Category: Politics and society

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I take it we aren’t cute enough for you?

This article originally appeared on Geek Feminism.

A few times within the lifetime of this blog, there’s been a major emergency in geekdom: a geek girl has needed a confidence boost.

I hear you cough. Someone just said “geek girl” on Geek Feminism, the home of “ahem, geek women, THANK YOU”?

No really, I mean it, a geek girl. A prepubescent girl has been bullied or heard some gender essentialist crap, and a call to arms goes out. The best known is probably Katie Goldman, the then seven year old whose mother wrote in November 2010 that Katie was being bullied for liking Star Wars, a boy thing:

But a week ago, as we were packing her lunch, Katie said, “My Star Wars water bottle is too small.  It doesn’t hold enough water.  Can I take a different one?”  She searched through the cupboard until she found a pink water bottle and said, “I’ll bring this.”

I was perplexed.  “Katie, that water bottle is no bigger than your Star Wars one.  I think it is actually smaller.”

“It’s fine, I’ll just take it,” she insisted.

I kept pushing the issue, because it didn’t make sense to me.  Suddenly, Katie burst into tears.

She wailed, “The first grade boys are teasing me at lunch because I have a Star Wars water bottle.  They say it’s only for boys.  Every day they make fun of me for drinking out of it.  I want them to stop, so I’ll just bring a pink water bottle.”

Katie’s story went viral including at the official Star Wars blog and a year later CNN reported that at GeekGirlCon when a brigade of Storm Troopers formed an honor guard for Katie, and that there’s an annual Wear Star Wars day as a result.

We had our own smaller burst of geek support on the Geek Feminism blog in May this year, for five year old Maya, who was turning away from her love of cars and robots. 170 comments were left on our blog for Maya, second only to Open Letter to Mark Shuttleworth (200 comments) in our history. In addition, it wasn’t an especially difficult thread to moderate as I recall: a few trolls showed up to tell Maya goodness knows what (sudo make me a sandwich LOL?) but in general people left warm, honest, open stories of their geek life for Maya.

Here’s something I was struck by: when I tweeted about Maya’s post, back in May, I saw replies from men saying that they were crying (with joy, I assume!) about the response to Maya. I have to say I do NOT see a lot of admitted crying about other posts on our blog, no matter how positive or inspirational. (People love the existence of the Wednesday Geek Women posts, but they are consistently our least read and commented on posts.) Or crying about stories that are negative and horrifying either.

It’s going to be hard to stand by a statement that I don’t begrudge Katie and Maya their outpouring of support, but: I don’t begrudge Katie and Maya their outpouring of support. I don’t think they should have less of it.

… but I think geek women and other bullied or oppressed geeks should have more.

Thus I do want to ask why girls? Why do we not have 170 comments on our blog reaching out to women who are frustrated with geekdom? I want to get this out in the open: people love to support geek girls, they are considerably more ambivalent about supporting geek women.

I’ve compared harassment of adults with bullying of children before: they have a lot in common. What they don’t seem to have in common is a universal condemnation from geekdom: bullying children? Totally evil*. Harassing adults? Eh… evil, except you know, he’s such a great guy, and he hasn’t got laid in a while, and (trigger warning for rapist enabling) he does have the best gaming table, so what are you gonna do, huh?

There are a number of reasons, I know, even aside from the (provocative!) title of the blog post. Some of them are more sympathetic than others:

  • Talking to adults about overcoming difficulties is harder. There can’t always be as much optimism or tales of It Gets Better. For some adults, that’s bullshit. (It’s not always true for children either and telling children this can be a disservice too, but it is more culturally comfortable.)
  • Adults are often angry when they’ve been mistreated. In this case, feminists are often angry. It’s harder to engage with angry people. They (we) are less appealing. We may not be grateful for your thoughts. Sometimes we pick them apart publicly if we don’t like them enough. And call you mean names.
  • When a child is bullied by another child, the bad guy is reassuringly definitely not you.
  • Children don’t talk back, or can’t. If an adult says that It Gets Better, the appropriate role for the child is to smile and look grateful. (This is also true of women when listening to men, but generally somewhat less so.)
  • Many of us are more familiar with the experience of being a bullied child than being a harassed or oppressed adult, and can be empathetic more easily.
  • We really really want to believe that things will be basically OK for Katie and Maya, even if they haven’t been for us and people we love.

There’s no easy answer. Many of us are very deeply invested in It Gets Better rhetoric, because the alternative is sure pretty sucky. But at the same time, if you’re doing one thing to stop gendered bullying this year, say, leaving the 170th supportive comment for a five year old girl, while kind, was probably not the single best use of your one thing. Join the fight. Make it better yourself. And, since you aren’t in fact limited to one thing, leave kind or supportive or co-signed righteously angry comments too, while you’re at it, and not only for children.

* At least, in the context of these discussions. I am far from believing that geeks are universally actively working to save children from bullying, nor that they are incapable of perpetrating child abuse.

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On opting out

Captain Awkward has a thread on lateness and keeping in contact with people who are constantly late or no-shows. Her answer is worth reading, because she takes both sides seriously: the way being late feeds into anxiety or depression disorders sometimes (and has for her), and the way to structure social engagements with people who are in that place (whether due to mental health issues or not, it doesn’t require disclosure).

She’s specifically asked that people who are good with time and todo lists (I am, relatively) not drop in with “handy hints”, which is fair enough, but now I’m finding some of the”just loosen up, I have rejected our culture’s terrible clock ticking obsession, and I think that makes me a better person” (uh, paraphrased) comments irritating. I’m posting here rather than there because of the relative privilege of being good with my culture’s approach to time, though.

However, opting out is also a pretty privileged thing to do, honestly. Here’s the big clock related things I can’t opt out of, right now: my son’s childcare, who (like most) fine about $1 a minute for late pickups. Moreover, those people also have children to pick up and errands to run, so a significantly late arrival from me would ruin at least three families’ evenings. (Two staff members are required on premises at all times, so one late parent is two late workers.)

Parenting is by no means the only type of problem here too (look at some writings on spoon budgeting some time: what happens when you are an hour late for someone who set aside spoons to see you?) but it’s a pretty typical set of examples. So are people who work in a great number of jobs, especially low pay and insecure jobs.

You can be over-scheduled in a privileged way (racing from piano lessons to dinner parties), but you can be over-scheduled without that (racing from end of shift to the hard childcare deadline to the hospital’s visiting hours to the mechanics for the 6th car repair this season), too. So, I find it difficult to respond to a fairly simple analysis of “I figure that half an hour doesn’t matter that much, or shouldn’t! We all survived before mobile phones [or clocks]! Just say no!” When your needs are dictated by other people armed with clocks and mobile phones, there may not be an exit sign visible.

There are a lot of living cultures with looser time constraints than the one I live in. (People talk about a “polychronic-monochronic” axis of cultures, which Wikipedia tells me is due to the anthropologist Edward Hall.) There are ways to systemically structure things so that half an hour doesn’t matter that much. But, when you don’t live in such a culture or can’t stay in one, it’s just not that easy. But when is “just say no” ever the solution to anything serious?

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Getting a passport in Australia

See Lindsey Kuper on a expedited US passport, here we have another “life in Australia” comparison piece.

Step 1: obtain passport form. If you are an adult renewing an existing adult passport that has been expired for less than 24 months, you can do this online. Otherwise, obtain form from nearest post office.

Step 2: track down someone — usually just another passport holder — to be your photo referee (ie, to agree that it is you in the picture). Gather relevant documentation, that is, proof of identity and of citizenship. If you were born in Australia on or after 20 August 1986, see below.

Step 3: ring up local post office for passport interview, usually granted within the week. If you need it sooner, call several post offices in turn or go to the Passport Office (in a capital city).

Step 4: attend post office. Have them take your photo, these days, because if they don’t approve it, they can take it again. Have interview, which in fact largely consists of having your documentation and photo checked for validity.

Step 5: pay fee ($233), extra $103 for priority.

Priority passports are printed to be mailed within 2 business days, other applications within 10. They arrive registered post (ie, signature required). If you require one within 2 days, it seems you need to attend a Passport Office in person and hope they can help.

Given that I understand it takes weeks and weeks to get a USA passport if not expedited, 10 days is not too bad.

Born in Australia on or after 20 August 1986? Tricky! This is when Australia stopped granting citizenship by right of birth alone. So you need proof of citizenship, which can include:

  • evidence that you were born in Australia and that one of your parents was either a citizen or permanent resident at the time of your birth
  • evidence that you were born in Australia and that you were still a resident of Australia on your 10th birthday (school records and so on)
  • evidence that you were born in Australia and were not eligible for any other citizenship
  • see also

This diversion has been known to be lengthy. 🙁 It’s also just about impossible to get one as a minor if your guardians don’t agree to you travelling.

Have a small child with you?

Good luck with that, because the photo standards require straight on face shot with open eyes and neutral facial expression. Try getting your pre- or semi-verbal child to do that.

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Should you give birth privately?

A few people have been researching their options over the last few years about giving birth in Australia, and have asked me what I think about having private health insurance or giving birth in a private hospital.

Background: maybe you shouldn’t ask me! I’m not a health professional, I’m a mother of one, and he was born in a public hospital, in which I was a public patient.

And now, crucial fact about private hospital cover: it pays much of your hospital stay fees and some of your doctor’s in-hospital fees. It does not pay for private consultations with a doctor in an outpatient/private room setting.

You know what obstetricians charge a lot for? The “pregnancy management” fee, to cover your outpatient care in pregnancy. If I recall correctly, the Medicare rebate for this is on the order of $400 to $500. In Sydney, private obstetricians may charge upwards of $4000 for this fee. Who covers the difference? You do. (OK, full disclosure, the Medicare Safety Net may help too, I don’t know the details except that MSN actually cut benefits specifically for obstetricians a few years ago because they’d all upped their fees to incorporate the MSN rebate. So, mostly you do!) Also, anaesthetists in the private hospitals usually end up with a decent gap fee, if you have an epidural or Caesearean.

So, private system birthing is expensive regardless of insurance.

Finally, tests like ultrasounds are usually Medicare plus out-of-pocket too.

Now, birth choices in Australia.

Homebirth. There are some very small number of hospitals in Australia that will allow their midwife staff to attend some homebirths. It’s very easy to get disqualified from such a program. I would be on several grounds (some more legit than the one I’m about to give you), including the simple fact that my son’s birthweight was over 4.0kg.

You might also birth with a privately practicing midwife, or, in theory, with a private midwife collaborating with an obstetrician as backup (there are very few such arrangements so far). Most, although not all, private midwives will also only work with pretty low-risk women (singleton pregnancies, head-down, no high blood pressure or diabetes, that sort of thing, about 80% of pregnancies get a low-risk classification IIRC).

Is private insurance useful? Some private health funds provide some limited cover for this, I believe, on the order of $1k to $2k of the midwife’s fee, which is around $5k last time I looked. In the collaboration setup Medicare contributes too, I think?

Birth centre These are midwife-only maternity units attached to public hospitals. (Sometimes at some physical distance, eg Ryde Hospital only has a birth centre, with transfers to Royal North Shore several suburbs away.) You need to be assessed as low risk and if that assessment changes (and this isn’t uncommon, eg, your baby is breech or you get diabetes or pre-eclampsia) you get summarily transferred to the doctors and your whole care team often is suddenly switched out from under you. (Also they usually don’t do epidurals, I think? So the transfer rate for pain relief is not insubstantial I believe.)

Is private insurance useful? No, this is publicly funded.

Public hospital, midwife’s clinic If you go to a public hospital, and are assessed as low risk, almost all of your pregnancy management will be by midwives. Often they “caseload” now, meaning you see the same one each time. Again, if you become high risk, swish, off to the doctors.

Is private insurance useful? No, this is publicly funded.

Public hospital, doctor’s clinic. If you aren’t low risk, this is you. (This was me.) Chronic health problems or pregnancy complications (like pre-eclampsia) put you here. For your appointments, or at least most of them, you see an OB registrar or staff specialist. On high rotation, often, that is, you won’t usually see the same one many times. If you have a vaginal birth it may still be midwife-only, or largely midwife managed.

Is private insurance useful? No, this is publicly funded.

Public hospital, private doctor’s patient. In this case, you choose your doctor, see them mostly in their own clinic, birth in a public hospital (with you or your private insurer paying for the facilities) with the doctor of your choice attending. This is subject to gap fees for the doctor.

Is private insurance useful? Yes, pays for your accommodation and some of the OB’s and anaethestist’s (if needed) gap.

Public hospital, private midwife’s patient. This depends on a midwife/obstetrician collaborative practice. As I said, rare, but there’s at least one that allows a public hospital birth (private admission) with the midwife of your choice: Melissa Maiman in Sydney.

Is private insurance useful? Yes, pays for your accommodation. Not sure what happens if an OB and/or anaethestist are needed.

Private hospital, private doctor’s patient. There’s no midwife-managed option. If you’re birthing in a private hospital, you need a doctor of your choice attending. Again, pre-birth consultations in their own clinic, and subject to gap fees.

It’s definitely worth noting that while your private doctor will be an obstretrician and can manage higher risk pregnancies, for really serious stuff like prematurity earlier than a certain point, pregnancies with more than 2 babies on board (I think) and similar, they will actually refer you into the public system!

Is private insurance useful? Yes, pays for your accommodation and some of the OB’s and anaethestist’s (if needed) gap.

Public hospital, high risk clinic. I don’t know much about this, I’m told it’s the next level up in risk, and it well might be my next pregnancy. Joy. This is where you end up with OBs with a high risk interest, maternal-fetal medicine specialists (OBs with a formal subspecialty in very high risk pregnancies), renal physicians, endocrinologists, etc. This often involves referral to a tertiary hospital. (Sometimes specialists can consult without you being in one of these, like, an endocrinologist might monitor diabetes or thyroid hormones with you in the regular doctor’s clinic or seeing a private OB.) Birth choices guides don’t talk about this option very much, because you don’t really have a choice at this point (except birthing unattended or with a very risk-tolerant private midwife).

Is private insurance useful? I’m not sure, to be honest. It probably depends on the risk profile of your actual birth, I guess? If your birth is able to be attended by a regular private OB, maybe they let you do this? But you can do this publicly too.

Further reading on birthing choices
My Birth has a lot of information on birth procedures and the outcomes of different birthing providers, from a low intervention advocacy standpoint. One thing of note which gets picked up a lot by low intervention advocates is that despite the private birthing system referring all their hardest cases back to public, and despite the public patient profile being poorer with less good preventative health care and so on, private hospitals have much higher intervention rates.

Conclusion

It really depends on where you want to birth and with who attending. If the idea of the same doctor doing your pregnancy management and attending your birth appeals, that’s tending towards private birthing and thus private health insurance. But it has high out of pocket costs on top of the insurance premiums. (Note also that private health insurance policies are expensive if you include obstetric coverage, and will always have a 12 month waiting period for it, so you must obtain it before pregnancy.)

I was reasonably happy as a doctor’s clinic patient for my first birth. If I was low-risk I’d probably likewise go public, ideally with a birth centre or caseload midwife pregnancy+birth.

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When your misdeeds are archived

This article originally appeared on Geek Feminism.

This is an Ask a Geek Feminist question for our readers. It’s the last for this round.

This one is actually from me, it’s related to some questions I’ve been asked by various people who will remain anonymous (and who didn’t formally write to Ask a Geek Feminist). I have my own thoughts on this, and I also think it can vary (helpful!)

What do you think people and groups should do about sexism in their “archives”? By this, I mean for example, older stuff on their blog, or Facebook postings from years ago, or similar? A lot of people have sexism in their past, varying from “I used to be a pretty committed sexist actually” to “um, I didn’t really think about it, and I wanted to fit in, and I went through a ‘Your Mom’ phase for a while there”. Things you do on the Internet are pretty long-lived now, and your sexism sticks to your name while it remains visible.

Assuming someone or someones have control of their content, and they have sexism they don’t like in there, and they have reason to think it’s going to hurt someone. Should they remove the content? Should they edit it with warnings and apologies?

Have you seen this in a real situation? What did they do? How did it work for them and for women near them/involved in their community?

At least for systemic stuff, I tend to be on the ‘edit’ side of the fence. There are a few reasons for this:

  1. even if you’ve totally changed and are ashamed and sorry, being a reformed sexist is something that may make people, women in particular, cautious about you. Living with that is part of the deal. You don’t get to get access to Has Always Been The Best Person Ever cred because you weren’t.
  2. it also serves as a guide to How To Do It, for other reforming sexists (or How Not To Do It, if you apologise but don’t actually change)

And while writing an apology that is short and not self-serving is a challenge, but that doesn’t mean one shouldn’t try.

On the other hand, I, in general, do wish that much informal discussion on the Internet yellowed and started to curl at the edges and be difficult to read as time passed, sometimes. I realise that the invention of writing was some considerable time ago now, but even so, having to stand by your casual thoughts for years is a big ask. I can’t see that one should make a special effort to preserve evidence of one’s sexism if that same set of archives is going to disappear in its entirety.

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Writing violence against a woman

This article originally appeared on Geek Feminism.

This is an Ask a Geek Feminist question for our readers:

I am male who wants to write a novel about a female superhero. Since this is a superhero novel there will be violence and at some point my hero will have to lose a fight (though of course she wins in the end).

I am wondering how I should write the scene where the supervillain beats the crap out out of my female hero. Should I just write as if she were a male? Or do I need to take precautions so I don’t end up glorifying violence against women?

A quick thought on this one: there’s no “just” in “write as if she were a male”. A big part of the problem is that this is pretty rare, hence the Women in Refrigerators trope and similar critiques. Your own knowledge that she’s a woman will influence you to write violence specific to her gender and to cultural tropes about male-on-female violence.

So, I think you’ve set up a bit of a false dilemma between “write what comes naturally and it will be just like as if she was a man getting beat up” or “go out of my way to de-glorify the violence against her”. Another thing you need to be careful of is “write what comes naturally and spew your cultural uglies about women and their bodies and violence against them all over the page completely unawares.”

Second thought: you don’t want to “write as if she were a male”, in any case, because she isn’t. You want to write as if she was a person. Your current thinking on this seems to be edging towards “men are the pattern for people, women are special unique cases of people” which is a little concerning for your characterisation of a woman!

Do you have a writing group who review each other’s drafts? Does this group contain women? Obviously the women in your writing group should be reviewing all the work that your male peers do, not just “hey, I have a woman-centric bit here, so now you’re the expert, but I’ll ask John about the rest of my writing.” But you could ask the group in general for feedback on this and since you can show them the actual draft, they may have more specific thoughts.

You could perhaps get some of the way with playing around with reading and writing drafts of your violence scenes gender-switched and with more ambiguous pronouns in order to try and keep the uglies out of it, but I think this is where we need some fiction writers to step in. What think you?

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Nannies and flexibility

Liam Hogan tweeted:

Further on rebates for nannies: if they’re a response to family-unfriendly working hours, flexible childcare is solving the wrong problem.

Here’s some systemic problems with childcare as it currently stands that one might hire a nanny as a possible solution to:

availability (strong form) For under 2s in Sydney, you simply might not get a childcare place accessible to you, by your scheduled return to work. Full-stop.

availability (weaker form) You have 2 or 3 children under 5, not uncommon. If you do get childcare places for them all, they (a) start to approach the price of a nanny and (b) are often not at the same daycare centre. So you can add 2 to 3 drop-offs to your commute run, 2 to 3 infection sources to your health problems, and when your children do all end up at the same daycare centre, you can enjoy four to six weeks of emotionally resettling them with the new centre. Or hire a nanny.

commuting in general Family unfriendly work hours are common. Family unfriendly commute hours are even more common: either a really tight schedule where you hope for no breakdowns/signals failures, or just total impossibility of getting to the centre in time. (Or you can have your kids in care near your work, and have them commute with you. Fun for the whole family. Plus you cannot use the centre when you are sick, which is one of the times when you really want to.)

illness I had four bouts of gastro and eight respiratory infections in the four months after my son began daycare. A nanny is an expensive way to avoid this, but that night I considered calling the police because we couldn’t lift him up to feed him? Maybe that’s worth $200 a day to people who can pay to avoid it.

throughout the day contact a privilege of (partial) telecommuters and (partially) at-home business people, and in theory daycare centres allow drop-ins if children are well-settled there and can handle two separations in a day (so, probably not in the first several months of care). For these people, a nanny may be one way of allowing the parent and child to have throughout-the-day contact without the parent needing to be first contact point for the child’s needs.

Now, I fully agree that funding nannies is less good ultimately than, say, free and freely available childcare, predictable work hours, widespread onsite/neighbourhood childcare with liberal allowance for parent drop-in, redesigning work and cities so that 1+ hour commutes aren’t the usual case, or… I don’t even know what you do about the illnesses, because I once saw my 9 month old licking another baby’s face and getting a good licking back. But there’s a raft of reasons why nannies are attractive. We may turn to one after our next child on cost alone. So that’s the context of nannies, for me.

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The practical reality of contraception, Australian edition

Background the first: The practical reality of contraception: A guide for men, by Valerie Aurora, about contraception in the US

Background the second: A layperson’s intro to paying for healthcare in Australia which I wrote as specific background to this post.

Things that are the same in Australia

Contraception works the same way! The side-effect risks are the same:

Let’s start with estrogen-based hormonal birth control and health. I know women who get life-threatening blood clots on estrogen birth control (if the clot gets lodged in a blood vessel, effects range from loss of a limb to death). Others have mood swings so bad that their partners threaten to break up with them and their boss calls them into their office to ask why they’re so mean and bitchy all of a sudden. Don’t laugh – losing your partner or your job is serious shit, and many women decide to risk pregnancy and an abortion rather than the certainty of being abandoned and broke. Another side effect is feeling like you’re going to barf, which usually goes away after a few weeks, but not for everyone. More side effects and health problems abound, but those are the ones I know about offhand.

The mechanism is the same:

Now let’s talk failure rates. You have to take the birth control pill every single day, within a few hours of the same time, to get that 98% or 99% effective rate. Big whoop, you may think. I take my blood pressure medicine every day. Usually. Actually, it’s pretty hard, even with those little day-of-the-week labels on the pills.

Those are specific to the combined pill, but there is no special magical Australian version of contraception. Same risks, same side-effects, same administration, same failure rate.

Valerie’s description of providers withholding prescriptions to force a patient to have a pelvic exams is also true here, although they usually aren’t called pelvic exams: they’re called Pap smears, even though the bimanual exam is often performed too. However, they’re done slightly less often: every 2 years in Australia for low-risk women.

I believe doctors and pharmacists in Australia can refuse the prescription and the supply based on personal moral considerations, and that really sucks. However, it doesn’t seem as common except for the (sometimes publicly-funded!) Catholic hospitals, ew. (See Lauredhel’s “Pro-life” Archbishop Hart’s murderous misogyny and Catholic Church says “Thalidomide-analogue cancer trial? No contraceptive advice for you!”)

Things that are different

Cost

Very important! Many many many brands of the pill are PBS medications, and cost about $30 for 4 months’ supply, so, getting close to Valerie’s mythical $8 a month mark.

Moreover, other contraceptive mechanisms (except condoms, which probably cost about the same) are cheaper too. For example, in the US I understand that I would be out of pocket at least $500 to have a Mirena IUD. In Australia, I had the insertion performed in a public hospital (being elective, I had to wait about 10 weeks), and bought the device from a pharmacy for $35 as it is a PBS medication. Total cost: $35! Length of contraceptive effectiveness: 5 years! (Downside: needs to be shoved into uterus. However, this is easier to do if you’ve shoved a baby the other way.)

Trouble at the doctor

As in Valerie’s entry, scripts for regular hormonal contraception do need to be re-done once a year or so, and given the side-effect profile of the Pill, I can see why. (If your blood pressure is up, you probably won’t notice, but you should be off the Pill.) At least in major metro areas, getting a non-essential appointment to get a script re-issued seems less of a pain though: a few days notice and your clinic will get you in for the required 15 minutes. Also, most doctors will prescribe the Pill to a brand-new patient after a short verbal medical history (at least, if you mention a Pap smear within the last two years) and a blood pressure check, so you can pop into a bulk billing clinic if you have one handy.

In addition, very recent law changes apparently will allow pharmacists to directly supply a small amount of contraceptives (and blood pressure meds) to patients to tide them over to their next doctor’s appointment. (I heard this on the radio, so, sadly, no citation.)

Trouble at the pharmacy

Like other meds in Australia, this just isn’t as much of a pain. The PBS contribution, if any (Nuvaring isn’t covered, say), goes on before you ever go anywhere near the pharmacy, you pay the remainder yourself usually. So the fighting with one’s insurer step is gone. Moreover, while pharmacies do only fill scripts towards the end of the previous supply, the “towards the end” test is more generous: you have two to three weeks at least.

Summary

I think Australia really wins here, especially on cost.

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A layperson's intro to paying for healthcare in Australia

I wanted to write a comparison post to Valerie’s The practical reality of contraception: A guide for men about the Australian equivalents. However, I realised a background in the Australian healthcare system might be needed. Hence this post.

Caution: I am not a medical professional or health administrator. There are plenty of details of healthcare payment in Australia I am blissfully unaware of. This is a guide to what it is like to pay for healthcare in Australia as a relatively healthy younger woman.

Summary

In Australia, many people in cities can see doctors mostly for free, and get free hospital treatment and pretty cheap pharmaceuticals. Yay. It isn’t the magical land of totally free though. Boo.

Medicare

Australia has government funded healthcare, called Medicare. Medicare is available to all Australian citizens and permanent residents living in the country. It is funded through the Medicare levy, a federal tax applied to people on moderate incomes and up.

To prove your eligibility for Medicare you have a Medicare card listing your name (often families are combined onto one card of which each adult gets a copy). In the absense of this card Medicare can verify coverage directly to health care services, I believe, but that’s more hassle. Most people carry their Medicare card in their wallet.

Further reading: overview of Medicare, tax guide to the Medicare levy.

Medicare pays for medical services: that is, (a fixed amount of) doctors’ fees and, for public hospitals, other costs associated with hospitalisation. That is, in Australia, you can for most conditions go to a public hospital, be admitted, and be operated on, x-rayed, diagnosed, etc, for free. Hooray!

The Pharmaceutical Benefits Scheme (PBS)

The PBS provides government subsidised pharmaceuticals to Medicare card holders. Basically, almost all common drugs are bought in huge numbers by the government at agreed prices and then sold in pharmacies to patients. No matter what the government paid, the patient will pay something in the order of $20 to $50 for PBS medication. Low income people can obtain a health care card entitling them to medication prices on the order of $5 or so.

Private health insurers (see below) may provide partial reimbursements for some non-PBS drugs.

People who have unusual drug needs (for example, some types of chemotherapy and painkillers, or a drug for which there are several PBS alternatives that for some reason you personally can’t take) can still end up paying huge amounts for medications.

Further reading: About the PBS, Health Care Card

Bulk billing, private billing, and gaps

Doctors’ fees are an important thing to understand here. A doctor in a public hosptial will bill the government for their fixed fee only (or rather, the hospital will bill the government, and pay the doctor a salary). A doctor working outside a public hospital has a choice, they can bulk bill, which is the jargon for billing the government directly, and which from the point of view of the patient is a free consultation. Or they can privately bill, and they can bill any fee they like. The patient can claim the fixed government contribution from Medicare. The difference between the doctor’s bill and the government scheduled fee is called a gap (not a “co-pay”, that’s American jargon) and it is often paid by the patient themselves, especially if the doctor was seen in their own clinic rather than in a private hospital.

The same can be true of other medical services like X-Rays and scans, or blood tests. There are some practitioners or clinics that bulk bill and some that don’t.

There are also some procedures that Medicare flat-out doesn’t cover. I mostly encounter this with unusual blood tests.

Availability of bulk billing

As above, public hospitals do it, and there are a lot of public hospitals. For non-emergency treatment or care for which there is contention, such as childbirth, the hospital usually has a defined catchment area, and will only treat in-area patients. So you have an assigned hospital, essentially, that will admit you and treat you under Medicare.

Outside hospitals, in major metropolitan areas it is often possible to find bulk-billing general practitioners, and, in some specialties, even bulk-billing specialists with their own practice. (This can have downsides such as shorter appointments or high practitioner turnover, but some private billing clinics have these problems too!) In smaller cities and regional and rural areas on the other hand, there is usually a shortage of medical practitioners and private billing can be near-universal. And underserved specialties often have near-universal enormous gap fees for out-of-hospital consultations.

There is some protection against enormous gaps. Some private insurers (below) have some coverage, and the Medicare Safety Net starts paying part of many gaps after you spend about $500 in a year on gaps.

Private insurance

Now, there is private health insurance, which you take out in addition to (not instead of) Medicare. What this gets you is:

  1. coverage of many expenses associated with choosing a private hospital (accommodation, operating theatre fees) and so on, and on some policies partial coverage of the gap amount on the doctors who treated you at the hospital
  2. coverage of some non- or partly-Medicare covered expenses, like dental, optical and physiotherapy fees (for example, Medicare covers eye exams to prescribe glasses, but not the actual glasses themselves), the jargon for that here is extras cover
  3. coverage of ambulance expenses in states where the state government doesn’t pay for them (NSW is one of the states where you pay for your own ambulance)
  4. coverage of a (usually pretty limited) range of non-PBS drugs

You can usually buy pieces of this too: eg, just hospital, or just ambulance.

As an indication as regards cost, private premiums presently start at about $150 for a family for a month, and a super-kickarse policy with huge yearly limits on extras and private obstetric care (this, psychiatric care and dialysis are often excluded from cheap policies) included starts around $350 a month for a family with adults my age. They actually have to get the federal government to approve their rate of premium rises.

Employers sometimes, but by no means always, offer private health cover. It’s usually a benefit associated with US-owned companies. (Google presently pays for my family’s private cover.) It’s not a tax-exempt benefit.

Why use the private system?

Here, the private system is anything where the patient may be billed. This includes:

  1. being admitted to a public hospital as a private patient, which is a choice they offer you, and the hospital bills you/your private insurer rather than Medicare
  2. being admitted to a privately funded hospital
  3. seeing a doctor or visiting a clinic that does not bulk bill

One major reason is that, as above, out of a hospital you simply may not have a local bulk billing practitioner. Or, if you are wealthy, you might, but you may have a personal preference for a particular practitioner who doesn’t bulk bill.

The other is to avoid the downsides of the public system:

  1. for some treatments, especially elective surgery (tangent, in Australian medical jargon, that means all surgery that isn’t urgent, it does not only mean “surgery for which there isn’t a medical need”) public hospitals may have long waiting lists, whereas you could get your treatment more swiftly in the private system, which may be considerably more pleasant for you!
  2. in the public system, you are not entitled to a choice of doctor. You get treated by the rostered doctor (often a registrar, ie, specialist-in-training in the appropriate specialty). In the private system (including a privately-paying patient in a public hospital) you appoint your doctor.
  3. public hospitals tend to have a lower standard of accommodation than private ones, ie, shared rooms, less light in rooms and similar. So, a class thing.
  4. quite a number of public hosptials are actually Catholic, and refuse proscribed services like abortion, tubal ligation, and prescribing or supplying contraception (whether publicly funded hospitals should be allowed to do this is an interesting question, but not really live, politically). Mind you, so are a lot of private ones, but since you can go to a private hospital of your choice, you can choose a non-Catholic one, and you may not be able to in the public system.

Nevertheless, as you can imagine, Medicare coverage suffices for many Australians even if they can afford private premiums. There are a couple of financial carrots and sticks used to encourage taking it up and, in theory, reduce the cost burden on Medicare.

Further reading: the Medicare levy surcharge tax on wealthy people who don’t take up private insurance, and lifetime health cover premiums in which your premium is locked to the age that you first bought private insurance at.

Comparisons with the US system

Improvements on the US system, based on my (very imperfect!) understanding of that system:

  1. the most obvious one is that when you lose your job you do not lose Medicare coverage if you are unemployed, or earn too much money, or earn it the wrong way, or are too old, too young, too healthy or too sick.
  2. likewise, you cannot end up with a health history that makes it impossible for you to be insured: private insurers cannot, by law, discriminate on anything other than age (higher age is higher premiums) or medical history, and the only permissable medical history discrimination is that they can (and always do) refuse to pay for treatment related to a “pre-existing condition” for the first 12 months of cover. Medicare does not discriminate other than on nationality and visa status.
  3. insurers don’t get involved in the details of your medical decisions. It’s fairly plain when something is covered and when it isn’t. There seems to be far fewer problems with “and then I presented my script in a month with a blue moon and it turns out that clause 197c2 subsection b means that I now pay for my medication myself this year”. Generally you and your treating professional make a decision, stuff happens, and Medicare, PBS and you collectively pay the same amount for it no matter who billed what when and who sacrificed which mammal to the gods.
  4. even privately billed stuff seems cheaper, probably because the giant single-payer forces all the prices down, and the fact that for things that Medicare doesn’t cover, you tend to see the entire bill, which seems to be more price transparency than the US has.

    As a price difference example, Valerie states that she had a USD 40 co-pay on Nuvaring. Nuvaring is not a PBS medication here and my private insurer didn’t cover it either. But I paid AUD 30 a month for it and that was the entire cost, not just a portion of it.

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Book review: Steve Jobs

Walter Isaacson, Steve Jobs.

It is the day in Australia to be thinking about poor leadership and its sequelae. And coincidentally I’ve just finished up everyone’s favourite summer hardback brick (all hail the Kindle), the authorised Steve Jobs biography, and I just read this today too:

However, sometimes really smart employees develop agendas other than improving the company. Rather than identifying weaknesses, so that he can fix them, he looks for faults to build his case. Specifically, he builds his case that the company is hopeless and run by a bunch of morons. The smarter the employee, the more destructive this type of behavior can be. Simply put, it takes a really smart person to be maximally destructive, because otherwise nobody else will listen to him.

Why would a smart person try to destroy the company that he works for?… He is fundamentally a rebel—She will not be happy unless she is rebelling; this can be a deep personality trait. Sometimes these people actually make better CEOs than employees.

When Smart People are Bad Employees

Well, good to see that someone understands Jobs better than me.

One major thing that struck me about this book is that Isaacson is really quite flattering about… Bill Gates. It is, however, fairly easy to do this in a biography of Jobs, because Gates was really one of the fairly few people with both power and emotional and financial distance to assess Jobs relatively dispassionately and to go on the record about it. He also never had a intense and short-lived mutual admiration relationship with him in the way that Jobs had with many men he worked more closely with. Gates and Jobs apparently always considered each other a little bit of a despicable miracle: astonishingly good work with your little company over there, Bill/Steve, I would never have considered it believed with your deluded pragmatic/uncompromising approach to software aesthetics.

I read these books mostly for the leadership and corporate governance insights at the moment: unfortunately there’s not a lot here. There is of course a lot of unreplicatable information about Jobs personally: I doubt a firm belief that vegans don’t need to wear deodorant is essential to building a massive IT company. Likewise, if your boss is uncompromising and divides the world into shitheads and geniuses, the solution turns out to (in this book) “be Jony Ive or John Lasseter”. Not really a repeatable result.

It shouldn’t (and didn’t!) really come as a surprise, but if you want to know more about Jobs personally, read this book. If you want to know a great deal about the successes and failures of Apple’s corporate strategy, you’ll largely see them through a Jobs-shaped lens. Which probably isn’t the worst lens for it, but not the only one. In any case, it’s a nice flowing read (I read it in a couple of days) and is ever so full of those “oh goodness he did WHAT?” anecdotes you can subject your patient housemates to, if you like.