Again, from the land of being controlled by the government - in Australia we have to have at the very least, Third Party Personal insurance before we are allowed to register our car. It's called the "green slip". We also have to have a certificate of roadworthiness (the "pink slip") before our car can be registered. It is a serious offence to drive an unregistered vehicle and if caught, you lose the car.
We have problems when kids (like difficult child 1) think the green slip also covers them for third party property. So when he ran a red light in abysmal wet weather and peak hour traffic and cleaned up a doctor's leased BMW, difficult child 1 was out of pocket $80,000. He was on the point of having to declare bankruptcy when the doctor's insurance company came knocking. They saw that they would get less than nothing out of him if he went bankrupt, plus it would make them look bad, so they dropped it all. Thank goodness.
As for how your health scheme gets paid for - I haven't read the document, so I can't say. But in Australia, our health scheme gets paid for via a very small tax levy. This means the people who can most afford it pay more than the poor people. Below a certain income level, you pay nothing. But this does require linking in everybody's tax return details to the health system. We do have to endure a lot of Big Brother to get this working. However, there are also very strict rules as to who can access the information and people (health employees or tax employees) do occasionally get caught and prosecuted for breaches of the law (with regard to not treating people's information with respect).
Something we also have in Australia with our private health 'extension' to our cover (which is optional) - we can choose to pay for 100% cover, or we can choose to have an excess, as we have with car insurance. In our case we have an excess. So for things our national health insurance doesn't cover us for, or for my recent choice to go private re my breast cancer in order to have it removed as soon as possible, we had to pay a certain dollar amount towards the fees. Also in our case, if a doctor chooses to charge more than the scheduled fee (which is set by the AMA) then the patient has to pay the extra. Anaesthetists, for example, always charge more than schedule fee because their costs are higher (someone has to pay for the anaesthetic medication and materials, that actually comes out of the anaesthetist's fee). The anaesthetists are always campaigning to have their schedule fee increased. But as a lobby group they are not so powerful as, say, orthopedic surgeons.
Continuing my example - there is no rush now that my tumour has been removed. So I have happily accepted the longer waiting time for the radiotherapy, and gone public. I'm not even sure there IS a private option. So all my specialist visits, and all my radiotherapy treatment, will be covered by Medicare (ie I won't have to pay anything). They even have dedicated parking right outside, for patients of the radiotherapy clinic! So I won't even have to pay a parking fee.
I have to go see my GP this afternoon for my regular monthly appointment to get my pain medications. My GP chooses to "bulk bill" which means she has accepted 85% of the schedule fee as payment, in exchange for not having to worry about making up accounts and trying to get the full fee up front from the patients. Doctors here are not allowed to charge the 'gap' and then bulk-bill.
Doctors who bulk-bill simply send the patient's Medicare number (a unique number for every Aussie citizen) plus the "item number" which identifies what kind of service, to the Medicare computer. The doctor's practice then gets a regular payment transfer from Medicare.
To "keep the B)(*&^ honest" (a famous Aussie political phrase) the Medicare computer keeps databanks on all the Medicare numbers and the doctor provider numbers as well as the item numbers, as well as the dates. So if I begin doctor-shopping, for example, seeing multiple GPs in the same day for the same sort of item number, Medicare will flag it and watch. They may even begin to ask questions. Similarly, if Medicare notice that a GP is servicing several thousand patients in one day, the computer will flag it and ask for an explanation. Even pharmacies are hooked in - a doctor who over-prescribes can get flagged. A pharmacy that allows too many addictive drugs to be dispensed without asking questions, can find themselves getting a visit also.
Another example - I was waiting outside the hamburger shop for difficult child 3 and noticed an almost empty rubbish bin beside me. At the bottom, glued perhaps by a remnant of bubble gum, was an empty packet of very strong pain medications. I removed the empty packet and noted the name of the patient, the name of the prescribing doctor, the amount of medications prescribed (a very hefty jolt, twice as much as I take and I know I take enough to make an ER doctor gasp) and TODAY's date! And the packet was empty. Underneath tat packet was another empty packet of a different but also addictive pain medication, also massive doses. Same patient, same doctor, same pharmacy, same date. I suspect the ink was still wet on the label.
Every capsule had been removed and the empty foil was also in the bin.
I went in to the pharmacy, the bin was right by the pharmacy back door.
The number of possible explanations were limited, and none of the explanations gave valid reasons for what I found. What I had found had to be the end result of drug-seeking behaviour and someone obtaining prescriptions for the purpose of abuse. A patient who NEEDS those medications for legitimate medical reasons, would not remove them from the packet, because the pack is a legal 'permission' to have those medications in that amount. Otherwise the police can run you in if they catch you with those drugs and no prescription label in your name.
So I reported my find to the pharmacist. Now it is possible that the pharmacist was in one some scam, but I doubt it - they can't risk losing their license and this is a major pharmacy, they would make far more from legitimate medications than from a payoff from a local junkie. They also have to justify ordering those medications from the warehouse, the government watches these prescriptions closely, and addictive medications require an authority prescription. A doctor prescribing for a patient who did what I found, would get flagged and questioned, risks losing his job.
as I left, the pharmacist was calling the police.
It is possible that the patient whose name was on the label, was a genuinely inform relative who had their prescriptions stolen, But this would need to be reported in order for replacement prescriptions to be issued. And if it happens again - questions get asked.
I'm trying to explain here, how our system has had to be made intricate and ever-watchful. If you are genuine, you have nothing to fear. But if you are trying to abuse the system, we have a system with cross-checks tat will catch up with the wrong-doers.
Some people find this level of official scrutiny to be a concern. I've never had it interfere with my personal freedoms, nor have I found the health system to be a problem when it comes to confidentiality. I live in a very small village with a neighbour (or a few) who would love to gossip about my pain medications, if they knew what I take. So my pharmacist who is aware of my concerns, always goes to great lengths to make absolutely sure that nobody knows. He packs my pain medications below the counter into an opaque bag and won't mention the name of the medications aloud if there is anyone else in the shop.
With any level of government involvement in a service to the community, you will need some level of official scrutiny in order to make sure it is working well. It is one of the costs that come with the hoped-for benefit. I know you all value the perceived freedoms in your country highly. We also consider Australia to be a very free country. I'm sure we give that imprssion to visitors. But we have become very accustomed to a high level of government 'tweaking' and watching.
it is so prevalent that we hardly notice it any more.
Marg