Ask Lemmy

Australia here.

I'm going to start off with this since most Americans I have spoken with don't know it: You can have private health cover on top of the universal healthcare which subsidizes dental, glasses, private hospital cover, maternity and prosthetics etc. Important to note, private cover still gets the benefit of the universal health care. For example, about 18 years ago having a voluntary c-section in a private hospital without health cover was ~$5k, but you would be covered in a public hospital or if your private cover took care of x%. For that $5k my wife and I had a private room with a queen size bed and I was also covered for meals for 3 nights. That's also when I realized my private cover didn't have maternity care, oh well.

Private cover also gives you a tax rebate.

Last year I went to doctor with a sore thumb that wasn't getting better after a week and a half (fell on it when sitting down on wet grass). Private practice, after hours, had to pay the gap fee of ~$80 for which I got a partial rebate back into my account next day. He examined me, wrote up up two scripts and told me to get an x-ray and ultrasound with urgency first thing in the morning.

I called up, made a booking while driving to work, and quoted what he said. By 10 am I was getting the scans. By 3pm I got a call that they had set me up to get an MRI at a private hospital for 8pm that night. Total cost? The $80 gap that I got partially refunded. I ended up going with a top rated private plastic surgeon since I had coverage but I could have gone with the public system and gotten fixed up. I ended up getting a tailor made splint at a private clinic during recovery and found out that way my private insurance didn't have prosthetics, so I ended up ~$180 out of pocket.

As another example, about 10 years ago my grandma was going through chemo. A pensioner ,no health insurance, she paid ~$20 gap for a months worth of medication. I looked up the unsubsidized price and it was the cost of a small car ~30,000. That is a result of the PBS (pharmaceutical benefit scheme) where the main lever is, the government negotiates the price of medicine, and then subsidies it. The standing agreement is that you can't charge more for a class of drugs that the lowest provider of a similar medication. Numerous Australia-US free trade agreements have tried to water this down but its always been a hard no, its a beloved system and even our conservative government knows it would be political suicide if they ever tried to weaken it.

Really importantly to understand is also the safety net. If your out of pocket costs for the public healthcare (gap fees etc) exceed a threshold for the year, those gap fees start getting additionally covered between 80-100% (depending if it is in hospital or out of hospital care.) And those benefits start coming in after you are only $594.40 out of pocket.
https://www.servicesaustralia.gov.au/how-medicare-safety-nets-and-thresholds-work?context=22001 https://www.servicesaustralia.gov.au/what-are-medicare-safety-nets-thresholds?context=22001