We’d only been living in Wellington, New Zealand, for 2 weeks when I had my first encounter with Kiwi emergency room care — not as a doctor, but as a patient.
My husband and I decided to take a walk one afternoon while the wind was blowing quite hard (as, in Wellington, it most always is). We were halfway up a city block where some contractors were dumping the detritus from a residential demo job when I felt a stabbing pain in my left eye. It was excruciating.
I stopped, buckled over, crying both from the pain and the intense need to flush it out with tears. T.J. had a water bottle, and I gave my eye a quick rinse, but the pain wouldn’t let up. There was no doubt: I needed immediate medical assistance.
We were able to walk to the hospital emergency department — right next to the mortuary where I perform coronial autopsies — just a few blocks away. We donned masks, went through the quick screen for COVID symptoms in a trailer outside the ED, scanned our phones on the COVID contact-tracing app, and went to the reception desk.
A kindly nurse behind the plexiglass screen asked why I was there; took my name, address, and phone number; and indicated that I should take a seat in the socially distanced waiting area, and wait.
She hadn’t asked for my insurance card or a credit card number. That was odd — or at least wasn’t what I was used to. I felt the need to come out with a worried confession: “I’m not a permanent resident here. Don’t you need my insurance information?”
“No, no,” the nurse said. “It’s covered under the ACC.”
“What’s … um … what’s that?”
The Accident Compensation Corporation, I would later learn, is part of New Zealand’s system of socialized healthcare. The ACC first started coming together in the late 1960s in response to the social burden and individual financial damage of car accidents and poorly funded workplace injury compensation.
The ACC has been expanded, codified, and improved ever since. New Zealand employers and the self-employed pay into a fund to cover accidental injuries, whether those injuries occur on the job or not. Drivers pay into a separate fund to cover injury auto accidents on a no-fault basis. The national government pays into another fund to cover all injuries to tourists and visitors like me and my family, students, children, and anyone else. All these accounts are managed and administered by the ACC.
If you are injured in New Zealand, the ACC will pay for your hospital costs — whether in the emergency department, as an outpatient, or as an inpatient. Whatever you need to get fixed up, they’ll do it. Chronic injuries suffered over time in the workplace are covered. So are sports injuries.
The ACC covers all your rehabilitation costs and transportation costs that are a consequence of your injury. You are paid weekly compensation for being out of work, even if your injury makes that work stoppage permanent. It also pays for mental health help associated with some injuries, with a special focus on victims of sexual violence. ACC will pay for your funeral if you die as the result of an accident.
As an American I found this pretty hard to wrap my head around. But we have seen the benefits in practice, and not just during my own ER visit. We have a new friend here who has a seizure disorder — the result of a head injury sustained in a serious motorcycle accident years ago. They are completely compensated for their disability — for life — and don’t have to sue anyone for a lump sum that may or may not run out in their old age.
On the other hand, we have noticed that Kiwis in Wellington seem to be more aggressive drivers than we had been used to in San Francisco. The ACC provides no-fault coverage for any and all injuries — so, are drivers here less careful because they don’t need to worry about getting sued if they cause an accident and injure someone?
Oh yes. I didn’t mention that part of the ACC: It essentially bans personal injury lawsuits.
Great, right? American society is infamously litigious and complains about it. But before you applaud the abolition of the right to sue over an injury, come walk in my shoes. There are uneven sidewalks, random lips and ledges, trip hazards everywhere. When we walk into town, we pass an open ditch that abuts the sidewalk — a single rotting two-by-four nailed across it as the only thing meant to impede a stumble into the Great Beyond.
Houses sit on ledges with no banisters, where someone could easily fall to a messy death. Sometimes I think my apartment is trying to kill me. It has these lever door handles with horrible little bulbs on them that snag my sweaters and grab my purse as I walk past. In the middle of Wellington’s waterfront there’s a staircase you can climb to jump into the harbor. It’s a 15-foot drop to the water. No signs, no lifeguards, no barriers.
As a lawyer friend of T.J.’s would say when contemplating such an easily accessible environmental hazard, “The litigation possibilities are endless!” As much as we Americans complain about our litigious society, are our arguably frivolous lawsuits actually keeping us safe?
I know that as a forensic pathologist I only get a snapshot of what kills people, and the things that kill people can be very location-specific. I don’t generally see the things that injure people but leave them alive. It wouldn’t be scientifically accurate — or fair — to draw any population-based conclusions based on the personal observations I’m sharing here.
What I can say for certain is that it’s a new experience to work in a place where I don’t have to worry about malpractice insurance, and where there’s no market for my expertise as a private-practice medicolegal consultant in civil litigation. I still do plenty of that work from here, but all my clients and the lawsuits they’re pursuing are in the U.S.
Healthcare costs in the U.S. continue to skyrocket, and the lack of universal coverage and ballooning deductibles prevent many from getting basic care. The last Congress, meanwhile, spent a great deal of energy in delaying pandemic relief funds because of lobbyists’ concern about lawsuits against corporations who don’t protect their workers.
Imagine if all the lawsuits just went away. Imagine if we had a publicly funded healthcare system so that nobody had to worry about losing their healthcare, or winning a lawsuit against their employer, if they were injured on the job.
I don’t know for sure that the Kiwis have the best healthcare system available to them. I do know that legislation along the lines of the ACC is one example among many of the ways healthcare reform in the U.S. could go forward.
Judy Melinek, MD, is a forensic pathologist and CEO of PathologyExpert Inc. She is currently working as a contract pathologist in Wellington, New Zealand. Her New York Times bestselling memoir, co-authored with her husband, writer T.J. Mitchell, is Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner. The duo have also embarked on a medical-examiner detective novel series with First Cut, available from Hanover Square Press.