Your body will be crushed by the unnaturally upright seat. A pressure sore is slowly forming on my elbow as I sit on the hard armrest with my wife on one side and a rather uncomfortable stranger on the other. I stared at the lopsided gray tray table as I tipped a styrofoam cup filled with Sky Chef’s special holy grail of lukewarm coffee. My ears became one with the constant sound of the engine, a prelude to the orchestra of impending jet lag. As my 1-year-old son attempts to escape from my lap for the 11th time, I’m not thinking about the length of this flight. Admittedly, it’s a long journey from Sydney to Dallas with his bipedal one-year-old. But my mind is focused on one thing as I make my way back to the United States, despite his pedo-jail escapee sprinting down the aisle to steal passengers’ paper cups. I’m an orthopedic surgeon. And my family has no medical care.
When living abroad, having a clear departure date makes you see things in a new light. Time flies. Life must be lived actively and not a moment should be wasted. Experiences are enjoyed as novelty and remain in our minds and camera rolls as memories. I completed my second surgical fellowship in Australia and lived with my family in Sydney for her 7 months. It was an adventure I’ll never forget. In my Sydney apartment overlooking the beautiful harbour, I watch my son learn to crawl, take his first steps and say his first words. Explore the isolated outback of Uluru and the breathtaking landscapes of nearby New Zealand. Driving on the wrong side of the road in a barely legal old Holden Captiva that broke down in a remote part of a road trip to Melbourne (after waiting for hours on a road with no soul or cell signal, I realized that the ubiquitous mode of transportation Cell phone reception has become commonplace again). During my adventures, I learned about more advanced shoulder and elbow surgeries from seasoned masters in the field. However, there was one thing that struck me during my surgical operations at various public and private hospitals. It is the universal nature of Australian healthcare.
Intellectually, anyone with access to the internet and a little initiative can glean the differences between various health care systems. Living it is another story. Before immigrating, I did academic research and understood the major differences between the US and Australian systems. But after working in it every day and seeing the opposite sides of the public and private system, I’ve come to understand the peace of mind that comes when you don’t have to worry about access to care. It’s great that the entire population has access to healthcare. Is the system perfect? Far from it. It is naive to expect something close to “perfect” from medical care. After all, human health is inherently imperfect. That’s why we get sick. That’s why we have doctors (and, in fact, why I have a career). As with any “public” or “socialized” system, waiting times are often long. But that’s also the reality of life. As Adam Smith quipped, there is no truly free lunch. You can either pay by time or you can pay by money. And if you’re very unlucky, you’ll end up paying for both. Wealthy Australians also have complementary private health insurance similar to the US system, allowing them choice of doctor, preferred hospital and prompt treatment options. Their countries function with a complete two-tier health system. Everyone has access to public health insurance without having to worry about losing it if they decide to change jobs.
As I mentally returned to my 18-hour caravan, I thought about these differences in beautiful airline interior decor. Of particular selfish interest, my son turned his 1st year and required routine childhood vaccines upon arrival in Texas. His wife and I were past our primary care visits and dental appointments. Just a few weeks before moving, I discovered that my health insurance wouldn’t cover me until I started working. 1 month blank period. My previous US insurance ended at the end of my first fellowship before moving to Sydney. And our Australian visitor health insurance ended on the day we returned.
Living in a state of ambiguity regarding insurance can be stressful. If nothing were wrong, no one would get sick. It’s just a hypothetical stress factor. Unfortunately, his monthly bill was not at all hypothetical. My son required routine childhood vaccinations. Pricing for cash payments is amazing. His wife and son both became ill and had long and expensive trips to emergency care. While they recovered, I came down with an illness that was not covered by insurance and required a similar emergency room visit. Then, as the month drew to a close and employment, paychecks and health insurance were about to start, his son had another ear infection. Suffice it to say, returning to the United States from another hemisphere was a bit of a challenge. Hardest on my bank account and emotions.
I chronicled this emotional (and somewhat redundant) quest simply because I had never before in my life been without health insurance. If I was single, young, and didn’t have a family to worry about, I probably wouldn’t have felt as stressed. But the terrifying 18-hour journey was compounded by the multiple health issues upon arrival (fortunately none of them were serious) that many in the U.S. are facing. It got me thinking about the lack of medical access. Australians did not share that fear. It’s not a question of medical care being “great” or “better.” This is not a debate about which system is “better”. It’s even simpler. Just access it. Ability to be seen in places other than emergency rooms. I am not going to provide a solution to this huge problem in a short essay. But I know something needs to change. Perhaps we can learn something from the land below.
Adil Shahzad Ahmed I’m an orthopedic surgeon.
