04 June, 2010

Why Universal Health Care is Vital to Any Civilised, Compassionate Society, and how it Benefits Everyone

There's no big secret about me having rheumatoid arthritis, or a broken back.  I tweet about it, share my experiences and get some good advice from others who know about auto-immune diseases, as well as having a plethora of specialists, including a consultant rheumatologist, taking care of me.
Due to the damage in my spine, which is currently held together with titanium pins, rods, screws, a cage and will power, I also suffer chronic, intense back pain which needs it's own management plan.  Lately the symptoms of the partial paraplegia, from the significant nerve damage, have been getting worse.  More pain, less mobility and some potentially embarrassing moments in public. (Other than my risqué conversations!)
Working out what's going on isn't that straight forward.  Physiotherapy have noticed the deterioration.  A muscular-skeletal exam confirmed what my physiotherapist suspected, an expensive custom made orthotic was made to assist me to walk further than a few metres without tripping over.  Meanwhile a pathologist investigates my blood and reports back to my rheumatologist and General Practitioner (GP, just a regular doctor).  My gastroenterologist orders Doppler ultrasound, and interprets the digital video remotely from the Imaging Services Department at the hospital.  My neurosurgeon is frequently updated with digital CT scans to look for change.
That's where the “problem” lays.  The titanium that is fused into my lower spine scatters x-rays, so high resolution images near the suspect site are not possible, but there is enough change for it to be noticed.  So an MRI scan is ordered.
I don’t know if anyone knows what having an MRI is like.  I’ve become used to them, but still they aren’t pleasant for me.  The MRI scan process for me is fairly straight forward; change into “something more comfortable”, double check for any metal I might be wearing, get wedged onto a plank, then loaded like a shell into a cannon.  For the next thirty or so minutes the sounds of thumping, banging, buzzing, and harmonics of all these all but drown out any music I’m listening to through plastic tubing.  While all this is happening the electro magnets (which resonate causing the disturbing banging sounds) are so powerful, any loose metal within a few metres of the machine would be flicked through at a velocity enough to break bones or, worse, the machine.  They are so powerful that it makes me vibrate.  Indeed, I can tell when they are focusing on my lumbar region as the titanium moves with the vertebrae to cause pinching of some nerves which results in a combinations of unpleasant discomfort and sensations of having hot pokers rammed through my feet and into my spine.  Then I’m unloaded briefly, but not allowed to move, as a contrast agent is injected into my wrist.  Normally they try and find the less painful area, but it’s not always possible. The contrast agent makes my tongue feel like someone’s put a dirty teaspoon on it.  Then it’s reload and do it all over again.
Yesterday’s little outing in the tubular coffin took no less than 90 minutes.
Now I’m not saying this is, or should be, a typical experience for anyone.  It’s simply my own experience due to my unique circumstances.  Most people that have an MRI have nothing more than a little discomfort from being in a confined space for about 15 minutes.  MRI scanning is routine in an emergency hospital, such as Royal Perth Hospital, and all across Australia’s major public hospitals.
Now, here’s the fun part.  How much do you think all this testing costs?  How much did it cost me?  The MRI scan alone costs are about AU$10,000.  Cost to me? AU$0.  That’s right.  Nothing.  Same for physiotherapy, pathology, rheumatology.  Even when I had the neurosurgery to remove the spiny growths of bone, the ruptured discs, and to reconstruct and repair fractured vertebrae using expensive titanium didn’t cost me a cent.  The room with a view that I had to myself for 2 weeks during recovery cost me nothing.  The rehab, zilch.  The fitting, construction and refitting of my high-tech orthotic?  Absolutely nothing.
Every Resident and Citizen of Australia has access to free, that’s right, free medical care at a public hospital.  There are private hospitals, but the only difference between the two is that private hospitals have more expensive art in the foyer and don’t have emergency facilities.  In fact, most consultants from all disciplines, including my wonderful rheumatologist, work in both private and public hospitals.
So how can it be free, and why?  The answer is simple.  Taxation pays for it.  It even subsidises General Practitioners so that going to a doctor is cheap, and in some cases, free.  Yes, that’s right, for some people it costs nothing to see a doctor.  Going further, most prescriptions are also subsidised, to the point that once a certain number of prescriptions have been used by an individual or family, for the rest of the calendar year all listed medications are free.  Yes, free.
Every Australian is aware of this to some point.  Most wouldn’t even think about it.
Surely this is madness!  Isn’t this socialist nonsense and surely it will bankrupt the country?  Like Greece for example?
Well, no.  It’s a vital service, Universal Health Care.  For those in the Tea Party movement in the US (referred, unflattering as “teabaggers”!) who are fighting to stop the Obama administration to trend towards Universal Health Care, countries like Canada, Australia, Great Britain, France and so on are to be pilloried for having such a blatantly evil “socialist” policy.
But if they really thought about it, why don’t they complain that the police or firefighters are part of a socialist agenda?  Or government schools?  Why should doctors become wealthy at the expense of patients when the police also have arguably difficult jobs, or firefighters or teachers?  Why is it that prisoners get better health care than they could ever hope to get outside of jail?  Or members of the US armed forces and veterans?  Or indigenous Americans?  Isn’t that also an evil socialist engineering program?
The fundamental arguments against Universal Health Care start to look pretty weak in light of the evidence.  Especially since those who make the most money out of the health industry in the US are the insurance companies are the same collection of people that make the decisions on what treatment, if any, a US citizen is entitled to, or what medication they can have.  It doesn’t take much brain power to understand that these people are making decisions based on a bottom line, not in terms of health outcomes for policy holders.
At the same time, medical services and medications costs in the US are practically extortionate.  This in turn means the insurers have to charge higher premiums, which mean less people, despite the Obama Administration’s changes to stop the practice of denying policies to people with pre-existing conditions, can afford any quality medical care.  Essentially, the US is a duality; those with money and influence get the best medical care money can buy at the expense of those who work just as hard, if not harder, for far less reward.
A civilised nation would treat all citizens as equal before the law, and enable access to all services on an equal footing, be it electricity, a police force, justice through the courts if accused of a crime, or health care.  A compassionate society would treat those who, for a variety of reasons, aren’t able to fully take care of themselves or make decisions for themselves about their welfare; this is no different to how parents look after their young children or children look after their aged parents.
Using taxes to pay for these things is money well spent.  Instead of someone who becomes horribly ill and unable to work never contributing to society ever again, they are more likely to be rehabilitated where they can contribute once again.  That in itself is a powerful incentive for the patient to become well again because no one likes to be dependent on others.
I would have thought most of this is self evident or self explanatory.  Anyone with a grain of sense would know Universal Health Care isn’t about a slippery slope to some form of evil Stalinism.  At least I believe anyone with a grain of sense would know that.
Of course, if critics wish to point out how I’m some form of bleeding heart lefty socialist, then fine.  Maybe I am.  I was born in, raised in, and live in a liberal socialist democracy.  That doesn’t mean a Laissez-faire, Marxist democracy, It means a free thinking, progressive, open to new ideas, let’s give everyone a fair go democracy.  Usually it means that governments are more centralist or left of centre than governments of the USA, but nonetheless a liberal socialist democracy is a long way right of Stalinist North Korea.
Critics are welcome, if they wish to ask me any questions they like.  I can begin by stating that currently I am on a Disability Support Pension.  It’s not a lot of money, but it’s enough for most things; rent, power, and as you can see, the internet.  And independence.  Would I rather be working?  Of course, but it’s not practical nor beneficial for myself or - more importantly - an employer at this point in my life.
Would I be just as happy if I was the one paying the tax and somebody else was on a pension due to illness or injury?  Absolutely.  Been there, done that, didn’t complain.
I leave with one final question: if you’re a US citizen and a “teabagger”, how would you like to be treated if you unexpectedly became ill for a protracted period?  Would you like to worry each day about how long the insurance is going to pay and what treatment they will pay for instead of focusing on getting better?  Or would you resign yourself to becoming homeless, even imprisoned for being homeless, when every one around you pities you but says you ought to have known this is what was going to happen and paid some faceless company more money.

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