Pub: Sydney Morning Herald

Pubdate: 07-Jul-2011

Edition: First

Section: News and Features

Subsection: Opinion

Page: 11

Wordcount: 1060

Insurance gap divides promise and reality

ELIZABETH FARRELLY

In a park near Central Station, a handpainted sign hangs from a tree. “The Association for Leaving the Chinese Communist Party” is its terse proclamation. It claims 91 million-odd members.

My club will be similarly revolting, although perhaps better for your health. It’s to be called the Association for Leaving Private Health Insurance. My evidence is strictly anecdotal, but true. It’s based on two stories of Sydney women recently diagnosed with cancer; one ovarian, the other breast.

Woman one, call her Angela, came to Australia, five months pregnant, in 1966. She immediately took out private health cover but, when four attempts to claim on it were refused, stormed out in disgust, did her sums and refused to rejoin.

Woman two, call her Kate, arrived in 1989, also from Britain. After having her first child through the public system, she took out private insurance during the big 1990s push – under the threat of the Medicare surcharge – and has kept it up since.

Angela routinely tells doctors, whenever the words “specialist” or “consultant” are mentioned that, being uninsured, she needs costs up front. As often as not, she says – as in a minor varicose vein operation – specialists add her to their public list, and her costs are zero.

Kate, on the other hand, always fesses up; yes, she is privately insured, and docilely pays the gap. Without ever calculating it – which is almost impossible to do – she always figured you had health insurance for the “just in case” thing of being really sick, which is to say, in hospital. That would be when you needed cover. Like all insurance, it plays on fear.

Angela and Kate were diagnosed with cancer a year apart; 2009 and 2010. Angela had severe abdominal pain, off and on, for months.

Eventually, at Royal North Shore emergency, she was put on a morphine drip but sent home undiagnosed. When the pain returned, she attended a local medical centre, was sent for an ultrasound and given a gastroenterologist’s appointment in a month.

When the gastro requested the ultrasound results, she phoned the clinic to get them. It was clear the medical centre doctor hadn’t so much as looked at the file, since her immediate response was an audible gasp. “You don’t need a gastro,” she said. “You need a gynaecologist – now.”

A fortnight passed before that appointment in a public hospital clinic, and another fortnight before the blood results came through, coinciding with a second ultrasound. This, almost two months after the first, showed a cyst twice the diameter, the size of a large grapefruit, “right in the middle of the screen”. The blood tests clinched it, with levels of the marker protein CA125 more than 1000 times normal. “You,” said the surgeon, “have cancer.”

Those words are like the Princess Diana moment. You never forget where you were. Yet with half of all Australians diagnosed with cancer by 85, it’s something we’ll be getting used to, like it or not.

Angela had another week to endure before surgery. By then, the tumour, containing a litre of fluid, had burst. This meant that although, as the surgeon noted, Angela’s “insides looked very clean”, she needed follow-up chemo; four sessions over three months. Her hair, always strikingly lovely, fell out. She felt poisoned.

But now, a year on, she looks and feels wonderful; slimmer, elfin-haired, energised. Throughout, she says, her standard of care made her feel “privileged to have been exposed to the oncology sector”. Even the chemo taught her about other people’s lives in ways she wouldn’t have missed. “People are so frightened of chemo,” she says. “But they’re wrong. Medics work hard at making it tolerable … and you bounce back.”

Angela had a colonoscopy and an endoscopy, for thoroughness, and still has follow-ups with the same specialised team. And – here’s the thing – none of it cost her a cent.

Compare Kate’s story. Her GP routinely advises women patients over 50 to supplement their mammograms with an ultrasound. “It costs more,” she says, “but it’s worth being sure.” This time, although Kate’s mammogram was clear, her ultrasound picked up a scattering of tiny white pinheads. Ductal carcinoma in situ. Cancer. Very early stage but, still, gulp.

They began with “breast-conserving” surgery, taking a chunk of breast the size of a petit four. The bad news was the tiny dots were spread throughout that morsel,

so a radical mastectomy followed within days. The only good news was that, since the lymph nodes were clear, Kate needed neither radiation nor chemo.

Just as well, since she had her work cut out to pay for the pleasure of mastectomy. At no point did Kate choose to be treated as a public or private patient. Nor did she have any idea of costs until, during her dazed and asymmetrical recovery, the bills started to roll in. The process cost her just over $8600, of which substantially less than half was rebated by Medibank or Medicare.

The next stage, breast construction, will cost her between $12,000 and $26,000. This is non-recoverable, no doubt because a breast is considered optional. Cosmetic.

All up, Kate will be out of pocket between $17,000 and $31,000, after tax. And after $29,000 in Medibank premiums over 21 years. Certainly, a small amount of that came back on dental expenses. And her cancer treatment was highly skilled, compassionate and, above all, fast.

But it is equally certain that just having insurance cost Kate heavily; once in premiums and again in the treatment. Say she earns $100,000, her 1.5 per cent Medicare levy is $1500. Medibank membership costs her more than twice that, and twice again if she gets seriously sick.

Both say they had excellent treatment, and maybe Angela was just lucky; her two-month wait could have been catastrophic. Also, ovarian cancer is rare and dealt with in specialised units. Breast cancer is terrifyingly common and people can wait months for treatment.

But in a market-forces system – or indeed a democracy – surely the very commonness should improve treatment, not worsen it. And if health insurance is really a compulsory saving scheme to ensure speed, couldn’t that work as well in a public system?

This is where Kate and Angela agree: if they must pay $3000 a year, they would much rather pay it all to Medicare and know fast, first-class medical treatment is available to everyone. That, they say, is civilisation. I believe they may be right.

Caption:

ILLUSTRATION: EDD ARAGON