Medicare

Posted at 9:09 PM, Thursday, November 16, 2006

I picked up a prescription for Australia's equivalent of Advair--those funky purple disks that administer a precise dose of asthma medicine. The American online pharmacy Drugstore.com will sell you a month's supply of the lowest dose Advair disc for $146.47. I paid about $23 for mine. The actual price that the Australian government pays is printed on the prescription label along with the subsidized price. The medicine cost the government about $36. The staff at the pharmacy where I had my prescription filled, including the pharmacist, were fascinated when I told them how much this medication costs in the U.S. Makes you kind of wonder why the manufacturer feels a need to charge an extra $100 for the same medicine in America.

For several months before Bobby and I relocated to Australia, I referred to us as healthcare refugees. The sad truth is that this was a fairly accurate description of our predicament. When our HMO raised our family rate to $950 per month after Nadav was born, we defaulted to catastrophic health insurance. We paid ever-increasing premiums of up to $500 per month and never collected a dime of coverage. Thankfully, we were spared any major health emergencies, so we never came close to meeting the $5000 annual deductible. But we did spend thousands of dollars out of pocket on medications, doctors' visits, and the odd trip to the emergency room. Bobby ran to the emergency room the day he managed to put a box cutter right through his thumbnail and into his thumb, and we're still getting the bills.

Life has been far more beautiful since our Australian Medicare cards arrived in the mail. All of a sudden, it seems natural to go to the doctor for an unexplained pain or irritating itching. I now realize that, although I swore that I would never limit my doctors' visits even though I was paying out-of-pocket, I did exactly that. As permanent residents, all four of us now enjoy doctors' visits that are either free or very inexpensive. We have access to a large number of prescription medicines that will cost us a maximum of $30 each. We also enjoy the fruits of sensible health policy. In the U.S., I paid an average of $35 for a one-month supply of birth control pills. Here, a box containing a four-month supply is $15.

We have chosen Beit Shalom member Pam Rachootin as our family physician, although she lives about twenty minutes away down the coast. Pam is a sole practitioner, which in her case means she doesn't even have a receptionist. She works out of a charming home office that includes an examining area, a supply closet, her desk and computer, and a small collection of antique pill bottles. She cheerfully admits that she knows of no other Australian physicians who practice medicine the way that she does. But there's really no reason they couldn't.

Although she's originally American, Pam is a great believer in the Medicare system. She bulk bills, meaning that she bills the Australian government for the total number of patients she treats and receives a modest reimbursement for each one. Physicians who work in this way rarely get rich, but they do get something American doctors can only dream of: they get to practice medicine unencumbered by any other concerns. Pam can spend as much time as she wants to with a patient, without fear that Aetna or Highmark is going to drop her from their plans for spending too much time on each case.

A semi-retired surgeon at Beit Shalom has hatched a rather far-fetched idea for growing our congregation: he wants to recruit disgruntled Americans to come live in South Australia. This region is suffering from a shortage of family practitioners, and American physicians are suffering from high burnout and frustration rates. Anyone out there want to come join us down under?