(Originally published at EisenhowersLastSmoke.com on 8/14/2013)
“Paging So-and-So to Gate Whatever,” went the airport overhead announcements throughout Australia. “Your plane is ready to depart and your fellow passengers are waiting for you. Please proceed to the gate immediately.” I really like the attempt to draw on people’s sense of obligation to other passengers. Or at least to use public shame to get planes out on time.
“We’re a society that doesn’t want to leave anyone behind,” said one of my hosts at a lovely lunch at the Sydney Women’s Club early in my stay. Rebecca Davies is the consumer representative on the National Health and Medical Research Committee, and has an accomplished history in the Australian health system, having previously served on the Private Health Insurance Administration Council. In this genteel setting of the Women’s Club, where sherry was served in the anteroom but not allowed in the dining room itself, Rebecca explained her take on the Australian safety net system, Medicare, and the way in which Australians look out for one another. “We don’t mind paying a bit of taxes to make sure no one goes without.” (I've always felt this way at home, but of course that makes me a socialist.)
In this regard, Australia has the U.S. beat by a mile. Let’s say by many many miles. There is no one in Australia who is not covered by the public insurance system. That doesn’t mean people don’t have challenges accessing services – there can be long waiting lists for procedures in the public system and high price tags in the private system. But literally everyone is provided for. By contrast, in the U.S., 45 million Americans have no health insurance, which means the only health care they can reliably access is emergency services, which, by law, must be provided regardless of ability to pay.
The number-one question I got – I think from every Australian I met, was about the impact of Obamacare. “What’ll it mean?” or “What do you think of it?” people asked me (without realizing that "Obamacare" is typically used pejoratively). Bernie Kelley, managing director of Intelog Business & Healthcare Performance Group and one of my wonderful hosts and collaborators in Australia, translated this questions for me (I paraphrase): 'We couldn’t really understand what the big deal was. There seemed to be such a fuss over it and it doesn’t even cover everyone.' Bernie also explained that Australians can’t generally fathom medical bankruptcy. It’s simply not something they need to worry about here. Score one (or many) for Australia.
I heard these themes over and over in Australia, and a statement something like this: “Look (many sentences start with ‘Look’), our system isn’t perfect, but we’re just not going to let people go without.”
That is, until my lunch with a bunch of entrepreneurs looking to shake up how consumers purchase products like electricity or health insurance: “Nah,” the 30-something, tall, brash founder of One Big Switch said over lunch. “We just want to make sure that there’s something there for us when WE need it.” Whatever the motivation, it’s true that everyone is covered here.
In Perth, with Sydney far behind me (far, far behind me; have you been to Perth? It’s damn far), I got another view of the egalitarian story. Here, I heard a lot more about Aboriginal health. In Perth, I didn’t have to ask before the topic arose organically, and the people in health care I spoke with seemed genuinely focused on how to improve health access and outcomes for Australia’s indigenous people. It’s not that the people in Perth are nicer or more liberal than the folks in Sydney (in fact, based on my visitor’s understanding of Australian politics, I actually believe Western Australia to be more conservative.). Rather, in Perth, they have no choice but to face the issues of Aboriginal health. Their emergency rooms and dialysis wards are full of Aboriginal patients. Western Australia is 3.8% Aboriginal, compared with 3% in the country as a whole. Doesn't seem like a big difference, but when you have only ~2.5 million people in a land mass one-third the size of the U.S., I think you notice small population differences.
Aboriginal health disparities are well documented. Mick Gooda, Australia’s Social Justice Commissioner and an Aboriginal leader, explained that “what we don’t know about Aboriginal health would fill a postage stamp,” while the solutions are scant. And the list of problems is extensive. Here are just a few:
- Aboriginals have life expectancy approximately a decade (11.5 for men and 10 for women) shorter than non-indigenous Australians.
- Two times as many Aboriginal and Torres Strait Islanders are born with low-birth weight than non-indigenous people in Australia.
- The infant mortality rate amongst Aboriginal people is higher than for non-Aboriginals; in the Northern Territories, for example, the state with the highest percentage of Aboriginals (nearly 30% of the state population is Aboriginal), has an infant mortality of 13 deaths per 1,000 live births, compared with the national average of 4.
- Almost half of Aboriginal people consider themselves a current smoker.
- Estimates are that between 10% and 30% of Aboriginals have diabetes, with approximately half not realizing it.
A bit of history. Aboriginals didn’t have the right to vote in federal elections until 1962, in the country they had inhabited for somewhere between 40,000 and 80,000 years.
The first real land-rights act, granting “inalienable” rights to some traditional lands passed in 1976. In 1992, an Australian High Court decision legally recognized certain land claims. In 1992, I was a sophomore in college. It doesn’t seem that long ago.
As Mick Gooda put it, there was a strategy of “smoothing the pillow”, essentially waiting for full-blooded Aborigines to die out. There were village massacres, carried out by European settlers in the 1800s, and as late as 1928, reportedly in the living memories of some Aboriginal elders alive today.
I heard about the "stolen generation" – Aboriginal children who were taken from their families, for their own good of course. This practice took place between the early 1900s and as late as 1970s. Children of ¼ or ½ Aboriginal ancestry (“half-caste”) were taken and given an “opportunity” to be integrated into European-Australian society, whereas full-blooded Aborigines were left to extinction. I heard stories from my contemporaries in Perth who had known children in grammar school whom they suspected of being “stolen.” In some states, laws enabled the government to take children without having to prove their parents were unfit. In other states, rules were less clear but government officials took similar latitude.. In 2008, then (and current, for now) prime minister Kevin Rudd issued an official apology to the victims of these policies, recognizing the detriment it had caused to individuals, families, and the Aboriginal community.
I am no expert on the plight of Native Americans, but I think it is a generally consistent story. As U.S. schoolchildren, we learn about the sometimes horrific treatment of Native American, in age-appropriate lessons of course. (Actually, most of what I remember from school has to do with Thanksgiving and the Pilgrims). But these stories are generally presented to us as remote history, certainly not something that has happened within our lifetimes.
In Far North Queensland, I heard from a Dutch-born retired engineer that he had been told to ‘go home, back where he came from’, in Brisbane, a cosmopolitan city in southern Queensland. In modern times. He also described great discrimination against the Italian immigrants who had settled in Mossman (and elsewhere), and how they would refuse to note their country-of-birth in health forms at the local hospital for fear of discrimination for being ‘not really white’. “Every country has its share of dickheads,” my driver quipped. “But Australia has more than its fair share.”
Australia is struggling with the effects of generations of inequity and mistreatment of the nation’s original owners. Some of my Australian contacts called it racism. Others acknowledged a troubled history with a long way to go. The current conditions of Aboriginal people in Australia illustrate how harmful that history has been. Campaigns such as Closing the Gap and organizations across Australia are working to remedy the disparities that indisputably exist. I met one health care leader in Melbourne whose office proudly displayed the Aboriginal flag alongside the Australian one, and who opens every meeting where there are Aboriginals present recognizing the original owners and paying respects to the elders.
There is a lot to the Australian “brand” of egalitarianism, which America doesn’t even come close to achieving or aspiring to (remember "Obamacare" is a negative term and if you support it, you may as well be a communist). But Australia’s history and culture are nuanced, with residual damage that will take generations yet to remedy. At least their goal is to leave no one behind.
 Australian Indigenous HealthInfoNet (2013) Summary of Australian Indigenous health, 2012. Retrieved [access date] from http://www.healthinfonet.ecu.edu.au/health-facts/summary
 Australian Institute of Health and Welfare website
 National Aboriginal and Torres Strait Islander Social Survey, 2008