public and private health. and anxiety

i feel it’s important for me to once again have a discussion about the australian healthcare system. this is very simplified. anyone more familiar with the intricacies of it, i am happy for corrections.

we DO have public health care. and we do have private health care.  i have private health cover through a company called Bupa.  it means, when i get scans, i have to pay out of pocket, and i am reimbursed for what is the schedule fee (ie, the set, standard fee) by 100%.  however, a lot of specialists and pathology and scan places who work privately charge above this fee – known as gap doctors. some doctors are no-gap – choosing to not charge their private patients any more than the amount their public and private health care covers, and some are gap doctors.

for example: my dad had open heart surgery  – a five-way bypass -in 2010 (i think?).  he was in intensive care for days, and had pneumonia.   he went privately, and did not pay once cent for the whole thing. they were no-gap doctors

my mum, however, had some weird therapy for an ovarian cyst.  her doctors – (anaesthetist, surgeon, etc) were gap doctors. she paid over $15000 for her surgery.

my process in this has essentially been – my GP got me into the private system, and then i stopped thinking. i did what each doctor told me. i paid the bills until i realised what was happening, and asked my parents for help.  i became bamboozled, appointment to appointment, no-cancer to maybe-cancer, to full-of-cancer. the terror overwhelmed me. i got fed with benzos. i am disoriented and facing one of the main things that have kept me up at night my whole life (as well as sniper guns shooting me while i’m in bed. my anxiety is erratic and weird). i know there are public options, but right now, i have doctors i like and trust, and every piece of advice people based in the ACT have given me is to stay private – mostly doctors and nurses and other cancer patients.  is this the right decision? am i bankrupting myself? does this make me a shit human being – complaining and getting freaked out about the costs, and someone kindly setting up a fund to help me with them – when i could be going public and having this for free? i am completely shuddering at these questions – each time i hear nothing but FRAUD, FRAUD, go PUBLIC, what are you DOING. no one means that. seriously i don’t think anyone means it at all.  i am wracked with guilt over it all – over everything to do with it. i take everything right now as a ‘you are being selfish. you won’t need any of this if you weren’t being a little princess using the private system because you are a special snowflake.’ this is not what anyone means at all. people are kind, people are helpful, and it is always more complicated.

i am just extraordinarily anxious and overwhelmed right now, by generosity and kindness beyond my wildest expectations, by my headache, by … by pretty much everything, and i can’t process much very well.  essentially, this is the decision my doctors made.  i trust them. i am going with that. i can stop complaining or mentioning money if it would be less dumb, because i had more options, but i don’t have the energy to keep rethinking and doubting this decision. i also have ethical issues with using the public system when you have private cover – and my doctors do too, i think. this is part of the reason they insist. a lot of people need it far more than i do. people with no support, and no help, and no home, and no job.  i don’t like the system, but i don’t want to make it worse.

i also puked on the way home from breakfast because i drank juice out of a carton, and then i smelled some onion cooking.  so, that’s added to the extreme anxiety and severe tension headache and the oh my GOD guilt. i hope the onion thing is liver related. the smell of it is horrific – on people, in houses, down the street. same with fresh or ground coffee, garlic, cabbage. so, further weakness. feel dizzy and weak from the headache, and becoming more wildly convinced that the cancer is effecting me more and more with each hour. IRRATIONAL. i stupidly googled to find out what stages of cancer mean. i was wrong, and i don’t have stage 3 cancer.  i have stage 4.

i want to write about how i feel about the donations i’ve received but i am not quite ready yet. i need to knit, and spend today and tonight thinking about it, and then i will have something to say about how i feel. right now i feel way too much to put it into any coherent words other than thank you.


About elizabeth

various things.
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10 Responses to public and private health. and anxiety

  1. If I was living in Australia and had private cover I wouldn’t go public esp. with cancer. other illnesses maybe. Most of my surgeries were by private surgeons in public hospitals.. Fu.k anxiety and its shittiness, and it’s not selfish at all going private.. if anything it’s quite smart considering the seriousness of this and that you are you most likely will get faster treatment. Wishing you the best liz.

    • veritas says:

      thank you. i just need to get past the feeling-bad-about-every-single-thing-i-do. i feel guilty for drinking so much powerade. that’s how nuts i’ve gone.

  2. Em says:

    I have found, in Canberra, that almost all the doctors and specialists I have ever had to see were ‘gap doctors’; and a lot of specialists, and pathology/scanning services, won’t process the Medicare rebate at the time of the appointment. So, even if you end up getting a full or partial refund, you still have to find the full amount, usually at the time of the appointment … and then go through the paperwork to get your refund (when all you want to do is sleep, or de-compress, or attend more appointments). I have a full-time job with a moderate wage … and money was still a huge stressor for me, especially when I didn’t have a choice about whether or not to have a treatment or a medication. I really feel for you on this point – I think it’s okay to be upset or angry (been there!), but my thoughts would be – don’t let it eat up energy that you need to put towards treatment and recovery. As to the public/private debate – you pay for private health insurance so that you have the option to go private if you need to, and it’s completely (ethically) legitimate to make that choice, especially if you get faster access or necessary specialists that way :o) Concerns about social inequity can be addressed by giving back what you can, when you can …

    My thoughts are with you…

    I hope you don’t mind me sharing this link to a couple of great posts about another woman’s experiences with cancer. I know that everyone’s experiences are very unique, but I wish I had been able to read other’s (honest) accounts before my own experience.

    • veritas says:

      thanks so much for the advice – and the great blog!

      i’m starting to feel a bit more settled in my choice, and a bit less frightened that people are judging me for it. i just need to start working on mindfulness a bit more, and start mentally preparing for what’s about to come. i think once i’ve got more outlined it might help? but one thing i’ve realised is that … this point never happens. stuff doesn’t just become ‘clear’! there’s no point at which they have all the answers. i get a day of relief when they know something more, and then it returns to all the forms of ambiguity, and all the questions, and all the fears once more. and i need to learn to be comfortable with that, and relaxed with that, as much as i can, i guess.

      the money … always a pain. the fundraiser has helped me more than i can say – just because i will have that immediate cash – which i can then get refunds from, and funnel back into the general fund for treatment. it gives me safety though, and will stop me going into debt. i can’t say how much that makes my life easier.

  3. greenspace01 says:

    the mind is a very powerful thing. sounds like your mind is simultaneously doing fight, flight and freeze, and giving you hell in the process. which is completely understandable, because cancer, and fears about that, and money – having no income and big expenditure is scary, enough to make anyone freak out in itself. good on your friend Cecilia for setting up the gofundme, and yay for everyone who has donated.

    I don’t know if this helps at all, but if you can avoid feeling guilty about having a freak-out, that would be one less thing… your mind is doing the best it knows how to keep you safe, by thinking of all the terrible things that could happen.

    hey, blue Powerade = calm blue ocean?

    • veritas says:

      Cec is amazing. i can’t say how much easier every cent is going to make things during this rotten process.

      i have good days and bad ones, pretty much. the anxiety comes and goes, and i just need to listen to my doctors and actually TAKE valium when i have anxiety attacks, and take it before bed (which is when i am most likely to have anxiety attacks).

      been into yellow powerade lately.

  4. The only decision you need to make is to choose the best doctor. That’s it. Public or private. Just the best.

    Don’t feel guilty. You are making an important contribution here by talking about this, and I’m sure you will keep making that contribution? But you and your health are at stake and you go with whoever can offer you the best care, whoever you can trust, the best facilities, the fastest tests… Just the best.

    • veritas says:

      i’m definitely going to try to keep writing about it – it actually helps as therapy very much, and helps to make sense of it all. there are actually some amazing public clinics in melbourne – but i can’t relocate there for a year or so, and to be honest, i don’t want to. Sydney has a lot of options, is close, and we have family there to stay with, who have spare rooms if i get surgery there.

      i think now that i’ve made my decision, and will stick to it, i feel less weak about it all. thank you though. i am always happy to be reminded that i’m not a terrible human being.

  5. Alison says:

    Unfortunately I’ve had a lot to do with the various elements of the Australian health system lately, so just to add to some context for non-Australians or those fortunate enough in health not to be overly familiar. Australia also has public and private hospitals – you can be treated as a private patient in a public hospital or a public patient in a public hospital, or a private patient in a private hospital or in a few few unusual circumstances, as a public patient in a private hospital. Specialists can be attached to a hospital or work independently or work across multiple hospitals or any mix of the above. Some specialists will only see private patients, many will see a predetermined mix of public and private. Some specialists will charge gap fees for private patients but will see a higher proportion of public patients, others don’t charge gap fees and see public patients taking a lower profit, some will just maximise their own bottom line etc

    It also varies hugely by discipline and location. So what an Adelaide renal patients public/private choices look like is totally different to a Broome cardiac patient or a Canberran with cancer, because of the local proliferation of specialists, the norms, and the organisation of medical training all have a pretty big impact in how many public/private patients are seen and what they are charged and who pays. Canberra has a shortage of specialists in most disciplines. And a very high average income. It’s a really shitty place to be poor and sick – a world away from, for example, Adelaide. Also, don’t forget the conditions if your health insurance package, which will change what you get back and how much the medical provider gets.

    It is insanely complicated.

    The key point: Going public isn’t necessarily ‘better’ for the public system.

    As a general rule, once you’ve paid your private health insurance, being treated as a private patient in a public hospital means the money to pay your doctors is being paid by your private insurer. And you, unfortunately. Being treated as a public patient is not a choice that returns more money to the public health system. And it may mean you are occupying a slot in the queue with that specialist, that someone who hasn’t got private health insurance, and therefore doesn’t get your options, might take.

    Choosing between a public or private hospital is a bit different. But frankly, in Australia, for life threatening situations the game seems to be almost entirely in the public system.

    None of this factors at all into any sane persons decision making when facing life threatening decisions.(The ‘ethics’ of it I mean. They money you have to pay unfortunately generally does factor in).

    Your one and only job right now is to get well, including as happy and comfortable as possible. It isn’t coming up with a moral position of the labyrinthine intricacies of the practical application of a hybrid health policy in Australia, as applies to your specific situation. And I really doubt that anyone is thinking otherwise, but if they are, they clearly haven’t been to an Australian hospital for something undiagnosed!

    • veritas says:

      thank you for articulating this SO much more clearly than i could.

      and alleviating some of the guilt too. the Canberra Problem is a part of what is bothering me – sydney is close, and if i need to consult there – pure numbers are in my favour. and i want the best outcome, the best doctors, the best i can get, because… well… not wanting to die and all. and god, who knows if i can get just as good treatment publicly. but i’m in the place where i’ve made my choice and i’m just going to go with that. plus, i think my oncologist is public anyhow?

      it’s now the difficulty of second opinions i’m facing, to be honest. i just need to understand that the doctors will not be offended by me asking if i can get one. and it’s just for the surgeons for my liver, and the oncology – the bowel is simple enough that i’m not worried, but i really really want advice on whatever on earth is happening in liver-land.

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