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Tag Archives: Health

Accidental Overeating is SO Easy

Today I learnt a valuable lesson about overeating. It is definitely a lesson I should NOT have had to learn (as in, I should already know better), but I’m very glad I did.

Edited to add clarification. I dislike counting calories, but I dislike pain a whole lot more. Given my ability to burn calories has been impacted by medical conditions, I, like many other people facing similar challenges, have to police my input given my reduced output. This is not an option unless I want to live on painkillers.

I had been at St. Vincent’s Hospital this morning for part of a pain management assessment. On the way home I stopped at the gym to do some indoor rowing and hit the treadmill, given walking outdoors in Melbourne’s current weather is a little on the risky side.

After burning off calories, I decided I’d buy myself lunch. I walked past Nando’s but decided to try something new. Two doors down was Spudbar with the tag line “a healthy addiction“.

Spudbar provides heaps of vitamins and minerals in our spuds and also through our range of fresh toppings. Top stuff for those wanting to be healthy and look great.

Source: spudbar.com.au

I was a very good girl and checked out the calories per serve (or so I thought). You see, Nando’s actually do provide nutrition per serve. My mind was working along that line so I didn’t correctly interpret the information I was reading – after all, all I wanted was some lunch! It was while entering the nutritional data into My Fitness Pal that the light dawned.

The nutritional information provided was PER 100 GRAMS, not per serve. The serve size was 663 grams. WHOA! All of a sudden my 365 calories per serve had morphed into a whopping 2,420 calories – more than DOUBLE my target total net daily calorie intake (see note 1). That’s 10,125 Kilojoules for those who prefer the Kj scale! Well over the average adult recommendation of 8,700 Kilojoules (depending on individual gender, age, weight, activity levels etc).

The only sensible thing to do was to stop eating! Which I did. Walked to the counter and asked them to put the remainder into a takeaway container for later.

Had I been paying attention to the size of the serving (or to the column headings), I would have done a quick calculation at a minimum of four calories per gram (see note 2) and realised it must have been more than 365 calories (600 * 4 = 2,400) per serve. But when you are busy and have other things on your mind there is a chance your mind doesn’t really absorb everything being presented to it. Also, humans tend to function on the basis of experience. My experience had been receiving nutrition information per serve in such a situation.

When I got home I weighed the container. 426 grams, meaning I ate over 200 grams, ingesting at least 730 calories. For lunch!

My intention is not to question the healthiness or otherwise of the Spudbar offerings. I will say Spudbar food is DELICIOUS so if you can cope with the calories, enjoy their menu! My intention is to highlight how easy overeating is in our western society. We then wonder why our scales don’t like us the next morning. Had I not been entering my meal information into My Fitness Pal I would not have realised I was overeating and would have merrily chewed my way through 2,420 calories thinking it was a mere 365 calories. I was planning on having enough spare calories banked to allow myself some ice cream today. THAT won’t be happening! If I were a male AFL footballer in my twenties 2,420 calories for lunch may not be a problem. As a 61 year-old woman with some physical restrictions for whom maintaining a healthy weight is essentially mandatory for joint protection and pain management: 2,420 calories for lunch is nothing short of a disaster!

Yes, indeed, caveat emptor. It is not the food vendor’s responsibility to ensure I manage my calories in and out. That is my responsibility. My lesson today was to BE MORE CAREFUL.

I feel very foolish, naturally, but I hope by sharing my stupidity I may alert others to the accidental overeating trap. Or is it just my failing?

Note 1: Personally I aim for 1,200 net calories a day, which means if I burn more, I can eat more. Yesterday I earnt 336 extra from swimming, so ate 1,510 calories. 1,200 + 336 = 1,536.

Note 2:  4 calories per gram for protein and carbohydrates, 9 calories per gram for fat, 7 calories per gram for alcohol.

 

Will we hate ourselves into oblivion?

Look around you, my friends. Hate. Everywhere. At first I thought to myself “this is worse than it has ever been”. Then I remembered the Holocaust, two World Wars, the Crusades, the Inquisition. Maybe this is just the next wave. It seems worse because the global population is the most it has ever been, so there is more hate noise spewing forth. But is it worse per capita? Probably not. Too many people shouting out hate for “the other side” rather than listening, comprehending, learning: the very things humans pride themselves on being able to do that allegedly separate us from the rest of the animal kingdom.

This time IS different though. This time our home is at stake.

“Rich western countries are now siphoning up the planet’s resources and destroying its ecosystems at an unprecedented rate,” said biologist Paul Ehrlich, of Stanford University in California. “We want to build highways across the Serengeti to get more rare earth minerals for our cellphones. We grab all the fish from the sea, wreck the coral reefs and put carbon dioxide into the atmosphere. We have triggered a major extinction event. The question is: how do we stop it?”

Despite the scientific community becoming more vocal than ever before, many countries, prominent, influential countries, have leaders who deny there is any environmental problem at all. Trump declares concerns a hoax perpetrated by China, Turnbull changes his mind once Prime Minister and, believe it or not, there are worse waiting in the wings. I don’t understand David Archibald at all, nor am I going to try.

I do understand people having different views, perspectives, beliefs, religions. What I struggle with is the vitriol of discourse, the hatred expressed. Nothing will be solved if the best the human race can do is hate the other side.

We have the unthinkable happening in the USA: press freedom under threat. Sure, some members of the media have not maintained the required degree of professionalism in recent years. The internet has made it difficult to determine the real from the unreal, a large proportion of the populace has become addicted to “reality TV shows” (that bear no resemblance to reality at all).

There is no escaping, however, the seriousness and historical learnings from silencing the press.

It isn’t just the press. As the people rise up in protest in the USA, those in power move to shut them down – in eighteen states. THE democracy that held itself up as THE political system all countries should follow, whether they wanted to or not, is trying to silence the people.

Hillary Clinton called the Trump supporters “deplorables”. Not a sensible move. Trump spoke of “draining the swamp” (but refilled it with worse).

There is no doubt Trump lies. The evidence is overwhelming and easily found. In Australia we have our current Brandis issue: not the first and not the last.

The efforts to disenfranchise the general populace is astounding. Trump’s administration is busy winding back school lunches, health care and protections for the LGBT community. The Turnbull government just readjusted penalty rates, probably on the basis parents’ should be buying houses for their children rather than the children working Sundays to put fuel in the car to attend their classes to try to get that good job to be able to afford their own house before they are forty.

But, you ask, where is the hate in all of that? Indifference might indeed be a better description of some of the actions taken, but that indifference leads to the have-nots hating the haves. The haves don’t listen, don’t learn, don’t comprehend and react with hatred.

During WWII we had the capacity to destroy ourselves. Surprisingly, we managed not to. Today we have even greater capacity to hate ourselves into oblivion. Whether than be by destroying our planet due to environmental mismanagement fueled by greed or firing nuclear and chemical weapons around the globe, we have more than enough capacity to annihilate ourselves.

The biggest threats are the “wannabe haves”. The ones that aren’t the billionaires but see politics as an avenue to power and prestige. Pauline Hanson – from fish and chip shop owner to a very nice high profile, well paying, powerful role. Both Hanson and Trump generate hate by attacking anyone who is not like them. Their followers take up arms, literally, in the belief they are faithfully following their leaders. What I do not understand is the inability of the followers to assess these dangerous leaders with critical thought processes. The blind adoration and acceptance is astounding. What have we become? Can we no longer think for ourselves? People like Trump and Hanson seize upon the lack of critical thought in the the population as an opportunity for them to rise to power, yet crush the very voters that put them there. Before we know it, we WILL be repeating history.

Even if we successfully manage not to blow ourselves up, we are at risk of stressing ourselves out of existence. Google “stress” with “health” and there are number of reputable articles.

Not having a lunch at school is stressful. Not being able to afford health care is stressful. Missing classes because the student is unable to afford to get to class or buy textbooks is stressful. Renting is stressful (refer Sally’s Tweets above). Being unemployed is stressful. Not having food to feed your children is stressful. Stress is cumulative and a massive health risk.

The human race must find a way to stop hating “the others” and work together for the benefit of all. Until that happens, every single one of us is at risk.

Related:

Is there a prescription drug shortage we don’t know about?

I’m on drugs. The legal kind. Earlier this year one of my specialists suggested to me I fill my prescription whether I needed a refill or not as there was a nationwide shortage of the drug. In Australia? Yes. So I dutifully filled my prescription. Doing so required a number of visits to local pharmacies, but one had a small supply left. The next time I needed a repeat, I was given a substitute drug. I didn’t think too much of all this at the time, but my experience then shows this is not now a new problem.

Last week I needed two drug prescriptions refilled. Pharmacy 1 – no supply of either. Pharmacy 2 – no supply of either but could order Drug A in for collection the next day from another pharmacy. Pharmacy 3 – no supply of either. Pharmacy 4 – had Drug A (so I kept that in mind in case Pharmacy 2’s order failed) and was able to substitute Drug B for me with another brand, something Pharmacy 3 had specifically told me they could not do without another prescription.

So I eventually got both drugs but it took two days, four pharmacies and a substitute drug. Not to mention the time and the travel costs involved. Yes, I could have called around, but I was already out of the house, so just kept going. Had no local pharmacy been able to supply, I’d have gone home and hit the phone.

Tell me again, I do live in a rich western country, don’t I?

When I returned to Pharmacy 2 the following day to collect Drug A, I asked why were these shortages occurring. The pharmacist told me it is because the government has lowered the prices they will pay the pharmaceutical companies to the point there is no profit in selling the drugs to Australia. Consequently they send their production to countries where sales are more profitable. If demand is higher elsewhere, Australia misses out.There is no profit in drugs for the pharmacy either, I was told. That explains why pharmacies are selling so much other “stuff” these days.

The pharmacist pointed to several heavily laden shelves. “Diabetes drugs”, I was told. Ordered in bulk to protect the health of their regular diabetes patients, because the pharmacy expects a drug shortage.

I don’t understand how the system works. Maybe I should, but I don’t – and I suggest the majority of the population don’t know the finer details. We get a prescription, we go get it filled, we take the drugs. We cringe if it is something not on the PBS. That’s about all of the process most of us delve into. I did read the following on the PBS website, titled “Setting an approved ex-manufacturer price for new or extended listings“. At that point I decided I wasn’t the woman for the job.

Price negotiations with the responsible person for new or changed listings are undertaken by the Pricing Section on behalf of the Minister, following a positive PBAC recommendation.  A Cost Information (PB11b) form is required to be submitted by the responsible person as part of the initial application to the PBAC.

 

After a price has been negotiated, the responsible person is requested to submit a Request for Approved Ex-manufacturer Price (PB11a) form in order to formalise the price offer.  The responsible person is then notified by email when the Minister has formally agreed to the negotiated price.

Who pays for the drugs? The government or the pharmacies? Do the pharmacies act as distribution centres? I thought the PBS provided subsidies: perhaps I am wrong. I’m not sure I want to understand. What I do know is that as a patient prescribed medication by my medical specialists, I expect to be able to get that medication without the risk of politically induced shortages – or pharmaceutical company avarice. I don’t begrudge the companies achieving a profit, businesses running at a loss don’t stay in business for very long. Greed is not good, despite Gordon Gekko‘s beliefs – or the current competition on Melbourne’s Gold 103.4 radio station.

The first time I experienced a shortage with Drug A, I asked the specialist was there an alternative. He said yes, there was, but the side effects were pretty undesirable (my words, not his) and he’d prefer to avoid prescribing it.

I think of all the chronic condition patients in this country and wonder what the future holds.

In 2007-08, around 15% of people in the 0-24 age group reported having either asthma, type 2 diabetes, coronary heart disease, cerebrovascular disease, arthritis, osteoporosis, chronic obstructive pulmonary disease, depression or high blood pressure.

We read about the horrific medical costs in the USA and watch the Australian government undermine universal health.

I only questioned one pharmacist but what I heard was enough to cause concern and I have no reason to doubt the sincerity of the speaker. Is there a mainstream investigative journalist who will take up the challenge to find out the truth? Do readers have similar experiences to share?

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.

 

Rebranding Wage Slavery: An Intentional Imbalance

The title of the article, belonging to the Herald Sun, is “Time to Embrace Life’s Imbalance”.

It sits squirrelled away in the bottom corner of page 26 of today’s business section, a measly couple of hundred words. Easy to overlook.

In it, we are compelled by “business consultant” Judy Reynolds to forfeit a good work-life balance and instead adopt an attitude of “intentional imbalance”.

There’s two words we don’t often hear thrown together. I wonder where else we’d like to implement an “intentional imbalance” in our lives?

The article mentions a study by the Australia Institute, which found that the balance between work and life had worsened for nearly five million workers in the past five years. Five million, in five years. That’s nearly the entire population of Victoria. Imagine, as you’re walking around today, that every person you encounter is part of that group, and then marvel at the size of even the small percentage of that five million you’ve witnessed in a single day. In human terms, we’re not talking about a minority.

Although the piece has been penned in the language of choice, there is nonetheless the sneaking recognition that for those five million people whose work-life balance has worsened, the likely scenario was not one of a comfortable selection between option A or option B, with pros and cons to consider on each side, but rather grim acceptance or financial ruin.

Does the author of the article believe that people will voluntarily choose to increase their own suffering and enjoy it simply by changing the way they talk about it? Who among us stands to benefit from longer work hours and increased job insecurity. the two phenomena listed as “main culprits” for the causation of poor work-life balance?

It seems that the blurring of the lines between our work life and our private existence is a source of some discomfort to many employees. Many companies and workplaces now encourage some form of technological linkage with their hierarchy, whether it’s by smartphone, email or through an intranet/employee website. While many upwardly mobile workers use technology after hours to further their careers, this use of communications technologies after hours has also been correlated with an increased reporting of work-life conflict, and it’s really any wonder. Leaving behind the stresses of the workplace when the clock ticks over to finishing hour is I’m sure a feature of the terrain in the vast majority of employee’s minds.

We like to have clear cut boundaries between when we must be “on” in terms of our responsibilities, persona and outward behaviour, and when we can simply relax and be ourselves. The encroachment of business into our private lives in this way seems likely to cause more than a little existential discomfort in a situation that should ideally be free from unwanted external observation or interaction.

In fact, several studies conducted into the effects of work-life balance on the psychological and physical wellbeing of employees point fairly strongly towards a good work-life balance being a stepping stone to enjoying better health.

A study published in the Journal of Social Service Research indicates that “results show that employees who viewed their work schedules as flexible reported higher levels of work-life balance, which in turn were associated with positive paths to well-being.”

Investigations carried out by the Government of South Australia point to the same conclusion. “Work life balance initiatives increase loyalty and dedication, and decrease employee absenteeism, improving client service and enhancing business reputation overall.”

This 2002 study even suggests a benefit for employers:

“Many employees reported clearly benefiting from the flexible policies/practices offered by their organization. HR managers also generally believed that such policies/practices yielded tangible business benefits, including improved employee morale, greater employee commitment and performance, and reduced casual absence and turnover.”

In real economic terms then, supporting employees in their movements towards more balanced schedules gives us happy, committed and productive workers. This seems like a sound investment, a win-win situation that extends beyond the employer/employee dyad and out to the clients and families of the two.

So the question floating to the surface of this muddied pond seems to be, “who stands to benefit from the adoption of an ‘intentional imbalance’ in our work-life arrangements?”, and we don’t have to look far to answer that.

It seems Judy Reynolds is more than comfortable employing doublespeak to gussy up worker suffering.

Rather than addressing the problem itself, namely that five million workers (and more) are dissatisfied with the security of their jobs and the amount of time worked, Reynolds simply entices us to call our suffering by any other name.

The phrase “intentional imbalance” is a re-branding of wage slavery. What it means in real terms, stripped of the doublespeak, is that we are being beckoned by the business community to smilingly accept infringements on our rights at work. We are being told that things are not going to get better, and that rather than calling a turd a turd, we should simply spice it and serve it as gourmet.

Adam Smith’s condemnation of the “vile maxim of the masters of mankind” is as cogent now as it was when it was written. We cannot acquiesce to those who would run the world along the lines of “all for ourselves, and nothing for anyone else”, and this undermining of workers serves to perform exactly that function.

Who benefits from job insecurity? Business, of course, who can simply replace unruly workers with cheap overseas labour should they have the cheek to stand up and exercise their legal rights. They need not even follow through, as the threat of replacement is often more than enough to quash any organised resistance to damaging workplace policies. It may be too obvious to warrant mention, but longer work hours means exhausted workers, and the likelihood of a tired man causing a fuss is significantly lower than that from a well rested individual.

The observant reader will have noticed by now that these negative effects on the lives of workers are anything but good for the economy, so in practice, those businesses without access to government subsidies or the ability to whipsaw labour forces over international boundaries will likely suffer as much as their workers from this justification of abuse.

Ms Reynolds concludes her stunning insights into the topic with the suggestion that we “work out a plan that includes [our] goals for work, family, friends, health and recreation.”

I say we add to that list the direct and active opposition of Ms Reynolds’ absurd attack on the backbone of this country, and that we work to “intentionally imbalance” any attempts to implement it in our own lives and the lives of our friends, family and co-workers.


This article was originally published on the author’s blog, which you can find here.

Choosing to Lie About Indigenous Australia: Why Tony Abbott Should Do More Than Just Apologize

Tony Abbott has, yet again, demonstrated his appalling lack of knowledge on even the most basic aspects of our society with comments made last week that claimed the problems Aboriginal people face are a result of “poor lifestyle choices”.

The irony of a rich, Catholic white male lecturing a people who have routinely been consciously disadvantaged by government after government after government in this country is palpable.

Anglo-saxon relationships with the indigenous people of Australia have been consistently poor, to understate the matter, since our cultures first crossed paths. The response of our “noble forefathers” to the presence of what they considered to be savages was to engage in mass killing, in genocide, to allow easier access to the land and it’s resources.

There are no Tasmanian aborigines left with 100% aboriginal genes.

Just think about that for a moment.

Imagine what it must be like to know that from an indigenous perspective, to understand that the white man has since the beginning been a force of slaughter, of death, of discord to your people.

Imagine then what it must feel like to hear one of these white men telling the nation he leads that it is the fault of the Aboriginal people that their living conditions rank among the worst in the developed world, that white police officers murder them in custody, that mining magnates such as Lang Hancock, Gina Rinehart’s father, have proposed they be sterilised.

In short, Tony Abbott is blaming the victims, and he’s not apologising for it.

“I’m not going to concede that. I accept people have a right to be critical of me, but I’m certainly not going to concede that.”

This statement made by the prime minister in response to journalists remarking that his framing of indigenous living conditions as a choice may have been a poor choice of words, demonstrates that this monkey in a suit has even less understanding of the situation than he does empathy towards it.

Was it a “lifestyle choice” that resulted in children of Aboriginal and Torres Strait Islanders being forcibly removed from their families for over a century?

Does the prime minister believe that these human beings are choosing to live seventeen years less than non-Aboriginal Australians?

This behaviour, from the man who is supposed to represent Australia on the world stage, is despicable. It alone is reason enough to oust Gina Rinehart’s praetorian guardsman and ensure he never holds a position of power in this country again.

For those wanting to learn more about Aboriginal Australia and the horrifying disparity between indigenous people and the rest of the populace, head on over to youtube and watch John Pilger’s excellent film, Utopia.

You can find it here.


This article was originally published on the author’s blog, which you can find here.

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.

Taxes

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.

PopulationServices

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.

Related:


Notes:

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

The forgotten poor – until we need a few bucks

imageTony Abbott has vowed to lift the poor of India and China from their poverty by selling them coal.  But what about poor people in Australia?

Various ministers tell us that education, health and welfare are no longer affordable.  Others tell us that we have been too greedy and that the “wage explosion” and “toxic taxes” are the root of our problems.  Joe Hockey assures that “a rising tide will lift all boats” while the girlinator tells us we must “live within our means” to fix “Labor’s debt and deficit disaster”.

All of this is crap of course as can easily be shown by reference to the facts.

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%.

As discussed on The Conversation, the real reason for co-payments appears to be ideological – a dislike of communal sharing even when it is to alleviate the financial burden of those already disadvantaged by illness.

Australia spends 19.5% of our GDP on social welfare, whereas some European countries like France and Belgium spend upwards of 30% of their GDP on the welfare system.

Australia ranks 25th of 30 countries in the Organisation for Economic Co-operation and Development with data available in terms of expenditure for unemployment.

The largest slice of our welfare payments goes towards the age pension. According to OECD Pensions at a Glance 2013, Australia’s public spending on the age pension is much lower than pension spending in Europe.

Australia spends 3.5% of GDP on the age pension, while Italy spends 15%, France spends 14% and the United Kingdom spends 6%.

A recent OECD report stated that Australia spends slightly less on education as a percentage of GDP (5.8 per cent) than the OECD average of 6.1 per cent. Although it also found that Australia’s total spend has increased relative to GDP over recent years, up from 5.2 per cent in 2000.

And as for a wage explosion, official figures show wage growth remaining at a historic low in the September quarter.  The Bureau of Statistics data shows the annual pace of wage growth remained at 2.6 per cent for the second straight quarter, as expected.

The index peaked over 4 per cent shortly before the financial crisis and has been on a downhill trajectory ever since, now running at its lowest level since the records started in 1997.

Abbott and Hockey also emphasise the need to increase productivity.  What they fail to mention is that, between 2003-04 and 2012-13, capital productivity shrank 23 per cent while labour productivity increased 14 per cent.  It would appear that the workers are doing the lifting while the owners of capital are very much leaning on them.

Meanwhile, the Australian Council of Social Service released a new report revealing that poverty is growing in Australia with an estimated 2.5 million people or 13.9% of all people living below the internationally accepted poverty line with 603,000 or 17.7% of all children living in poverty in Australia.  Over a third (36.8%) of children in sole parent families are living in poverty.

“Most of the poverty we found is concentrated among the groups of people facing the most disadvantage and barriers to fully participating in our community. Those most likely to be in poverty are people who are unemployed (61.2%) and those in a household that relies on social security as its main source of income (40.1%), particularly on the Newstart Allowance (55.1%) or Youth Allowance (50.6%).

This finding brings into focus the sheer inadequacy of these allowance payments which fall well below the poverty line. The poverty line for a single adult is $400 per week yet the maximum rate of payment for a single person on Newstart – when Rent Assistance and other supplementary payments is added – is only $303 per week. This is $97 per week below the 50% of median income poverty line.”

Since 1996, payments for the single unemployed have fallen from 23.5% of the average wage for males to 19.5%. Furthermore, the level of Newstart for a single person has fallen from around 54% to 45% of the after-tax minimum wage. Newstart has fallen from 46% of median family income in 1996 to 36% in 2009-10 – or, from a little way below a standard relative income poverty line, to a long way below.

Before the last election, the Greens had the Parliamentary Budget Office cost an increase of $50 a week to the Newstart payment.  It would cost about $1.8 billion a year.  Not only would this help lift about 1 million people from poverty, it would provide stimulus to the economy as every cent would be recycled, spent on survival.  It would lead to better health and education outcomes and facilitate more people finding employment.  It’s much easier to look for a job if you have an address and enough to eat and a little left over to buy an outfit and get public transport there should you get an interview.

Give low income earners more money, demand increases, creating more jobs and more profit – an upward spiral instead of the depths to which Hockey would like to send us (aside from a few polaris missiles like Gina and Twiggy).

$1.8 billion is how much we gave up by repealing the changes to the FBT requiring people to justify the business usage of their cars by keeping a logbook for three months once every five years.  Abbott and Hockey would much rather protect tax avoiders than help the poor.  Instead, they want the poor to carry the burden of finding the money to pay for their war games whilst delivering a surplus.

Let’s not forget, in April Tony Abbott decided to spend $12.4 billion ordering 58 more Joint Strike Fighters in addition to the 14 already on order.  The first Joint Strike Fighters will arrive in Australia in 2018 and enter service in 2020.

As part of the announcement, more than $1.6 billion will be spent on new facilities at air bases in Williamtown in New South Wales and Tindal in the Northern Territory.

But a specialist in US defence strategy has questioned whether Australia’s purchase is good value for money.

If Australia wants to be able to have aircraft that can go up against what China might deploy – in way of not only its own fighters but advanced air defences in years and decades [to come] – then I think you want something… like the F-35.

[But] if you think more about your military needs being the Afghanistan-style operations, the troubled waters of the South China Sea, counter-piracy, peace operations, keeping some degree of regional calm with some turbulence in the ASEAN region but not necessarily China, then frankly it’s a debatable proposition whether the F-35 is the best bang for your buck.

“If you think that that kind of high-end threat is not realistically where you’re headed with your military requirements, then it’s more of a debatable proposition.

In August, defence minister David Johnstone announced

HUNDREDS of millions of dollars will be spent bolstering the RAAF’s fleet — and the prime minister is in line for a new long-range jet, promising uninterrupted global travel.

The government plan — scheduled to be delivered as part of next year’s Defence White Paper — includes the purchase of up to four new aircraft: an additional two Airbus tanker-transport planes and one or two Boeing C-17 heavy lift aircraft.

One of the Airbus KC-30A multi-role tanker transports would be converted to a VIP configuration and would service the prime minister’s international travel needs.

It would carry the PM’s entourage and the travelling media pack, who are currently forced on to commercial planes as the government’s existing Boeing 737 BBJs are too small.

Since handing down its budget in May, the Government has given national security agencies an extra $630 million over four years.

The Government has also estimated that the military deployment to the Middle East will cost about $500 million per year.

Then we have submarines and unmanned drones and patrol boats and more – a seemingly endless display of military hardware – but we ask our defence personnel to take a pay cut.

I await Joe Hockey’s MYEFO with a sense of anticipation and trepidation.  Will the poor be asked to shoulder more of the burden or will Joe admit where the big bucks are to be found and have the guts to go after them?

Why remaining silent on the fight for other people’s wages could be bad for your health

Originally published on Polyfeministix

Many Australians will shy away from talking about, discussing and signing petitions that fight for the rights of wages and benefits for our fellow Australians.

Since the Howard era of Work Choices, and individual agreements, and his war on collectivism, we have seen a dramatic decline in union density and the Abbott Government has done its best to stigmatize and de-legitimize the hard work that Unions do in Australia.

This brings about the problem of people from all walks of life, not wanting to get involved in protests and social awareness campaigns about ‘other people’s wages and benefits.’  Many people also do not want to get involved or sign up to a union, which is simply a collective body of workers joining together to fight for wages and conditions.

Now the right-winged thinkers, Australian Liberals and Libertarians will do their best to shame you and ridicule you for fighting for wages and conditions. They will call you a dirty filthy Marxist, a Communist and a radical socialist.  They will also tell you it is “unAustralian” and it is unions who have ruined the country. However, people who are not in this group and who have fought for the wages and conditions and stood in solidarity, know that it is far more than that.  They know that what we value in Australian working life was fought for by the workers.

What we have now is the Liberals now trying to reap the rewards of their hard earned messages to decimate unions and collective action. In Queensland there is a situation, that is absolutely dire.  Every single business owner and manager in the public sector should be fighting for the best talent.  The best talent is what makes organisations great. In one area this is absolutely critical is in our Health Sector.

The Conservative arms of Government have spent years and years stigmatizing unions and collectivist fights for better wages and conditions, so they could pull stunts like they are now.

Political greedy stunts that might save a few short term dollars, but have very long term health implications for the every day Australian.  For your mum, grandma, granddad, children, babies and loved ones.

The Campbell Newman Queensland Government want to introduce a two tiered wages system, which will see a lower level of wages for entry level health professionals.   What this is aimed to do, is to drive the talent towards the Private Sector, where the QLD Government wants to outsource so many areas of public health.

The Campbell Newman’s next agenda (and no doubt Abbott’s) will be to:

Privatise Health, based on the argument that the Public Sector is unsustainable and cannot attract the right talent.

To maintain and attract the best talent in our public sector system, it is essential that all Australian’s stand up to their state Governments and to the Abbott Governments “pressure to sell public assets” to the States and their agenda on privatisation.

To ensure the best in health care is given to all Australians, do NOT let the QLD Government set this precedent, or your state will be next.

Please sign and share this petition, or we will end up with a poorer, ineffective health system.  Don’t let the Government use the argument that they cannot attract talent to privatise our health system.

Petition: Stop Building A Two Tier Health System

Stand up and be counted! As Gough would say “It’s Time”

The jails are full and starting a penal colony may not be the answer

Image from algemeiner.com

Image from algemeiner.com

“In response to growing demands on the state’s prison system, the Victorian Coalition Government will bring forward the expansion of Victoria’s newest prison, Premier Denis Napthine announced today.

Dr Napthine said the new medium security male prison, to be built at Ravenhall in Melbourne’s West, will now be expanded to accommodate 1,000 prisoners. The prison was initially announced as a 500 bed facility on a footprint for 1,000 beds.”

A few months ago, Victoria’s Premier, Dennis Nap-time announced plans for a new prison. The cost of building this was well over a half a billion dollars. That doesn’t take into account the $100,000 or so per year that it costs to keep them a person in jail. But I have a much better plan.

We can’t afford this sort of money, so we should let most of the prisoners go. Just keep the most violent and dangerous. Release the others. Don’t prosecute any new offenders unless they’re a risk to the community.

Forget this law and order policy. Many crimes are financial or drug related. If a person is caught doing a robbery, just give them $25,000 and tell them not to do it again. A repeat offender would get $50,000. After that, we start can send them to a course on financial management. And supply drugs to the addicts. It’s a much cheaper solution. And it should ensure we retain our triple A credit rating.

Now, I know that some people will think that this is ridiculous. If we need a new jail, we need a new jail and we just have to find the money somewhere. This is a necessity.

Strange though, that when hospitals need more beds, or schools need more classrooms, they have to wait until the economy’s in better shape. Strange that we can allow people to go without treatment rather than say that this too, is a priority. Strange that we can slash spending on TAFE, and other educational pathways without a thought as to how much that may cost the community in the long run.

And strange that a “Get tough on crime” policy is never examined in terms of what we’re choosing not to spend the money on. Or even in terms of how cost efficient it is.

No, it’s easier to get the public baying for blood because a sentence is too light. (Although I don’t remember much about the leniency of the judgement in Andrew Bolt or Derryn Hinch’s court cases.) It’s easier to think that if we just lock people away for a few years, then the community will be safer without stopping to think that we may actually be “safer” if we spent some of that money on upgrading the ambulance system.

For sure, some people need to go to jail. But, as absurd as my suggestion for simply giving people the money may be, how much could we have saved if we’d spent the money more effectively in the first place.

Fonnix rools – it is the onilly wae to teech studants to spel!

It’s a vision of the future – grounded in the past. New Education Minister Christopher Pyne invites us to imagine classrooms where teachers return to old-school instruction – becoming more a deliverer of facts, less a convener of activity-based learning.

 

He wants young readers to sound out words – and public school administrators to enjoy more of the freedoms of their private education counterparts…

 

And in an ominous sign for the government body that oversees curriculum development, Pyne warns the agency it is ”not the final arbiter on everything that is good in education” and he will take a much more hands-on role.

 

It’s a crusade that Pyne appears to relish.

 

”I don’t mind if the left want to have a fight with the Coalition about Australia’s history,” the minister says in his new Parliament House office, where he has on his wall a 1963 Liberal Party flyer denouncing Labor’s faceless men.

 

”People need to understand that the government has changed in Canberra, that we’re not simply administering the previous government’s policies and views.

The Age, 28th September, 2013

As part of a budget move, Treasury announced that they’d be using abacuses in all future calculations, citing their potential for reducing emissions, as well as the cost saving of replacing batteries.

In a further move, the Health Minister, Mr Peter Dudton has announced that he’ll also be taking a more “hands-on” role in health. This won’t actually involve him personally. but he’ll be encouraging the “laying of on of hands” as a first step by all medical practitioners.

A spokesman for Mr Dudton said that it was a method that had been successfully applied for thousands of years and was still being used in many parts of the world.

“It’s cheap and it’s easy, and if it doesn’t work we can always apply the leeches later.”

The spokesman explained that Mr Dudton was unable to make the announcement himself due to Mr Abbott’s ban on ministers speaking without prior approval, and also because no-one in his Department had actually ever seen him.

The Minister for Communications, Mr Malcolm Bullturner, announced that he favoured face to face communications and as such would not be taking calls or answering emails. When asked if this would make it difficult for people to contact him, he excused himself and shut the door.

minister for woman

The Minister assisting the Prime Minister for Woman (See above. Apparently misreported as “Women” in some newspapers – a further reason to exclusively teach “phonics” in schools) , Senator Cash issued a recipe book and announced that her department was working on some very helpful tips for keeping your man happy when he comes home from a hard day at work. “A touch-up on your makeup before he gets home can work wonders,” she said.

A press release on Research and Development announced that as the Government knew everything, there was little need for any R & D funding in the future. “If the Government were to ever find itself in a position where it was unsure, Mr Abbott has a hotline to Archbishop Pell, who has the advantage of infallibility on his side.” When it was put to the Prime Minister’s office that it was the Pope who was the one who was meant to be infallible, we were told that we clearly hadn’t talked to George Pell. The Minister for Science was non-existent for comment.

The Ministries for Ageing and Youth have been combined, therefore cancelling each other out, leaving a minister free to ensure the smooth transition to the tried and true practices of the past. while the Minister for Secrecy and Keeping News of The Front Page assured us that he didn’t exist.

People told me to read between the lines, but I didn’t see anything written there!

“Opposition Leader Tony Abbott says a Coalition policy to pay long-term unemployed young people who find a job up to $15,500 is “a sensible investment”.

 

Mr Abbott has released a policy, similar to one he took to the 2010 election, to pay a bonus to those under 30 years old who have been on unemployment benefits for more than a year and then find work.

 

If the employee stays in a job for 12 months, they would receive an initial $2,000 bonus; if they stay in the job for two years, a Coalition government would pay them another $4,500″          The ABC

As someone who taught Drama, I often find it necessary to teach kids about subtext. What’s implicit, but not actually said. “But if it’s not actually said, how do you know it’s there?”

Some want to know but that’s not always easy to answer without providing an example.

Fortunately, Tony Abbott is giving us heaps of examples over the past few weeks. His policy on the unemployed reeks of subtext.

“We’ll pay you lazy bastards a bonus if you get off your spotty backsides, find a job and keep it for twelve months,” says the subtext, “because we know that you’re just not trying.”

And, of course, when in spite of this generous incentive, some people still haven’t found work, it’ll be because they just aren’t trying. After all, didn’t we offer them a bonus. And, like performance pay for teachers, that should be all that’s needed.

Someone did suggest that it might be more effective to pay the bonus to employers to encourage them to actually take on workers, but there’s a problem with that – it might actually work! This is far better.

Of course, one could also ask where the money’s coming from, but that just seems petty. And it’s Labor that’s sent the country broke, we’re the ones committing to a surplus, but not for ten years. So what if the budget doesn’t balance in our first term.

Besides, we haven’t made many “promises”, we’ve stated our “aspirations”, we’ve only said we “intend”, we only say whatever the situation it’d be worse under Labor, we have “plans” and we support motherhood – look at our Parental Leave Scheme. And anyway, most of it we didn’t write down, and we told you that it’s only the written stuff that counts.

What have we written down? It’s all in our booklet. For example, we have a whole page on Health, including a whole paragraph on Mental Health, where we say we will work with people to make it better.

Ah, yes, subtext is a wonderful thing!

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