The Australian health system is usually lauded as one of the best in the world. All citizens have access to public healthcare, no matter their income, but they can also sign up for private health insurance (PHI) if they so choose.

But the system is not without issues. Challenges include a shortage of health workers, the uneven geographic distribution of doctors, and the growing demand for care from the ageing population. In the past weeks, we’ve also discussed inadequate Medicare rebates prompting general practitioners to change their payment schemes and forcing patients to pay out of pocket.

A recent post on the social news website Reddit highlighted another problem: long wait lists for elective surgeries.

One Redditor shared their experience of how PHI came in handy after they had a herniated disc. They said: ‘I will preface this story by saying, I wish this wasn't the case, I wish our public system was always there for us when we needed it, but it's not.

‘I'm a healthcare professional with around 12 years of experience. I'd never bothered with PHI, as I loved and trusted our public healthcare system. I also figured if worse came to worse, I could pay out of pocket to go privately.

‘Then, around eight months ago, I bulged a disc in my lower back, which saw me unable to work and in high levels of pain. After trying a conservative approach, I was advised that surgery was now the only option.

‘To my absolute shock and horror, the public waitlist was 3-4 years, and for spine surgery, no surgeon would see me without private health insurance, even with me willing to pay completely out of pocket. Apparently, both due litigation risk and risk of owing tens of thousands if I ended up in ICU.’

‘Unable to bear the thought of waiting the 12-month waiting period for existing conditions with private health insurance, I started to ask around. Luckily, being in the industry, I was able to pull some strings and get a surgeon to take pity on me and I was in for the surgery as a privately paying patient two weeks later. I'm now three months post-surgery and back at work.

‘I now have the highest level of PHI and regretfully probably will for life.’

Many Aussies found the story to be a justification for national health reform. A top comment on the post said: ‘We need a real universal healthcare system. We desperately need to expand Medicare and fix bulk billing and dental care while we're at it.’

Another concurred: ‘Exactly. They need to stop tax-incentivising private health, start paying doctors better through the public system and focus on primary health and preventative measures. But private = profit and that’s what Australia is driven by.’

Thousands of Australians have to wait months to undergo elective surgery. Credit: Shutterstock​

Others said that the story was a public healthcare fail rather than a PHI win. ‘If the system were adequately funded from staff through to facilities, we wouldn’t have seen this post,’ said one Aussie.

But not everyone is into the idea, with a Redditor saying: ‘You can have whatever level of public healthcare you want - you just have to pay for it. In the words of the fat man, "it comes with a gold plated Rolls Royce so long as you pay for it”... If we aren't happy with paying a high-income tax, then we need to discuss how much you are willing to pay, and then provide the best services we can within that.’

The comment received a strong objection: ‘We could reprioritise where we spend the existing taxation income. Less tax relief for millionaires and those who profit from our natural resources.’ We previously wrote about how 60 millionaires did not pay any taxes in the fiscal year 2019-20, even though everyday citizens were still the biggest source of tax revenue.

Some Redditors called for the rejection of PHI: ‘If everyone refused to get private health insurance, the public system would be significantly better. The more people pay to avoid it, the worse it'll become.’

However, the recommendation is not workable for many Aussies, like one commenter pointed out: ‘Not everyone can afford to refuse to get PHI on principle… We need the healthcare it covers now, not after we reach the top of a months-long or even years-long waiting list.’

Longer waiting times have always been a concern in OECD countries, including Australia, but the COVID-19 pandemic has exacerbated the issue. Non-urgent elective surgeries, which fall under categories two and three in the urgency scale, were suspended in the last two years. Further, hospitals had reduced capacity, with available workers prioritising Covid patients. According to the Australian Institute of Health and Welfare, patients who had to wait more than a year to receive elective surgery increased from 2.8% in 2019-20 to 7.6% in 2020-21.

Not everyone could afford to wait. Patients with heart conditions and cancer need prompt care, of course. But cases like the original poster’s herniated disc, carpal tunnel syndrome, and hip problems also impact the quality of life for many Aussies, with some forced to stop working. Delayed care is costly, but private insurance is also not accessible to the most vulnerable.

Moreover, PHI is not perfect, even if it provides benefits such as shorter wait times, better coverage, and access to more health services. At least 42 per cent of Australians have experienced ‘bill shock’ even with PHI, and 52 per cent did not think it provided good value, especially when patients still had to pay out of pocket.

The original poster also had another advantage - they are in healthcare and have a network they can tap to expedite the waiting process. One commenter said: ‘Surgery really is about who you know and who you reach out to.’

Another agreed: ‘If the OP hadn't had connections, they would still be waiting. You need to both be able to afford private health insurance and have connections to achieve this result.’

What do you think of the story, folks? Do you think the system has to be reformed? Have you benefited from PHI? Share your thoughts in the comments!

 

[Suzanne rose]

My married daughter does not have health insurance and had to wait 2 years to have a gallbladder removed and 2 years of severe pain including 2 trips by ambulance to emergency.

My husband had a little bit of pain , went to a surgeon and was in the same public hospital that my daughter kept going to, having surgery 10 days later, why because we have phi

My surgeries even during covid I was in quickly although a private hospital.

Even though I have good insurance I am paying $400 a month ..

My last surgery cost me out of pocket.

$500 hospital excess this is paid for 2 family admission a year

$1,200 surgeon

$500 anesthesist and that was hugely discounted as my daughter works with him at another hospital as the anaesthetic nurse

I would love to drop my health insurance but I'm not game too

 

[Ricci]

I don't have phi, never have had and now I have a bad back. I know I require an operation and sooner rather than later but it's not going to happen anytime soon. partly my fault as I kept putting off committing to it as I'd heard some rather scary stories but partly as I wanted to try all my alternative options first. I have now exhausted all the alternatives and none of them gave me any relief so I find myself at the bottom of a very long list.

 

[JayKay]

Ah, all my working life and during my marriage I was privately covered.
Now, as pensioner, I rely on Medicare.
After breast cancer treatment, I started breaking bones spontaneously, despite having normal bone density.
For 5 years, bits of bone kept breaking off my hip joint.
Then Covid came....more waiting.
I finally got in as an emergency 12 months ago.
Due to the numerous fractures in my hip, there were enormous complications during the Surgery.
The surgeons ended up ripping my pubic bone apart....it is normally held firmly together by muscles and ligaments.
I am suffering worse pain than before the hip replacement, and I am now unable to drive.
They also severed the outer quadrant lateral cutaneous nerve, so I have a weird sensation in my outer thigh from the hip to the knee. If I knock that area on a chair, it is excruciatingly painful.
Would any of this have occurred in the private sector?
I doubt it!
I know surgeons have to learn, but I always expected a Senior surgeon to be in control.

 

[ElizaKaye]

I enquired about having a knee replacement up on the North Coast of NSW which was about $12000 without cover. Then I had to move to another town and the cost where I have moved to, I enquired, states that I would have to pay approx $25000. If you pay into a medical benefites fund you have to pay $500 excess, and then there is still a big gap to pay, plus aneathesatist , that doesn't seem to be covered even under the private cover. As a pensioner I could not afford either. When I had my back operated on, there was little waiting time but I ended up having to pay about $15000, out of pocket after the operation. That ended me having to be able to pay for any other operations. Last Nov 2021 I had an accident and broke my hip, the doctor replaced only the ball of the hip and I have been in pain ever since with the hip as well as a nerve catching. I was placed on a waiting list under the category of elective. Apparently there is no category in between emergency and elective. After waiting 6 months, I finally pointed out to the doctor that my problem was not an elective, as he said my problem was that I would now need the cap put in. And he went on to explain that when the hip is in an accident, they have to cut the tendon, which was already torn because of chemo the year before, but when it is a full hip replacement they don't have to cut the tendon. The tendon is still so tight that I cannot reach my foot on that side. I have not had an explanation why the doctor did not replace the whole hip. Any way after a letter from the doctor to the Booking Officer phoned me and told him to escalte me and I was told that I was on 3 month waiting list. After a month I received a letter to say I was on a 6 - 18 months wating list. I phoned him to ask what had happened, and he then realised he had not put me on the 3 month list. It is now September, when I was suposed to be on the list, and I phoned to find out is I was on the list and was told 'NO' for September. I asked if he could tell me when I will be on the list. the answer was "NO", even though he is the one who handles the list to let the patients know how long they have to wait 6 - 18 months in advance. This is very confusing. I emailed the doctor again, and was told to contact the Booking Officer that they have all the lists. I wrote back and then they condifrm that I was on the October waiting list. It seems that not many people know what is going on inclduing the main Booking Officer who is supposed to organise the lists. It will be a long 11 months waiting for something that shoulod have been done correctly in the first place with no cut tentdon apparently.

 

[Capsam]

I do not have phi. I simply can no longer afford it. I did have phi for many years but as a single taxpayer & with the Medicare levy & bracket creep I was paying more tax than billionaires on a basic salary! I gave it up in my mid 50’s. I was told in 2020 that I required surgery to remove a multinodular growth in the right lobe of my thyroid gland. My left lobe was removed over 25 years ago for the same reason. However, when I finally got to see the surgical Registrar, it was clear that COVID, ageism & the need to follow the risk versus benefit model of healthcare meant I was sent packing with the “…we will review in 12 months…” etc. My questioning if waiting was advisable in the event that there was a possibility of cancer were tut tutted away as nothing to worry about! Today, I had a follow-up ultrasound which was very tricky to complete. I was asked if I was seeing a Specialist & had I had biopsies done! I told the young man conducting the test that if I had phi we would NOT be having this conversation because the operation would have been completed 2 years ago!! However, as I rely on Medicare & am over 70 it appears that I can just go away & possibly die rather than be a “drain on resources”! YES! Our health system needs fixing to cater for ALL of us!

 

[Suzanne rose]

I don't have phi, never have had and now I have a bad back. I know I require an operation and sooner rather than later but it's not going to happen anytime soon. partly my fault as I kept putting off committing to it as I'd heard some rather scary stories but partly as I wanted to try all my alternative options first. I have now exhausted all the alternatives and none of them gave me any relief so I find myself at the bottom of a very long list.

Is it sciatica that you have ? The L4 L5 disc touching a nerve

 

[Suzanne rose]

I enquired about having a knee replacement up on the North Coast of NSW which was about $12000 without cover. Then I had to move to another town and the cost where I have moved to, I enquired, states that I would have to pay approx $25000. If you pay into a medical benefites fund you have to pay $500 excess, and then there is still a big gap to pay, plus aneathesatist , that doesn't seem to be covered even under the private cover. As a pensioner I could not afford either. When I had my back operated on, there was little waiting time but I ended up having to pay about $15000, out of pocket after the operation. That ended me having to be able to pay for any other operations. Last Nov 2021 I had an accident and broke my hip, the doctor replaced only the ball of the hip and I have been in pain ever since with the hip as well as a nerve catching. I was placed on a waiting list under the category of elective. Apparently there is no category in between emergency and elective. After waiting 6 months, I finally pointed out to the doctor that my problem was not an elective, as he said my problem was that I would now need the cap put in. And he went on to explain that when the hip is in an accident, they have to cut the tendon, which was already torn because of chemo the year before, but when it is a full hip replacement they don't have to cut the tendon. The tendon is still so tight that I cannot reach my foot on that side. I have not had an explanation why the doctor did not replace the whole hip. Any way after a letter from the doctor to the Booking Officer phoned me and told him to escalte me and I was told that I was on 3 month waiting list. After a month I received a letter to say I was on a 6 - 18 months wating list. I phoned him to ask what had happened, and he then realised he had not put me on the 3 month list. It is now September, when I was suposed to be on the list, and I phoned to find out is I was on the list and was told 'NO' for September. I asked if he could tell me when I will be on the list. the answer was "NO", even though he is the one who handles the list to let the patients know how long they have to wait 6 - 18 months in advance. This is very confusing. I emailed the doctor again, and was told to contact the Booking Officer that they have all the lists. I wrote back and then they condifrm that I was on the October waiting list. It seems that not many people know what is going on inclduing the main Booking Officer who is supposed to organise the lists. It will be a long 11 months waiting for something that shoulod have been done correctly in the first place with no cut tentdon apparently.

 

[Suzanne rose]

After reading all the stories , it makes me shoulder on a bit longer with my insurance

My last surgery if I paid for it in full would have been $25,000.

I paid just under $2,000

The other thing having insurance allows you to chose your surgeon.

I wished they would let you claim the cost of surgeons through your insurance.

Last week I paid $100 got $39 back .
Same yesterday.
And I'm back there next week that will cost me $260 I will get back $80

My belly it must be made of gold now

 

[DrivingGirl]

Peoples stories are terrible and so sad - and yes the health system does need to be reviewed. But I fear it will never happen while huge organisations rely on us becoming very ill to make enormous profits. I am a very grateful cancer survivor of 25 years and received my treatment courtesy of Medicare with a co payment. All my effort and money has subsequently been directed towards preventing illness where possible through diet and a grateful and appreciative attitude for my life. I intend to continue to spend my money in the area of the best food available which has helped me far more than any medicine.
This is the area we should be developing our knowledge and we would be so much better.
There’s so much that needs fixing in this world- where to start?…..

 

[Ricci]

Is it sciatica that you have ? The L4 L5 disc touching a nerve

I have spinal stenosis, virtually all the way down my spine, but L3,4 & 5 are the worst.

 

[Suzanne rose]

I have spinal stenosis, virtually all the way down my spine, but L3,4 & 5 are the worst.

I feel for you, my husband had severe back pain for 5 years, it made him a very grumpy man.

They wanted to operate but after researching and doctors saying they couldn't guarantee success plus a friend who works at RPA hospital said he saw people returning for 2nd and 3rd time.

The last thing he did was visit a sports physio, only because it was a friend off a friend and it worked .
He had previously been to other physio and so many doctors.
At night he slept on the floor at at times couldn't even sit it a chair.

Now after going to the sports physio he only gets paain here n there and doesn't interrupt just life

 

[Suzanne rose]

I feel for you, my husband had severe back pain for 5 years, it made him a very grumpy man.

They wanted to operate but after researching and doctors saying they couldn't guarantee success plus a friend who works at RPA hospital said he saw people returning for 2nd and 3rd time.

The last thing he did was visit a sports physio, only because it was a friend off a friend and it worked .
He had previously been to other physio and so many doctors.
At night he slept on the floor at at times couldn't even sit it a chair.

Now after going to the sports physio he only gets paain here n there and doesn't interrupt just life

His L4 and L5 was bent and touching nerves

 

[barbwire]

The Australian health system is usually lauded as one of the best in the world. All citizens have access to public healthcare, no matter their income, but they can also sign up for private health insurance (PHI) if they so choose.

But the system is not without issues. Challenges include a shortage of health workers, the uneven geographic distribution of doctors, and the growing demand for care from the ageing population. In the past weeks, we’ve also discussed inadequate Medicare rebates prompting general practitioners to change their payment schemes and forcing patients to pay out of pocket.

A recent post on the social news website Reddit highlighted another problem: long wait lists for elective surgeries.

One Redditor shared their experience of how PHI came in handy after they had a herniated disc. They said: ‘I will preface this story by saying, I wish this wasn't the case, I wish our public system was always there for us when we needed it, but it's not.

‘I'm a healthcare professional with around 12 years of experience. I'd never bothered with PHI, as I loved and trusted our public healthcare system. I also figured if worse came to worse, I could pay out of pocket to go privately.

‘Then, around eight months ago, I bulged a disc in my lower back, which saw me unable to work and in high levels of pain. After trying a conservative approach, I was advised that surgery was now the only option.

‘To my absolute shock and horror, the public waitlist was 3-4 years, and for spine surgery, no surgeon would see me without private health insurance, even with me willing to pay completely out of pocket. Apparently, both due litigation risk and risk of owing tens of thousands if I ended up in ICU.’

‘Unable to bear the thought of waiting the 12-month waiting period for existing conditions with private health insurance, I started to ask around. Luckily, being in the industry, I was able to pull some strings and get a surgeon to take pity on me and I was in for the surgery as a privately paying patient two weeks later. I'm now three months post-surgery and back at work.

‘I now have the highest level of PHI and regretfully probably will for life.’

Many Aussies found the story to be a justification for national health reform. A top comment on the post said: ‘We need a real universal healthcare system. We desperately need to expand Medicare and fix bulk billing and dental care while we're at it.’

Another concurred: ‘Exactly. They need to stop tax-incentivising private health, start paying doctors better through the public system and focus on primary health and preventative measures. But private = profit and that’s what Australia is driven by.’

View attachment 5771
Thousands of Australians have to wait months to undergo elective surgery. Credit: Shutterstock​

Others said that the story was a public healthcare fail rather than a PHI win. ‘If the system were adequately funded from staff through to facilities, we wouldn’t have seen this post,’ said one Aussie.

But not everyone is into the idea, with a Redditor saying: ‘You can have whatever level of public healthcare you want - you just have to pay for it. In the words of the fat man, "it comes with a gold plated Rolls Royce so long as you pay for it”... If we aren't happy with paying a high-income tax, then we need to discuss how much you are willing to pay, and then provide the best services we can within that.’

The comment received a strong objection: ‘We could reprioritise where we spend the existing taxation income. Less tax relief for millionaires and those who profit from our natural resources.’ We previously wrote about how 60 millionaires did not pay any taxes in the fiscal year 2019-20, even though everyday citizens were still the biggest source of tax revenue.

Some Redditors called for the rejection of PHI: ‘If everyone refused to get private health insurance, the public system would be significantly better. The more people pay to avoid it, the worse it'll become.’

However, the recommendation is not workable for many Aussies, like one commenter pointed out: ‘Not everyone can afford to refuse to get PHI on principle… We need the healthcare it covers now, not after we reach the top of a months-long or even years-long waiting list.’

Longer waiting times have always been a concern in OECD countries, including Australia, but the COVID-19 pandemic has exacerbated the issue. Non-urgent elective surgeries, which fall under categories two and three in the urgency scale, were suspended in the last two years. Further, hospitals had reduced capacity, with available workers prioritising Covid patients. According to the Australian Institute of Health and Welfare, patients who had to wait more than a year to receive elective surgery increased from 2.8% in 2019-20 to 7.6% in 2020-21.

Not everyone could afford to wait. Patients with heart conditions and cancer need prompt care, of course. But cases like the original poster’s herniated disc, carpal tunnel syndrome, and hip problems also impact the quality of life for many Aussies, with some forced to stop working. Delayed care is costly, but private insurance is also not accessible to the most vulnerable.

Moreover, PHI is not perfect, even if it provides benefits such as shorter wait times, better coverage, and access to more health services. At least 42 per cent of Australians have experienced ‘bill shock’ even with PHI, and 52 per cent did not think it provided good value, especially when patients still had to pay out of pocket.

The original poster also had another advantage - they are in healthcare and have a network they can tap to expedite the waiting process. One commenter said: ‘Surgery really is about who you know and who you reach out to.’

Another agreed: ‘If the OP hadn't had connections, they would still be waiting. You need to both be able to afford private health insurance and have connections to achieve this result.’

What do you think of the story, folks? Do you think the system has to be reformed? Have you benefited from PHI? Share your thoughts in the comments!

My Daughters partner (23) has a severe back injury and was referred to a Specialist almost 2years ago and told he needs surgery. He’s obviously unemployed and my Daughter (21) is only on Study allowance while going to TAFE. Neither of which can afford PHI. In May this year a letter finally arrived to say he’s on the waiting list. His condition became worse and his GP wrote to the Hospital to change his urgency category. A new letter arrived stating he will be seen within the next 3 months. But there has been no contact from the Hospital since. It’s over now 4 months on and this young man is completely wheelchair bound, suffering depression, feels suicidal and becoming pain relief dependant. My poor exhausted Daughter is tending to his every need 24/7 and barely able to keep up her own study/TAFE. (She also has Fibromyalgia, PCOS & multiple illnesses of her own). So back to the GP, who wrote a ‘chase up referral’… then, 3 days ago, a letter arrived stating “he is now on a waiting list”. It’s as if he’s considered a New patient and the process has started all over again! This young man will become paralysed by the time this gets rectified at this stage. A phone call to the Hospital explaining that he’s not a New patient, but an existing one, has now got us waiting yet again while they ‘look into it’ for us.
The health system is absolutely disgusting. It seems like the left hand ha no idea what the right hand is doing. He needs surgery Urgently. Life is already a struggle for everyone, we don’t need this worry as well.

 

[Shane O'Neill]

The Australian health system is usually lauded as one of the best in the world. All citizens have access to public healthcare, no matter their income, but they can also sign up for private health insurance (PHI) if they so choose.

But the system is not without issues. Challenges include a shortage of health workers, the uneven geographic distribution of doctors, and the growing demand for care from the ageing population. In the past weeks, we’ve also discussed inadequate Medicare rebates prompting general practitioners to change their payment schemes and forcing patients to pay out of pocket.

A recent post on the social news website Reddit highlighted another problem: long wait lists for elective surgeries.

One Redditor shared their experience of how PHI came in handy after they had a herniated disc. They said: ‘I will preface this story by saying, I wish this wasn't the case, I wish our public system was always there for us when we needed it, but it's not.

‘I'm a healthcare professional with around 12 years of experience. I'd never bothered with PHI, as I loved and trusted our public healthcare system. I also figured if worse came to worse, I could pay out of pocket to go privately.

‘Then, around eight months ago, I bulged a disc in my lower back, which saw me unable to work and in high levels of pain. After trying a conservative approach, I was advised that surgery was now the only option.

‘To my absolute shock and horror, the public waitlist was 3-4 years, and for spine surgery, no surgeon would see me without private health insurance, even with me willing to pay completely out of pocket. Apparently, both due litigation risk and risk of owing tens of thousands if I ended up in ICU.’

‘Unable to bear the thought of waiting the 12-month waiting period for existing conditions with private health insurance, I started to ask around. Luckily, being in the industry, I was able to pull some strings and get a surgeon to take pity on me and I was in for the surgery as a privately paying patient two weeks later. I'm now three months post-surgery and back at work.

‘I now have the highest level of PHI and regretfully probably will for life.’

Many Aussies found the story to be a justification for national health reform. A top comment on the post said: ‘We need a real universal healthcare system. We desperately need to expand Medicare and fix bulk billing and dental care while we're at it.’

Another concurred: ‘Exactly. They need to stop tax-incentivising private health, start paying doctors better through the public system and focus on primary health and preventative measures. But private = profit and that’s what Australia is driven by.’

View attachment 5771
Thousands of Australians have to wait months to undergo elective surgery. Credit: Shutterstock​

Others said that the story was a public healthcare fail rather than a PHI win. ‘If the system were adequately funded from staff through to facilities, we wouldn’t have seen this post,’ said one Aussie.

But not everyone is into the idea, with a Redditor saying: ‘You can have whatever level of public healthcare you want - you just have to pay for it. In the words of the fat man, "it comes with a gold plated Rolls Royce so long as you pay for it”... If we aren't happy with paying a high-income tax, then we need to discuss how much you are willing to pay, and then provide the best services we can within that.’

The comment received a strong objection: ‘We could reprioritise where we spend the existing taxation income. Less tax relief for millionaires and those who profit from our natural resources.’ We previously wrote about how 60 millionaires did not pay any taxes in the fiscal year 2019-20, even though everyday citizens were still the biggest source of tax revenue.

Some Redditors called for the rejection of PHI: ‘If everyone refused to get private health insurance, the public system would be significantly better. The more people pay to avoid it, the worse it'll become.’

However, the recommendation is not workable for many Aussies, like one commenter pointed out: ‘Not everyone can afford to refuse to get PHI on principle… We need the healthcare it covers now, not after we reach the top of a months-long or even years-long waiting list.’

Longer waiting times have always been a concern in OECD countries, including Australia, but the COVID-19 pandemic has exacerbated the issue. Non-urgent elective surgeries, which fall under categories two and three in the urgency scale, were suspended in the last two years. Further, hospitals had reduced capacity, with available workers prioritising Covid patients. According to the Australian Institute of Health and Welfare, patients who had to wait more than a year to receive elective surgery increased from 2.8% in 2019-20 to 7.6% in 2020-21.

Not everyone could afford to wait. Patients with heart conditions and cancer need prompt care, of course. But cases like the original poster’s herniated disc, carpal tunnel syndrome, and hip problems also impact the quality of life for many Aussies, with some forced to stop working. Delayed care is costly, but private insurance is also not accessible to the most vulnerable.

Moreover, PHI is not perfect, even if it provides benefits such as shorter wait times, better coverage, and access to more health services. At least 42 per cent of Australians have experienced ‘bill shock’ even with PHI, and 52 per cent did not think it provided good value, especially when patients still had to pay out of pocket.

The original poster also had another advantage - they are in healthcare and have a network they can tap to expedite the waiting process. One commenter said: ‘Surgery really is about who you know and who you reach out to.’

Another agreed: ‘If the OP hadn't had connections, they would still be waiting. You need to both be able to afford private health insurance and have connections to achieve this result.’

What do you think of the story, folks? Do you think the system has to be reformed? Have you benefited from PHI? Share your thoughts in the comments!

Medicare was introduced by Labor for all rich an poor since the inception and changing government (LNP) once in power they started to dismantle it every time they were in power and feed millions of taxpayers money into private health insurance companies to the detriment of the public health system (Medicare) and yes covid played a part in it to (waiting lists) but the detriment of Medicare is from the liberal government reain now it's up to Labor to repair this and remember anything that is public owned has been sold off by the Liberal government and yes I waited 91/2 months for a hernia operation last year

 

[Singomate]

The Australian health system is usually lauded as one of the best in the world. All citizens have access to public healthcare, no matter their income, but they can also sign up for private health insurance (PHI) if they so choose.

But the system is not without issues. Challenges include a shortage of health workers, the uneven geographic distribution of doctors, and the growing demand for care from the ageing population. In the past weeks, we’ve also discussed inadequate Medicare rebates prompting general practitioners to change their payment schemes and forcing patients to pay out of pocket.

A recent post on the social news website Reddit highlighted another problem: long wait lists for elective surgeries.

One Redditor shared their experience of how PHI came in handy after they had a herniated disc. They said: ‘I will preface this story by saying, I wish this wasn't the case, I wish our public system was always there for us when we needed it, but it's not.

‘I'm a healthcare professional with around 12 years of experience. I'd never bothered with PHI, as I loved and trusted our public healthcare system. I also figured if worse came to worse, I could pay out of pocket to go privately.

‘Then, around eight months ago, I bulged a disc in my lower back, which saw me unable to work and in high levels of pain. After trying a conservative approach, I was advised that surgery was now the only option.

‘To my absolute shock and horror, the public waitlist was 3-4 years, and for spine surgery, no surgeon would see me without private health insurance, even with me willing to pay completely out of pocket. Apparently, both due litigation risk and risk of owing tens of thousands if I ended up in ICU.’

‘Unable to bear the thought of waiting the 12-month waiting period for existing conditions with private health insurance, I started to ask around. Luckily, being in the industry, I was able to pull some strings and get a surgeon to take pity on me and I was in for the surgery as a privately paying patient two weeks later. I'm now three months post-surgery and back at work.

‘I now have the highest level of PHI and regretfully probably will for life.’

Many Aussies found the story to be a justification for national health reform. A top comment on the post said: ‘We need a real universal healthcare system. We desperately need to expand Medicare and fix bulk billing and dental care while we're at it.’

Another concurred: ‘Exactly. They need to stop tax-incentivising private health, start paying doctors better through the public system and focus on primary health and preventative measures. But private = profit and that’s what Australia is driven by.’

View attachment 5771
Thousands of Australians have to wait months to undergo elective surgery. Credit: Shutterstock​

Others said that the story was a public healthcare fail rather than a PHI win. ‘If the system were adequately funded from staff through to facilities, we wouldn’t have seen this post,’ said one Aussie.

But not everyone is into the idea, with a Redditor saying: ‘You can have whatever level of public healthcare you want - you just have to pay for it. In the words of the fat man, "it comes with a gold plated Rolls Royce so long as you pay for it”... If we aren't happy with paying a high-income tax, then we need to discuss how much you are willing to pay, and then provide the best services we can within that.’

The comment received a strong objection: ‘We could reprioritise where we spend the existing taxation income. Less tax relief for millionaires and those who profit from our natural resources.’ We previously wrote about how 60 millionaires did not pay any taxes in the fiscal year 2019-20, even though everyday citizens were still the biggest source of tax revenue.

Some Redditors called for the rejection of PHI: ‘If everyone refused to get private health insurance, the public system would be significantly better. The more people pay to avoid it, the worse it'll become.’

However, the recommendation is not workable for many Aussies, like one commenter pointed out: ‘Not everyone can afford to refuse to get PHI on principle… We need the healthcare it covers now, not after we reach the top of a months-long or even years-long waiting list.’

Longer waiting times have always been a concern in OECD countries, including Australia, but the COVID-19 pandemic has exacerbated the issue. Non-urgent elective surgeries, which fall under categories two and three in the urgency scale, were suspended in the last two years. Further, hospitals had reduced capacity, with available workers prioritising Covid patients. According to the Australian Institute of Health and Welfare, patients who had to wait more than a year to receive elective surgery increased from 2.8% in 2019-20 to 7.6% in 2020-21.

Not everyone could afford to wait. Patients with heart conditions and cancer need prompt care, of course. But cases like the original poster’s herniated disc, carpal tunnel syndrome, and hip problems also impact the quality of life for many Aussies, with some forced to stop working. Delayed care is costly, but private insurance is also not accessible to the most vulnerable.

Moreover, PHI is not perfect, even if it provides benefits such as shorter wait times, better coverage, and access to more health services. At least 42 per cent of Australians have experienced ‘bill shock’ even with PHI, and 52 per cent did not think it provided good value, especially when patients still had to pay out of pocket.

The original poster also had another advantage - they are in healthcare and have a network they can tap to expedite the waiting process. One commenter said: ‘Surgery really is about who you know and who you reach out to.’

Another agreed: ‘If the OP hadn't had connections, they would still be waiting. You need to both be able to afford private health insurance and have connections to achieve this result.’

What do you think of the story, folks? Do you think the system has to be reformed? Have you benefited from PHI? Share your thoughts in the comments!

Currently waiting on a hip replacement, get this Doctors to frightened to operate because I have cancer, it doesn't matter that I have to live with constant pain and on massive doses of pain killers. I have told them I will sign any documents to release them from any responsibility. That's my winge for the day. Have been waiting for procedure for 3 years.

 

[Mistydolphin1]

I was on a waiting list for cataract surgery. After nearly 3 years I had to pay to have it done privately. Being on a pension with no private health cover it was not cheap but what the worst part of this was - the private hospital put up their prices after I had signed for the op. It was not a small increase it went up $623, how is a charge of that magnitude just happen overnight. That was payable for both eyes that were affected but being told I was legally blind in one eye and not far off in the other I had to go ahead with it even with the cost having increased by over $1200. A person would think that if you try to help yourself, rather than stay on an overburdened hospital system, you would get some of that cost subsidised by Medicare. Anaesthetic and the specialist were claimable but not the most expensive cost - the hospital - and I was only there for about 3 hours each time. Over $700 an hour ????

 

[Robbo3006]

Ah, all my working life and during my marriage I was privately covered.
Now, as pensioner, I rely on Medicare.
After breast cancer treatment, I started breaking bones spontaneously, despite having normal bone density.
For 5 years, bits of bone kept breaking off my hip joint.
Then Covid came....more waiting.
I finally got in as an emergency 12 months ago.
Due to the numerous fractures in my hip, there were enormous complications during the Surgery.
The surgeons ended up ripping my pubic bone apart....it is normally held firmly together by muscles and ligaments.
I am suffering worse pain than before the hip replacement, and I am now unable to drive.
They also severed the outer quadrant lateral cutaneous nerve, so I have a weird sensation in my outer thigh from the hip to the knee. If I knock that area on a chair, it is excruciatingly painful.
Would any of this have occurred in the private sector?
I doubt it!
I know surgeons have to learn, but I always expected a Senior surgeon to be in control.

When You're older We become Guinea pigs and are used for young surgeons to practice and learn on, if the outcome is bad, they don't care, we are expendable, I've had 3 shoulder surgeries, absolutely worse now than before disgraceful how they treat us, we're disposable now that the government can't extort tax revenue from us.

 

[JustPat]

I am 65 and my hubby 64 and not due to retire for 3 years and we have always had PHI and over the past 5 years it has been in heavy use when I had spinal surgery in 2016 no specialist would see me unless I had PHI and waiting time was up to 2 years then just to see a specialist. For the surgery I had to have two tests which cost $1800 each and medicare only covered $1000 of the $3600 and PHI would not cover any unless I had them as a patient in hospital and then I would only have been $40 out of pocket. 2018 I had a hysterectomy due to ovarian cancer and once again to expediate surgery used PHI or it was a 2 to 3 year wait and I had the surgery 6 weeks after seeing the specialist and between aniethiest and specialist and co payment I was out of pocket $2000 and then there was the further $1000 out of pocket for cateract surgery (one eye early 2019 and other just before hospitals shut for elective surgery in 2019 due to COVID). When we originally had PHI in our 20's and I had my children in 1984 and 1986 spending 3 months in hospital for each - PHI covered everything and we were not out of pocket 1 cent.

 

[Ezzy]

The Australian health system is usually lauded as one of the best in the world. All citizens have access to public healthcare, no matter their income, but they can also sign up for private health insurance (PHI) if they so choose.

But the system is not without issues. Challenges include a shortage of health workers, the uneven geographic distribution of doctors, and the growing demand for care from the ageing population. In the past weeks, we’ve also discussed inadequate Medicare rebates prompting general practitioners to change their payment schemes and forcing patients to pay out of pocket.

A recent post on the social news website Reddit highlighted another problem: long wait lists for elective surgeries.

One Redditor shared their experience of how PHI came in handy after they had a herniated disc. They said: ‘I will preface this story by saying, I wish this wasn't the case, I wish our public system was always there for us when we needed it, but it's not.

‘I'm a healthcare professional with around 12 years of experience. I'd never bothered with PHI, as I loved and trusted our public healthcare system. I also figured if worse came to worse, I could pay out of pocket to go privately.

‘Then, around eight months ago, I bulged a disc in my lower back, which saw me unable to work and in high levels of pain. After trying a conservative approach, I was advised that surgery was now the only option.

‘To my absolute shock and horror, the public waitlist was 3-4 years, and for spine surgery, no surgeon would see me without private health insurance, even with me willing to pay completely out of pocket. Apparently, both due litigation risk and risk of owing tens of thousands if I ended up in ICU.’

‘Unable to bear the thought of waiting the 12-month waiting period for existing conditions with private health insurance, I started to ask around. Luckily, being in the industry, I was able to pull some strings and get a surgeon to take pity on me and I was in for the surgery as a privately paying patient two weeks later. I'm now three months post-surgery and back at work.

‘I now have the highest level of PHI and regretfully probably will for life.’

Many Aussies found the story to be a justification for national health reform. A top comment on the post said: ‘We need a real universal healthcare system. We desperately need to expand Medicare and fix bulk billing and dental care while we're at it.’

Another concurred: ‘Exactly. They need to stop tax-incentivising private health, start paying doctors better through the public system and focus on primary health and preventative measures. But private = profit and that’s what Australia is driven by.’

View attachment 5771
Thousands of Australians have to wait months to undergo elective surgery. Credit: Shutterstock​

Others said that the story was a public healthcare fail rather than a PHI win. ‘If the system were adequately funded from staff through to facilities, we wouldn’t have seen this post,’ said one Aussie.

But not everyone is into the idea, with a Redditor saying: ‘You can have whatever level of public healthcare you want - you just have to pay for it. In the words of the fat man, "it comes with a gold plated Rolls Royce so long as you pay for it”... If we aren't happy with paying a high-income tax, then we need to discuss how much you are willing to pay, and then provide the best services we can within that.’

The comment received a strong objection: ‘We could reprioritise where we spend the existing taxation income. Less tax relief for millionaires and those who profit from our natural resources.’ We previously wrote about how 60 millionaires did not pay any taxes in the fiscal year 2019-20, even though everyday citizens were still the biggest source of tax revenue.

Some Redditors called for the rejection of PHI: ‘If everyone refused to get private health insurance, the public system would be significantly better. The more people pay to avoid it, the worse it'll become.’

However, the recommendation is not workable for many Aussies, like one commenter pointed out: ‘Not everyone can afford to refuse to get PHI on principle… We need the healthcare it covers now, not after we reach the top of a months-long or even years-long waiting list.’

Longer waiting times have always been a concern in OECD countries, including Australia, but the COVID-19 pandemic has exacerbated the issue. Non-urgent elective surgeries, which fall under categories two and three in the urgency scale, were suspended in the last two years. Further, hospitals had reduced capacity, with available workers prioritising Covid patients. According to the Australian Institute of Health and Welfare, patients who had to wait more than a year to receive elective surgery increased from 2.8% in 2019-20 to 7.6% in 2020-21.

Not everyone could afford to wait. Patients with heart conditions and cancer need prompt care, of course. But cases like the original poster’s herniated disc, carpal tunnel syndrome, and hip problems also impact the quality of life for many Aussies, with some forced to stop working. Delayed care is costly, but private insurance is also not accessible to the most vulnerable.

Moreover, PHI is not perfect, even if it provides benefits such as shorter wait times, better coverage, and access to more health services. At least 42 per cent of Australians have experienced ‘bill shock’ even with PHI, and 52 per cent did not think it provided good value, especially when patients still had to pay out of pocket.

The original poster also had another advantage - they are in healthcare and have a network they can tap to expedite the waiting process. One commenter said: ‘Surgery really is about who you know and who you reach out to.’

Another agreed: ‘If the OP hadn't had connections, they would still be waiting. You need to both be able to afford private health insurance and have connections to achieve this result.’

What do you think of the story, folks? Do you think the system has to be reformed? Have you benefited from PHI? Share your thoughts in the comments!

As stated, PHI can get you onto an operating list quicker but the shock which inevitably comes with the gap payment can be worse. Some Specialists require a gap payment up front before surgery.

This has now become 'the haves' & 'the have nots'. Those who have cover & those who do not. One of the first things a surgeon will a ask is if you have PHI or this will be a question on the form filled in prior to seeing one. Are we becoming more Americanized in this attitude?

The Federal Government need to make this problem a priority in an effort to help all Australians.