Medicare (D21)

Yesterday I went to see Newtown. A busy working class suburb. Reminds me of Longsight, Manchester, famously named in an Oasis song. But without Asian people. It is very white. There is a bustling main street with lots of little shops on both sides. There is also the University Teaching Hospital and the Heart Research Institute. A schooner costs $6.

I'm going to try to tell you about the Aussie health service, so if you're not interested move down to the end of the page. Aussies have a National Health Service called Medicare. They are proud of it and it is paid for from general taxation. The Medicare levy is 1.5% of taxable income. It is free at the point of need. Well, not quite.

The Medicare system will pay for a lot of things at a government set tariff price. This includes visits to the GP, cost of drugs, and referrals to specialists. Doctors, both GPs and Specialists can charge the government tariff or they can charge more if they like. The patient pays the doctor, then fills out a form and gets reimbursement at the Government tariff price. So any extra comes out of their pocket. There are Medicare centres in various places where people can cue up to get their reimbursements. Patients will judge if they want to go to a doctor that only charges tariff price (what's called 'bulk billing') or go to another doctor who charges more. The bigger your practice the more you can charge and the richer you get. Meanwhile those who can't afford it go to 'bulk billing' only doctors.

Some individuals and families on incomes above the Medicare levy surcharge (MLS) thresholds who do not have private patient hospital cover may have to pay the Medicare levy surcharge. This surcharge is in addition to the Medicare levy and is at the rate of 1% of your taxable income (including your total reportable fringe benefits). With me so far?

So you pay the surcharge if you are a single person with no dependants and a taxable income for MLS purposes greater than $70,000 (35,000 pounds); or a member of a family and the combined taxable income for MLS purposes was above the relevant family surcharge threshold shown in the family surcharge threshold table and you do not have private patient hospital cover. Yeah?

In the last year you do not have to pay MLS if you were in an exemption category for the whole of 2008–09 and you did not have any dependants or, if you had dependants, they were also all in an exemption category and/or they all had private patient hospital cover for the whole of 2008–09. Obviously.

You do not have to pay MLS if you had private patient hospital cover for the whole of 2008–09 and you did not have any dependants or, if you had dependants, they also all had private patient hospital cover for the whole of 2008–09 and/or they were all in an exemption category. Got it?

You do not have to pay MLS for the full year if you had private patient health cover for part of the year and:
you and your dependants, if any, were not in an exemption category at any time during 2008–09, and your taxable income or combined taxable income for MLS purposes was above the relevant threshold. However, you must pay MLS for the number of days you or any of your dependants did not have private patient hospital cover.

So many people take out extra insurance to cover extra costs if necessary and avoid the MLS.

Simple.

Doctors in big towns do alright for themselves, and so do accountants.

From the patient's point of view it seems much like the UK system. There is more freedom to pick and choose who you see, but you would usually pick a GP and stick with them. The waiting times for surgery and outpatient appointments are longer. There is also a proliferation of what we'd call complementary medicine. Every main street has Chiropractors, Thai massage, podiatrists, sports physios, you name it, you can get it. I'm not sure how they are regulated. Many GP practices will have these attached. They are not covered by Medicare usually. The bureaucracy is a constant complaint, not surprisingly, and successive governments try to address it. nevertheless Aussies are proud of it and will defend it as fervently as we defend our health service. Anything but the American system.

Now here's something I learnt yesterday. Granpere was a male midwife on Rodrigues, an island close to Mauritius. It was here that Matant Marcelyn was born and, Jocelyne thinks, he and Granmere were converted to Adventicism. Need confirmation of this, but another piece in the picture.