every day for
three days. A child-health-service nurse also visited, giving
Christina and Billy phone numbers they could call at any time
of day or night with any problem.

Christina made an appointment with a postnatal physical
therapist, who spent 45 minutes with her, coaching her on
exercises to get her body back in shape. In six weeks she will
be able to go to postnatal-exercise classes with her baby.

How much, I asked Billy, did all this cost the couple?

Nothing, said Billy. Not the prenatal care, not the hospital,
not the supplies, not the postnatal care, not the physical
therapy. He and Christina have not spent a penny.

And there's more. In the next few weeks, the couple will
receive a check from the government for $3,500, to help with
the expenses of a new child.

How does Australia pay for all this? With a flat 1.5-percent
levy on everyone's income, plus a 1-percent surcharge on
people with higher incomes ($50,000 for an individual,
$100,000 for a family). So if your taxable income is $45,000,
you pay $675 a year.

Still think we in America have the world's best health-care

Susanna Rodell, editorial-page editor of The Charleston
(W.Va.) Gazette, is teaching journalism at the University of

© 2006 The Providence Journal Co.

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