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I've lived and learned for quite a number of years. I don't stop learning. A CPA and IT professional transitioning to a new career in health and well-being.

What it is REALLY like to be unemployed

Unemployed. If there has been any day in my 61.5 years of life when I’ve felt it is all just too much, yesterday was that day. Today is not much better. While sharing the pain I feel publicly may further hinder my employment prospects (is that even possible?) I share in the hope my experience may help others know they are not alone and may, just may, encourage some employers and recruitment agents to rethink their approach to candidates. The government also needs to walk a mile in my shoes, then tell me I can get a job and they can safely cut the Newstart Allowance. And yes, Grace Collier, I am training to start my own business – if I can hold my body together. Holding my body together costs money.

Where to start? Some background for context, perhaps. I was diagnosed late 2014/early 2015 with autoimmune (AI) conditions. Nothing I can’t manage, providing I can AFFORD to manage them. In my experience, AI conditions can take a lot of time and money to manage to the point where I look and feel normal (photo supplied as evidence). With a couple of exceptions: I can no longer sit for hours without moving, like a good little accountant should. I have to move reasonably often.

In June 2015 I was made redundant. In September 2015 I secured a new job which lasted a massively long six weeks. It seemed to boil down to the fact I refused to get my hair cut short, but I was called at home and told not to go back in, by “mutual agreement”. It was indeed mutual, as I found it a very toxic environment and had already contacted the recruitment agency with my concerns. The agency had encouraged me to “hold on until January”, which I had tried to do.

Having been made redundant in June then effectively fired (for the first time in my working life) in October, I wasn’t feeling very good psychologically. Off to the psychologist who was my saviour and the GP for anxiety medication.

AI needs time to manage properly, so a senior management role is no longer an option for me. Given the medical situation Centrelink have me in the disability support stream of job seekers to provide additional employment assistance – but most of that assistance seems only to kick in AFTER I secure a job, such as they can provide a sit-stand desk. In all the time I’ve been with this Job Search Provider, I have been referred for ONE interview! ONE! The Job Search Provider network seems, to me, to be more about meeting the contractual compliance obligation paperwork to “earn” their revenue (funded by the taxpayer) than actually finding work for the unemployed. That is an analysis for another day. When I ended up in tears one day I was told to go and get a medical certificate to exempt me from job hunting. I was in tears because I DON’T HAVE A JOB! Getting a medical certificate to stop me looking for a job wasn’t going to improve the situation!

I started studying a Diploma of Fitness Coaching with the objective of setting up my own business providing training to people like myself who need exercise for pain control/management. I understand what it is like to not be able to move first thing in the morning and I know the benefits exercise has provided me. My doctors (of whom I have a battalion) all support my business plan. Getting the qualification, however has proven difficult. Registered training organisations (RTOs) seem to me to be of a similar ilk in many instances to the Job Search Provider network. I need 120 hours of practical placement and within that be able to train five people for about six weeks to complete a final assignment. That is just one complication: we were told on enrollment we would be able to work after six months of the twelve month course (obviously an attractive proposition to an unemployed person). Well, yes, if we can find someone to employ us without insurance. I’m a CPA – am I likely to do that? Anyway, really, a minor problem. I just don’t need people like Grace Collier telling me to “start my own business” – I’m trying, but I’d like to stay alive in the meantime.

I am under the care of four specialists: endocrinologist, rheumatologist, dermatologist and gastroenterologist. Then there is my GP (who thankfully bulk-bills), my physiotherapist and massage therapist. Luckily these days I see the specialists less frequently than I used to: every three or six months, but they are not cheap. Yes, Medicare covers some of the cost, but the patient still has to pay up-front. No, I am not going the public health system route with chronic conditions unless I absolutely have to, because I need this team of specialists to provide continuity of care, not be seeing a different one of each specialty each visit. The specialists’ visits vary between $120 and $180 a visit. Then I am to have three skin biopsies next month – that’s not cheap either. At one stage I was having endoscopies every six months: private patient with health insurance I may soon have to give up. Not to mention the travel costs to see all these health professionals.

Then there is the cost of the prescriptions: because I have a pension card (thanks Centrelink, I really needed to be reminded you think I am a hopeless case too old for a Health Care Card) these are reduced to $5.20, but the other supplements, like fish oil, glucosamine, Vitamin D, magnesium etc are not. I get a Pharmaceutical Allowance of $3.10 a week.

Are you stressed out so far just reading this? Actually, NONE of that is too bad. With exercise I am rebuilding my muscle strength (working on hip adductor strength at the moment for the physically inclined among you) and keep the pain away almost 100% of the time. Until my stress levels get too high and cause a flare.

Job hunting is the most stressful thing in my life. Ever. Worse than the suicides of my parents or my four divorces. The four divorces? That’s why I am not independently wealthy at my age, which is what people like Scott Morrison no doubt expect. Pity I’m not a famous film star – they always seem to stay rich after divorces. I digress.

Let me share some examples that stand out in my mind. One major hospital interviewed me for a job I really was very keen on. They didn’t employ me, but subsequently interviewed one of my ex-staff for the same position and asked her about me. They did tell me to keep applying for other jobs at the hospital. So I did. Never got one. In the end you dread being the resume the HR staff member looks at and goes “oh, no, not her AGAIN!” and automatically throws your resume in the reject pile. So I don’t apply to that organisation any more.

The government department that sends you an email stating you were “in this instance rated non-competitive” and then sends you a follow-up email of how to break the government job application code/secret.

The private, family owned company who did a phone interview with me for forty minutes and invited me to a job interview the next day for which I had to take a day off work from my then eight week contract position (so lost a day’s pay)  – and never got back to me to tell me I didn’t have the job, despite promising to contact me the following week. They ALWAYS promise to be in touch tomorrow, by the end of the week, next week….. they lie. If recruiters actually interview an applicant, surely they can have the common courtesy to notify the applicant of the outcome?

The state government authority that wrote to tell me a job I had applied for had been withdrawn. When I saw it advertised again a fortnight later I wrote and asked if I could submit another application. Oh yes, was the response, “but please note the criteria includes specific knowledge of our INTERNAL computer system”. Then why advertise externally? Policy requirements, yes, I know. Easy to circumvent by framing the selection criteria in such a way only an internal applicant will qualify.

The sporting body that sends you an email with a subject line of “Not this time around…”. I accept that if you haven’t been unemployed for twelve months, the subject line might not bother you. When it is just another in a long line of rejections, the impact is harsh.

The legal firm that promises second round interviews will be held in two weeks time and unsuccessful applicants will be notified with feedback. Dead silence.

Over time, the rejections become just too damaging to the soul. What doesn’t kill us makes us stronger? No, I’m sorry, not always true. As a very wise psychologist once said to me, the reality is more like water dripping on a stone – eventually the stone wears away. There comes times when you just can’t bear another rejection. Hiding under the doona with digital dragons is less soul-destroying than applying for yet another job you won’t get.

Then there is Centrelink demanding a certain number of job applications per week. Just to meet the KPIs. It doesn’t matter if the jobs are suitable, just anything to meet the numbers. Naturally, this results in more rejections which heightens the stress levels.

Network, they say. So you do. You contact people you have worked with in the past via the professional version of Facebook. Dead silence. That is depressing, because you think you had a good working relationship with many of those people – but that was in many cases years ago – perhaps they no longer even remember you, although you remember them. Thank you to the few that did respond, I appreciate it.

Younger people tell me today’s recruitment environment requires that applicants follow-up as it shows interest to the recruiter. In my day that was frowned upon, just was not done. So while I do it, it goes against every fibre of my upbringing. More stress.

Other advice I am given – change my resume. Basically, turn it into a lie. I can’t do that, I can’t lie about who I am – I don’t want to work for people to whom I have to pretend I’m something I’m not. I am a CPA, I have skills and experience which, while I may not be able to work 100% as a desk jockey any more, I can still use. My brain still works, damn it. Also another thing that wasn’t done when I was growing up.

When I was in my twenties, if you got the job you were most likely offered the job at the end of the interview. Yes, I know the competition is greater today, I know unemployment is higher – all those logical points don’t reduce the stress of being unemployed.

I’ve joked no-one wants to employ their mothers. Hiring managers are predominantly mid-thirties to mid-forties. And woe-betide you if you want a less senior role for medical reasons. These days people want carbon copies of the previous incumbent of a position, nothing more, nothing less. If an applicant doesn’t fit the mould: rejection. The knowledge that in most cases the recruiter only has time to read the first three lines of any application, if that, isn’t comforting.

I’m scared. Scared I will never get a job, scared I won’t be able to pay my medical bills and will therefore not be able to keep my AI conditions controlled. Scared I’ll never have my own private space again. Yes, I don’t even have my own space. Thanks to the generosity of my wonderful daughter and her equally wonderful husband, I have a roof over my head – but it costs me $120 a month to have my stuff in storage. I am 61, I want my own space! I feel I am interrupting their lives and it makes me cringe inside. I’ve been independent since I was 15 years old – this is an adjustment I am not dealing with well at all. More stress. There is no-where I could rent for less than the Newstart Allowance of $264.35 a week and still pay for food, utilities and medical care.

There is a known relationship between stress and AI conditions. The doctors say over and over “reduce the stress in your life”. Yesterday was a day when the stress boiled over and the pain had flared. The physiotherapist sent me home to lay on a heat pack and I woke this morning with a very sore back. She also strongly suggested I revisit my psychologist and was concerned I hadn’t had a massage (money considerations). I went to the psychologist’s office and made an appointment. As I got back in my car, a gust of wind slammed the car door into the side of my head. I burst into tears for the umpteenth time that day, I came home (missing class), lay on the heat pack and took a Serepax – the first I’ve taken in months. Physiotherapist suggests I touch base with my rheumatologist….. in other words, she is suggesting I have a condition flare. First in over six months.

How do I REALLY feel? As if life has no point any more. No-one needs me, no-one wants me. I have no social life: a social life is expensive and I have no idea how much longer I have to survive on what little money I do have. I feel I am a burden to my daughter. If this is what the next twenty years is going to be like then please stop the planet, I want to get off. There are days when I ask myself why am I bothering to fight back? Why push my body through the bench press and leg press? Why bother taking all these damn medicines and supplements? Just why in the hell bother at all?

Once I can’t afford to maintain my health, then I will be unemployable and end up on the Disability Pension. Hopefully, in my specific case my studies will prevent that, but on a daily basis it can be hard to see past just today. Not everyone in my sort of situation has the option to develop a new career and I do worry about the chances of business success at my age. But 68 year-old Hillary Clinton ran for President of the United States, so there is hope.

The lack of physical contact with anyone other than my physiotherapist or massage therapist grows more stressful each passing day.

Other unemployed have different sets of problems: mortgages, children to feed, car loans to pay. The emotional feelings, the stress, the sheer degradation of it all, is the same.

RUOK? No, I’m not OK. Not that anyone ever asks. We are just numbers – the great unwashed of unemployed. Past our prime, not valuable any more. A burden on society, our government keeps telling us. Malcolm Turnbull, do you have ANY idea what it is like to be told in the news cycle nearly every single day what you and your government ministers think about us?

I’ll bounce back, I always do. But not everyone can, not everyone does.

NB: I have deliberately not tried to “take the emotion out” of this article. If it is to serve any purpose, the emotion needs to be there. It is why I have written it today, a day when I feel absolutely NOT OK.

I also want to add that while I have criticised the Job Provider Network and RTOs in this article, I want to make it clear in both those systems there are some wonderfully caring people and in the latter some terrific teachers. It is the system I’m railing against, not the front line staff. Centrelink staff have always also been very nice to me.



Let’s Talk About Sex

Growing up, I was taught there were three things one didn’t discuss in polite company: sex, religion and politics. Religion and politics can lead to heated arguments – just look at several countries around the world at the moment with very volatile political environments. As a respite from the politics, let’s talk about sex, baby.

Edit October 24, 2016: Judging by the comments below, it seems I may did have made clear my main argument, so I’ll be blunt. I’m hypothesising lack of sexual compatibility can result in love dying in a relationship. Lack of compatibility can be the result of lack of knowledge, lack of skill, lack of similar desires/needs and the societal repression of female sexuality. I specifically avoided the use of the word “love” in order to retain focus. There is no question that love + sex can and should be, well, mind-blowing!

My focus is the social repression of female sexuality and the lack of training/skill development generally. Sometimes I read articles that make my blood boil. I read one such article yesterday. Apparently, in 2016, it is still OK to send completely different messages to our young people.

He spoke to the girls about sex — and how they shouldn’t have it — in a mandatory assembly, during the school day, attended by all 350 female students. But he spoke to the boys about “dating tips” in a voluntary, after-school assembly attended by only 25 male students.


In response to a question, Henning explained that guys are sexual so the species won’t die out, while girls have a low sex drive so the planet will not get overpopulated.

Let’s look at some of our society’s “standards”. Young men are encouraged to “sow their wild oats” but girls are to be virgins when they walk down the aisle. A male fellow student of mine, a father in his mid-thirties, has completely different ideas about the allowable dating lives of his sons and daughters. Years ago my son ranted and raved at me for allowing my daughter’s boyfriend to stay over. “But”, I countered, “you are sleeping with your girlfriend!” His response? “That’s different.” How? That girlfriend was someone’s daughter! How did he develop that double standard? From society. Both son and daughter were adults by this stage.

Who, exactly, are these young men supposed to sowing their wild oats with? Each other? Because us women are all so busy protecting our virginity, after all – or at least not bedding too many partners….. We have sex education in some societies and some schools, but even then it focuses on the mechanics of how the male and female bodies work. I distinctly remember my own daughter coming home from school after sex education at about age seven or eight. The conversation went like this.

M: “Mum, we had sex ed today”.

Me: ” That’s good, dear.”

M: “Yes, but I’m confused.”

Me: “Why?”

M: “Well, we learnt the sperm comes from the man and the egg from the woman and together that makes a baby, but they didn’t tell us how the sperm and the egg meet.”

On the basis if a child is old enough to ask a question, they are old enough for an answer, I proceeded to explain, in the simplest terms I could, how the sperm and the egg meet. Her reaction? “Oh, Mum, that’s disgusting, they pee with that!” As she is now 37 and very happily married, I guess she has moved past her initial horror. I did explain the function of the prostate to her at the time! (Conversation shared with permission)

About 20 years prior I had also had sex ed at school. Not much had changed, I thought.

At no point in time do we instruct our young people how to have a good sexual relationship, how to make love well, how to enjoy sex. No, we are still too busy encouraging young men to sow their wild oats and women to refrain from being sluts. Not as blatantly as in the 1950s perhaps, but generally that undercurrent is still there, loud and clear. It is OK for males to enjoy sex, but not women. Yet we have no hesitation in draping scantily clad women over anything and everything to sell “stuff” – more mixed messages. An amusing look at that cultural proclivity can be found at The Huffington Post, “If Men Posed Like Motorcycle Babes“.

Many readers will be familiar with Maslow’s Hierarchy of Needs


We teach our children how to cook, we toilet train them, we teach them to get enough sleep and drink enough water. Breathing and homeostasis really take care of themselves. But sex, the other basic physiological need? No, we ignore that. Heaven forbid we should actually provide any guidance to our young people on one of the most important aspects of their adult life.

Not only that, but society is effectively still repressing female sexuality. We still have double standards, we still have a culture that will blame rape victims for the way they dressed or because they were drunk which effectively is nothing more than excusing the rapist and buying into the very rubbish the lecturer cited above spouted: women have a low sex drive and men have a high sex drive. How about society considers some people have a low sex drive and some people have a high sex drive irrespective of gender. I can think of examples of all four situations I have known during my life.

I applaud the efforts to eradicate the rape culture we still seem to be saddled with and the efforts to hold rapists accountable for their actions irrespective of a woman’s dress. What I don’t see is society teaching young people how to be good lovers. Many young men get much of their “guidance” from porn movies, much more readily available today than pre-internet. Maybe they’d be better having a decent conversation with their father. Some do, but many don’t.

”In my private practice I had a 16-year-old girl who came in and said her 18-year-old boyfriend told her her vagina didn’t look like the images he saw on the internet.

Source: The Age

That’s a great start to a sexual relationship, don’t you think? That is an interesting article worth reading in full, even though a few years old now.

Teenagers are always usually highly embarrassed if their parents try to talk about sex, but isn’t that society’s fault? If we treated sex no differently to teaching young people how to cook or eat a balanced diet or get enough sleep, perhaps our young people would be better equipped to enter the adult world and find sexually compatible partners.

It has long been cited that when relationships start to breakdown, the sex stops. While I am not a psychologist, I’ve often wondered what comes first here, the chicken or the egg? Is it always the case other relationship dynamics fail first, or is it that the sexual compatibility isn’t there and that triggers other issues in the relationship? Could sex be the glue that may keep a relationship together? Remember, we are talking about a basic physiological need, according to Maslow. He didn’t publish gender specific hierarchies, however the following observation is noted:

Although Maslow (1970) did study self-actualized females, such as Eleanor Roosevelt and Mother Teresa, they comprised a small proportion of his sample. This makes it difficult to generalize his theory to females and individuals from lower social classes or different ethnicity. Thus questioning the population validity of Maslow’s findings.

Source: Simply Psychology

There are other aspects of Maslow’s theory open to question, outlined in the above article.

I am not the only one who has wondered.

Can sex kill a marriage? Absolutely. Problems in the bedroom can lead to deep dissatisfaction. A marital sex problem is like a canary in a coal mine — a warning alarm that danger lies ahead.

Source: The Huffington Post

One reason the author of the above article didn’t cite was simply lack of skill or sexual incompatibility (although Reason 6. comes close to the latter). Incompatibility can (not always) result from lack of skill, I suggest.

Think back to the very first time you had sex – did you really have any idea what you were doing, apart from the mechanics of the act? Feel free to share in the comments! We learnt as we went along. I may not recall the stats correctly but I have a recollection of reading, in my dim, dark, youthful past, that some 60% of women (at the time, it has improved) did not achieve orgasm. While it may be that some women are physiologically unable to reach orgasm, maybe with a little, oh, EDUCATION it might be possible for many more. Recently our modern imaging technologies have provided a much better understanding of the female clitoris. Bit bigger than many people think, huh?


Image source: Company handout.

The Guardian has a good article covering the details, “This is a 3D model of a clitoris – and the start of a sexual revolution“. The French will use this 3D model in sex education. Good. That’s a start.

There is a wealth of material out there to assist people, yet even so, many people don’t seek any guidance until after they’ve experienced a failed relationship or they blame other aspects for the relationship breakdown. Young people are unlikely to read a sex text book before they embark on a sexual relationship because we have created a society that finds such things embarrassing.

Individuals in a relationship can certainly learn from each other, but what if neither knows?

Incompatibility is a completely different issue. We are all different. Like different things, high, low, medium sex drive, morning versus night people, missionary versus the Kamasutra. Although certainly compromise is possible as in any aspect of life, if compromise has to be such that one person is no longer being fulfilled or enjoying the sex, this is likely to lead to relationship problems. If we didn’t send our young people out into the world with the belief that “it will be alright on the night” and everything will naturally fall into place, perhaps they could make more informed choices.

Sex requires energy. If the female in the relationship is working full-time, picking kids up from childcare, preparing dinner, doing the dishes, helping with homework and folding washing while the male catches up with the latest sport and news on TV, guess what? Said female is not going to have the energy for sex, irrespective of how much she may want it or need it or desire it. Suddenly it will become yet another task for the day and most likely just one task too many. None of us, male or female, have inexhaustible energy stores. It isn’t just the sexual skills we need in relationships, it is the knowledge around sex: ensuring the timing and environment is conducive is just one important aspect.

Imagine if we stopped treating sex as some great secret. Imagine if we actually treated sex as the normal part of life that it actually is, if we stopped preaching that females are somehow less sexual that males. Perhaps we could reduce the divorce rate. Perhaps we would eradicate or minimise the rape culture. Perhaps we would stop the victim blaming. Perhaps everyone could have a better sex life! The transition may take a generation or two, but surely it is time.

We won’t know unless we try.

Interestingly, some time after I published this article, I came across an article in The Guardian which discusses this very topic with an historical perspective. I found it very interesting: so might you! The Story of Sex: from Apes to Robots is a book written by a French academic.



Men, women . . . and Trump

The media, social, mainstream and everything in between, have been flooded with justifications, discussions, jibes, insults and everything in between over the proven (by his own words and voice) predatory behaviour of Trump towards women. There are a string of labels attached and debate over the legal definition. I’ve no idea what “skeezing” means, but I can guess: the latest release is a video of Trump “skeezing” on a 10 year-old-girl.


The NSW parliament have labelled Trump “a revolting slug” unfit for public office. I almost agree, although I think slugs are being insulted by the comparison. I won’t insult the many fine men I have known in my life by calling Trump a man – he isn’t a man. Of the male gender he may be, a man he is not.

My concern is not actually with Trump himself – he will get taken care of in due course, I hope. My concern is the fact Trump is not alone.

As unscientific as the numbers may be, a Trump supporter issued forecasts that allege if women did not have the vote, Trump would win the election. Within a very short space of time Twitter was awash with #repealthe19th. The Nineteenth Amendment gave women the right to vote.

The Nineteenth Amendment is identical to the Fifteenth Amendment, except that the Nineteenth prohibits the denial of suffrage because of sex and the Fifteenth because of “race, color, or previous condition of servitude”

Then we have the right-wing pastor Dave Daubenmire terrified of a woman becoming the President because according to him the “immorality of a sinful man” is not as bad as breaking the biblical principle that “when a woman rules over a man …. it’s a sign of the judgement of the Lord”. May I suggest to Dear Dave that perhaps that’s precisely what IS going to happen, because his Lord has judged men like Trump are not fit to rule and when the Lord sees other men supporting Trump, the Lord has decided enough is enough.

More than 3,000 sexual assault survivors have taken out an ad pleading with the Republicans to dump Trump. Author Kelly Oxford took to Twitter encouraging women to share their sexual assault stories. Over a million women answered her call. I read some of those tweets. Girls being groped on public transport at ages as young as nine and ten. For a million women to have been sexually assaulted, there have to have been a fair number of perpetrators. One man alone does not manage that many assaults.

I’ve been pleased to see athletes come out saying the sort of talk Trump claims is “locker room banter” is actually not what constitutes locker room banter in their experience. We need more men to stand up and be counted. To denounce Trump’s behaviour.

When I was young, forty years ago, I believed the genders were equal. It never occurred to me there were men like Trump or the pastor in existence. Then again, I am still stunned over Abbott and his “when they are doing the ironing” nonsense. My initial awakening came during my first management tenure. My female staff asked if they could wear tailored trousers to work. I saw absolutely no reason why not, yet the human resources department ruled only if the women wore a trouser SUIT. Back then, trouser suits were inordinately expensive. It was economically unrealistic to expect my staff to buy trouser suits. I saw nothing wrong with tailored trousers and a nice shirt or (as it was winter) a nice jumper. At the time male staff DID NOT have to wear suits unless they were management. Yes, I won the battle, but the fact the battle even had to be fought opened my eyes a little.

Some time later, at a business women’s networking lunch, a speaker outlined how not so many years before, women had been required to give up work once they married. How had I got to adulthood without knowing any of this stuff, I wondered.

Here we are forty years later and we have a predator running for the most powerful position in the world (some other world leaders might of course dispute the most powerful bit). We have people spouting the Bible and others (or many of the same) wanting women to lose the vote.

This is 2016 – or did I get caught in a time warp?

There is absolutely NO justification in 2016 for Trump’s behaviour. The is absolutely NO justification in 2016 for gender inequality.

In case it has escaped the notice of some members of the male gender, you are only on this planet because a FEMALE gave birth to you. Carried you and protected you in her body for nine months. Fed you from her breasts. How DARE you, those of you who are so inclined, demand that women be second class citizens? How dare you support Trump’s (and those like him) treatment of women? The women who support such nonsense: I have no words at all for you.

Having read as much as I have read over the past few days, I consider myself lucky. I have never been subjected to sexual abuse or assault. The closest I ever came was when I was propositioned by the CEO of the company I worked for many years ago. He assured me he and his wife had an open marriage. I told him I’d believe that when his wife told me, but the answer would still be thanks, but no thanks, I wasn’t interested. I did advise him I did not expect to be fired on Monday for refusing. I wasn’t. End of story. Not all female members of my extended family have been so lucky. While I have seen their pain and know it is real, while I have witnessed the health and psychological aftermath, I can’t feel it myself.

All I can do is say Trump is not a man. A real man doesn’t need to grab women’s parts uninvited. What, I wonder, is the underlying inadequacy of this individual that fuels his behaviour? What then leads him to try to incriminate all other men? His son got in on the act saying it was typical of alpha males. He thinks his father is an alpha male? Heaven forbid! Even his suits fit badly.

New York Magazine has a very informative and detailed article about this, but the take-home message is that before the 1960s there were barely any examples of humans being described as alpha males, the term was restricted to fields like primatology research. Species like chimps and gorillas do have social structures and hierarchies with a dominant individual at the top, typically a male who has achieved that positon via displays of strength and physical prowess. The fact that alpha males exist isn’t disputed, it’s whether humans can actually be such a thing.

Source: The Guardian

An alpha male in the primate world is the pack leader – and pack leaders don’t get that position easily, they have to prove their worth. As leaders and protectors.

Trump refuses to protect 50% of the population, believing that 50% are there for his personal gratification and pleasure.

There are many wonderful men in this world: men who treat women with respect and as equals. May those men flourish and prosper and raise their sons in their image and raise their daughters to have no qualms about placing a knee strategically and forcefully when required.

Don’t anyone come bleating to me about how Islam treats women while the western world even considers making Trump POTUS.

A final word to Dear Pastor Dave. Dave, in all of my life there has been only one man that I ever felt like submitting to and I still have no explanation for that. However, don’t confuse the often inexplicable dynamics of personal relationships on the one hand and how a healthy society should function on the other hand. Oh, and if Hillary wins? Well, I guess your Lord passed judgement.

Edited to Add: I have recalled another incident when I was 15. After my parents passed, I was in a foster home. I asked my foster father to cash a cheque for me. It was a Saturday, before ATMs. He suggested if I sat on the bed with him, he’d give me the money and I didn’t need to give him the cheque. I declined and moved out about a week later. The executor of my father’s will sent me to a psychologist as he didn’t believe me. I still consider myself fortunate – neither incidents involved physical contact of any sort.

If you have regular pathology tests, here is something you should know

A little back story may be appropriate. In February 2015 I looked at Medicare. It was noticeable that pathology services constituted a large percentage of the total services. I doubt the proportion has dropped since. I contribute to that proportion: I have auto-immune conditions. I spend considerable time and money ensuring they are kept under control. Well, as under control as possible. I’m under the care of three specialists and a general practitioner. Every now and then extra specialists get involved, such as a skin specialist or an ophthalmologist. One of these days I’m going to have a medical party for them all.

As we all know, blood tests are very useful to medical professionals. At one stage I was having regular blood tests under Rule 3X due to the risk of possible rather nasty side effects of a drug I was on. As a patient, I don’t know the finer details of Rule 3X, but I do know it allowed me to have regular tests based on the one pathology request. Necessary in many medical situations and very useful.

At one point in time, early in my “what is wrong” phase, I happened to have medical appointments scheduled in the same week with different specialists. The week before the appointments I went into the pathology collection point with two pathology requests. I later received an invoice for one of the tests. At the time, I paid little attention. I knew my gastroenterologist had ordered a non-rebateable test at some point so assumed it was that and just paid it. As you do, in most cases.

Some time later I again had coinciding appointments and again attended the collection point with two pathology requests. All my specialists monitor my thyroid function. I was told if I had the two pathology requests done on the same day, one would not be bulk-billed. Naturally, I asked why not. Surely, I suggested, only one test was needed and then the result could simply be shared. Same blood, same day, same test. Seemed logical to me. More than that, it seemed cost-effective.

The technician was only able to advise those were the directions from head office, but she believed Medicare wouldn’t pay a second rebate on the same day. Neither should Medicare pay two rebates for the same test on the same day, I thought to myself. By this stage I had been made redundant, so time was really not a major issue, however money was, so I went on two different days to have the blood tests.

When I saw one of my specialists, I mentioned the situation to him. He was in such a state of disbelief, he called a contact within the pathology company. The conversation went something like this:

Specialist: Explains what I have described above and asks if this is correct.

Pathology: “How do you know that?”

Specialist: “Because a patient is sitting in my office telling me!”

My explanation was confirmed by the contact. However, if the specialist hand-wrote a lengthy instruction on the pathology request to share the results of duplicated requests, then they (the pathology company) would do it. My specialist, dear caring man that he is, was sure this was because they were caring for the patients, to ensure the right doctors got the right results. Rubbish, I countered, the rebates are their revenue stream. It was a light-bulb moment for the doctor. That, I said, is why I am the accountant and you are the doctor!

For a few months my appointments didn’t coincide so I really didn’t worry about it. Then the week before last, I got hammered. Now I am working and studying and driving a lot. In what little time remains I sleep, exercise – or visit doctors. As it happened, I had all three appointments close together and the way my schedule went that week I had one opportunity to get the blood tests done. Three pathology requests. Thyroid function on all three, plus some other duplicates.

I was warned I would get billed for the thyroid function test TWICE and some others singly. Wouldn’t I prefer to come back tomorrow and the next day? That is, get the three requests done on three consecutive days so all the tests could be bulk-billed. No, I wouldn’t prefer that at all, I simply do not have the time, was my somewhat irritated response. Of course the aforementioned lengthy handwritten share request was not written on any of the forms this time. Not my doctors’ fault, they shouldn’t have to do that in the first place. So I’ll be paying.

I discussed the situation with my other two specialists. One was aware of the practice and our discussions I shall keep confidential. The other crossed some tests off the new form he gave me for my next visit. We are all going to co-ordinate and share a little better!

Without the operational and administrative cost details I can’t be sure, but I propose running the test once and sharing the results would be cheaper than running the test three times and generating an invoice (maybe two invoices) to me. The company may be “protecting” the revenue stream (Medicare rebates) without looking at the impact of actions on gross margin. Of course, it is a fair bet I am billed more than the Medicare rebate. When I receive the invoices I will compare.

I am told not all pathology companies operate this way, something I am going to put to the test in the coming months. After all, like many other patients, I have years ahead of me to investigate this issue! I would be interested to hear of others’ experiences.

Do you think changes should be made to the system? My specialists should not have to have a conference call to check each others’ test plans: imagine if they had to do that for many patients? I should not have to go on three separate days to have my blood tests. I specifically try to get my appointments all on the same day as this minimises disruption to other parts of my life and time off work. Consequently I am trying to have my blood tests in one hit. When it works out: if one condition flares or requires closer monitoring for a period of time, then my plans don’t work out and then the whole duplication of bloods isn’t a problem. At the moment, with everything running smoothly and in what I call “management mode” I can co-ordinate. Many other patients I am sure are in the exact same situation.

The taxpayer should not have to pay rebates for the exact same test to be performed three times on the same day. Nor should the patient.


What’s in it for ME? Society’s dilemma

what-e1426943260530Managing change is part of my day job. One of the catch phrases we use these days is “what’s in it for me”. In “selling” change in an organisation we need to show the employees, the board, the management and all other stakeholders “what’s in it for them”. If you don’t believe me, Google “change management what’s in it for me” and you will see plenty of results.

Rhiannon’s masterclass, ‘What’s in it for me?’ … and other change management challenges demonstrated how addressing the people side of change management can increase the probability of business success during periods of significant change. Source: CMC Partnership

What ever happened to what’s in it for you is you get paid and we all keep our jobs? Or what is in it for you is we will engage your firm as a preferred supplier? That might sound a bit harsh, but I’m not looking at industrial or commercial relations here, I’m looking at the me, me, me mentality of much of society. Western society at least. I always love the hashtag #FirstWorldProblems on Twitter. Provides quite a giggle a lot of the time. I often think “what’s in it for me” is distinctly a first world issue, if not a looming problem.

If we only ever do anything because of what is in it for ourselves, don’t we risk becoming a very selfish society? I have no doubt, from my own practical experience, that introducing change into the workplace is more successful if the people involved can see a personal benefit. I am no different when I am asked to change. My immediate question is “While this make my life easier or harder?” If I think the change will make my life harder, my natural inclination will be to resist the change, covertly or overtly, unless I can see a greater good for all in the change.

I’ve talked before about the differences between societies of collectivism and societies of individualism. Western societies are almost exclusively societies of individualism. I considered such individualism in a look at the feminists’ debate.

Geert Hofstede describes these cultural dimensions rather well.

The high side of this dimension, called individualism, can be defined as a preference for a loosely-knit social framework in which individuals are expected to take care of only themselves and their immediate families. Its opposite, collectivism, represents a preference for a tightly-knit framework in society in which individuals can expect their relatives or members of a particular in-group to look after them in exchange for unquestioning loyalty. A society’s position on this dimension is reflected in whether people’s self-image is defined in terms of “I” or “we.” Source: geert-hofstede.com

There is research that indicates a culture of individualism leads to high growth and more progress because societies of collectivism can be assessed as anti-innovation. I stress this is one perspective, one I perceive as rather negative. Other studies present a more caring, positive picture of collectivism.

Platteau (2000) for example illustrates collective culture in the context of African development. Specifically, he documents that productive individuals are seen with suspicion and are coaxed into sharing their surplus with the community. Collective punishments exist to penalize the rich. They take the form of social ostracism, loss of status, or even violence. Communities have for example frequently used accusations of witchcraft to punish greed and acquisitiveness as well as aspirations to move to other places. Behind these punishments is the fear that the community’s cohesiveness will be undermined and that an individual who proves more successful will leave the village or will not redistribute any surplus food or production. Source: Berkeley

However, individualism gave us the Global Financial Crisis.

If you’ve been blaming reckless men for the collapse of America’s leading investment houses and the plunging markets, you may be on to something. High levels of testosterone are correlated with riskier financial behavior, new research suggests. Source: Scientific American

In a society of collectivism, this individualistic behaviour would have been curbed by the cultural norms.

I am a very firm believer in the rights of the individual. I started writing because I was denied my individual rights. I married a man from a culture of collectivism. In many respects, I live both cultures. I think there are aspects of both that humans need for survival as a species.

Collectivism worked very well in hunter-gatherer days. Collectivism ensures the elderly are cared for. Individualism gives us…..more money? Individualism gives us innovation and progress that we may or may not need as a species, but it also gives us personal greed. It gives us “what’s in it for ME”.

Gary Stamper says:

Collectivism, as a system has many faults, but individualism, which isn’t even a system, but rather the lack of a system, also has many faults. Each, by themselves are partial. The new collectivism, championed by the political left, has emerged as a response to the unbridled individualism of the political right. Source: Collapsing into Consciousness

Gary quotes Gerhard Adam:

“True individualism is not common and in our society is typically marked as being a sociopath.  This is an individual for whom no social connections matter, and there is little ability to empathize with fellow humans.”

Perhaps Gary is correct, the long term solution lies in the concept of “individual collectivism”.

Individual collectivism understands that individuals need to be recognized and acknowledged within the larger social group. In our culture, it is a rare person who is able – or even wants – to act outside some sort of collective, whether its a policeman or fireman, an employee or a business owner, a sports or  corporate team, a local or national culture, a religion or spiritual calling, or a political leaning, or a politician. Even as individuals, we seek like-minded people to associate with, to support and be supported, to share common goals. It is our nature.

And while we claim to abhor “collectives,” we automatically join them, leaving the impression that it’s not really about collectives at all, but rather, the freedom to choose which collective we participate in rather than our objections about collectivism. This doesn’t deny our personal identities or rob us of the choices we make regarding our participation in a collective. Source: Collapsing into Consciousness

Both individualism and collectivism have faults. Both have served a purpose at different stages of human development. Do we need something new? It is at least worth considering.

Looking back to my opening employment related situation, “What’s in it for me” only has worth providing we also consider what’s in it for the organisation that keeps us employed. For without the organisation there is no “what” for me at all. If our social fabric collapses like the global markets did, we will have nothing.

There is nothing so constant in this world as change. Perhaps this is one we need.

This is an edited version of the article originally published on Robyn’s blog.


Scrap the Medicare Levy, increase GST

We have to think outside the square. I am not suggesting this concept is THE answer, by any means. I’m merely suggesting we need to look for alternative solutions and encourage ideas and discussion.

I recently suggested scrapping the Medicare Levy totally on the basis it leads politicians to focus on the wrong aspects of Medicare. “Medicare is not sustainable” they cry, yet primary care accounts for only 10.2% of the health budget. An admission to hospital costs, on average, $5,000 – even 20 GP visits a year times the rebate is a lot cheaper than $5,000. In 2012 the University of Melbourne completed a study which showed there were 7,000,000 bed days in hospital that could have been prevented (Source: Prof John Dwyer, Insight, at 27 min mark). What a saving that could be to the health budget (although there would be costs associated with the prevention).

I’m not suggesting the nation forgo the Medicare Levy revenue stream. I am suggesting we stop allowing it to divert attention from the real areas of potential cost savings. Aside from the 7,000,000 bed days, do you know that doctors have to get a new provider number when they relocate? Think of the administrative costs. What is the rationale? What is the benefit? Isn’t Dr J. Smith the same doctor irrespective of whether she or he is located in Euroa or Williamstown? Doesn’t this make reporting and auditing of a doctor’s performance or claiming patterns over his or her career more difficult and possibly expensive?

Subsequent to my admittedly rather off-the-cuff suggestion of scrapping the Medicare Levy, I was reminded that a number of our working population still have access to forms of salary sacrificing that have disappeared for many of us due to Fringe Benefits Tax (FBT). About twenty years ago we could salary sacrifice a car, private school fees, health insurance premiums and a number of other expenses. When FBT was introduced, the salary sacrificing of old virtually disappeared. Of course CEOs still receive shares and other “indirect” remuneration, but the average management level employee suddenly had to pay their own health insurance premiums. For a while I was lucky and worked for an international company that had a global policy of paying health insurance premiums, irrespective of FBT in Australia, but it is no longer the norm for the majority of workers.

FBT doesn’t apply to all employees the same way. Not-for-profits have certain concessions, enabling them to provide salary sacrificing the commercial world no longer offers. Government department employees and politicians, for example, can take advantage. In June 2013, 16.4% of the working population in Australia were employed in the public sector. Not all of them would have access to salary sacrificing, but possibly enough to make a dint in the Medicare Levy revenue stream.

We are know there are various ways of reducing taxable income and minimising income tax. Those who have higher earnings have more opportunities to do so than the average wage earner or salaried middle manager.

When income tax in minimised, so is the Medicare Levy. After all, it is assessed on taxable income. Get taxable income below the magic threshold and receive a higher rebate for private health insurance or avoid or reduce the Medicare Levy Surcharge.

Yet there is no reduction in rebate for those who may be shirking their fair contribution. Surely a better collection mechanism would be via the GST system, for the same reasons GST was implemented in the first place: those with a higher disposable income spend more and therefore pay more in GST.

There are, therefore two major problems with the Medicare Levy as it stands. First, it is distracting, as stated above. Secondly, it can be minimised by the very taxpayers who can most afford it. Increasing the Levy places the burden on those who can least afford it and does nothing to address the question of focus.

The challenge with the concept of moving the collection to the GST collection method is that we have a massive, expensive bureaucracy “managing” the collection and claiming back of GST by business. The businesses would not, I suspect, be overly thrilled with the idea of being expected to contribute to the universal health system when paying GST that is not claimable as a tax credit under the GST legislation. Edited to clarify – I am only referring to any GST that did not qualify as a tax credit under current policy. There is no suggestion the increase would be treated any differently. Yet why not? Is it not in the interests of business to have a healthy workforce? What is the impost on business of GST not able to be claimed as a tax credit? The costs of compliance could well be higher, although I’ve never set about analysing it. The end consumer is the one paying the bulk of the GST, as illustrated very nicely by the manufacture and sale of a table on the Australian Tax Office web site. An awful lot of toing and froing for $30, if you ask me. We have some very inefficient systems, we do. That is a debate for another day.

eHealth and the silo culture of medicine

In February SBS Insight broadcast Saving Health. If you missed it, it is worth watching given recent Medicare funding discussions.

As a patient seeing multiple health professionals and having registered, in great hope, for eHealth, I was very interested to hear the doctors thoughts about their own profession. I understood the patients’ perspectives all too well.

There was a general consensus from the medical personnel about the silo culture of medicine in this country. As Dr Ranjana Srivastava said (in relation to repeat testing), “when doctors work in silos, you kind of don’t want to get into other people’s way”: we see this in many walks of life, not just medicine. Dr Charlotte Hespe spoke about the difficulties of getting results across barriers of fragmented communication, Dr Nick Bretland spoke of having to fax (yes, fax) forms to a public hospital to get x-ray results. I had an MRI and the films were available on my smartphone 5 minutes after the scan. Yet the GP has to fax forms to get the results? Bureaucratic red tape forms many of those barriers.

Professor John Dwyer stated ” … we do not have a patient focused health care system.” Assoc. Prof. Terry Hannan of Launceston General Hospital said, “patient centred care is the patient having their own record.”

This is where eHealth comes in. Two people in the studio audience had signed up for eHealth. TWO! Once I discovered I was unwell, I signed up for eHealth. The driver for my doing so was a very embarrassing discussion with my gastroenterologist.

“Have you had a colonoscopy before?”

“Yes, I have, years ago.”

“Who did it?”

“Ummmm, I’ve forgotten.”

“Where did you have it done?”

“Ummmm, I’ve forgotten.”

eHealth would solve that problem, nicely, wouldn’t it?

Not so much. Watching the above Insight episode, I learnt I actually have to have my GP upload some sort of summary, and according to Dr Bretland he had initially had to fill out paper forms to send in to establish his patients’ eHealth records. That will explain the scanty nature of my own eHealth record – I’ve not discussed it with my GP at all.

Candice Kriewaldt, a patient with rheumatoid arthritis, spoke of having to navigate the system herself and collate her own medical record. She highlighted the difficulties of getting medical records from one specialist to pass on to a new specialist and the problems that lead to in her treatment. I do exactly the same as Candice. I have a pretty pink folder I carry around with pathology requests pending, results, imaging CDs and details of medications.

The programme makes it reasonably clear the medical profession in Australia is still very paper based, despite the availability of technology. It appears some 4% of Australian’s surveyed expressed concerns about privacy, so eHealth is not yet where it could be or should be. May I suggest we let the 4% opt-out if they so wish and let the rest of us have our eHealth fully functional!

Here is a screen shot from my eHealth record.

No data about my MRI

No data about my MRI

The eHealth website says:

Your eHealth record allows you and your doctors, hospitals and other healthcare providers to view and share your health information to provide you with the best possible care.

I had taken “share your health information” to mean all my recent scans and blood test results would be there. After all, I had scans available on my mobile phone five minutes after I had the scans! Surely they would be on the big fancy new eHealth web site? Well, actually, no, they are not there. I dug a little deeper into the FAQs (that means Frequently Asked Questions for the uninitiated) and found out why.

It is expected that you may start to see your pathology and diagnostic imaging reports in your eHealth record from mid-2015, once the Clinical Information Systems used by healthcare providers have been upgraded with the functionality to upload these reports to your eHealth record.

My pathology page looks equally empty.


I have had SO many pathology tests! Both my endocrinologist and my rheumatologist test my thyroid function. Sometimes I have managed to co-ordinate the testing so I get one test and it gets shared to the two specialists, but that is me, the patient, doing the co-ordinating, not the doctors. I also ask for the results of tests to be sent to all three specialists and my GP – when I remember. In my view, eHealth should solve these issues. Unnecessary testing is estimated to be worth about six or seven billion dollars a year. This would sure help fight the funding “shortfall” of Medicare!

As for any actual medical information, the claims via Medicare are there too, but not much information that would be useful to a consulting specialist. If I look at the record for my last specialist appointment it says:

Consultant Physician (other than in Psychiatry) Review of Referred patient treatment and management plan – Surgery or Hospital

and gives the provider’s name. There is information about me (name, gender, age, date of birth, ID number) and not much else. In fact, it has my name, age, gender, ID number and date of birth in the header of the record and in the detail of the record. We call that data redundancy. I’m looking at my records, surely I only need to be told all that once. Even if a new doctor was looking, I think a doctor is probably smart enough to read it once and “get it”. There may be a reason for this duplication: I’d love to hear what it is! At the very least it would tell a new doctor who to contact if he needed more details, so that is something although there are no contact details for the doctor. I don’t know how many doctors have the same name, but I assume there may be more than one called Mary Jones. I tried Yellow Pages to prove my point, but couldn’t sort or filter by name. The joys of technology.

Have you ever noticed that referrals are still paper based? Dr Hespe raised the point that none of the specialists she refers to can accept electronic communication. The medical profession can do some of the most amazing things with imaging our bodies and surgical techniques have improved dramatically – but the same specialists can’t accept electronic referrals?

I can understand sharing information without a central system is difficult. Doctors work in various locations: their office, the public system, the private system, they are in theatre or on ward rounds. It is not always easy to just pick up the phone and say, “Hey Fred, we have this mutual patient….”

I expected I would be able to log on to eHealth and nominate my doctors to have access so they could all see everything. I still hope we get there. This would help break down the fragmented communication and the silos.

My son had bi-lateral de-rotation osteotomies at the Royal Children’s Hospital. The hospital has gone electronic: we have an xray and when we go upstairs to see the Professor, the xrays are on his computer screen. Yet they sent a paper letter to us to give to our GP. There is no record on eHealth that my son had this major surgery and has metal plates in both legs. I was showing the GP photos of the xrays on my phone the other day.

We have recently had endless discussions about Medicare being unsustainable. How much could we save by modernising what appears to be very outdated systems, processes and procedures? What could we achieve by eliminating some of the unnecessary red tape the doctors referred to? These are the questions we need to be asking. We need politicians with vision.

On a technical note, there are a multitude of systems involved and most of of them don’t “talk” to each, other however this is not insurmountable. It is not necessary to have real time interfaces to eHealth from the various systems in use by the many, many health providers. Most doctors (even specialists) do have their patient records on computers these days. These could be exported in a predefined format, transmitted and uploaded nightly or weekly. It is possible to achieve more detail than is currently there without massively expensive upgrades to every providers’ systems. Scandinavia can do it. Why is Australia lagging behind?

Sadly it looks as if we may now have an uphill battle to save eHealth. Pulse+IT Magazine reports momentum for the system has stalled.

Ms Powell provided a breakdown of where funds from the $140 million provided in the 2014-15 budget were allocated. $82m went to DoH to operate the system, $21.8m went to the Department of Human Services, and $2.3m to the Office of the Australian Information Commissioner. The federal government’s contribution to NEHTA for the year was $34.4m.

This isn’t a cheap system, but it does need a usability overhaul. How can we get this back on track?

Keeping active if you have chronic conditions

Chronic conditions can strike at any age. For some conditions, such as the arthritis family, exercise is vital. Yet one can easily over do it and crash the next day. I was faced with strict instructions to manage my weight (while taking a steroid – huh!) and exercise. But stop if it hurts. Don’t over do it. Balancing exercise and rest becomes a new skill to be developed!

Yes, I’ve joined the VivoFit crowd. I mentioned this the other day in passing in an article I wrote about learning to live with a chronic health condition (its a bit of a learning curve). I don’t need some really expensive piece of equipment to keep track of my activity levels, but I did need something now that exercise is so important to keep my rheumatoid arthritis managed. In conjunction with the drugs, of course! My pedometers from the Global Corporate Challenge had finally died/been passed on. The clip broke on one from being attached to my bra, the other one I handed to the kids who had been pleading for months to be allowed to see how many steps they do in a day.

Costco had VivoFits at a reasonable price, so I grabbed one. AFTER I bought my VivoFit, I read a couple of reviews. One really should do this BEFORE purchasing, but I was in a daring mood. I done a little research beforehand and I knew this was about the cheapest I was going to get.

My VivoFit

It is all good – I like it! See the little + beside the word goal? That indicates I have exceeded my daily target!

Both reviews I read had some valid points, both good and not so good.

The first was by Brent Rose on Gizmodo, Garmin Vivofit Review: Some Good Ideas But Not Quite There. The second, much more positive review, was by DC Rainmaker, Garmin Vivofit In-Depth Review. Both of these reviews were written in March 2014, almost twelve months ago. No-one can accuse me of being an early adopter!

Rose didn’t like the lack of a light on the screen, or that it needs a separate heart rate monitor. Rose also had some difficulty with it recognising his run distance correctly and there is no elevation functionality. Rose felt a GPS watch would be better.

Rainmaker, on the other had, found the VivoFit eminently fit for purpose. He has way more photos than I include here, so if you want some artistic shots, click over to his review.

What neither Rose nor Rainmaker discussed was using it as a partner app for MyFitnessPal, a nifty food and exercise tracking app. I had tried tracking my food during the Global Corporate Challenge, but with a different app and it was just too time-consuming. I like MyFitnessPal and have counted every calorie this week. What makes it so easy is the barcode reader, the ability to copy meals to other days and when you do search manually, your recent foods are listed.

The big plus with the VivoFit device itself for me is you really never have to take it off. It is comfortable to wear and water resistant. The battery lasts 12 months without charging (just replace it). VivoFit also tracks your sleep – well, it tracks how restless your sleep was, no stages of sleep tracking.

For people like me who want to track activity levels to ensure they get a healthy amount of steps a day minimum (and we all know that is 10,000 steps, don’t we?) it is perfect. Not to say there aren’t other equally great devices out there, but for people in my situation we want something that meets our limited needs. I’m not about to start training for a marathon, I don’t need a $800 sports watch with all the fancy statistics gathering capability. I just want to know how many more steps I need, what the time is, and if I do want to attach a heart rate monitor it has the ability to synch with several different ones including one you can buy with the VivoFit if you desire. Personally, I’m not sure I’ll ever be back at heart rate monitor stage, but one can hope!

Garmin Connect for the VivoFit talks to MyFitnessPal on your computer and/or your phone. The VivoFit uses bluetooth to communicate with your phone and comes with a little USB receiver for your computer. I use the phone. One complaint I do have is the synch of the two apps is not as reliable as one might expect. It does catch up in the end.

Here are some of the MyFitnessPal screens from the phone. My calorie allowance is 1200 a day, but I earnt 100 extra from my step count. At the time I took this shot I was three calories in the red, but I’ll do enough steps before bed to wipe that out. Love to “earn” a small Freddo Frog every now and then!


I have noticed the vitamin and mineral values seem to be N/A for a lot of foods and consequently my readings for potassium and Vit. A seem to be down everyday when looking at the daily nutrient summary. The above screen is the first screen that displays when opening the app. It has made me VERY aware, one could say overly aware, of my daily sugar intake. So much so I have subsequently had a bit of a rant about avoiding sugar – or at least avoiding ingesting too much of the stuff.

You can click on the grey bar containing the daily summary numbers to view the food diary. I rarely click on the big “Add to Diary” button which goes to a much less interesting screen. I like the diary view.


Under each meal you click “Add Food” to add something to that meal. Scrolling down there are sections for each meal, snacks, water intake and right at the bottom of the display a summary of the information from the VivoFit device. Under the “More” link are options to copy the meal to other days. Very handy for meals like breakfast.

Once you click on “Add Food” you can search for a food, read the barcode or select from Recent Foods. You can also save meals and there is a multi-add function as well.


LOVE that magic barcode button!

If you do like the big “Add to Diary” button, the screen looks like this. Yes, you can add exercise in here too and that will feed over to the VivoFit app. Entering start times and duration means there is no double counting.


Meanwhile, over on the Garmin Connect app, we have detailed information from the VivoFit.


Then we have various other helpful screens including how the sleep looked.

These screens are fine on the phone, but if you sign into the actual website on the phone to change any of the settings, the website is a nightmare on a phone device. I can see, having looked at the website from the PC browser, the website pages have not been optimised for mobile devices. I have not looked at them on a tablet.

Looking at the home screen on the PC, the display looks remarkably like the tiles on the phone, just arranged differently.

Garmin Connnect on PC

It is the settings screens that have not been optimised for mobile devices and you can see how this layout would be a struggle on a phone. I didn’t bother taking a screen shot of the phone, as it made no sense to do so!

Heart Rate Settings

MyFitnessPal also has a website and while graphs are available on the phone app, the web reports are slightly better.

Net Calories

OK – I had a couple of bad days. It was a tough week!

Why the funny target numbers on the Garmin screens? I thought you’d ask that. On the VivoFit you can have the daily step target adjust automatically or you can set it manually. As I am getting back into it slowly I am allowing the VivoFit to adjust automatically. If you don’t hit the target, the next day is a little lower. If you do hit the target, the next day is a little higher. When I’m a bit stronger, I’ll set it manually – or I may not, given my particular circumstances.

There is one thing I really like. The VivoFit has several different displays including a screen of your step count for the day, but the home screen is how many steps you need to reach ZERO. Don’t ask me why, but I like counting DOWN so much better than watching it count UP to the target!

Great for desk jockeys is the red inactivity bar. Rose didn’t like it much, Rainmaker liked it. I like it. You do notice it. When you have been inactive for one hour, the red bar appears and each fifteen minutes after that another small segment appears. Get off your butt and move around for a few minutes and the red disappears.

The fact that the screen goes across your wrist does take a little getting used to, but it works. There is a button on the side to activate the synch and to tell the device you are going to sleep (although even that can be handled with default times). And it caters for naps.

The VivoFit is not going to suit a marathon runner. But for little old ladies like me trying to stay active, it works very well. I ventured back into the pool this weekend, and testing out the exercise synch from MyFitnessPal back to the VivoFit. It works well. Sadly I managed a whole twenty-four laps, not my 100 lap sessions of the GCC.

In summary, the improvements I’d like to see relate to the software. Both websites are a little slow, plus the Garmin Connect website is a bit cumbersome and certainly not optimised for mobile devices. The reliability of the synch between the two apps on the phone could be improved. The ingredients of available foods in MyFitnessPal could be more accurate, but I realise they are dependent on what information is provided to them by the manufacturer. However, the apps are free, so how much can we really complain? Not much, I suggest!

The Vivofit gives you more than just a really cheap pedometer from K-Mart while not expecting you to fork out hundreds of dollars for functionality you will never use. If you already have an ANT+ heart rate monitor, it will likely connect to your VivoFit.

The VivoFit 2 should hit the shops any day (hence the discounted original model at Costco, no doubt) and rumour has it, it will have fancy designer bands available that will also fit the original device.

There was no incentive received to to write this review. I just like the device and thought my experience maybe helpful to others in a similar situation to myself.

For reviews of many fitness trackers for 2015, visit Best Fitness Trackers 2015.

This is an edited version of an article was originally published on Robyn’s blog as Exercising and activity tracking with VivoFit.

We need politicians with vision

One of the things that bothers me about the current Australian government is lack of vision, lack of the ability to think outside the square or to challenge the status quo.

I’m going to illustrate with an example built around our health system (on which I have written voluminously lately), the horrific domestic violence record in this country, auto-immune conditions and food.

A little background to set the scene. As you may know I am learning the ropes of living with a chronic illness. Trust me, it isn’t as easy or simple as seeing a specialist who gives you a prescription and reviews you once a year. Partly as a result of my own personal experience, I got involved in the Medicare changes debate, while also following research about food and chronic illness. I watch as the Minister for Women remains silent on the continuing violence against women in this country and noticed the financial cost of family violence to the nation.

I see links between all of these, yet I don’t see our politicians acknowledging any connections at all, much less driving any investigations or research. They are much too busy restricting our freedoms, completely contradicting their pre-election stance on the question of individual freedoms.

As a starting point, let’s look at one of the findings from my Medicare analysis. Readers may remember this graph from an earlier article.


This graph compares the number of primary care medical services to the population by gender and by age bracket. What is this telling us? It is telling us women between the ages of twenty-five and seventy-four are the highest users of our primary care medical services. To read about this in the broader context of our health system costs, read Medicare is not the problem. For now, I am only interested in the disproportionate need for medical services of the adult female population and what factors may be driving this. If we could reduce this demand, we’d not only have healthy women, we’d save tax dollars. We can take into account prescriptions for the contraceptive pill as being gender specific, but that is not twelve visits a year. Not all women attend an obstetrician for pregnancy and child-birth, so we can allow a few visits from some women for obstetrics reasons as well. Neither of those gender specific medical needs explain the graph. Edit: After publication I was reminded by a doctor of the reluctance of men to seek medical help as pro-actively as they should, which contributes to the gender differences above. This is a factor that should be considered when considering introducing value signals financial barriers to early detection.

Family violence is estimated to cost Australia $16.2 billion. If domestic violence was eradicated from the community, the health costs for women would drop accordingly. Not all of the $16.2 billion are health costs, but they are costs that are considered to flow from domestic violence crimes. If we eradicate domestic violence, not only do we save lives and families, we have $16.2 billion to put towards unavoidable health costs. We also reduce the demand for health service resources, allowing deployment to alternative health areas.

Violence is more damaging to the health of Victorian women aged 15–44 years than any other well-known risk factors, including high blood pressure, obesity and smoking.

Source: VicHealth

At least one of my medical conditions is an auto-immune condition. There is considerable research being undertaken into the increase in incidence of auto-immune diseases. Many of the auto-immune diseases affect predominantly women: seven out of eight suffers of systemic lupus, for example, are women. Auto-immune diseases are one of the top ten causes of death of females aged up to sixty-four.

We have increasing incidence plus a predominance of women: the graph above starts to look more realistic now, doesn’t it? Many of the auto-immune conditions can take some time to diagnose, requiring more visits. As our testing technology improves, so we are able to diagnose some conditions more promptly than in years gone by, but that doesn’t apply to all conditions. For some conditions there are no simple or single positive or negative tests and diagnosis can take time. Even once diagnosed, establishing the correct treatment regime can take quite a while. I’ve been to both my GP and my rheumatologist so far this week, dosages and drugs will be tweaked in another three weeks. It isn’t a perfect science.

We need to be investing into research to find out why the incidence of auto-immune conditions is increasing. That will have long term benefits: improved health and reduced health care costs. There may be no solution to the gender bias, but if we understand the gender connection, we may be able to manage it.

One possible cause of the increase is the food we eat, which I looked at in some detail yesterday in The dose makes the poison. There is work currently being done looking at the relationship between gut bacteria and rheumatoid arthritis. That article also talks about a possible link between asthma and bacteria.

Some research indicates that the bacteria may reduce the risk of asthma, perhaps by curtailing the body’s immune response to airborne stimuli. Blaser suspects that asthma is one of the illnesses affected by our changing microbiome: Rates in the U.S. have been climbing for three decades, and grew by more than 28 percent between 2001 and 2011.

Restaurant Dessert Tray

Yet we happily continue to ingest food that has been processed and modified to excess. I was actually surprised at the low interest shown in yesterday’s article. Do we not want to face the fact we could be poisoning ourselves, or effectively altering our bodies’ natural functions? Is this too confronting in our fast-paced world where flying through the supermarket to grab a TV dinner is the only way we can find time to hit the gym?

The oft-cited reasoning around additives that are KNOWN to be toxic is something along the lines of “in small does it is OK”. Perhaps we could make that “ALONE in small doses”. The levels of toxicity we are exposed to in 2015 in just getting from home to work is nothing like it was in 1815. Way, way higher. A little bit of toxicity in your drink, a little more in your pre-packaged pudding and what is in your toothpaste and nail polish that is being absorbed by your body? What are the possible long term effects on the human body of  an accumulation of these approved small doses of toxicity in combination with each other and/or external toxins we are exposed to daily such as carbon monoxide? Or even just some human bodies if some of us are immune (or just tougher).

I’ve written before about the relationship between stress and AI conditions. Perhaps we are reducing our body’s ability to deal with stress effectively. The possibilities are endless.

80% of auto-immune condition sufferers can describe a major stressful event in their lives prior to the onset of the condition. While a causal link is yet to be established, it is definitely worth the research being undertaken. Maybe our food reduces our body’s ability to process stress (perhaps in conjunction with our social constraints) or these toxins directly change our immune systems in some way.

These are only the few correlations I have considered over the last month. There are many more. What I don’t see is a government with vision, a government looking to enable investigation of these correlations. I see a government who doesn’t appoint a Science Minister, a government that guts our CSIRO and is now attempting to make changes to our universal health system that are neither sensible nor substantiated.  A government who is looking in the wrong place for dollars and a Minister for Women who ignores the domestic violence epidemic.

Our politicians need to open their eyes. For all our sakes. We, the voting public, need to support our scientists and medical researchers to get the message across. Don’t leave it to the experts to battle on alone: it is YOUR body!

If you or someone you know is impacted by sexual assault or family violence, call 1800RESPECT on 1800 737 732 or visit http://www.1800RESPECT.org.au. In an emergency, call 000

This article was originally published on Robyn’s blog, Love versus Goliath.

Medicare is the wrong target

This article continues from Sussan Ley updates the nation on Medicare.

I spent several hours Friday night looking at the Medicare statistics. I came to a conclusion which may send a few readers reaching for their smelling salts. I ask that after you’ve taken a whiff, you stick with me. My conclusion may seem radical a first, but I believe there is method in my madness.


Australia has to make a decision on a very simple question. Do the majority of Australians want universal health care? I believe the answer is yes, on the basis over 80% of Australians support Medicare. As we can see above, this country’s largest single expense line is Health. 17.8% of the taxes you and I pay is spent on Health. If we group all the Welfare lines together, Welfare accounts for 36.8%, more than  double Health.

The Medicare ruckus has focussed on general practitioner services. Although broken into several sub-categories in the Medicare report, I have grouped them into Primary Care below. That category accounts for 33% of Medicare expenditure. This sounds like a lot – until we factor in total Health expenditure of $62 billion. Medicare is only 30.8% of total Health costs. Put another way, the government is making a massive fuss over 10.2% of our Health expenditure. The most concerning aspect is that front line primary care is vital. Ample evidence has been provided by the experts showing that early detection of health concerns allows for early intervention resulting in lower health costs overall. Yet this is the very area of medicine the government want to make less accessible for sections of the community.

Yes, I agree, if we look at Medicare alone primary care is the largest category. Even of I grouped the specialists, obstetrics and anaesthetics categories together, primary care would still be the area of highest financial outlay. It is understandable that the government look at the information and leap to the conclusion the area that has to be tackled is primary care. Pathology, while a high number of services, is financially efficient per service: the bean counters would be happy to leave it alone.

The trigger for the government’s focus is possibly the Medicare Levy itself. In round numbers, the Medicare Levy contributed $10 billion against a services outlay of $19 billion – just over half. We all know that if we earn $1,000 a week we can’t continually spend $1,900 a week or we will be in major financial strife. But we can’t peg back $62 billion by focussing on only 10.2% of the costs.

I suggest we scrap the Medicare Levy as a separate revenue stream altogether. It is misleading and encourages policy makers to focus in the wrong area. Medicare has been around for forty years, let’s just accept we have a universal health system and be done with it. I am not suggesting we forego the income stream from the Medicare Levy, simply absorb it into the income tax system. Alternatively, absorb it into an increase in the GST rate. There are options here and our policy makers should be considering a range of ideas. The GST increase option may be a better alternative as the Federal Government makes grants of GST proceeds to the states and makes health grants to the states. Those who have more disposable income would contribute equitably to our health system costs. An increase to the marginal tax rates may be harder to sell.

While such a strategy will remove the focus from that $9 billion “shortfall”, it won’t reduce the proportion of our taxes that go towards providing a universal health system. Several commentators and experts focus on health expenditure as a percentage of GDP. One such expert is Professor Jeff Richardson, Foundation Director, Centre for Health Economics at Monash University. Here is an extract of a recent article on The Conversation:

As a percentage of GDP, Australian government spending on health is the tenth lowest of the 33 countries in the OECD database and the lowest among wealthy countries.
The 8.3% of GDP spent by the US government, for instance, is higher than the 6.4% spent by the Commonwealth and state governments in Australia.
Nor is it true that total health expenditure – government plus private spending – are unsustainable. Australia spends about 9.5% of GDP on health services; the United States spends 17.7%. And while US spending may or may not be good value for money, it hasn’t undermined its economy or sapped the vitality of the country.
Source: The Conversation

It is interesting that Professor Richardson uses the term “value for money” given Sussan Ley has taken to using the term “value signals” rather than price signals. Value must be considered an easier word to sell to the electorate than price.

I spent considerable time massaging numbers to see if I could find a way to have bulk-billing of children and the retired continue, require a reasonable co-payment from those of us earning an income (we already do pay, as discussed in my previous article) and have Medicare break even without sending doctors to the poor house. I ignored the NDIS in that exercise. I looked at such options as increasing the rebate to 100% of the scheduled fee for concessional patients, and a $20 co-payment for the rest of us with our rebate remaining at 85%. With a workforce of 11,666,000 (as at January 2015) this just wasn’t going to work. There are other more sophisticated approaches that could be considered but all would make Medicare more complex to administer (and were too complex for me to model at the dining room table on a Friday night). Such options could be to have a scale of rebates and co-payments linked to annual income or to have marginal levy rates. These options all make the system more complex to administer and where is the value-add in that? I don’t see it. Complexity for no real health benefit would surely lead to a situation of diminishing returns.

Without boring everyone to tears with spreadsheets, it is suffice to say the easiest solution would be to increase the Medicare levy to 3%. Based on our work force and the average weekly wage, the revenue from the Medicare Levy should be closer to $13 million than $10 billion, but I’ll leave it to the ATO to work out where the other $3 billion is – the health insurance rebate, perhaps? Setting the levy to 3% means many of us would be paying a considerable amount per year. Check your ATO assessment notice and double the amount.

It has been suggested that the burden of our ageing population’s health costs, especially once we start living to 150 years old, will be one of the factors that will lead to Medicare becoming unsustainable. I compared the services age brackets with our population.


Blue for the males, pink for the females. Don’t go getting all feminist on me for that, it was convenient and I like pink. Sue me. As we can see, it really isn’t the aged members of our community that are highest users of services. Remember, we are looking at only 30.8% of our total Health expenditure here, not the $62 billion. Women between the ages of twenty-five and seventy-four are the highest users of Medicare services. I don’t believe we are all hypochondriacs. When I was researching my own medical conditions I discovered many medical conditions occur more frequently in women that men. Hyperthyroidism is one such condition and many of the eighty plus auto-immune conditions affect women more than men. Auto-immune conditions are also worryingly on the rise.

Interesting learnings, too. Studies have shown up to 80% of patients who develop auto-immune condition can describe a major stressful event in their lives prior to developing the condition. Smoking is also implicated in combination with genetic predisposition for rheumatoid arthritis and yes I smoked. Studies show about 25% of patients with an auto-immune condition develop more than one. The incidence of auto-immune conditionsin the population is increasing – the question is why? The health costs to the community are huge and auto-immune disease is one of the top 10 leading causes of death in female children and women in all age groups up to 64 years of age. Auto-immune conditions are more common in women than men. Why? Gender specific hormone factors?

Source: Love versus Goliath

If we want to reduce our Medicare costs and I suggest our Welfare costs, we need to be looking at why adult women are needing more health care and finding solutions. We also have to accept there may be no solutions. I cite auto-immune conditions because I’m personally impacted and therefore have done more research on the topic, but there may well be other drivers to women needing more medical care. Obviously having children is one driver, but we see in the second graph above obstetrics is not a major category of Medicare services. I am currently under the care of three specialists and my general practitioner. During 2014 I had a high number of Medicare services so I certainly fit the statistical profile. I had umpteen blood tests and the gambit of imaging (MRI, CTs, ultrasounds, nuclear scans). The comments on my previous article indicate I am not the only one under the care of more than one specialist.

The rate of bulk-billing still stuns me and comments from readers on both The Australian Independent Media Network publication and on my site produced very little evidence of patients being consistently bulk-billed. I thought perhaps pathology and imaging services were distorting the overall average, but close examination of the statistics revealed this was not the case. It remains an aspect to this whole debate that I have trouble accepting. I’ve even considered there is a flag in the computer systems not getting checked, but then our Medicare statements wouldn’t be accurate and my recollection is mine generally has been. So I have to accept the 77.2% bulk-billing rate on face value.

To summarise:

  • Primary care is only 10.2% of Australia’s total health bill.
  • To ensure early detection and intervention it is vital patients are not deterred from seeking treatment.
  • If Australia is concerned that 17.8% of government expenditure is allocated to health, look into the other 89.8% of health expenditure for cost savings. Simplifying administration could save billions, I have no doubt.
  • Research why women between the ages of twenty-five and seventy-four are the highest users of Medicare services.
  • Accept Australia is a nation that wants to retain a universal health system in line with the initial objectives: universal in coverage, equitable in distribution of costs, and administratively simple to manage.
  • As a percentage of GDP, we are performing better than the USA.



Population statistics sourced from the ABS.

Medicare statistics sourced from The Department of Health.

Allocation of government expenditure from my personal Tax Assessment Notice.

All graphs developed by the author.

This article was first published on Robyn’s blog Love versus Goliath

Sussan Ley updates the nation on Medicare

As any regular reader of my work is aware, I have been very vocal about the various changes to Medicare proposed by the LNP government. A list of past articles is provided at the end of this article should you have missed out. I also appeared on the ABC News supporting the RACGP in their “You’ve Been Targeted” campaign.

Earlier this week I wondered what was happening. Minister Ley had promised to consult with doctors before making any changes. I’d suggested Ley not forget about the most important demographic: the patients. I Googled and didn’t find much. I checked Ley’s Twitter feed and found the odd tweet about consulting with doctors.


Meeting with doctors and

more doctors.

Where are the meetings with PATIENTS? This one, maybe?

Possibly, but they look suspiciously like more medicos to me. I was becoming a little depressed. Yesterday Ley finally held a press conference. The full transcript is available: Update on nationwide Medicare policy consultation.

Craig Laundy: It’s great to have the Health Minister, the Honorable Sussan Ley and my good friend the Member for Lyne Dr David Gillespie here in Reid for an afternoon of consulting with local GPs so without further ado Sussan welcome.

Not one word about PATIENTS! More doctors! Yes, doctors are voters, just like you or I. Yes, doctors pay the Medicare levy just like you or I. Yes, doctors have a vital voice in any changes to Medicare. You and I have a far greater voice and we must not let Ley forget that.

I’ve just come from breakfast this morning on the Central Coast. There were 40 doctors and lots of different views in the room and the same for last night and I’m on my way to another part of the country to do something similar.

Still no mention of PATIENTS. *sigh*

…accept that unless you’re in a vulnerable category maybe those services don’t come absolutely for free and that where there is an ability to pay that you value the high quality service that you receive that you do indeed pay something. When I look at the number of bulk-billed consultations across the country 76 per cent of all episodes of care are bulk-billed to non-concessional patients.

No, Ley, any bulk-billed service to a non-concessional patient is certainly not for “absolutely free” as most non-concessional patients are working and paying the Medicare Levy! Or are the children of people paying the Medicare Levy. That’s not “free”, we pay an insurance premium. I’ve heard it said there are medical practices that bulk-bill 100% of their consultations. I’ve yet to actually attend one, but I have no doubt there are some. There are also practices that bulk-bill only those holding a Health Care Card.

The practice I go to has a policy of bulk-billing walk-ins (see first available doctor) between 7 am and 6 pm. Appointments are not bulk-billed, nor are consultations after 6 pm or on weekends or public holidays. I think there are many practices with similar policies. How often am I a walk-in? Not too often. I work full-time and also have medical conditions which I prefer to have overseen by a regular doctor. Consequently most of my consultations are either by appointment or outside of the bulk-bill hours, even if I am walking in with a child that needs a stitch in a toe – no appointment, but 8 pm at night. $90 payment, $49 rebate. My co-payment is already $41, thank you very much. The average patient contribution for out-of-hospital services for patients who pay is $51 (including specialists visits).

My GP visit

I wanted to see proof of this 76%. I thought the annual report might be a good place to start, but as Medicare has been absorbed into the Department of Human Services, there doesn’t seem to be much Medicare detail in that report. The Department of Human Services ended the 2013-14 year with an operating SURPLUS.

In 2013–14 the department administered an estimated $159.2 billion in payments or around 38 per cent of government outlays. Financial performance targets were met, for the most part, and the department reported an operating surplus of $132.6 million after adjustment for unfunded depreciation and the revaluation of assets. This compares with a deficit of $7.7 million in 2012–13.

Source: Department of Human Services Annual Report

That doesn’t tell me anything about bulk-billing though, interesting as the information may be. Further research found bulk-billing statistics. Click the image to go to the full table. According to the Medicare statistics, 77.2% of consultations were bulk-billed for the 2013-14 year, but there are vast differences across services. GP visits are bulk-billed 82.2% of the time, whereas specialists a mere 29.2%. No clear differentiation is given in the report between concessional and non-concessional patients, so are we to assume only 1.2% of consultations were for concessional patients?

Clearly doctors in Canberra don’t believe in bulk-billing politicians.

I am struggling to believe the rate is this high. If you want to delve into the full statistics yourself, the spreadsheet available is very useful.

Why is the rate of bulk-billing so high? Based on my own personal experience and that of friends, family and co-workers, my guess would have been less than 50%. The history of Medicare may have something to do with it. I found this interesting snippet. Read very carefully.

Levels of bulk billing for unreferred GP attendances have been declining in recent years after reaching a high of 79.7 per cent in1996-97. By the December quarter 2002 bulk billing for unreferred GP attendances had declined to 68.8 per cent, but by June 2004 this had improved to 70.2 percent.

Source: APH

The decline in bulk-billing had been viewed as a negative! Incentives of $7.50 to encourage doctors to bulk-bill were introduced in 2004.

From 1 May a $7.50 incentive paid to GPs for bulk-billed GP consultations with concession card holders and children under 16 in non-metropolitan areas (RRMAs 3-7) and Tasmania introduced. This incentive replaces the earlier $5 incentive in these areas.

As of 1 September eligibility for the $7.50 incentive payment to GPs extended to eligible urban areas and large regional centres.

Clearly bulk-billing was encouraged in more ways than one.

Between 1992 and 2003 the Scheduled Fee rose 26%. The CPI rose 31%. Doctors were taking a pay cut.

Interestingly, during the 2004 election campaign, the Coalition proposed to increase the rebate to 100% of the scheduled fee. Different captain at the same helm eleven (eleventy?) years later wants to cut the rebate.

Proposals for changes to Medicare were announced by the Coalition during the 2004 election campaign. These include from 1 January 2005 increasing the Medicare rebate for all GP services to 100 per cent of the Schedule fee…

Source: APH Library Archive

When did the big clinics emerge? Edelsten opened the first after Medicare came into being in 1984. We now have very professional corporate medical businesses, minus the chandeliers and gawdy trimmings.

Reading through the history, it is clear Medicare has been tweaked many times over the years. The practice of medicine has evolved. We no longer visit our local family doctor in the front room of his residence as in days gone by. The economies of scale from multi-disciplinary and multi-doctor practices would, I think, be necessary in circumstances where fee increases were running well behind CPI increases AND bulk-billing was being encouraged.

The HICAPS system has been a great innovation. The doctor gets paid at the time of service and the patient receives the rebate overnight in their bank account. As noted in the past, I’ve actually received the rebate credit before the payment debit hit my bank account. For patients this saves considerable time. In the last twelve months I’ve only visited one medical provider (and we know I’ve visited a few) that had not yet moved to HICAPS. Gone are the days of lining up in a Medicare office to claim medical bills.

The medical profession was initially resistant to Medicare. The medical profession today is a very different beast to the medical profession of forty years ago. Many practitioners are not as politically right wing as their predecessors. Free university education saw many from different backgrounds obtain degrees.

Forty years is a long time. You may be reading this on a smartphone. Medicare was launched three years before Telstra launched the first mass mobile network in Australia.The phone cost $5,200. Technology, medicine, society: all have changed.

How much revenue does the Medicare Levy raise? That seems to be the greatest secret, as despite considerable research, I can’t find the answer. The spreadsheet I referred to above analyses the costs of Medicare to the nth degree, sliced and diced to within an inch of the core and tells me the benefits paid were $19.1 billion. Not a revenue number in sight.  Nor, for that matter the infrastructure, staff and other costs (such as HICAPS).

Was Medicare ever intended to be completely self-funding?

The objectives of the original Medibank were summarised by R. B. Scotton (1977) as universal in coverage, equitable in distribution of costs, and administratively simple to manage.

That statement doesn’t really specify self-funding. As it turns out, the original funding bills weren’t passed and the funding came from general revenue. The levy came later.

“Equitable in distribution of costs” doesn’t mean the same thing as self-funding. In any case, what was appropriate forty years ago may not be appropriate today – and that could be either way.  How do we assess “equitable”? These are social questions, not medical questions, yet I see Ley focussing on the medical profession and not the people.

To be continued . . .

Previous Medicare related articles by the author:

This is a slightly edited version of the article originally published on Love versus Goliath

Selective compassion

We must ask ourselves, are we truly a compassionate nation?

I am against the death penalty. I always have been and I always will be. I cannot see how we can say murder is a crime, yet kill people as a punishment. As expedient a solution as the death penalty may be, we should not be killing people.

That said, I cannot reconcile in my mind the public outcry over the looming executions of Andrew Chan and Myuran Sukumaran and the lack of public outcry over the incarceration of innocent children.

Despite Jeff Kennett’s rather flippant comment six days ago, we cannot deflect the blame onto the parents of the children. If we do that and follow that logic through, we should blame the parents of Chan and Sukumaran for raising children to become drug mules and clearly that is neither appropriate nor realistic.

Yes, the parents of the children took the children on a dangerous and torturous journey, seeking a safe haven. The parents are not responsible for locking the children up behind bars. No more than the parents of Chan and Sukumaran are responsible for Indonesia having the death penalty.

I understand there is not overwhelming concern in the community for the two people in Indonesia, yet there does seem to be far more concern than for the many hundreds of children suffering in detention. The Forgotten Children report, released by the Australian Human Rights Commission this month, provides comprehensive and horrifying details of the damage to these poor innocents.

Read the comments on articles about either situation. There are people who don’t see anything wrong with the executions or with the incarceration of the children. Yet it seems to me far more people in Australia are expressing anger about the executions than are irate about The Forgotten Children. Is this because in the case of the executions someone else (Indonesians) is doing the “bad” thing, while we (Australians) are doing the bad thing with the children?

Why this selective compassion? A life is a life. Many Australians are equally concerned about both situations, but it seems to me too many are not.

Under international human rights law neither the executions nor the incarcerations should be happening.

The Universal Declaration of Human Rights, adopted by the United Nations General Assembly in December 1948, recognizes each person’s right to life. It categorically states that “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment” (Article 5). In Amnesty International’s view, the death penalty violates these rights.

The children haven’t committed ANY crime yet are being subjected to cruel, inhuman and degrading punishment.

We should be witnessing equal outrage for both situations, surely? I understand death is final, incarceration is not. Yet many of these children may be damaged for life. In one situation we are talking of two lives, in the other many hundreds of lives. Some of those children are highly likely to die in detention, probably more than two.

I do not understand the selective compassion. Do you?

Immigration Detention: try living with the life changing effects

CartoonAIMSo many experts have warned the government about the effects of detention on asylum seekers. The experts have been publicly denouncing detention for years, yet we detain more and more people. Most sadly, we detain children, a situation the Human Rights Commission has reported on, in graphic and disturbing detail, this week in The Forgotten Children.

Here we are in 2015, incarcerating innocent children in conditions worse than those in which we jail convicted criminals. Julie Bishop cries tears of pain over the looming deaths of two convicted drug smugglers, yet Tony Abbott’s response when asked if he felt any guilt over the treatment of children in detention was “None whatsoever”. While I do not agree with the death penalty and I feel for the drug smugglers and their families at this tragic time, the contradiction evident in the two responses is nothing short of astonishing.

I left my country because there was a war and I wanted freedom. I left my country. I came to have a better future, not to sit in a prison. If I remain in this prison, I will not have a good future. I came to become a good man in the future to help poor people … I am tired of life. I cannot wait much longer. What will happen to us? What are we guilty of? What have we done to be imprisoned?87 I’m just a kid, I haven’t done anything wrong. They are putting me in a jail. We can’t talk with Australian people.

(13 year old child, Blaydin Detention Centre, Darwin, 12 April 2014)

Source: The Forgotten Children

Abbott launched a scathing attack on Gillian Triggs, Human Rights Commission President and it was reported today the government has sought her removal prior to the release of the report.

The Abbott government sought the resignation of the president of the Australian Human Rights Commission Gillian Triggs two weeks before it launched an extraordinary attack on the commission over its report on children in immigration detention.

While The Forgotten Children report is about children, it is also about detention. The effects of detention don’t disappear the moment a detainee is released. The experts have warned of this for years and I know from personal experience this is true. There may be some particularly resilient individuals that are released unscathed, but I suggest the vast majority do not find recovery instant or easy. Sometimes the effects are not immediately apparent. Post Traumatic Stress Disorder (PTSD) often doesn’t appear until sometime later. A member of my family suffers PTSD as the result of a life experience totally unrelated to detention. The PTSD did not reach full expression until ten years after the event, although it could be argued with appropriate professional intervention her PTSD may have been detected earlier. There is considerable debate about delayed-onset PTSD and research continues: a good reference article is A Quarter of Cases of Posttraumatic Stress Disorder Is With Delayed Onset. The article discusses patients suffering “subthreshold” symptoms after the event but before full expression of the PTSD condition.

Of course PTSD is only one of the many mental health issues that can result from detention. Anxiety and depression are also common.

Not only are we risking the welfare of vulnerable children while in detention, we are risking their future welfare as well because there is a very high risk we are damaging the mental health of their parents (those children who are not unaccompanied minors). This means the parents will be less able to engage with their children as parents at a time when the child most needs their parents to support their recovery.

In 2012 Dr Belinda Liddell, as a Postdoctoral Research Fellow in the School of Psychology at UNSW, wrote of the impact of immigration policies on the mental health of asylum seekers. Since then our treatment of asylum seekers has worsened, not improved.

In Nauru, where more than 380 asylum seekers are currently being detained, there have been reports of hunger strikes, self-harm, aggression and suicide attempts.

Unfortunately this isn’t new – these signs of psychological distress have been repeatedly witnessed in Australia’s immigration detention centres since the early 1990s.

For several decades now, mental health professionals have documented the psychological health of asylum seekers within mandatory detention facilities. Findings from multiple studies provide clear evidence of deteriorating mental health as a result of indefinite detention, with profound long-term consequences even after community resettlement.

I note “profound long-term consequences“. So should our government. This report isn’t just about children. It is about whole families. This report isn’t just about the conditions in detention. It is about the future of the children, the future of the families. The long-term effects will be different for each person. Many may end up unable to be gainfully employed or to study to build a life after detention. Society will, as society often does in many situations such as rape and domestic violence, blame the victim rather than accept responsibility for allowing the detention in the first place.

Abbott and his ministry should be considering the lives of these people, not some “Stop the boats” slogan that is well past its use-by date. The government need to deliver the “good government” promised on Monday and act responsibly. Persecuting innocent people is not responsible. More importantly, it is not humane and is in contravention of Australia’s responsibilities under international law. It has life-long effects on the imprisoned, long after release.

Robyn Oyeniyi lives with the effects from detention on a daily basis. Robyn writes on Love versus Goliath.

Image by Jen Bethune.

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