Monday, March 19, 2012

From your Kiwi Correspondent Part III

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?

“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.