Thursday, May 22, 2014

Healthcare, disruption and death

The other thing that the right has done with its toxic “safety net” label, a form of words so easily and unthinkingly adopted, is to make an association that public hospitals are for the poor.

Yes, I'm sure that a government member that's schooled to consider $20,000 lunches and $60,000 gifts and all the rest as normal – people in that class probably do think that way.

Now, I'll paint a scene: since Ms T has a minor procedure next week – an endoscopy – today we had to line up at St George Hospital for the pre-admission clinic (now there is a process that could be made much more efficient and cheaper, but that's for another day).

The talk in the waiting room – with no dissenting voices – was the likely horror that the government is preparing for us, by way of Americanising the health system. The only individual who didn't participate was the one that had an interpreter handy. Elsewise, the voices in one of The Shire's major hospitals were unanimous, that the government is on the wrong track.

And these weren't poor people. At least one of them was worth more on the hoof, once you count clothes and jewels, than I would usually spend on a car.

Hang on, what's someone like that doing in a public hospital.

It happens that St George has some a bunch of very good gastroenterologists, both on the diagnostic side an the surgical side. And in at least one case, Ms T's specialist, the focus is on the public system.

We first met him in the public system at RPA, he saved Ms T's life with a diagnosis that was, strictly speaking, way outside his speciality. Her gut had brought her into his care, other specialists were dithering about the diagnosis so much that she was in danger from the wait, so (let's call him) Axel made a call and got it right.

Which is why we followed him from RPA to the 45-minutes-distant St George. One of these days, he's the kind of doctor that will get an Order of Australia.

And he's still in the public system – that is, if someone says “you need the best”, they won't be sending you to the nearest private, because Axel isn't there, he's in the public system.

I think that's where he thinks he can do the most good.

I've never asked him about this, because in spite of a very-well-crafted persona that he presents to the world – confident, polished, in charge, smooth, articulate and all the rest – he's also modest. My family once encountered his at a farmers' market: his blush when I told his wife “he saved Ms T's life” was so delicious I'm grinning wildly as I remember it.

Back to the “safety net” theory.

The Liberal narrative that public hospitals are a safety net is not only insulting to some of the country's best doctors, it's manifestly untrue. It's untrue in a way that could only be adopted by journalists who have had very, very sheltered lives: they've never been told that your best or perhaps only hope is at RPA, so don't go to St Vincent's Private (since it would just be a transit trip anyhow)?

Ms T had, at one point, four professors considering her case – all in the public system. If, as is the endpoint of the Liberal philosophy, the public system is destroyed, the professors will still be there – but only if you're rich enough to be insured to your back teeth.

And the training of those professors – at least three of them regarded as gods of their specialties (guts, cardiac and immunology), as well as “Axel” – is down to the public teaching hospitals, and they're all still in the public system.

See, the public system isn't only a “safety net” for the poor. It's also a “safety net” for people whose malaise defeats the narrow silos of private health-care.

Before Ms T landed at RPA's emergency department, she was in the hands of a private clinic of note: one of its “names” gave the world the antibiotic treatment of helicobactor pilori. I don't blame them that they utterly mis-diagnosed Ms T, because it was them that sent us to emergency and saved her life.

The collegiate model, in which a big teaching hospital has access to a bunch of heavy specialists at call in the public system, doesn't just help the patients. It also helps the specialists and the teaching of those who will come after them.

Sure, the warriors of the libertarian right will say that America can produce hospitals that could replicate my experience at RPA that are wholly private. But – ignoring questions of equity – America's hospitals are an artefact of its history, exactly as Australia's hospitals are an artefact of ours.

It's absurd to think that you could take one template, impose it over an existing system, and achieve the same result without an atrocious amount of disruption on the way.

Healthcare isn't a taxi service: if you disrupt a working system in taxis, as Uber is doing, people will lose money. If you disrupt a working health system, people will die.

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