I’m squished in an unnaturally upright seat. My elbows slowly develop pressure sores atop rigid armrests, with my wife on one side and a semi-uncomfortable stranger on the other. I stare at my lopsided gray tray table, sporting a Styrofoam cup of lukewarm coffee, the chalice special of Sky Chefs. My ears have become one with the perpetual background hum of engines, a prelude to the impending orchestra of jet lag. As my one-year-old son attempts his eleventh escape from my lap, I’m not thinking about the length of this flight. Sure – Sydney to Dallas is a long jaunt with a bipedal one-year-old. But despite his pediatric prison break attempts to sprint down the aisle and pilfer passengers’ paper cups, my mind is focused on one thing as we return to the U.S. I’m an orthopedic surgeon. And my family does not have health care.
Having a definite departure date when living abroad forces one to see with a new perspective. Time is fleeting. Life must be actively lived, no moment wasted. Experiences are relished for novelty and cherished as memories in our minds and camera rolls. I completed my second surgical fellowship in Australia, living in Sydney for seven months with my family. It was an adventure we will never forget. Watching our son learn to crawl, take his first steps, and say his first words in our Sydney apartment overlooking the stunning harbor. Exploring the isolated outback of Uluru and the breathtaking landscapes of nearby New Zealand. Navigating the opposite side of the street in our barely-legal ancient Holden Captiva, which broke down on a remote stretch of our road trip to Melbourne (after waiting hours on a road with no human soul or cell signal, I’ll never take ubiquitous cell phone reception for granted again). Amongst the adventures, I learned some more advanced shoulder and elbow surgery from seasoned masters in the field. But one thing stood out to me during surgical days in the various public and private hospitals: the universal nature of Australian health care.
Intellectually, anyone with internet access and a bit of initiative can glean differences across various health care systems. Living it is a different story. Prior to moving, I researched and understood the broad differences between the U.S. and Australian systems academically. But working in it every day, seeing the polar opposite sides of the public versus private system, I came to appreciate the peace of mind when one need not worry about access to care. An entire populace with access to health care is a beautiful thing. Is the system perfect? Far from it. Expecting anything nearing “perfection” from health care is naïve. After all, human health is, by definition imperfect. It’s why we get sick. It’s why we have doctors (and, in fact, why I have a career). There are often lengthy wait times, not unlike other “public” or “socialized” systems. But that, too, is a reality of life. As Adam Smith quipped, there is truly no free lunch. You either pay with your time, or you pay with your money. And if very unlucky, you pay with both. Affluent Australians further purchase supplementary private health insurance, much like the U.S. system, allowing options for choice of doctor, preferred hospital, and faster care. Their country functions with a complete two-tiered health system. Everyone has access to public health care without the worry of losing health care coverage if one is in the limbo of changing jobs.
Mentally migrating back to our 18-hour caravan, I pondered these differences in the lovely airline upholstery. Of particular selfish interest, my son turned one and needed routine pediatric vaccines upon arrival in Texas. My wife and I were overdue for primary care visits and dental work. I realized only a few weeks prior to moving back that we would not have health insurance until I began working. A one-month gap. Our prior U.S. insurance terminated at the end of my first fellowship before moving to Sydney. And our Australian visitor health insurance ended the day we moved back.
Dwelling in insurance limbo is stressful. If nothing goes wrong, no one gets sick; it’s simply a hypothetical stressor. Unfortunately, in that one-month span, our bills were anything but hypothetical. My son required routine pediatric vaccinations. The cash-pay pricing is beyond impressive. My wife and son both got sick, with lengthy and costly jaunts to urgent care. As they recovered, I then succumbed to insurance-absent illness, requiring a similar ER excursion. And as the month drew to a close, and the commencement of employment, attending salary, and health insurance drew near, my son sustained yet another ear infection. Suffice it to say that returning to the U.S. from another hemisphere was slightly rough. Rougher on my bank account and emotions than anything else.
I chronicle this emotional (and semi-verbose) quest simply because I had never before been without health insurance in my life. If I was single and younger, with no family to worry over, perhaps I wouldn’t have been stressed. However, the preamble of dread during the 18-hour transit, compounded by multiple health issues on arrival (thankfully none severe), made me ponder the lack of health care access many in the U.S. face. Australians did not share that fear. It’s not even a question of “amazing” or “better” health care. It’s not a discussion of which system is “superior.” It’s even more simple. Just access. Just the ability to be seen in a venue other than an emergency room. I don’t pretend to offer a solution to this enormous problem in a short essay. But I know something needs to change. Perhaps we can learn something from the land down under.
Adil Shahzad Ahmed is an orthopedic surgeon.