Government contribution to private hospital costs has declineed drastically

Because of the long wait times and unreliable service in government hospitals, just about anyone who can afford to goes private in Australia

THE Medicare rebate now covers as little as 16 per cent of the AMA recommended fee for common private hospital procedures - a key reason patients are being forced to sell their homes and raid their super to pay medical bills.

While AMA fees are adjusted for inflation and indexed annually, the rebate has only been increased at less than the rate of inflation or wages growth for decades.

And although health funds offer their members rebates to cover the gap, these rebates are capped - leaving many patients with hefty bills that can amount to thousands of dollars.

A News Limited investigation has found Medicare now covers less than 50 per cent of the AMA fee for ten of the most common procedures in a private hospital.

It covers only 16 per cent of the fee for cataract removal, and just 28 per cent of the fee for hip and knee replacements.

Medicare will cover only 18 per cent of the fee the AMA recommends for delivering a baby, only a third of the bill for bowel cancer surgery and just 28 per cent of the cost of repairing a fractured arm or leg.

As a result the gap fees that have to be met by health funds can be as high as $2,930 for cataract removal and $2,506 for a hip replacement.

So even after gap rebates members of our two largest health funds can be up to $527 out pocket for breast removal surgery, over $1,600 out of pocket for cataract surgery and $185 out of pocket for hip and knee surgery.

Twelve years ago a government commissioned study found Medicare rebates for a specialist visit needed to be increased by 66 per cent, rebates for delivering a baby needed to rise by 150 per cent and for a hip replacement by 30 per cent.  The recommendations were dismissed because they were too expensive.

Australian Medical Association president Dr Steve Hambleton says it is time for the adequacy of at least some Medicare rebates for eye surgery and hip and knee replacements to be re-examined.

"The two things that make a difference in life when a person is old is their mobility and their vision," he said.  "Even though people have been in health funds for 50 years I have to say to them: "Can you afford the gap if you need a hip replacement and if you can't why are you still in private insurance?"

Health Minister Tanya Plibersek says bulk-billing rates have never been as high and says the government has invested $2 billion to drive up the rates with incentives for general practice, pathology diagnostic imaging and telehealth services.

Consumers Health Forum chief Carol Bennett says we need to stop paying for surgical throughput and start paying for health outcomes.

"If the government caves in to the fees the AMA recommends our health system will go quickly broke, we need to refocus what we do and limit demand," she said.

While eight out of ten GP visits are bulk-billed at no charge to patients, only one in four specialist services and only 8 per cent of anaesthetists services are bulk-billed.

Mind the gap

WHEN it started in 1984 Medicare covered 68 per cent of the AMA's recommended fee for a GP visit

BY 2012 it covers just over 51 per cent

IN 1984, Medicare covered 72 percent of the AMA's recommended fee for a specialist visit

IT now covers only 46 per cent

IN 2011-12 financial year the average gap payment to see a specialist who didn't bulk-bill was $53.10, for an anaesthetist it was $103.60 and for a GP $26.97.

THE government's Private Health Insurance Administration Council calculates around 88 per cent of medical services provided in private hospitals have no gaps.

HEALTH fund members paid $630 million in out of pocket costs for over 3.4 million doctors services when they used their health insurance in the year to September 2012.

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It might be rude but it shouldn't be a crime

David Penberthy

RESEARCH is everything in journalism, so I am happy to be able to report that for this piece I spent a good half hour watching Rodney Rude videos on YouTube.

It was around 1983 when I last devoted that level of attention to the work of the Australian comedian.

At our cutting-edge public school, there was a tiny room you could hire called the audio visual centre which contained a single cassette player and many lunch hours in year 10 were spent with mates listening to our tape of the ground-breaking comedy LP Rodney Rude Live.

From memory, the album went No.1 in the charts. It was regarded as massively offensive by many people.

Rude was banned from performing in Queensland for swearing and would probably be regarded in today's more politically correct age as even more objectionable.

The album is filled with bizarre stream of consciousness anecdotes involving moments such as Rude's sexual encounter with a lesbian at a rock festival who subsequently challenged him to a farting competition and his description of how he went to school with a boy who was born without any arms or legs or anything, he was just a head and who sank to the bottom of the school pool on account of having a cramp.

Rude later released a single entitled I May Not Be a Wog (But I Look Like One) which did not fare as well as his debut LP.

He still pops up in the clubs from time to time with material which involves aberrant sexual banter, jokes about Japanese people, New Zealanders, Germans, albinos, the Pope, people with disabilities and himself, a general smorgasbord of filth and weirdness.

I am not holding Rude out as the greatest comic of all time, but there was a kind of charming and intense level of stupidity about him which endeared him to many Australians.

I write about him today because his largely squalid body of work forms a handy checklist for the types of sentiments which could soon be illegal. In the movie The People Versus Larry Flynt, the American pornographer and founder of Hustler magazine argued that anyone who believed in free speech should support his cause because "I'm the worst", and that as someone at the squalid outer limits of taste, he needed to win in the Supreme Court to affirm the sanctity of the First Amendment.

The weird thing about Australia right now is the types of laws which are being canvassed won't affect the most extreme, offensive and inflammatory sentiments or forms of behaviour, such as Larry Flynt's repellent concept of satire, but could actually snare behaviour which is quite mundane.

You could go through the once chart-topping LP by a largely harmless nut such as Rodney Rude and draw up a handy checklist of aggrieved groups who could have a humourless moan in a court of law under Canberra's beefed-up anti-discrimination laws.

The immediate past chief justice of NSW, Jim Spigelman, is such a level-headed and reasonable person that he is known in legal circles as Gentleman Jim.

Spigelman is now the ABC chairman and he gave a terrific speech this week looking at how, under the proposed changes, it will become unlawful to offend people.

"We would be pretty much on our own in declaring conduct which does no more than offend to be unlawful. The freedom to offend is an integral component of freedom of speech," Mr Spigelman said. "There is no right not to be offended.

"I am not aware of any international human rights instrument or national anti-discrimination statute in another liberal democracy that extends to conduct which is merely offensive."

If you think back over the life of this toxic and dysfunctional Parliament, where minority government has flushed out conduct on both sides which is way out of step with the way most people behave, the language of politics has become more heated than usual.

JULIA Gillard has been labelled JuLiar, called a witch, a crook, a feminazi; Tony Abbott has been labelled a misogynist, a negative, policy-free fraud, the Liberals accused of dealing with scumbags to pursue the AWU story, and so on.

I am not sure whether any of this language is desirable.

But I am convinced that none if it should be actionable, as all of it has the capacity to offend someone.

And the moment we start letting people try their luck in court because they have their precious feelings hurt, we are heading down a pretty disturbing path towards state-sanctioned limits on what passes for conversation.

There are already limits to what we can and cannot say through the common law, with defamation being a very popular and often lucrative way to take action if you feel you have been hard done by and can convince a judge or a jury of your peers of that fact.

One of the most inflammatory moments of this year was the absurd and violent protest by the ratty minority within Sydney's Lebanese Muslim community, who thought that belting cops was a reasonable response to the screening of a film overseas ridiculing their prophet. These blokes were clearly deeply offended. So much so that it was offensive to the rest of us.

We don't need our government treating us like those nuts in Martin Place, who clearly devote much of their time to being offended.

The long-standing advice to calm down, keep things in perspective, or lighten up should hold more value than any government-mandated attempts to make sure no one ever says anything offensive, ever.

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Queensland farmers approved for lethal Damage Mitigation Permits to shoot and kill fruit bats

The creation of orchards has caused their numbers to explode

THE first shots against Queensland's flying fox population were fired this weekend with fed up farmers finally given the all clear to shoot to kill.

Queensland authorities have approved nine shoot-to-kill licences out of 17 applications for lethal damage mitigation permits to deter the night-time raids of flying foxes on fruit growers across the state.

From the apple orchards of Stanthorpe, to the citrus trees of Bundaberg, to the lychee plantations of the deep north, bat lovers claim a modern "yippee shoot" is the new battlefront in wildlife conservation.

Farmers retort: "Shooting is a last resort".  Mostly they use lights, noise, netting, electric shock, poison and hot chilli spray to ward off hungry hordes of bats - one colony of thousands of flying foxes can strip a $100,000 harvest bare in a few nights.

Successful applicants of lethal permits must have previously used "prescribed methods" such as netting or sound to deter flying foxes.

Lethal permit holders said yesterday how they did not want to be photographed for this story because they felt it would make them a target for "green hysteria".

"We don't want to end up in the cross hairs," said fruit producer Derek Foley, of Electra near Bundaberg.  "It'll be us with the bullseye on our heads.  "But we do believe in our right to farm, to feed the nation, and shoot the odd flying fox to protect our crop."  Mr Foley has 14,000-odd trees of lychee, avocado, mango and lemon.

Full canopy netting covers the trees, gas guns make a sound barrier, and six 18m high towers with 24 metal halide 2000-watt lights light up the farm "like the Sydney Cricket Ground".

Shooting is the final option to "take out scout bats" he said.

Under the permit, producers are strictly capped per motnh to take down: 30 black flying foxes; 30 little red flying foxes; 20 grey-headed flying foxes; and 15 spectacled flying foxes.

Conservationists believe the permits will still put some species at risk.

"This is barbaric," said Bat Conservation and Rescue Queensland president Louise Saunders.  "These permits are a sick joke. It is near impossible to get a clean shot on a bat at night," said the Brisbane-based animal carer.

She believes wounded and winged creatures will be left to die an agonising death in the forests.  "Bats are not some ravenous, rabid, violent monster out there to eat you. They are beautiful, clever, loving mammals.  "This'll be one big yippee shoot."

The Newman Government overturned a four-year ban on killing flying foxes earlier this year, opening the permit system in September. In the 1920s, organised hunts killed thousands of bats a night.

Alf Poefinger, 73, a lychee and mango grower of Mutarnee, north of Townsville, prefers to use hot chilli spray over the messy and expensive practice of shooting.

"Bats bite or lick the hot chilli on the fruit, it does not kill them, but they don't like it," said Mr Poefinger.

"It is definitely cheaper than netting and not as vicious as shooting them."

Fellow Mutarnee grower Martin Joyce was the first producer in Queensland to be granted a lethal permit.  He said when the bats come in their thousands they are very hard to control.  "Now, if we do get a great influx, we have the permit."

Environment Department Director Wildlife Rebecca Williams confirmed nine out of 17 applications for lethal DMPs had been approved.

But they were always willing to consider applications on non-lethal methods of managing flying foxes, she said.

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OECD delivers snapshot of Aussie economy

A heavily Leftist report

The Federal Government should be prepared to delay returning the budget to surplus if economic conditions significantly worsen, according to an international analysis of Australia's economy.

A report by the Organisation for Economic Co-operation and Development (OECD) says the forecast surplus of $1.1 billion this financial year could turn into a deficit of 2-3 per cent of GDP if the terms of trade return to their longer-term average.

It says Australia weathered the global financial crisis well, through sound macroeconomic policy and strong demand from China.

But it suggests the Government should be flexible about its approach to the budget, saying: "Authorities should let automatic stabilisers work in case of a sharper-than-expected cyclical weakening, even if this postpones the return to a budgetary surplus".

The report adds to the growing calls for a possible delay to surplus, including from senior Labor MP Joel Fitzgibbon.

If a new economic crisis were to break out, the OECD suggests the Government should be prepared to implement a new fiscal stimulus package, as it did during 2008-09.

Treasurer Wayne Swan says the report is another sign that Australia's economy has been well managed, and that the current policy mix is appropriate to sustain recovery.

"While we understand that not everyone is doing it easy, this OECD report today is another reminder that Australians have a lot to be proud of and confident about," he said in a statement.

Shadow treasurer Joe Hockey has today continued his attack on the Government's economic credentials, saying: "It's not in the Labor party's DNA to run a surplus, to live within their means, and to start paying down $251 billion of debt".

More HERE