1997_08_augustl_stolen generation

The Commonwealth Government and the High Court came very close this week to accepting the Nuremberg defence over the stolen generation.

The Nuremberg defence was broadly that “”we were following orders and what we did was at the time lawful under the laws of Germany”.

Comparisons with Nazi Germany are usually hyperbole and nearly always odious. I am making a comparison in legal thinking, not in the enormity of the offence. In dry jurisprudential terms it is a debate between legal positivism and natural law.
Continue reading “1997_08_augustl_stolen generation”

1997_08_augustl_health insurance

<span class=”drop_cap”>H</span>ow could the Government have been so dumb over health costs?

A year ago the Government promised to stem the exodus from private health insurance.

It offered incentives to low-income people to enter or stay in private cover and hit high-income earners with a penalty levy unless they entered or stayed in private cover. It budgeted $500 million for the low income people and expected $75 million in penalty levies.

What as been the result? As predicted, it was a total waste of money. The sums did not add up. This week’s figures show that for the 52nd consecutive quarter the percentage of people with private cover has fallen. Talk about a recession in private health cover. And the greatly heralded measures last Budget to stem the exodus have made no change.

The incentives have changed no-one’s behaviour and the penalties have done precious little. All the Government has done is give a subsidy to people who would have stayed in private cover anyway. Moreover, the cost of that subsidy has apparently risen from $500 million at budget time to $1.7 billion now. As to the penalty for high-income earners not taking private cover, on the Government’s own figures it will cajole only 60,000 to 70,000 into private cover, increasing the participation rate by a mere 1.5 per cent.

The Private Health Insurance Administration Council says 91,000 people dropped their private cover in the three months to June, on top of the 100,000 who left health funds between January and March.

Now 31.9 per cent of the population compared to 62.8 per cent in 1983.

And there was the Health Minister, Michael Wooldridge, bravely saying that the hemorrage from private cover is over.

“”So effectively what’s happened today draws a line under the sand of 10 to 15 years of inactivity in private health care,” he said. “”It’s all on from here.”

What an apt analogy the line in the sand is. After all, Saddam Hussein is still there.

So what has gone wrong?

The first point is that the Government has defined the wrong problem; small wonder it gets the wrong answer. The problem is not people opting out of private cover. The problem is fewer funds (public or private) goin gin to health care at a time when health costs are rising with increased medical technology and an aging population.

The shortfall is huge. The Commonwealth outlays about $20 billion for health and recovers only $4 billion from the Medicare levy. You cannot hope to fund a health system that costs 8 per cent of GDP (with GDP continually rising) on a levy of 1.5 per cent of income. Even allowing for large expenditures on pharamcueticals and other non-medicare non-hospital helath spending, the gap remains impossible.

It cannot be breached by pathetic subsidies for low-income earners or comparatively small penalties for high-income earners.

People will continue to desert private cover until the govenment addresses several fundamental defects in it.

The first is that Medicare is too good. At present anyone with a serious illness or catastrophic injury is better off in the public system. You get treated for nothing. There is no delay and there are no bills. If you opt to be a private patient you get the same treatment at the same time and yet you cop a bill at the end.

This farce must end. Medicare patients must get a means-tested bill and private patients must be able to insure for the gap so they get no bill. Otherwise why be a private patient. At present the only reason for being a private patient is to jump the queue for elective surgery.

In any event, the Medicare levy should match costs. Surely, this user-pays government should realise that. The levy should be about 3 per cent of income.

The second is that Medicare and private insurers should compete at an even level. At present everyone pays the Medicare levy. Privately insured people should not pay it, but the insurance company should pay the whole rebate of medical costs (in addition to hospital costs). It may be they insure for 100 per cent of costs or something less. And those in Medicare would get their whole rebate from Medicare. Provided coverage remains universal with some sort of annual cap on patients’ costs, this would work better than the present system.

It is likely that Medicare would do very well because present administration costs run at 3 per cent of premiums, whereas the private funds’ administration runs much higher.

Then something must be done about health costs. At present the funds have no control over costs; they are decided by doctors, hospitals, governments and marginally by patients. Moreover, four or five organisations pay for patient care in hospital: the fund, the Commonwealth (through the inter-government hospitals agreement), the state, the patient and Medicare. Typically, they all shift costs from one to the other without addressing the base line.

All the financial risk is borne by those who pay for the care (fund, patient, and govenrments), who pay up if anything goes wrong, and none of the risk is borne by the providers of the care (doctors and hospitals). So there is no financial incentive on the providers to contain costs, be efficieint and effective.

And there is no informed choice by patients. Most patients have no idea who is a good specialist, what is a good hospital, or what treatment regimes are most effective.

The funds should, on behalf of the patient, draw together and pay for full treatment options for entire maladies to get the best outcome for patients. The funds would have a vested interest in seeking out the best medical outcome, not just the best financial outcome in the short term. Some in the medical profession may not like this becuase it would show them up; others (the more competent) would welcome it.

In any event, Dr Wooldridge should stop playing in the sand and look at the fundamentals before the aging population makes the costs of the ideal of universal coverage impossible.

1997_07_july_leader22jul sth pacific

The damage done by the secret briefing paper on South Pacific nations and leaders comes not from its content, but from the carelessness that enabled the document to be made public.

Australian officials should make frank assessments about nations with which Australia has dealings, in particular nations which receive large amounts of Australian aid. Continue reading “1997_07_july_leader22jul sth pacific”

1997_07_july_hospital

We came to the lake like tens of thousands of Canberrans with mixed emotions.

We came for the spectacle, the carnival, the wow-ee of a building collapsing before us. We were in a unit on the 16th floor of Capital Tower.

In our group several had been born at the hospital. We had experienced hope and fear there. We thought about our lives and those of people close to us. Motor-cycle accidents; births; disease and death. We thought about chance.
Continue reading “1997_07_july_hospital”

1997_06_june_elliott forum

John Elliott’s campaign against the National Crime Authority back-fired this week and in doing so did not put either Elliott or the courts in a good light.

Elliott has accused the NCA of running a political smear campaign and a witchhunt against him; that it was an arm of the then Labor Government out to discredit him because he was federal president of the Liberal Party. Continue reading “1997_06_june_elliott forum”

1997_02_february_uk high commissioner

Misconceptions and misunderstandings by Australians about Britain and Britons about Australia are preventing better partnerships, trade and investment opportunities for both countries, according to the British High Commissioner, Sir Roger Carrick.

He told the National Press Club yesterday that the typical Australian impression of Britain was one of beefeaters, castles, feral tabloid newspapers, warm beer and lousy food.

In fact, he pointed out, the best French cuisine in Europe was to be found in London.
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1996_03_march_leader27mar

Residents of Ainslie joined the concern of other residents associations in the inner north about traffic in their suburb this week. They say it is getting as bad as on the western side of Northbourne Avenue. The traffic flow, particularly at peak hours, in residential streets on both sides of Northbourne Avenue has increased substantially in the past five years and is likely to continue climbing. The reason has been obvious. New suburbs have been built, notably Gungahlin, North Lyneham and West Belconnen without laying out reasonable road infrastructure to bear the traffic they would generate. The land has been sold for the newer suburbs, with profits going to the developers, without provision for the necessary public infrastructure outside those suburbs. (And incidentally, the town centre and other non-traffic infrastructure in Gungahlin have been similarly ignored.)

The result is a bunfight of competing interests. Residents of Gungahlin, quite reasonably, want to get to work in Civic, Woden and beyond. Residents of inner north, quite reasonably, do not want large volumes of through-traffic charging through their suburbs on roads that were never designed to take it. Residents of the fringe of Mount Ainslie and the green belt between inner north and Belconnen do not want freeways carved through the bushland to take the Gungahlin traffic. ACT rate-payers do not want to subsidise a light-rail system or some other economically irresponsible dream solution. People who respect the notion of Canberra as the national city do not want Northbourne Avenue … the present gateway to Canberra … to lose chunks of its median strip to turning lanes, bus lanes, train lanes, or extra lanes.
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1996_03_march_leader11mar

The industrial dispute, or more correctly disputes, in the ACT are reaching crisis. The disputes are not so much about pay and conditions, but about power and the whole public-sector industrial-relations culture. On one side the Liberal Government is determined to break-up the monolithic approach of the previous Labor Government which was to deal with the whole public-sector as one and make wage rises and changes in conditions across the board. The Liberal Government wants industrial relations to take place agency by agency. Moreover, it wants pay rises to be paid for by efficiencies, rather than by Budget allocation. There are more efficiencies and trade-offs if practices in each agency are looked at rather than looking at only practices across the service.

Over the past month or so the Government has tried to break the ranks of the 12 unions with which it is dealing by offering separate pay rises to separate sections of the public sector. The unions have rejected each offer, and clearly the strategy has failed. The union leaders obviously feel they have greater bargaining power if they act collectively (because they can cause greater disruption and revenue loss) and have persuaded their membership of that. Employees, however, might get higher pay rises if they dealt on an agency basis because more money would be available than through the Budget alone.

This dispute is more about power than pay. It is about union power and government power. And Canberrans are caught in between. During the dispute, Canberrans are inconvenienced by bans and after it, Canberra ratepayers will suffer if the Government gives in and provides pay rises out of the Budget.
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1996_02_february_health

John Howard’s policy of matching Labor’s bribe and don’t frighten the horses on Medicare may neutralise health as an election issue, but it will surely fail as a long-term solution to Australia’s health problems.

It fails to understand Medicare’s weaknesses and therefore fails to do anything about them. And without those weaknesses being fixed, Medicare fundamental strength will be eroded. Continue reading “1996_02_february_health”

1996_01_january_leader19jan

It is so easy. Out comes the credit card. A quick slash across the electronic reader and the purchases are taken away for consumption. Last month Australia put another $2 billion on the international credit card, according to figures issued yesterday. Next month interest will have to be paid on it, and the rest of the $180 billion we owe overseas. Continue reading “1996_01_january_leader19jan”