A Stitch in Time

The first thing you learn when you’re diagnosed with a melanoma in Australia is that virtually every Aussie has either had one themselves or can claim a friend or family member who has. That’s not surprising in a country that is: 1) populated largely by people of white-skinned European descent, and 2) exposed to intense sunlight over much of its territory thanks to its location near the equator. Indeed, it was our extended stay in Australia that prompted Eric and me to book routine skin checks, not expecting anything to crop up. Instead, the doctor detected a pinhead-sized spot on Eric’s left foot that warranted a biopsy. Four days later we got the melanoma diagnosis.

It went uphill—and I do mean uphill—from there.

It probably goes without saying that you have to be in good health to undertake a voyage like ours at all. Accidents are the bigger worry, and we are fortunate that in the four years and 15,000 miles since leaving Florida, we have had only two that required medical care. One was in 2017 in Antigua when Eric gashed his finger in the shipyard and received stitches in the ER. The other was in 2020 on Magnetic Island off the coast of Townsville, when Eric inexplicably passed out in a restaurant; an ambulance ride and examination at the local clinic found dehydration to be the probable cause. Other than that, we’ve had six-month dental checkups and the replacement of some old fillings. Between us, we (Eric again) have had a grand total of one cold.

This is all the more fortunate because although we have Medicare and continue to pay for it every month, it ceased to cover us 60 days after we left the USA. We tried to obtain travelers’ insurance, but few companies offer it to people in our age bracket and those that do charge exorbitant rates. On the plus side, like many cruisers we avail ourselves of a program called “DAN Boater” which, for a yearly fee of $100, covers air transportation back to the United States, where our Medicare would resume. This is our recourse should we face an expensive, long-term care situation. Meanwhile, we pay out of pocket for any treatment en route.

Here is where it all went uphill. First, thanks to the early detection, we caught the melanoma at Stage 0. How lucky can you get? Although the surgery required 17 stitches, pain medication, and two weeks off his feet, the quick catch spared Eric a significantly more complicated and painful procedure, including a skin graft. Second, imagine if we’d set off across the Indian Ocean, as we’re hoping to do this summer, without getting a skin check at all. Third, knowing that in Australia Eric would receive excellent medical care greatly reduced our stress. We also were cheered by the good wishes of marina friends, fellow museum volunteers (one of whom loaned us a cane), and the Uber drivers who transported us to and from appointments—“You’ll be right, mate!”   

There was one glitch—on a Sunday, of course—when a suspected infection necessitated a precautionary trip to the ER. Penicillin quickly curtailed it, and now, four weeks post-surgery, Eric is walking normally and the wound continues to heal. The total bill (initial skin check, biopsy, melanoma surgery, lab fees, ER visit, stitches removal) was AUD $2,414 (US $1,810). I don’t know how that compares to current prices in the USA, but we were happy to pay.

On the mend

Australian citizens and permanent residents in a similar situation are covered by their universal healthcare system, implemented in 1984. Like our system, it’s called Medicare. Unlike our 65-and-older system, it covers all ages. It’s funded by a 2% levy on taxable income with a slightly higher percentage paid by high income earners who don’t have a private insurance plan. It covers the entire cost of public hospital services and some or all of the costs of GPs and medical specialists. Preventive medicine includes a free annual skin cancer screen and a free mammogram every two years for women and men aged 50-75. The latter service is provided by a nationwide program called BreastScreen, and given Eric’s close call and not having a GP, I phoned the Townsville location to inquire if I could get a mammogram there. I stressed that I could and would pay, but the doctor refused to let me. “I consider you to be a Covid refugee in our country,” she said. “Come on in.”

Eric and I already have seen firsthand how well Australia’s version of Medicare has functioned during the pandemic. Covid testing: Free. Covid treatment, in or out of hospital: Free. As a result, no one hesitated to get tested and treated for fear they couldn’t afford it, providing accurate statistics on the disease and containing it more quickly. The Covid vaccine, now being rolled out, will be free both to citizens and temporary residents like us. It was heartening to read on the CDC website that the vaccine likewise will be free to everyone in the USA and that any charges for administering the vaccine (i.e., the doctor or clinic fee) will be reimbursed.

What if we didn’t stop there? If Australia can provide universal health care, why can’t the USA? The Australian system offers choice. If you think you’ll get better care at a private hospital or clinic, you can buy private insurance tailored to your needs. Nor are Australians blind to the challenges of maintaining universal healthcare in the face of rising costs for high-tech treatments and an aging population, an issue for many countries. Yet I think Australia will pull it off. For one thing, they like bragging about their medical care too much to let it go.

More important, Australians believe healthcare is a basic human right. That people come before profit. That you shouldn’t lose your insurance because you lose your job. That being sick or injured shouldn’t drive you into bankruptcy. That all children deserve a healthy start. That the frail and elderly should not be sacrificed to “save the economy.” That you should look out for your mates, and in Australia, everyone is your mate, no matter which political party or football team you support.

Providing healthcare will always be a work in progress, especially when a pandemic sweeps in and blindsides the globe. In the USA, the Affordable Care Act and the free Covid vaccine are a start. What we need next is the commitment to take it further. In Australia, universal healthcare is a mindset that, once adopted, has become part of the national character.

I’d like to see it become part of ours.

P.S. – In appreciation for my free mammogram, I’ve made a donation to a breast cancer organization. Thank you, Australia!