A rose is a rose is a rose is a rose. So wrote Gertrude Stein, initially in 1913 and then in altered states over the following decades. Many have debated the meaning at the heart of the sentence, but she used it in many cases as a way to explore semantics; it is part of a law of identity, where the use of a name confers automatic imagery and understanding in the mind of the reader.
Today I’m lying on the REM– column chart the term “socialized medicine”. First, two facts you probably know everywhere: Australia has socialized medicine, and socialized medicine is a bit of a dirty word in the United States.
I can’t speak for the latter, but I can offer some theories working within the Australian system. In a way, socialized has been equated with socialism, which itself has been confused and mixed with communism, and we all know that communism is a failed paradigm and a dead political-economic philosophy. Therefore, the same must apply to socialized medicine.
Socialism, of course, has softer terms of definition than communism: the things that matter are owned and distributed by the public rather than in the hands of private property. Marxist theory holds that socialism lies somewhere in the liminal space between the overthrow of capitalism and the realization of communism.
In favor of a socialized medicine
But, if you allow me, allow me to say a few words in favor of socialized medicine. Interchangeable terms for socialized medicine are “universal health care” and “public safety net”. Without getting into the slightly tedious history of this one, we’ve only had it since 1984, and it’s funded by the federally tax-funded Medicare system (a levy of about 2% on taxable income of a resident). But we also have a thriving private sector, which caters to those who have private insurance (about 44% of the population), making it a hybrid scheme.
Interestingly, the two systems have partnered and helped each other through tough times, like the pandemic, with hospital beds being leased to each other for capacity and dividing and (sometimes) conquering increases workload issues. The private system is still partially guaranteed by the government; costs are shared for each patient that goes through the system.
Australian health care is far from perfect. And when I say far, I mean the kind of distance where you still can’t see its horizon even when you squint. We have a stalemate between state funding and federal funding (often allowing both to cover their ears and say it’s the other’s problem). We’ve cut costs to the point that the system groans under the twisting human weight of emergency room presentations.
The government is reducing physician fees in the system so that costs can be passed on to certain patient demographics. Inefficiency and complacency can creep in when no incentive fees are paid to health workers. Public outpatient clinics in hospitals are drowning, some with unacceptable wait times. The system has a long way to go in how we deal with disenfranchised, disadvantaged, vulnerable populations.
All treated the same
But what we have is the safety net. Nowhere is this more evident than in emergency departments. No one is turned away, certainly never for financial reasons. Even those who are not Australian residents or covered by Medicare are treated the same. I find the latter fascinating. When ‘undocumented’ patients arrive requiring care, office staff are required to advise them of the costs, but we always follow up with a wink. Invoices are never prosecuted.
Fairness is one of the greatest conflicts facing humanity today, and at least our system is moving in that direction. What about health outcomes in general? They also benefit from it. Macro indicators are favorable with a robust hybrid system.
Some of the Australian figures speak for themselves. Life expectancy? 82.9 years old. Infant survival rate? 2.5 deaths per 1000 live births. Maternal mortality rate? Six per 100,000 live births. Australia also has the lowest cancer death rate in the world, thanks in part to a robust national system that not only provides universal health care, but also benchmark standards among all health care sites.
So, yes, we have a long way to go, but socialized medicine is unquestionably the greatest strength we have to provide the most equitable health to a population, even in a country where wildlife intends to kill us.
Dr Johnstonis a certified ER doctor, so the same as you but with a weird accent. She works at a trauma center in the old fashioned end of Perth, Western Australia. She is the author of the novels Little uncertain miracles (available November 3) and dust fall, available on his website, http://michellejohnston.com.au. She is also a regular contributor to the Life in the Fast Lane blog athttps://litfl.com. Follow her on Twitter@Eleytheriusand read its past columns athttp://bit.ly/EMN-WhatLiesBeneath.