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Thursday, September 10, 2009

The healthcare debate

Being Malaysian, I wonder at the American debate raging over ObamaCare. Not that the debate exists - obviously, as being more conservative than anything else, I can see why anyone would be shocked and horrified at the idiocy President BHOmbastic is spouting forth. No, my wonder is at some people on the left who seemingly do not wish to examine what they are putting forth and comparing it with other countries.

I will be upfront about this post. I really have very little clue about the details of country-specific healthcare systems, so this is really just my take on the matter, having experienced the Australian and Malaysian medical system firsthand.

In Australia, the country-wide health care system that serves all Australian citizens (as well as Australian Permanent Residents, New Zealanders, and some specific EU countries that have similar systems) is called Medicare. This provides for all clinic visits, and free health care at government hospitals. It is paid for by taxpayers in the form of the Medicare levy, which can be up to 2.5% of your taxable income. International students in Australia have to pay a certain annual fee (at the time I was there, around AUD275) to get student coverage identical to that provided by Medicare. Presumably, foreign workers have to pay a substantially higher amount for the same coverage.

Australia also has a private health insurance system, which kicks in for private hospitals and other stuff that Medicare doesn't cover. Let me repeat that. All private health insurance systems ride on top of Medicare, and the only 'replacement' is whether you use a public hospital or a private one. But... for this single 'private option', shall we say, the Australian government actually pays you to take up private health insurance. Up to 30% of your insurance premium, in fact.

For clinic visits, doctors can choose either to bulk-bill (charge you nothing and collect from Medicare directly) or not (in which case you pay upfront and claim back from Medicare). Guess what; doctors hate bulk-billing. They much rather charge you upfront; you go try collect from Medicare. And of course, only the Uni had a walk-in clinic - all the other clinics had appointment times in the weeks or months.

Okay, so that's Australia. Malaysia's got a slightly different scheme. The Malaysian healthcare system is split into two separate and completely distinct components; private and public. All Malaysian citizens have access to the public clinics and hospitals at ludicrously low prices. In fact, they're really just token charges - and if you are a (retired) civil servant, you get it for free. Well, for cattle class treatment, anyway. Even then, for first class wards, you get ludicrously low rates; $80/night. Treatments are similarly ridiculous in pricing; $200 per chemo treatment. Of course, you also get the long lines, the queues for treatment, etc etc etc.

You also have the private clinics and hospitals. Every doctor who wishes to be licensed in Malaysia must work for 3 years in the government healthcare sector; after which, he is free to set up shop and practice anywhere and anyhow he pleases. This is a completely free market situation; within 5 mins walk of my house, I can count upwards to 10 GP clinics, 3 OB/GYN, any number of dentists, and 4-5 of the alternative quacks. You also have the private hospitals, and they're good enough that medical tourism is a viable model for them. To fund these trips to the hospital, you get what's known as medical/health insurance - but only for inpatient treatment. There is no such thing as individual outpatient insurance - if your company doesn't offer it, you pony up the cash yourself. Medical insurance for hospital cover starts from $300 annually.

So, in Australia, the government practically begs people to take up the private option. In Malaysia, those who can afford it quickly buy private health cover themselves, because nobody wants to go to a public hospital if they can help it. Which is really unfair to the public hospitals, because they are of fairly good quality... for government, anyway. But that's the way it is.

I must wonder, therefore, why the morons in the Left want to impose the public option, when others want to get away from it.

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