Caulfield South, Australia — When Eloise Shepherd was pregnant with her three children, she had a decision to make each time: She could deliver at a public facility, which meant government-provided insurance would pay for most of the cost of delivery; or she could go to a private hospital and pay through the private insurance she carried.
All three times, she opted for the public route. It wasn’t glamorous. For her second baby, Shepherd remembers being in a hospital room with three other women, only curtains between their beds. She could hear one of her roommates Skyping with her family through the night. She describes the food as “slop in a trough.”
Her sister Madeleine Campbell went the other way in fall 2018, when she was expecting her first child. She wanted to deliver at a private hospital, not a public hospital like her sister, with an obstetrician of her choice, who would see her from her first prenatal appointment all the way to labor. Shepherd, on the other hand, says she saw a different midwife or obstetrician on every visit to the public hospital.
The country’s health care system is perched precariously between two principles: universal coverage and personal choice. Australians generally believe everybody should be able to get care, affordably. At the same time, they believe that people who can pay more should be able to get more.
The hybrid system is partly the result of a long-running political tug-of-war. Conservatives argue the public system should function as a safety net, and warn it would be overwhelmed without the private sector there to relieve some of the pressure. The left-leaning Labor Party believes funding the public system sufficiently should be the priority and seems more content to let private insurance coexist with Medicare. Even at the system’s lowest point, in the mid-1990s, 30 percent of Australians were buying private insurance. The current share is well above that.