Between large kangaroos and small wallabies there is a critter of intermediate scale known as a wallaroo. There are several species of wallaroo, but I have to admit that I was completely unaware of their existence until I was standing in a field at Lone Pine Koala Sanctuary in Brisbane, surrounded by dozens, if not hundreds, of the the waist-high 'roos. At first glance, Lone Pine could seem like a somewhat shabby little zoo. It has none of the spectacular enclosures found at the the best known American zoos. What it does have is several hundred native Australian animals, all of which appear to be healthy, and most of which have plenty of room to roam. It also has the audacity to let people and animals mingle. You can stroll through several acres of fields with kangaroos, wallabies, emus, and those middle-weight wallaroos. You can take your turn hugging one of the namesake koalas, which they have in abundance. Considering the difference in the visitor experience, it's not so surprising that in at least one poll Lone Pine was voted one of the top ten zoos in the world. Wallaroo fur, in case you're wondering, feels a bit coarse, not silky -- something like a deer.
Brisbane itself is a lovely city. It doesn't have quite the jaw-dropping landscape of a city like Vancouver, where every view seems ready to be pressed on a postcard, but it has interesting architecture, a riverfront unmatched anywhere else, and one thing that makes it quite different from most English-speaking competitors: a lush, sub-tropical climate. The weather in Brisbane is so equitable that interior and exterior spaces play together in a way I've seen nowhere else, especially along the delightful Queen Street. Brisbane has another thing going for it that's hard to top, the population there is the most attractive I've seen anywhere, LA included. Part of the reason for this is simply style. Brisbaners (Brissies? I never thought to ask) seem to wear a broader palette of clothing than the inhabitants of any American city I've visited. Women, even those heading in for a day at the office, were as likely to be wearing something that had a touch of Chanel circa 1960 -- something Audrey Hepburn might have worn while starring alongside Peter O'Toole or Gary Cooper -- as they were to be wearing a business suit. The population also seemed to be fearsomely fit. The reason for both fashion and fitness rests in part on that wonderful climate, which filled the (numerous and well-maintained) public running trails, pools, and exercise areas every day of the week and made it a lot more pleasant to dress lightly than it would in many cities at any time of the year. The other reason for the overabundance of attractiveness comes from Brisbane's principal export: students. There were over 80,000 international students in the central part of Brisbane alone, and an equal number of Aussies. Pump 150K well-heeled 20-somethings into the heart of any city, and it's sure to do wonders for scenery of the two-legged variety.
From those first two paragraphs, you'd likely suspect I enjoyed my opportunity to visit Queensland, Australia. I have to say that for a few days there, a place where every tree and bird was unfamiliar was an absolute delight. I loved riding on the fleet of catamarans that many people there use to commute to work along the river. I loved walked across the Story Bridge at twilight when flying foxes with a four foot wingspan swung low along the river front. Coming from St. Louis where the wintertime streets seem all but deserted, it was a joy just to shuffle through the dense and diverse crowds along the city's sidewalks.
All of this was great... until I started feeling odd aches in my back. Since I'd just flown 9,000 miles and was sleeping in an unfamiliar bed, at first I put it down to simple muscle ache, though it didn't feel like muscle ache. But soon enough the pain scaled up from mild misery to low-grade agony, which gave me a chance to view something that would be as exotic to most Americans as a wombat: the Australian health care system in action. Please don't get the impression that I have any expertise in the area, or that my experiences can be generalized to all situations. This is purely an incidental report, but even as the singular experience of one short-term visitor, it provides an interesting contrast to my own experiences with the system in the US.
My first stop was at the office of a general practitioner. I strolled in without appointment, filled out a piece of paper with just my name and address, and was called in by the doctor within a few minutes. I got a very thorough exam, a lengthy discussion, and a preliminary diagnosis — kidney stones. To confirm this, the doctor scribbled down some quick instructions, put them in an envelope, and sent me off with directions to the nearby St. Andrew's Hospital. At this point I was still feeling well enough that I strolled up the hill and past a couple of pleasant green parks on my way to the hospital, but by the time I searched out the hospital entrance the pain was beginning to escalate again and I was really not looking forward to spending an hour waiting in the emergency room. I shouldn't have worried. There was no waiting room. Instead I came through the door, and handed over my envelope. The woman behind the desk warned me that, since I didn't have a Medicare number (which is the name of the public health care plan) I would have to pay in advance. She also told me, more quietly, that the cost would be lower than it would be in the United States. Since I didn't have much choice, I agreed that this would be fine.
Immediately a nurse appeared and took me into a side room. There she spoke to me for only a few minutes before taking me to the back and bringing me face to face with a doctor. Ten minutes after I had walked through the door, I was in a gown being wheeled toward a CAT scan. Twenty minutes after that, I was in a bed as the CAT scan images went up onto a light box and their meaning was explained. The original diagnosis was confirmed. Soon enough the low grade agony was revealed to be only the opening salvo of this little internal battle. In the past I had cracked three ribs while pressing through a tight squeeze in a cave (my caving tip: don't store your spare batteries in your shirt pocket). On another occasion I took a tumble rock climbing that stripped most of the skin off my calf and tore a ragged grove in my right tibia. Until last week, I thought those things hurt. Now I know better. Neither incident was a patch on what an object the size of a small pea managed to inflict on its short journey. The pain dial goes to 11, trust me on that.
As I was discovering this, the physicians were kind enough to introduce me to that friend to man, morphine, and to pump in some IV fluids. By the time I checked myself out the next morning, I'd had two series of CAT scans, visited with two doctors and had the images interpreted by a third, had three shots of My New Pal, a liter of fluids, a double handful of pills, and occupied a bed overnight. On my way out the door, the woman behind the counter — the same one who had checked me in — told me that my bill was ready. She handed me a fresh envelope. As I waited for the cab to take me back down the streets I had walked up the day before (a feat that now seemed as unlikely as swimming back to the US) I wondered just what was in that envelope. A couple of thousand was my best guess. Five thousand didn't seem out of line, and I certainly wouldn't have complained. But I waited until I was sitting in the back of the cab to peek. The total cost was $248.
If this makes it sound as if the Australian system is a single-payer public plan ala Canada, that's not quite right. In fact, some of the factors involved in Australian health care are similar to those that we're wrestling with in our own health care debate. Australia has universal health care, but to get there they have a hybrid of public and private treatment. Free hospital care and subsidized physician care are available to everyone through the Medicare plan. Those that make more money are encouraged to buy private insurance — with encouragement involving a system of tax penalties that grow the longer you put it off and the more you make. There are a number of private plans, offered by for-profit and not-for-profit groups. There is also a plan which is owned by the government that is available for purchase in competition with the private plans, in essence a "public option." Private plans are not allowed to exclude people because of preexisting conditions, but they can impose a waiting period to avoid people signing up for insurance only when they need it. Cost of insurance is based on "community rating," not individual history, so your rate doesn't soar even if you're coming into a plan with a preexisting condition. So, for example, a women who tried to enter a private plan in the sixth month of a pregnancy might find that she would not be allowed in until sometime after the birth. Someone who had a heart condition might be delayed for a matter of weeks or even months getting into a private plan. But both of them would have hospital coverage on the public plan (possibly with a penalty depending on their income) and when either of them finished the waiting period they would be able to enter a private plan while paying something around the average for people in their area. In addition to reducing the copay on physician visits, private insurance allows members to access doctors and hospitals that may not be available on the public plan. Private health insurance in Australia also commonly provides such bonuses as exercise classes and therapeutic massage. The government subsidizes the cost of private health care by an amount that varies by income.
The system has some interesting results. Not only is the cost for treatment low, paperwork is nearly nonexistent. Because pre-existing conditions don't raise costs or threaten the availability of care, people are much more open with their health information. Employers commonly track conditions of their employees (from allergies to heart conditions) so they can help with any issue that pops up during working hours.
Like every system, it's not perfect. I heard several complaints (both in person and on local TV) about the slowness of treating some conditions if you didn't have access to private hospitals. A major surgery treated privately could still leave a patient with a $10,000 copay if they had a private plan at the lower end of the scale. But none of the stories I was told came close to the kind of horrors experienced by my friends and family with the US health care system. For my part, being in a bed and getting treatment at a point where I'd still have been filling out the paperwork in a US facility was worth enough to stick an extra zero on the end of my check. But I won't do it. After all, with $18 / hour minimum wage almost nobody tips in Australia. And I'd hate to be un-Australian… even if I am.