Monday, February 14, 2011

Gillard to cut the health bureaucracy?

One fervently hopes it is true but I am not holding my breath. The claim that the State Health bureaucracies will end is laughable. Like cockroaches, they would survive a nuclear winter

Julia Gillard last night secured a history-making agreement for a new national health reform plan with the states, after 12 hours of heated talks in Canberra. It was a breakthrough for the Prime Minister who is badly trailing Opposition Leader Tony Abbott despite a series of Liberal controversies.

Ms Gillard said the Council of Australian Governments (COAG) meeting in Canberra had secured a better deal for patients which would pay for "tens of thousands" of extra treatments and reduce waiting lists for elective surgery and emergency room treatment times.

Extra funds to total $16.4 billion over the coming 10 years will be provided from July 1, but only only with State governments reform of health delivery systems. Some $200 million of the funding will be brought forward for immediate spending.

"When we walked into that (meeting) room today, we didn't have the benefit of one national funding body or the the kind of transparency I have outlined," said the Prime Minister. "We have walked out of the room having ensured we have one national agreement, transparency, proper funding, local control (of hospitals), new investments in primary care, and less bureaucracy. "For people around the country this does mean more money, more beds, less waiting time, more access to the health care they want now."

Missing from the deal was the original demand by the Federal Government that the states kick in a third of the GST revenue to boost the nation funding pool. This demand set by former Prime Minister Kevin Rudd was preventing a full agreement, and was a political obstacle identified for removal by Ms Gillard.

A national funding pool would ensure hospitals are "transparently and fairly funded", while "a giant axe" will be taken to health red tape and the ending of eight separate bureaucracies of the states and territories.

"The Commonwealth will become 50 per cent partner in growth for the future," said Ms Gillard, pledging to pay for half of hospital cost increases. She also pledged extra primary care, including after-hours GP services.

A heads of agreement was signed tonight but the full agreement will be delayed by the sorting out of "comprehensive technical details" to be settled by another COAG meeting mid-year.


Premiers warn the detail of health reforms still to be hammered out

QUESTIONS are emerging over the detail of Julia Gillard's $16.4 billion health reforms, with state premiers warning of prolonged negotiations over the specifics of the plan.

West Australian Premier Colin Barnett said the introduction of an activity based funding system through a national pool by mid next year was achievable, but stressed it needed to be "well understood and easy to administer".

Mr Barnett said exact state and federal responsibilities under the plan still had to be worked through, while the details of the pooled funding arrangement were yet to be finalised.

Unless the structure of the pool was right, positive health reform could not be delivered, he said.

"We agreed on the broad principles," Mr Barnett told ABC radio. "The detail will not be an easy task, but I've got confidence that some of the best brains in health administration at a commonwealth and state level will be able to solve that problem. "The absolutely critical thing will be the arrangements for management, who has responsibility for what, how the money flows. And if we don't get that right, then the system won't work."

Prime Minister Julia Gillard hit the airwaves this morning to spruik her new national agreement, declaring the blame game was over. She said the deal would provide greater transparency but conceded the "fine details need to be nutted out".

Ms Gillard said an independent body would work out the "efficient price" of hospital services to govern the flow of funding, an innovation she claimed would bolster transparency.

However, father of the Medicare system, Dr John Deeble, told The Australian Online he had doubts about how the efficient price could reasonably be set. "I think that will have to be significantly modified. You can do some sums on what looks to be an efficient cost, but the people who make the decisions are the doctors who treat people. "I'm a bit concerned that the determination of the efficient price will end with great deal of squabbling."

Federal opposition health spokesman Peter Dutton said removing the levels of bureaucracy from the previous Rudd reform plan was a positive.

Rural GPs were also worried the new agreement won't improve services in the bush, because it did not address the issues of minimum standards to ensure adequate services in country areas, or new measures to improve staff recruitment and retention. “It doesn't have a significant shift in terms of the funding models that we can see immediately,” Rural Doctors Association of Queensland president Dr Dan Halliday also told the ABC.

However Victoria's premier Ted Baillieu says the new deal is a better result for patients. It meant more money upfront for Victoria and better protection of Victoria's local health networks and of home and community care. “This is a much better deal than the deal that was in place which Victoria had signed up to,” Mr Baillieu told ABC Radio.

NSW Opposition Leader Barry O'Farrell, widely tipped to be the state's next premier, said he needed more time to decide whether to support the health reform deal.

“I won't be a part of any agreement that sells (the public) short once again, as they have been sold short so many times by this state Labor government,” he told Sky News.


Dangers of hidden justice highlighted as News takes aim at secrecy in the nation's courts

The growing reach of suppression orders came under sustained attack over the weekend from the nation's largest publisher, News Limited, the Press Council and one of the most experienced media law judges in NSW.

Model legislation for a national suppression order scheme "sends a shiver down my spine -- and not in a good way", said John Hartigan, chairman and chief executive of News Limited (publisher of The Australian). "This legislation is fatally flawed and has the capacity to send open justice behind closed doors," he said.

Mr Hartigan's concerns about suppression orders were one of the main themes of a paper he delivered on Saturday at a conference on courts and the media at Bond University. He warned that the planned changes to suppression orders would enable judges to close their courts on an additional new "public interest" ground.

Because the scheme did not make open justice its primary objective, it could potentially be used to protect the privacy of the accused, he said.

As well as calling for the withdrawal of the proposed suppression order regime, Mr Hartigan outlined a broad reform agenda aimed at winding back the restrictions that limit scrutiny of the justice system. The main items on his reform agenda are:

* Freedom to use still cameras and television cameras in courts for the opening remarks in cases and judges' sentencing remarks.

* Real-time access to transcripts and documents used in court.

* Removal of "take-down" orders in which judges order material removed from websites.

He told the conference it was time to "halt the suppression orders juggernaut. And the first stop must be the secret state of Victoria."

He said lawyers for The New York Post had not received a single suppression order in the past five years. But News Limited lawyers in Australia had faced more than 500 in the past 12 months and 270 of those were in Victoria.

David Levine, formerly of the NSW Supreme Court, told the conference that last year's decision by the Supreme Court of Victoria to suppress an edition of The Australian Weekend Magazine had been "wimpish".

The magazine was suppressed by Victorian Supreme Court judge Lex Lasry, who had been hearing a murder case. He was concerned that an article in the magazine about an unrelated murder in South Australia with different facts and a different defence might persuade the jury in his case to convict.

Mr Levine told the conference he agreed with this newspaper's criticism that the Victorian Supreme Court had suppressed the magazine too readily. "My general view is the evolution of suppression orders -- particularly in Victoria -- has been especially troubling," said Mr Levine, who was formerly the judge in charge of the NSW Supreme Court's defamation list.

"There has been a change of government in that state. Mr (Rob) Hulls is no longer attorney-general and there might be some liberalisation. I would be hard-pressed to think of a case for a suppression order other than in generally recognised circumstances, and that is traditionally the name of a victim of a sexual assault and in yet-to-be-clarified circumstances involving national security."

Press Council member Prue Innes said the model suppression order scheme was accompanied by a proposal for a public register of suppression orders that had not been thought through. "The information on a public register would have to be so vague as to be almost useless," said Ms Innes, who produced a 2008 report on suppression orders for the media industry's Right to Know coalition.

She said the scheme that had been approved by the nation's governments had misunderstood the Right to Know's position. "I hope that will be reconsidered. As it stands, this proposal in my view is a wasted opportunity," said Ms Innes, who is a former court reporter for The Age and was information officer for the Supreme Court of Victoria.

The dean of law at Bond University, Geraldine Mackenzie, said a lack of open justice led to a lack of understanding about court procedures. "And that leads almost inevitably to a lack of public confidence," she said. "Low public confidence brings with it a lack of support for policy initiatives which would bring reform to the system. It brings a lack of respect for the courts; it undermines the courts' authority."

Ms Mackenzie told the conference she was part of a team that had been working on a major survey of public opinion about confidence in the courts . "The conclusion that can be drawn from our study is that the more information and knowledge people have about the operation of the courts, the more confidence they will have that the courts are acting appropriately," Ms Mackenzie said.


Typical Leftist dishonesty over the fibre broadband boondoggle

For years, Communications Minister Stephen Conroy has been citing South Korea to justify his National Broadband Network.

But after a report this week by The Economist's Economic Intelligence Unit ranked Conroy's NBN plan poorly against top-ranked South Korea, Conroy claimed that comparing Australia with South Korea was like comparing "apples with oranges".

This typifies that strategy that Conroy has consistently employed to defend his NBN: when comparisons (no matter how misleading) help your case, use them -- but when they don't, dump on them and anyone making those comparisons. Such hypocrisy is truly galling. This time around, Conroy is actually right on one thing: it is indeed an "apples and oranges" comparison. But that's never stopped him comparing Australian and South Korea before. Critics have pointed out many times that comparing Australia with countries like South Korea is silly (see, for example, "Scrapping NBN tender a huge waste of money", The Australian, August 4, 2009) for many reasons, particularly the enormous difference in population densities -- but he kept making them. Now, when it suits him, he has borrowed his critics' argument and bent it for his own purposes.

Conroy's continued misuse of selective, piecemeal comparisons is the very reason why a cost-benefit analysis of the NBN is required. It may sound obvious, but government policies should serve the public interest; a policy serves the public interest only if -- when implemented in Australia -- it delivers benefits that exceed the costs (and if it delivers bigger net benefits than any alternative policy). Various bits of information can help in assessing the costs and benefits, but selectively highlighting some bits and ignoring other bits is grossly misleading.

If your doctor recommended having a nose job because your mate Fred did, you wouldn't find that compelling.

If she said Fred benefited greatly from the nose job, you'd want to check out whether the benefits were real and what the job cost Fred. And you'd want to think about what benefits you'd get and how much you'd pay.

But suppose your doctor's allusions to Fred convinced you to get the nose job. Just before you're wheeled into theatre, she hands you a bill for 24 times what Fred paid. When you protest, she haughtily replies that of course it costs you more because your nose is different -- it needs much more work than Fred's.

Would you trust this doctor again? No. Would you want to reconsider whether the nose job is a good idea? Yes.

Conroy is the nose doctor of broadband. In announcing the NBN in April 2009, he led with the "Fred" tactic: we'll be joining "world leaders" in FTTH like South Korea. Of course, just because other countries "lead" in something doesn't mean we should copy them. Germany was a world leader in Zeppelin airships. Michael Jackson was a world leader in nose jobs.

Conroy later employed the "Fred benefits" tactics. For example, in a November 2009 speech, he said: "For countries targeting broadband and ICT (information and communications technology) investments to stimulate economic growth, Korea provides a significant example of the capacity to succeed."

He also said: "Although Korea was among the nations hardest hit by the Asian financial crisis in the late 1990s, the country turned a disaster into an opportunity to grow its IT sector. Spending on broadband and other high-technology equipment helped lead a transformation of the economy . . . By May 2004, about one-third of Korea's exports were from the IT sector."

Actually, South Korea's average annual GDP growth over the last decade (4.2 per cent) is less than half the 9.2 per cent it achieved in the decade preceding the Asian financial crisis. ICT exports were about one-third (33.9 per cent) of Korea's exports in 2004, but Conroy didn't mention that they were already 31.4 per cent in 1999, nor that they had dropped to 26.2 per cent -- below their level before the Asian financial crisis -- well before he gave his speech.

My point isn't that nose jobs and broadband deliver no benefits, but that claimed benefits by vested interests -- like a nose doctor or a minister whose entire credibility rests on defending the NBN -- need to be checked out.

Like the doctor, Conroy avoided cost comparisons. He happily made comparisons with South Korea on what they were doing (FTTH) and in claiming big benefits, but was silent on any comparisons of cost per capita. He only mentioned density-related costs when defending why FTTH would serve a slightly smaller proportion of premises than in Korea.

When the EIU this week said that Australia's NBN would cost taxpayers 24 times more than South Korea's fibre rollout cost its taxpayers, he tried the "your nose is different" tactic. He used population density differences to argue that "trying to compare the rollout in South Korea with the rollout in Australia is fraught with challenges".

Conroy is right that such comparisons are dangerous. Given Australia's much lower population densities, the cost per premises here will be much higher. But Conroy's response begs the key question: given the enormously greater cost in Australia, shouldn't we examine whether the costs are worth the benefits, or whether there is a better way to gain those benefits at lower cost?

Here's another comparison to highlight Conroy's hypocrisy. Conroy attempted to dismiss the EIU's report by holding up one page and saying: "For those who haven't spent the $3000 (to buy the report) I just wanted you to see the entire analysis in this document". Putting aside the fact that this gives grossly misleading impression of how much analysis the EIU did, that's still one more page than Conroy produced when he committed $43 billion of taxpayer money to the NBN with absolutely no analysis whatsoever. Thirteen months later, he produced the Implementation Study. Taxpayers were forced to pay $25m for that, which works out at $45,788 a page. The EIU report is incredibly cheap by comparison and no one is forced to buy it. The Productivity Commission could conduct a cost-benefit analysis for under $2.5m.

But selective comparisons are endemic in this government. While Ireland's economy appeared to be growing, Industry Minister Kim Carr used to it to justify state-funded "industry development" (aka handouts). He didn't present any evidence to show that state funding had caused higher economic growth, or that any benefits were worth the costs. He just hand-waved. Ireland is now one of European's biggest basket cases.

We should decide policy objectively by assessing benefits and costs of the options and choosing the one that best serves the public interest. Unfortunately, this government got it arse-up: it decided policy first and ever since has made any comparison or claim it could to defend itself. If someone makes a good argument that harms the case, the tactic is to dump on them.

Conroy claimed the EIU -- run by The Economist, the most highly respected economics magazine on the planet -- was just spouting "right-wing dogma" in its report.

Conroy does the same whenever other highly respected organisations say something he doesn't like. Last October, he said a cost-benefit analysis would be a "waste of money" because "the OECD are about to complete a major study".

The next month, he cherry-picked a statement about the benefits of broadband from an OECD report to claim that the report supported the NBN, when in fact the OECD damned the NBN as "winner-picking", competition-constraining and very costly and urged that a cost-benefit analysis be conducted.

While dumping on highly respected independent critics, he selectively chooses to cite reports written for vested interests (like IBM) to support the NBN.

Taxpayers should insist that the government ask the independent Productivity Commission to conduct a cost-benefit analysis.


Another step along the road towards medicalizing all problems: Grief now a mental illness

By that standard, the much-respected Queen Victoria was as nutty as a fruitcake

A PUSH to classify grief as a psychological disorder has been criticised by experts as "disease-mongering". Prolonged grief disorder (PGD) will be included in the next edition of the Diagnostic Statistical Manual of Mental Disorders, the psychiatrists' bible used to diagnose mental problems.

Bereavement, a normal part of life, has been excluded from previous editions of the manual, but Australian Medical Association spokesman and psychiatrist Tom Stanley says there is significant evidence of PGD. "Occasionally, normal grief will become pathological and, in many cases, it will precipitate severe depression," Dr Stanley said.

Prolonged grief disorder was originally identified by US psychiatrists, but counsellor Mal McKissock, of Sydney's Bereavement Centre, said: "It's nothing more than disease-mongering. "My colleagues in the US get reimbursed only if there's a real sickness, so they created one."

Mr McKissock is concerned about the growing number of patients he sees who have been medicated with anti-depressants. "I'd venture that 50 per cent of the people I see are on anti-depressants - and that includes children, which is outrageous," he said.

"People think they have a disease. They think they're depressed, but they are sad, passionately sad, and it's a natural process."

Former Australian of the Year and campaigner for mental health Professor Pat McGorry said there was a distinction between normal grief and prolonged grief that could lead to severe depression.


1 comment:

Paul said...

Julia's health victory. more blah blah blah in which nothing changes. Getting too old for this.