Imagine
that you’ve driven your car off the road and into a Eucalyptus tree and busted
up your ankle. During the subsequent ambulance ride, what thoughts might pop
into your head?
“Ouch!”
“Thank
goodness no one else was hurt.”
“What in the heck were those possums
doing?”
“I’ve
never liked Eucalyptus trees.”
“How in
the world am I going to pay my medical bill?”
A Marin
County resident could conceivably have some, or all, of these thoughts. But
here in New Zealand, at least one of these notions would be quite unusual. And
no, it’s not the one about possums – they are as plentiful as sheep around
these parts. Rather, it is the bit about medical costs. You see in New Zealand,
accident and injury-related medical care is fully compensated – regardless of
insurance or fault. More about that soon, but first, for those who may have
missed my last column, a quick catch-up…I’m in the midst of a six-month stay in
Auckland, grappling with how Kiwi perceptions of health and wellness differ
from American ones. Now, I recognize (disclaimer alert!) that perceptions of
health are diverse and that this endeavor hazards broad generalizations. Perhaps
my query is as unanswerable as the age-old “nature versus nurture debate.”
Nonetheless, there are identifiable differences in geography, culture and
statute that would seem to shape how health is perceived in these two
countries.
Let’s
return to the example of medical care for the wounded. We all know that some injured
patients in the U.S. just cannot pay for healthcare, but that eventually
(probably in an ER) they are likely to receive treatment anyway. Everyone else picks up the tab for this
through higher insurance premiums and other cost shifting. Of course, in some cases,
it’s not that simple. For example, some uninsured patients might be able to pay
their medical bills, but risk bankruptcy in the process.
Injuries are
handled quite differently in New Zealand under a system called the Accident
Compensation Corporation (ACC). First enacted in 1974 and revised many times
since then, the ACC hinges on a crucial trade off – free medical care for
injuries (regardless of fault) for all citizens and non-citizens alike in
return for higher taxes and, importantly, forfeiture of the right to sue for
damages.
Here’s how it
works… let’s say an American tourist tries Zorbing – a “sport” in which you are
rolled down a hill inside a large plastic sphere that looks like an overfed
yoga ball. This American then suffers an unscheduled tumble into the path of a campervan.
When he is taken to the Accident and Emergency (aka, the ER), the physician
will complete an ACC form, verifying that he has sustained a valid injury and
that his medical care will be paid for by the ACC. In return, said American
cannot sue the Zorbing company, the driver of the campervan, the physician who
treats him, or anyone else. He can, however, take solace in the fact that if
any of these parties has acted negligently, they may be criminally prosecuted
(as opposed to sued).
This system, it
seems to me, helps mitigate fear. I’ve noticed this on many levels but it’s
most pronounced with the children. There is a tool bench at my son’s preschool
and it’s equipped with actual carpenter-worthy hammers, screwdrivers, nails,
and Philips heads for actual building projects (take that Bob the Builder!) The
kids go shoeless much of the day – they take their kicks off when they arrive
at school and (maybe) put them
back on when they leave (of course the lack of poisonous snakes or spiders
helps make this a safer proposition than it might be elsewhere). Trampolines
and “bouncing pillows” are common, as are the injuries they cause. Kids play
rugby, without helmets, which does not seem like a good idea to me. For young
adults, the fearlessness manifests in adventure sports such as white water
river sledging (river rafting on a boogie board). But it’s in professional life
where diminished fear may make the most substantive difference. Kiwis I’ve
spoken to are amazed at the thought of staying in a bum job just because it
offers good health coverage. An American physician who spent a decade in New
Zealand put it this way, “we
[Americans] have to buy protection against the health care system that could
make us poor. They have freedom from that fear.” Of course, these are perceptions, not hard facts, and fear
(especially the type that softly itches at you each day) is a hard thing to
measure objectively.
There are
certainly downsides to the ACC scheme – a 2% earner’s levy (income tax) which
caps at approximately $2000/year/person as well as the potential for both fraud
and reckless behavior. As to the latter, Kiwis are certainly adventurous, but
not particularly reckless. The roads are safe and well-policed and fatal motor
vehicle accidents rare (396 in all of 2008) and less frequent (per vehicle)
than in the U.S. And, while I see
far more unhelmeted cyclists here than at home, I also note far fewer folks
texting while behind the wheel. Any freedom that an individual might feel to
act carelessly seems to be more than counterbalanced by a public health
incentive (financial and otherwise) to prevent severe injuries. The only truly
reckless activity I’ve heard about is as a coed rugby squad called the Nude
Blacks (if that isn’t explanation enough, there are YouTube videos.)
“Normal fear protects us;
abnormal fear paralyses us,” so wrote Marin Luther King Jr. True enough, but
what is “normal,” and how much is it defined by the social contract of the
society in which we live?
It would seem that American society creates certain “abnormal”
fears that may not exist in New Zealand. And this might help explain
differences between the two peoples in regard to how they view their health. It
does not, however, explain what the heck those possums were doing in the the
road.
