I am really, really pissed off about the proposed GP co-payment. I’m a child of the Medicare system: it’s three years older than I am. Because I grew up in a rural area, where doctors routinely charge twice the medicare rate, GP visits were not actually free for me until I hit university and the uni bulk-billing clinic. But I grew up with the unquestioning certainty that some people at least were entitled to free health care: my childhood doctor bulk-billed health care card holders and holders of the DVA Gold Card. In the kid-friendly explanations I got when I read the notices aloud, these were people who couldn’t afford to pay up-front, and people whose war service warranted particular respect and provisions from the government.
As an adult, I know it’s not so simple – that many people who don’t have health care cards still struggle to pay for GP visits, and that if you’re ill, or have children, the benefits from your health care card often don’t go far enough. But as an adult, I have been a health care card holder. I have had my pap smears and my contraception and my ridiculous injuries (ask me about the time I gave myself chemical burns with Dettol) dealt with for free at bulk-billing clinics. When I had a mental health meltdown and wasn’t sure if it was really worth bothering a doctor with, I at least didn’t have to worry about the cost of the initial consultation. When a member of my family had a serious eating disorder and their parents weren’t around to coax them into treatment, I bustled them over to my doctor, saving them the mental weight of finding a good bulk-billing doctor on their own. I didn’t have to worry about whether they, or their parents, had seven bucks change to pay for it (and this family member could not be counted on to have seven bucks change at the time) or if I’d end up paying for someone else’s care.
All of those things stand to get a little bit harder now. So I’m pissed off.
Moreover, even a small co-payment stands to make life a lot harder for students and teachers both. Allow me to elaborate:
Quick perspective from me-as-astudent:
I’m a postgraduate student as well as a staff-member. I’m fairly well-paid (very well, in global postgrad terms), even on a 70% contract, but I spend over 1/3 of my salary in rent. And then there’s health care premiums. Swiss health care is the kind of system which Barrack Obama dreams of, but a complete horror to me as a child of Medicare. Compulsory, private health insurance with no barriers on the grounds of prior conditions (thank you, St Christina) and a list of compulsory coverage items.
Unlike the Medicare levy, one’s basic health insurance fees here are not scaled by income. Fees vary and the level of service you get depends on what you can pay. So my swanky lawyer friend mails all her bills off to her insurer, and they add her co-payments to her next bill. Me? I have to pay upfront and claim the money back. Oh, and there’s an excess, like when you crash your car in Australia: the first x many francs per year you pay entirely out of pocket. The lower your excess, the higher your monthly fees. There is also an equivalent to the medicare safety net, beyond which I will get all my money back for subsequent treatment, but I haven’t reached it yet.
I have to plan my doctors’ appointments – more than two in a month, and I’m digging into my safety buffer money. The time I had to visit the emergency clinic, the bill took months to arrive, leaving me with the knowledge that a bill for an unspecified amount would turn up some day, probably when I least wanted it.
All of this would be why I’m overdue for a pap smear and routine STD tests. I have to triage my problems: what’s more important, contraception or blood tests or vaccinations? I’ve got a reliable salary, and my mother taught me the art of stinginess, so I can manage. Many of my students here, I suspect, cannot. I would be pushed beyond my budget if I developed a major mental or physical health issue right now.
GP access becomes a teaching issue
Right now I would be laughing if all I had to pay was seven bucks (the proposed medicare co-pay) to see my GP. But seven bucks is a lot of money to many students.
It’s a lot of money if you have to see a doctor frequently: a student with a recurring mental or physical illness will find they have to work more to have the cash to pay the doctor to get the treatment so they can stay at uni. Sam M, A former student of mine from Sydney – who, more’s the pity, had to drop out because she couldn’t keep up full-time study with her chronic illness – told Facebook recently that she already spends $200 per month on medical expenses. She’s got a stable job now: maybe she will be able to scrape up the $7, $14, however many dollars she needs to see her GP as often as she needs to under the proposed system. Maybe she won’t. And even if she can, isn’t it insulting to declare that she ‘has to contribute something’ to her medical expenses? She’s already paying $200 per month!*
Students’ ability to balance study and work, and turn up and contribute to class, suffers for every medical expense they can expect. I had a few students in Sydney who would skip classes because of work , and I do not fondly remember the semesterly dance with students who needed their tutorial times changed because of work (which is not officially an acceptable excuse). I think, though it’s hard to tell because I teach fewer classes here, that I have a far greater percentage of students in Geneva needing to leave early, suddenly not come to class, or fail to turn up for assessments because of plausible demands placed on them by work. Jobs they need to keep, because the costs of being a human in Switzerland are much higher and there is far less support – no AusStudy, no Medicare, no university doctors… the list goes on.
Then there’s the compliance issue which arises with unexpected medical costs. Seeing the emergency clinic, as I mentioned, put me in budget stress for months. How much worse is it for students in unstable jobs? In Sydney I had absolutely no qualms about telling a student that if they failed to turn up for an assessment, they needed to bring me a doctors’ certificate. If they missed class frequently, doctors’ certificate! There’s a bulk-billing clinic on campus, and in sSydneyat least, bulk-billing clinics scattered across the suburbs.
Here, I had to speak to a student about attendance, and he turned to me and said: “I can’t afford to go to the doctor!” Fair enough, mate. I can’t either. And therefore I really don’t want you in my class with your germs. I often miss USyd’s clear, publicly available and rigid regulations (eg, the Faculty of Arts attendance policy is online for anyone to scrutinse) here, where many decisions rely on discretion, advice from superiors, and long-standing tradition. But if there were a specified number of absences after which one must fail (and the students on the Commission Mixte of my department have, for good reasons, rejected proposals to introduce such a policy), its implementation would be unjustly harsh at least some of the time.
I can’t afford CHF 150 to get a doctors’ cert for a bad cold. Neither can my students. I could afford seven bucks, but many students could not. The family member I mentioned above? Not without parental intervention. The former student with chronic illness? Very unlikely – especially given that many chronic illness flare-ups one wouldn’t see a GP about, anyway, unless something seemed worse than usual.
My very erudite conclusion:
It’s all shit, I’m pissed off, and current policy directions are eroding my comfortable sense that at least I could go home to Australia where public health coverage actually works. I predict that higher ed teachers will find themselves dealing with more student crises due to health-and-finance stress (and, given the state of academic employment, many higher ed teachers will be in the same boat). I predict that clear, public and standardised regulations regarding attendance, illness and accommodations will become harder to enforce, and more damaging when they are enforced.
* I sought Sam’s permission to cite her anonymously, and recieved permission to use her name as well. 🙂