Just before reaching age 65, we announced to family and friends that we planned to retire for a few years to Australia, on the beautiful island state of Tasmania. Typical of comments we heard were:
“Awesome, I wish I could do that…”
“Why would you want to go there?”
“What would happen if you got sick?”
The last question concerned us. My family history is poor: parents had diabetes, kidney cancer, arthritis and a younger brother who died in his fifties from a heart attack. Additionally, after 30 years of Florida sun, my fair-skinned wife had several occurrences of skin cancer, and Australia has the highest incidence in the world. So, using the Internet and expatriate forums, we investigated the Australian health care system.
We found that as temporary residents on retirement visas, we couldn’t take advantage of the free public (Medicare) system citizens and permanent residents had at their disposal. But, we learned, Australian private policies provide more comprehensive coverage than US Medicare and a private “gap” policy, pay prescription coverage, and for the two of us, cost less than $5,000 per year.
Tasmania is about the size of West Virginia, and while it has natural beauty and the cleanest air on earth, its public health-care system struggles to care for its population of 500,000. Disregarding concern about the caliber of hospitals we might find in Hobart, the capital city of 200,000, we said no worries, if anything serious comes up, we’ll fly 45 minutes to Melbourne. Anyway, other than mild hypertension and a slightly enlarged prostate, my health was excellent. I had complete physicals every year for the past 35 years and exercised for at least an hour, five days a week on a treadmill and weight machines. By December 2006, we had sold our house and cars, packed our furniture, and moved halfway around the world.
My first encounter with health care in Australia was after three months, when I visited a doctor to renew my prostate medication. He scratched his head and wondered aloud why it had been prescribed. The prescription I had used for 12 years had been outlawed in Australia because it caused heart attacks in a percentage of patients. The doctor prescribed another medication but it was clear after three weeks, it was not as effective. At the second visit, the doctor asked if I ever had a prostrate and kidney examination to check for kidney damage from the sometimes-blocked urine flow. I said sure, I had annual physicals and there were prostate exams, blood and PSA tests. Everything was normal. He asked when the last ultra-sound had been done. I had to say never. He was surprised and dismayed that in 12 years I was treated for the condition, a simple ultrasound had never been done. He prescribed another prostate medication but since he encouraged it, I agreed to have an ultrasound.
That ultrasound changed my view of US medical care. The results found two cysts and an unidentified “mass” in my left kidney. A CT scan confirmed it was a tumor, probably cancer. In the US, all of my doctors knew of a family history of kidney cancer, (mother discovered with bleeding in stage 2, an uncle died from its spread over his entire body in stage 4). US doctors treated me with a drug for prostate enlargement but none ever ordered an ultrasound of my urinary tract.
In my lifetime, I have always had health insurance provided by employers and have watched doctors switch extremes in medical testing. In the ’60s and ’70s, they ordered tests for everything. In the past 25 years, the influence of HMO’s and “managed care” has swung the pendulum. Doctors who prescribe too many tests risk exclusion from the insurance company’s network and loss of practices. The reason I never had an ultrasound of my urinary tract was the test (in the US) is expensive and without symptoms is not considered necessary by insurers. Unfortunately, kidney cancer doesn’t display symptoms until it’s often too late …
The recommendation here was no different than it would have been in the US — remove my kidney. Chemotherapy and radiation are ineffective in killing renal cell cancers. Rather than fly to the Australian mainland or to the States (requiring significant time delay and insurance concerns without a Medicare gap policy), I opted to have the surgery done in Hobart. We were fortunate to find an outstanding urologist, trained in the US in laparoscopic (keyhole) surgery. The pathology showed the cancer was Stage 1, small and localized, making the prognosis for a normal life excellent.
Unfortunately, in the alternative life scenario in the US, the cancer would have gone unnoticed until it showed symptoms, perhaps far enough along to have spread to the lungs, lymph nodes, brain and bones. The Australian health-care system and lack of insurance-company pressure on doctor’s use of diagnostic tools saved and extended my life. The cost? Four days in a private hospital, including 2 surgeons: $12,193. Insurance covered all but $500. (A conservative estimate of the procedure done in the US exceeds $80,000.) The cost of the ultrasound that saved my life? $100, again covered by insurance.
Insurance-provider influence on doctor’s medical decisions in the US has become pervasive and dangerous, without lowering costs. There is no oversight or recourse with insurance company decisions other than lawsuits, which are lengthy, unsatisfying and after-the-fact. Curiously, the prostate drug outlawed in Australia because it causes heart attacks was “recommended” by my health insurer to my US doctor, as a lower-cost alternative to what he originally prescribed.
After a UN study recently revealed US health care ranked 37th in the world, the reaction of most was the low ranking was caused by the high number of uninsured citizens. Uncontrolled high costs and pressure by insurance companies to reduce payments for preventative diagnostic testing have as much to do with our low quality rank, as does the number of uninsured. Health care systems outside our country demonstrate that medical costs need not be as extraordinarily high as they are in the US, and still provide superior care.
Among themselves, Aussies refer to their homeland as “The Lucky Country.” I consider myself lucky to have visited them, had my life extended and to have seen what can be done with health care, where people have the political will to change.
Rick Moltzon was a corporate manager for over 30 years. He is currently semi-retired, doing part-time consulting while living in Hobart, Tasmania.
From The Progressive Populist, December 15, 2007
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