Tuesday, July 28, 2009

Rudd fails economic history lesson

PRIME Minister Kevin Rudd has got his economic history in his latest exercise in essaying "exactly wrong". That's the view of RMIT University academic Sinclair Davidson, who says it doesn't augur well for our future. The Sydney Morning Herald and The Age morphed into something similar to the Pyongyang Post when they ran 6000 words of the PM's most recent deep thoughts over two full pages on Saturday, replete with sub-headings rarely seen outside an election manifesto. The headline across the front page of the SMH read "Rudd's recipe for recovery".

Davidson wants to know how we can trust a bloke who has got the past wrong to lead us into the future.

There's yet more huffing and puffing about those dastardly neo-liberals in the PM's piece. He also takes the novel step of having a go at the 1931 premiers' plan where governments cut expenditure, a bugbear of the ALP since the Scullin Labor government lost power at the end of that year. "It was seen as a very anti-Labor policy," Davidson says. "It was crammed down their throats by Sir Otto Niemeyer and the Bank of England and the Scullin government introduced it and lost the election.

But he adds, "whatever the flaws of the premiers' plan, it certainly did not give rise to catastrophic unemployment". Davidson points to research by RMIT colleague Steven Kates which shows how unemployment in Australia after 1932 fell more swiftly than in the US and Britain. And he pulls out a glittering nugget of trivia -- Niemeyer beat the PM's new hero JM Keynes in their civil service economics exam.

Davidson isn't worried that the PM is channelling Paul Keating channelling Jack Lang. He's worried that Rudd is talking about an entirely different country. "Australia had a v-shaped depression while the US had a big u-shaped depression. The essay shows how ignorant Kevin Rudd is of Australian economic history. He's taking the populist lessons of the Great Depression from the United States. "Americans seem to often think America is the world but the Prime Minister of Australia shouldn't think that American history is Australian history. His advisers either don't know this or don't care enough to tell him."

All up, Davidson describes the background to Rudd's latest essay as extraordinary. "He's put us into debt to the tune of $300 billion having claimed to have learned lessons that he doesn't know."

SOURCE. More on Rudd's warped manifesto here

More beds, not more bureaucrats, are what Australia's hospitals need

RUDD should invest in a voucher scheme instead of taking over hospitals. It's a quarter of a century since Medicare was established, but no one is celebrating. No wonder, considering the critical condition of the public hospital system throughout Australia. Instead we have a 300-page reform blueprint from the National Health and Hospital Reform Commission.

At least the report has identified the main problem. The reality is that Australia's dangerously overcrowded public hospitals don't have enough beds to provide a safe and timely standard of care even for emergency patients. Unfortunately, the commission has strongly supported a range of non-solutions. The primary care reforms it proposes will not help our dysfunctional state-run public hospitals cope with an inexorable rise in demand from an ageing population.

Since 1983 the state health bureaucracies that are responsible for allocating funding, planning services and rationing public hospital care have cut the number of public hospital beds by one-third: from 74,000 beds to just over 54,000. This is a 60 per cent cut, taking population growth into account, from 4.8 public acute beds for every 1000 Australians to 2.5 beds.

Overcrowding occurs when bed occupancy exceeds 85 per cent in hospitals, operating near or beyond full capacity. Average bed occupancy in most leading metropolitan public hospitals is above 90per cent and hospitals routinely operate above 100 per cent occupancy because of political pressure to reduce electorally sensitive waiting times for elective surgery.

The nationwide bed shortage means one-third of emergency patients wait longer than eight hours for a bed to become available. Emergency staff spend more than one-third of their time caring for these patients, which leads to more than 30 per cent of patients not being seen in emergency departments within the recommended time.

The queue for free public hospital care now starts in crowded hospital corridors lined with ailing, mostly frail, elderly patients who are parked on trolleys for hours and sometimes days.

The pressure on hospitals is intensifying because rising numbers of older patients with complex conditions are requiring unplanned admission for bed-based medical and nursing care. In the past five years, admissions by patients aged between 75 and 84, and 85 and older, increased by 25 per cent. A decade ago, the 85-plus demographic wasn't even distinguished in the statistics.

The problem is not that hospitals are underfunded. Over the past decade, real expenditure on public hospitals increased by 64 per cent to top $27 billion in 2006-07. The real problem is that not enough of the money gets through to the frontlines. Between 1996 and 2006 the number of acute public hospital beds fell by 18 per cent per 1000. But between 2001 and 2006, the number of administrators increased by 69 per cent.

The large and costly area health services that administer public hospitals in most states are better at paying for bureaucrats than for beds, and have a deservedly notorious reputation among overworked hands-on hospital staff for warehousing armies of clerks and managers who have no involvement in patient care.

As more and more people live to older ages, a tsunami of demand will break in public hospitals. Increasing numbers of very old patients will inevitably require emergency and bed-based hospital care due to the age-related onset of chronic conditions. Going by the state of the health reform debate, the hospital crisis will become a catastrophe. The wrong-headed premise of the Rudd government's reform agenda is that the commonwealth must spend billions on a national network of comprehensive general practice "super clinics" to take pressure off hospitals.

The NHHRC has fully endorsed this approach. It claims that 10 per cent of public hospital admissions can potentially be prevented by providing better co-ordinated primary and allied health care for chronically ill and elderly patients.

Yet even the discussion paper on the subject commissioned by the commission shows that trial co-ordinated care programs have failed to keep people out ofhospital.

The 15 per cent boost in bed numbers recommended by the commission is welcome. But even if the government accepts this, a one-off and costly boost in bed numbers is not a long-term solution.

Instead of wasting money building stand-alone elective hospitals and wasting political capital trying to take full responsibility for the primary care system, the Rudd government should focus on structural reform of the hospital system.

Flexible and responsive funding and administrative arrangement must be created to allow hospitals to increase the supply of beds and meet the demand that rising numbers of older and sicker patients will generate in coming decades.

The first step towards rebuilding the hospital system is for the commonwealth to take full control of public hospital funding and introduce Medicare-issued, case-mix-calculated hospital vouchers to pay for treatment in either public or private hospitals. The second step is for state governments to agree to re-introduce local public hospital boards with full financial and administrative responsibility for their facilities. The third step is to close down the area health services and use the money saved to fund vouchers and open and staff more hospital beds.

This isn't a plan for Canberra to take over and run hospitals. Funding will be centralised by converting the present federal grants and state hospital budgets into vouchers, while the management of hospitals will be decentralised to local boards. Nor is this a plan to privatise the health system. Tying taxpayer funding to the treatment of patients, increasing choice and competition, and freeing hospitals to respond appropriately to the health needs of the community is not that radical.

This parallels the voucher-based policies the Rudd government is considering implementing to increase efficiency and improve access to publicly funded education in schools, TAFE and universities.

A 50 per cent increase in patients presenting at emergency aged over 85 is predicted over the next five years alone. Bed numbers must increase significantly to equip the hospital system to cope with the unprecedented impact of demographic change. The challenge for policy-makers is to dispense with the failed methods of running public hospitals that have created a continuing crisis 25 years in the making.


Whiners slapped down: Cheap fuel OK

FUEL commissioner Joe Dimasi has declared the 40c-a-litre discounts offered by Coles and Woolworths last week were not anti-competitive. Independent fuel and grocery retailers protested that the discounts were an abuse of market power by the two supermarket majors, who each control about 22 per cent of the fuel retailing sector.

But after a week of deliberation, Mr Dimasi said yesterday the Australian Competition & Consumer Commission had concluded that the promotions did not breach the Trade Practices Act.

Coles supermarkets last week ran a three-day promotion under which shoppers spending $300 in a single visit received vouchers for a 40c-a-litre discount on fuel at Coles Express petrol stations. The offer, which also included 25c- and 10c-a-litre rebates for shoppers spending $200 and $100 respectively, was matched by Woolworths.

The Australasian Convenience and Petrol Marketers Association slammed the promotion as threatening the survival of independent service stations struggling to maintain their 6 per cent market share.

But Mr Dimasi yesterday said that the offer was only a short-term discount for consumers. "For most consumers the discounts will only apply to one weekly or fortnightly shop, and to one tank of fuel," he said.

A Coles spokesman said the supermarket giant welcomed the ACCC's decision. "Our initiative was always aimed at giving customers extra value and we'll continue to look at other ways in which we can be the customer champion," he said.

Mr Dimasi also noted that Metcash, the grocery wholesaler behind the IGA chain of independently owned supermarkets, had this week made its own 40c-a-litre offer.


QANTAS again

The faults and failings never stop. Anybody who flies QANTAS these days is asking for trouble. Their maintenance is obviously close to non-existent. There has got to be a major disaster waiting in the wings

A LOSS of cabin pressure at 25,000 feet forced a Brisbane-bound Qantas aircraft to turn back to Auckland shortly after take-off from New Zealand, a spokesman for the airline says. The Boeing 737 was carrying 91 passengers and crew for the Saturday morning flight out of Auckland, but Qantas spokesman Joe Aston said it was not necessary to treat the malfunction as an emergency.

”The aircraft ... this morning experienced a subtle pressurisation problem at 25,000 feet (7,600m) on ascent out of Auckland,” Mr Aston said. ”The cabin was depressurising at a controlled rate but certainly not rapidly or noticeably to passengers. There was never any imminent threat to passengers, the crew or the aircraft.” The incident would not have been noticeable to passengers inside the main cabin of the aircraft and it was not necessary to supply oxygen masks, he said.

The aircraft landed back at Auckland without incident and passengers were transferred to a different plane which arrived in Brisbane just under three hours late. ”The original aircraft is now being inspected by our engineers in Auckland,” Mr Aston said.


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