Thursday, September 22, 2016

The Macro View – Health And Political News Relevant To E-Health And Health In General.

September 22 Edition.
Parliament has now risen and won’t be back for a good few weeks. (Back October 10, 2016).
Seems that last week was good for the Government with lots of Budget Savings passed and receiving Royal Assent and apparent resolution of a range of issues around Superannuation.
The big issue for this week will, for once not be focussed on just what a mess politics seems to have become but some relative co-operative success!
On the global stage things will be clearer by the time you read this.
Thursday Update:
With both Japan and the US continuing very loose policies our markets (and theirs) have done well so far this week!
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Here are a few other things I have noticed.
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Budget Issues.

  • September 11 2016 - 11:30PM

Scott Morrison says government, Labor inching towards deal on $6 billion savings

James Massola
The Coalition and Labor are inching towards a deal to pass the $6 billion so-called omnibus savings package, Treasurer Scott Morrison says.
Federal parliament resumes this week and debate will begin on the savings package, which contains 26 savings measures the government argues Labor indicated it would adopt during the election campaign.
Labor has partly disputed that claim, arguing its election policies did not explicitly commit to a $1 billion cut to the renewable energy agency ARENA, nor to a $1.3 billion cut to the clean energy supplement, originally linked to the axed carbon tax, which would actually deliver a cut in real terms to the incomes of Newstart recipients.
A rearguard action has been underway within Labor, publicly led by shadow cabinet minister Anthony Albanese and backed by welfare groups such as ACOSS, to oppose the cut to the supplement and, behind the scenes, the government and opposition have been negotiating over a way to find alternative savings.
Mr Morrison told Fairfax Media on Sunday that, since the bill had been introduced to the Parliament, discussions over a compromise deal had been "constructive".
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  • Sep 12 2016 at 11:45 PM
  • Updated Sep 13 2016 at 7:51 AM

Coalition compromises on dole cuts to win budget deal with ALP

The Coalition has scrapped plans to cut welfare payments by $1.3 billion as part of a deal with Labor to secure the passage of the omnibus budget bill and still deliver most – if not all – of the promised $6 billion in savings.
Following backroom talks led by Finance Minister Mathias Cormann and shadow treasurer Chris Bowen, sources said the government agreed to drop the largest of the 24 spending cuts in the bill – the removal of carbon tax compensation from the payments to future welfare recipients.
It is understood that the revenue will be recouped by cuts elsewhere in welfare. It is believed there will be a further paring back of the Family Tax Benefit end-of-year supplements which the government has wanted to abolish altogether since the 2014 budget. 
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  • September 13 2016 - 3:59PM

Credit rating downgrade would have 'very little to no' impact, says AOFM chief executive Rob Nicholl

Jessica Irvine
The man responsible for managing the nation's credit card says a credit rating downgrade would have "little to no" impact on the government's cost of borrowing or investors' willingness to lend.
The observation undermines some of the rhetoric about a "budget emergency", as the government and Labor commit to $6 billion in cuts to funding for students, families, and families.
And in an unprecedented move, the government's debt manager will issue the first 30-year Australian government bond next month.
Governments borrowing on 30-year terms is common overseas, but this is the first time an Australian government has ever sought to borrow for such a long time.
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ANALYSIS
  • September 14 2016 - 12:15AM

Malcolm Turnbull promised economic leadership. A year later we're still waiting

Peter Martin
Unveiling his surprise strike against Tony Abbott a year ago, Malcolm Turnbull identified just one reason for rolling a sitting prime minister: "economic leadership".
"It is not the fault of individual ministers," he told a packed press conference in a Parliament House courtyard. "Ultimately, the Prime Minister has not been capable of providing the economic leadership our nation needs.
"We need a style of leadership that explains complex issues, sets out the course of action we believe we should take, and makes a case for it. We need advocacy, not slogans. We need to respect the intelligence of the Australian people."
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  • Sep 13 2016 at 6:30 PM
  • Updated 45 mins ago

Budget deal to keep wolves from the door for now: Scott Morrison

A landmark deal between the government and Labor to deliver $6.3 billion in spending cuts would satisfy the credit agencies for now but much more was needed if the nation's AAA rating was to be preserved and the budget ever restored to balance, the federal government says.
Peak business groups welcomed the deal, which involved significant compromise from both sides, as a positive start to the new Parliament but also cautioned it was just a first step.
In a boost for the government and Malcolm Turnbull, who marks his first anniversary as leader on Wednesday, the Coalition secured support for the passage of the budget omnibus bill that originally contained 24 spending cuts worth $6 billion.
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Negotiations boost savings to fight Budget deficit

September 13, 20162:55pm

The government and Labor have agreed to a $6.3 billion cut in spending over four years

THE government and Labor have quietly and carefully agreed to a $6.3 billion cut in spending over four years, and produced a rare offer of cross-aisle congratulations.
At issue was the content of a $6 billion omnibus Bill Treasurer Scott Morrison said was needed to repair the Budget deficit, and which included measures the Opposition had proposed during the election.
The negotiations dropped some measures but provided alternatives, which boosted savings by $300 million.
One of the biggest single casualties in negotiations was the Baby Bonus, dumped to save $300 million even though it was a favourite of the National Party. Its removal was described by Labor as a government “capitulation”.
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Compromise on budget repair a welcome relief amid bickering

- on September 14, 2016, 11:52 am
Just when it appeared that the hotchpotch Federal Parliament delivered at the last election would never work together to produce anything of worth, a light has appeared on the horizon.
Yesterday, as bickering and division continued over the marginal issue of same-sex marriage, the major parties came forward with a compromise over the so-called Omnibus Bill to begin the process of budget repair.
WA Senator and Finance Minister Mathias Cormann and shadow treasurer Chris Bowen managed to negotiate an outcome to deliver $6.3 billion into the bottom line.
While Labor supported only 20 of the 24 measures in the Turnbull Government’s Omnibus plan, the total savings are in excess of what was originally outlined.
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Cuts in government spending alone can lower Australia’s deficit

  • The Australian
  • 12:00AM September 15, 2016

David Uren

Former treasurer Peter Costello proudly claims that of the 13 balanced budgets delivered in the past 40 years, he was responsible for 10. While the mining boom may have helped deliver some of them, it was not dreamt of when the first of Costello’s balanced budgets was achieved in 1997-98.
Costello noted, in a speech to the Minerals Council of Australia this week, that he was producing big budget surpluses in 2000, when the iron ore price was below $US13 a tonne. “We were in surplus at the low point of the mining cycle. It was at the height of the boom that we were running deficits,” he said, adding that the tragedy of Aus­tralia’s fiscal policy was that the Rudd government’s fiscal stimulus was overdone, then never withdrawn.
There is certainly a stark contrast between Costello’s 11 budgets and the nine that followed. Where Costello’s budgets delivered a combined surplus of just under $100 billion, the deficits from 2008-09 through to this year reach $355bn.
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  • September 15 2016 - 9:00AM

Government 'nudge unit' to attempt to change people's behaviours

Nick Miller
London: Psychological tricks used by governments to "nudge" how citizens behave may soon be applied to the contentious area of living wills and end-of-life decisions.
After early wins in areas such as persuading people to pay fines on time, or cut down on fizzy drinks, the so-called behavioural scientists are raising their sights, said Dr Rory Gallagher, head of the Behavioural Insights (BI) Team in Australia.
"We are now looking at corruption at an international level, we are dealing with issues like anti-microbial resistance … pretty complex topics," he said.
"So I would hope that in a couple of years' time we could start to get into things like end-of-life – very pressing issues, but very amenable hopefully to our methods."
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Turnbull says compromise to be expected

September 16, 20162:39pm
Paul Osborne, AAP Senior Political Writer Australian Associated Press
Malcolm Turnbull says voters outside the "political bubble" expect the government to make some compromises on its election promises to get them through parliament.
The prime minister on Friday hailed the passing of $11 billion in budget savings over four days of parliament sittings as evidence the coalition was delivering on its pledges.
Labor has criticised the government for making changes to what Mr Turnbull called "iron clad" policies, such as superannuation which was also earmarked for amendment this week.
Labor's vote was central to the parliament on Thursday night passing the $6.3 billion omnibus budget bill, which was also amended to win support, and the $4.6 billion hike in tobacco excise on Wednesday.
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COMMENT
  • September 17 2016

Is the power of king coal overstated?

Ross Gittins
If you want to shock and appal a politician, just suggest Australia join the United States and China in limiting the building of new coal mines.
Think of all the growth we'd be giving up, they protest. All the jobs that wouldn't be created. Some even argue we have a moral duty to sell more coal to the world. How else will the poor countries be able to develop their economies so they become as rich as we are?
Coal seam gas, fracking, extraction: here's what it all means.
Short answer: by relying more on other, less carbon-emitting forms of energy.
Surely the sooner we arrest global warming the better off we'll all be, rich and poor.
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Health Budget Issues.

Sweeping Medicare changes to curb rorts

  • 12:00AM September 12, 2016

Sean Parnell

The taskforce reviewing the $21 billion Medicare Benefits Schedule is finalising the most sweeping changes in more than a decade to crack down on rebate rorts and protect patients, including restricting GPs ordering powerful scans for back pain and reducing the ­number of colonoscopies and sleep tests.
The MBS Review Taskforce has called for feedback on a series of landmark recommendations from specialist clinical committees established to examine areas as diverse as diagnostic imaging and maternity care.
The new proposals include a requirement for mandatory health testing for pregnant women and new mothers, restrictions on GPs ordering expensive service such as low back scans, and a strict limit on surgeons ­ordering multiple MBS items for a single service.
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Focus MBS funds on right tests at right place and time

  • Bruce Robinson
  • The Australian
  • 12:00AM September 12, 2016
In April last year, the government commissioned a review of the 5700 items covered in the Medicare Benefits Schedule.
Clearly, the first comprehensive review in 30 years of all the health procedures, consultations and diagnostic tests subsidised under the MBS is long overdue.
The changes in the practice of medicine over the past three decades are enormous. The schedule, meanwhile, continues to fund procedures and tests now overtaken by better treatments and approaches to care. As it stands, it does not fully reflect the wealth of research evidence coming out of universities, hospitals and clinics that provides guidance to clinicians on the best practice of medicine.
The MBS taskforce has spent the 16 months since it was commissioned reviewing thousands of different medical tests, procedures and clinical consultations against the research evidence. At the front line of its robust methodology are expert committees, comprising clinicians and patient representatives working through lists of Medicare item numbers, considering whether each reflect the best clinical practice. One of the earliest problems identified are the inconsistent rules that determine access to services. Across all item numbers, the committees look to ensure that there is consistency and value delivered for every dollar spent.
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12 September 2016

Person-centred care vital to Health Care Homes

Authored by Leanne Wells
IT IS self-evident that we should build health services around the needs of the patient, isn’t it?
But this becomes all the more compelling when we consider the evidence: approaches to person-centred care such as shared decision making and self-management support can improve a range of factors in addition to patient satisfaction such as care quality and health outcomes. When person-centred care practices like these are adopted, people tend to choose less invasive and costly treatments because they have been informed and supported in their decision making.
We have seen our policy makers and health system drift towards a preoccupation with organisational efficiencies and budgets. These are important, but not as important as the needs of patients for individually-tailored attention. While Medicare is embedded in our health landscape and its current design effectively funds episodic care, relatively little attention has been given to how to better meet the needs of the more frequent users of the system: patients with chronic and complex conditions.
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  • September 13 2016 - 2:01PM

Australian Institute of Health and Welfare report card: seven ways to grade our health

Kate Aubusson
We're living longer than ever before and our death rates are falling, but the Australian Institute of Health and Welfare's national report card shows where we're still falling down. 
The Australia's Health biennial report released Tuesday "shows that Australia has much to be proud of in terms of health," AIHW director and chief executive Barry Sandison said.

An integrative approach to tackling diabetes

Mt Druitt Medical Centre is leading the way with an integrative approach to diabetes treatment and the results are proving positive.
A baby boy born between 2012 and 2014 can expect to live to 80.3 years old and a baby girl's life expectancy is 84.4, and our disease survival rates are rising. 
But how well did Australians score on our national report card?
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Ageing population pushes hospital visits higher

  • The Australian
  • 12:00AM September 14, 2016

Sean Parnell

Australians are more likely to be hospitalised now than 10 years ago and are also admitted more often, with private hospitals leading the growth, according to data from a federal health agency.
The Australian Institute of Health and Welfare yesterday provided a voluminous update of the nation’s health status, drawing together previously published information on specific conditions with new data on shifts in hospital service provision.
In 2013-14, when $155 billion was spent on health, $145bn of that was recurrent spending, predominantly hospitals (40 per cent) and primary healthcare (38 per cent). Governments, and their taxpayers, contributed $105bn overall.
Hospitalisations rose faster than population growth between 2003-04 and 2013-14 — the biggest increases were in age groups above 44 — although patients were more likely to be admitted and discharged on the same day.
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Labor 'playing politics with cancer': govt

September 13, 20167:09pm
Australian Associated Press
Labor has been accused of playing politics with cancer, potentially delaying the rollout of an improved cervical cancer test.
The federal government wanted legislation to establish a new national cancer screening register to pass parliament this week, in time for a new five-yearly cervical cancer test to be rolled out from May 2017, replacing the two-yearly pap smear.
But Labor and the Greens joined forces on Tuesday to send the bills to a Senate inquiry for further scrutiny, to report back on October 11.
Health Minister Sussan Ley launched a scathing attack, accusing the opposition of sending the bills into a vacuum.
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  • September 14 2016 - 7:37PM

'Worksharing' agreements with overseas authorities to mean faster approval for medicines

·         Harriet Alexander
Medicines that have been approved in the United States or Europe will be fast-tracked into the Australian market under new medicine regulations to be introduced by the federal government.
The move is estimated to reduce by 4½ months the amount of time that Australians wait for new medicines, and bring more medicines into the market.
Health Minister Sussan Ley on Thursday will release the government's response to a review of medicines and medical devices regulations, 15 months after it was submitted by independent expert Lloyd Sansom.
​ She said the government would adopt most of the recommendations, including greater use of comparable overseas regulators such as the US Food and Drug Administration and the European Medicines Agency. 
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The treatments for sleep disorders are improving

  • The Australian
  • 12:00AM September 16, 2016

Sean Parnell

Chris Hart was clutching at straws, figuratively and literally. On a work trip to Mount Isa, the Brisbane dentist was tired of feeling tired, of having his busy days sabotaged by nights with sleep apnoea.
As he drank more coffee in a city cafe, Hart fiddled around with drinking straws on the table, fashioning a rudimentary prototype of a device to help him breathe. That night, desperate for a decent sleep, he rigged up some dental tubes and glue in hope it would keep his airway clear during the night.
“And it worked,” Hart says of that unplanned experiment in 2012. “I then made one out of wax and tried that, but I chewed through it because it was soft. Then I had my lab assistant make one out of plastic, but it was time consuming and I thought we needed better.”
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Australian hospital parking fees are now costing some families more than their weekly rent

September 17, 20168:22pm

Hospital parking fee calamity

THE sickest patients and their families are paying over $100 million a year in hospital parking fees with some unable to afford to visit sick and dying relatives.
The fees, which can be charged more than once per day if families make more than a single visit to the hospital, are striking at the heart of Australia’s promise of a free public hospital system.
Some families have reported they are spending more on parking than they are on rent if they have a sick relative they need to visit every day.
The Consumer’s Health Forum chief Leanne Wells says exorbitant parking fees are “distressing” and an extra stress on families trying to care for sick loved ones.
A News Corp investigation has found the revenue raised from hospital parking fees in NSW has soared by 37 per cent to $38.7 million in the last three years, twelve times the rate of inflation over the same period.
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Superannuation Issues.

Government’s super, pension test changes will hit 70pc

  • Glena Korporaal
  • The Australian
  • 12:00AM September 13, 2016
Seventy per cent of Australians would be worse off from a combination of tighter pension assets test and superannuation tax changes coming into force next year, a government briefing paper circulated to backbenchers says.
The report, distributed by Scott Morrison to explain the federal government’s proposed super changes, shows people benefiting the most from the combined changes would be those on the lowest income levels.
The combined impact of the two changes means, however, that everyone earning above the bottom 30 per cent of incomes is worse off. The government’s superannuation proposals include retention of the Low Income Tax offset for people earning $37,000 and below, which was due to end in mid-2017.
Other changes are designed to hit higher income earners including capping the total amount that can be rolled into tax-free superannuation at $1.6 million, cutting the concessional and post-tax ceilings on super contributions, effectively wiping out the attractions of the current transition-to-retirement scheme and increased taxes on super contributions for people earning more than $250,000 a year.
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Super taxation as a cash grab won’t work

  • The Australian
  • 12:00AM September 13, 2016

Judith Sloan

Scott Morrison and Revenue and Financial Services Minister Kelly O’Dwyer may well regret ever hearing the word superannuation. Having experienced a rush of blood to their heads and working on the basis of misleading and deceptive advice given to them by activist bureaucrats, they now find themselves in a right royal pickle.
The ill-considered and over-engineered package of superannuation changes announced in the budget — out-Laboring Labor — has produced a monumental headache for the dynamic duo.
Their problems started from the decision to opt for the faulty definition of the purpose of superannuation offered in the Murray report into the financial system. (At a general level, it has to be said that the Murray report was much weaker on superannuation than on other aspects of the financial system.)
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COMMENT
  • September 14 2016 - 12:29AM

Super tax reforms will give Malcolm Turnbull boasting rights

Ross Gittins
Everyone wants to know what achievements Malcolm Turnbull can point to after his first year as Prime Minister. Well, I can think of something: his reform of the tax breaks on superannuation – provided he gets it through without major watering down.
Why is it such a big deal? Because it ticks so many boxes. Because it makes the taxation of super much less unfair.
Note, I didn't say much fairer. It will still be an arrangement that gives the least incentive to save to those who find saving hardest, and the greatest to those whose income so far exceeds their immediate needs that they'd save a lot of it anyway.
A report by John Daley and others at the Grattan Institute, A Better Super System: Assessing the 2016 tax reforms, independently confirms the government's claim that the changes will adversely affect only about the top 4 per cent of people in super schemes.
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COMMENT
  • September 15 2016 - 1:31PM

Scott Morrison's super cap change a cave-in to the wealthy

John Collett
You'd have to say Treasurer Scott Morrison's re-set of the cap on non-concessional superannuation contributions is a deft move.
It's a big cave-in to the wealthy dressed up as something less generous. The best tax shelter for the well-off this side of the Cayman Islands survives pretty much intact.

Government's super compromise

Treasurer Scott Morrison has announced changes to the Government's superannuation policy after much opposition to the original plan.
The change to the cap should see the government's entire superannuation package of reforms passed by parliament. So it looks as if we can be fairly certain that this will now be the rules under which super will work for many years to come.
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Morrison, O’Dwyer will keep messing with superannuation policy

  • The Australian
  • 12:00AM September 17, 2016

Judith Sloan

The biggest take-home message from this week’s superannuation changes by the government is that the Coalition can never be trusted on superannuation. Its leaders say one thing and do another, trying to out-Labor the ALP when it comes to imposing higher taxes on savers who are seeking to provide for their retirement.
And how should we interpret the government’s backflip on the crazy backdated lifetime post-tax super cap? During the election campaign, Malcolm Turnbull was adamant: “I’ve made it clear there will no changes to the (superannuation) policy. It’s set out in the budget and that is the government’s policy.” I guess that was then. What a complete fiasco the superannuation saga has been. Mind you, Scott Morrison and Revenue and Financial Services Minister Kelly O’Dwyer have only themselves to blame. They were hoodwinked by extraordinarily complex and misleading advice given by deeply conflicted bureaucrats. The only conclusion is that they are just not that smart.
How do I know this? Because Treasury has been trying to convince treasurers for years that these sorts of changes must be made to the tax concessions that apply to superannuation. Mind you, these concessions apply because superannuation is a long-term arrangement in which assets are locked away until preservation age is reached.
I look forward to comments on all this!
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David.

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