Thursday, July 21, 2016

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

July 21  Edition.
“This is being written over the weekend and to date we seem to know that Malcolm Turnbull will remain PM with a level of majority that is yet to be determined.” I wrote this a week ago and it is still true. Maybe next week the result in both the reps and Senate will be clear!
Thursday Update - still waiting for final seat and Senate results - but Government has been sworn in and Ms Ley back as Health etc. Minister.
Globally we seem to be going to hell in a hand basket! What a mess!
At a global level we have had all sorts of horror in France and Turkey and the financial world seems also to have a major issue lurking in Europe. See below:

Why Italy's banking crisis will shake the eurozone to its core

16 July 2016 • 4:41pm
They call them le sofferenze – the suffering. The imagery is striking, the thousands of sofferenze across Italy, unwanted and ignored, a problem unsolved.
But despite the emotional name, these are not people. They are loans. Bad debts, draining banks of profits and undermining economic growth.
The name is less clinical than the English term “non-performing loans”, a reflection of the Italian authorities’ emotional rather than business-like approach to the problem.
None the less, the loans are indeed causing real suffering. The €360bn (£300bn) of sofferenze from Italian banks show borrowers are weighed down with debts they cannot afford, while the banks are struggling to offer new credit to the households and firms that need them.
Here the most amazing thing is the AMA coming out suggesting a new Medicare Co-payment. No matter what is meant by his remarks the optics are awful and the reaction has been pretty loud.
See here:

Health groups slam AMA president over co-payment suggestion

Editor: Melissa Sweet Author: A coalition of health and social groups on: July 15, 2016
In a radio interview this morning, the new AMA president, Dr Michael Gannon, appeared to open the door to supporting further discussions about a GP co-payment, although he later issued this tweet.
Meanwhile, a coalition of health groups has put out this statement opposing the suggestion in the strongest possible terms. (It’s not a good look for the AMA.)
Today’s suggestion by the Australian Medical Association (AMA) that the Coalition’s abandoned general practice (GP) co-payments policy might be resurrected has been strongly condemned by the Australian Healthcare and Hospitals Association (AHHA), Public Health Association of Australia (PHAA), Consumers Health Forum of Australia (CHF), National Aboriginal Community Controlled Health Organisation (NACCHO) and Australian Council of Social Services (ACOSS).
Here is the report:
15 Jul 2016 - 7:16am

AMA boss suggests rethink of GP co-payment

AAP - 15 Jul 2016 - 7:16 AM 
The head of the Australian Medical Association has suggested a rethink of the federal government's deeply unpopular GP co-payment.
Michael Gannon says the problem with the co-payment - declared "dead, buried and cremated" by the government last year - was that it didn't give GPs the opportunity to make a judgment about which patients could afford it.
"I'm happy that anything can be on the table but we cannot have policy that doesn't protect the most vulnerable," he told ABC radio on Friday.
Here are a few other things I have noticed.

General Budget Issues.

  • Jul 10 2016 at 11:45 PM
  • Updated Jul 10 2016 at 11:45 PM

$100 billion of spending, taxing measures in hands of new Senate

There is scope for significant budget improvement – built around both the 2016 budget and so-called zombie measures from earlier budgets – despite the make up of the new Senate, according to a new analysis of party positions on crucial budget measures.
The analysis by the Australia Institute summarises the various outstanding budget measures that need Senate approval and notes that up to $100 billion of spending cuts and revenue measures over 10 years are up for negotiation in the new Senate with the most expensive measure overall being the Coalition's proposed company tax cut. 
Australia Institute executive director Ben Oquist argues there are potential budget improvements to be had both from the Senate passing, amending and blocking policy proposals in the wake of the election outcome.

Property prices forecast to fall as glut kicks in

  • The Australian
  • 12:00AM July 11, 2016

Samantha Hutchinson

A new wave of apartment development is combining with stalling population growth to create a glut in some pockets of the housing market.
Homeowners and property ­investors are facing steep falls in house prices and a weakening rental market as a new wave of apartment development combines with stalling population growth to create a glut in some areas.
In perhaps the bleakest assessment of the local housing market so far, BIS Shrapnel analysts have predicted median house price falls, an oversupply of apartments and serious vacancy issues which will bite all capital cities by June 2019.
Homes in Sydney, Melbourne and Adelaide are likely to sustain falls of 2 per cent in nominal terms, and steeper drops of 10 per cent in real terms — which takes inflation into account — as population growth plummets to 10-year lows and more than 220,000 new homes started this year ­approach completion.

Treasury has economic googly for Scott Morrison

  • The Australian
  • 12:00AM July 11, 2016

David Uren

Since his appointment as Treasurer in September, Scott Morrison has emphasised his focus on issues within his control.
Treasury’s brief for Scott Morrison will emphasise the importance of implementing savings measures in the May budget and pushing harder to break a deadlock over measures stalled in the Senate; it will also point to worrying signs in the global economy.
The International Monetary Fund’s global economic update in two weeks is expected to downgrade estimates of global growth to the weakest level since 2008-09 and will highlight the risks from both Britain’s decision to leave the EU and the slowing economies of China and the rest of Asia.
Mr Morrison would be expected to attend the G20 finance ministers and central bank governors’ meeting in Chengdu in China on July 23-24, having missed the last meeting in Washington in April.

Federal election 2016: Chris Bowen signals tough line on budget repair

  • The Australian
  • 7:56AM July 11, 2016

Jared Owens

Opposition treasury spokesman Chris Bowen has signalled a tough line to the government’s efforts to repair the budget, saying the Coalition should adopt Labor’s election policies if it wants to balance the nation’s books.
Mr Bowen also demanded Malcolm Turnbull make public whatever coalition agreement he strikes with Nationals leader Barnaby Joyce, so that Australians can see where the Prime Minister has decided to “sell out” Liberal positions.
Mr Joyce has made passing the effects test, which is aimed at preventing big businesses acting in a way that damages small businesses, a key priority of the next parliament as well as cracking down on $1 milk offers by major supermarkets.

The Coalition must switch to a budget for all Australians

Date July 13, 2016 - 12:00AM

Ross Gittins

The Sydney Morning Herald's Economics Editor

 Maybe those who complain about a boring election campaign are condemned to an exciting election finish. Many in the establishment – particularly the business establishment – have convinced themselves the country is off to hell in a handcart, but it doesn't have to be like that.
The nation won't be ungovernable provided Malcolm Turnbull is willing to negotiate with the minor parties when necessary – hardly a new experience for governments, which rarely have a majority in the Senate.
Surely Turnbull will use this opportunity to find Morrison "a job to which you're better suited". 
Nor does it follow that the government will be unable to hasten the budget's return to surplus.

How to fix the budget and the Parliamentary Budget Office so our leaders tell the truth

Date July 14, 2016 - 12:00AM

Peter Martin

Economics Editor, The Age

What if budgets, and candidates for office, told the truth?
Nick Xenophon and the rest of the Senate crossbench have been handed an unparalleled opportunity to remake the budget and political process while their bargaining power is at its peak.  
All it would need is a few simple changes to the law. Each is within reach. Nick Xenophon and the rest of the Senate crossbench have been handed an unparalleled opportunity to remake the budget and political process while their bargaining power is at its peak. Malcolm Turnbull probably wouldn't even mind. Like his predecessors, he would like things to work better, but left to himself he'll never get around to it.
Nick Xenophon and the rest of the Senate crossbench have the opportunity to make a big difference.

Moody’s warns on Coalition’s slim majority

  • The Australian
  • 11:49AM July 14, 2016

Michael Roddan

Moody’s has added to ratings agencies’ recent warnings on the nation’s credit outlook, saying Malcolm Turnbull’s mandate to govern has been weakened by the government’s slim majority in parliament.
“The latest results indicate that the Coalition of the Liberal and National parties will govern with a weaker mandate than it has had over the past three years,” Moody’s senior vice president Marie Diron said.
“A narrow win in the House of Representatives for the Coalition, combined with the likelihood of a more splintered outcome in the Senate, is credit negative for the sovereign because it will challenge the government’s ability to implement measures aimed at curbing the budget deficit,” she said.

Think twice before throwing open the government coffers

July 16 2016
Ross Gittins
Labor's Mediscare will have a benefit if it causes our politicians to think twice before they resort to "outsourcing" or "contracting out" the provision of government services, a practice that's led to a string of disasters.
The pretext for Labor's claim that the Coalition was planning to "privatise" Medicare was the Turnbull government's intention to save a little money by shifting the processing of Medicare's many bank transfers from its giant cheque-writing agency, the Department of Human Services, to a private provider.
We wouldn't even have noticed this back-office switch, but Malcolm Turnbull felt obliged to swear the proposal would be abandoned.
This probably means he'll also have to give up any thought of outsourcing all the many other, pension, allowance and benefit payments the department makes.

IMF boss Christine Lagarde calls turn away from globalisation world's top challenge

July 15 2016
·         Andrew Mayeda
The risk of countries turning their back on global co-operation is the biggest challenge facing the world, as low growth and rising inequality fuel the rise of populism, said IMF managing director Christine Lagarde.
"It did not take the Brexit vote to understand that low growth, rising inequality, and a lack of jobs have combined with social and geopolitical concerns to fuel the rise of populism and inward-looking forces," Ms Lagarde said in the text of a speech on Thursday at the Centre for Global Development in Washington.
"The greatest challenge we face today is the risk of the world turning its back on global co-operation - the cooperation which has served us all well."

Health Budget Issues.

Costly Coalition failure to heed health warnings

  • Michael Gannon
  • The Australian
  • 12:00AM July 11, 2016
Since election night, there has been much conjecture about the significance of health policy, and the use of a scare campaign in changing votes.
The Coalition has attacked Labor over its Mediscare campaign that deliberately painted a picture of a fully privatised Medicare. The Prime Minister subsequently called it an “extreme act of dishonesty”.
The AMA, too, is critical of the opposition’s Medicare privatisation claims. There is and was no move to privatise Medicare. All that was announced, and later withdrawn, was a plan to ask the Productivity Commission to look at outsourcing some backroom administration arrangements in the antiquated payments system, something the AMA would still welcome and support.
Nevertheless, the political reality is health played a major part in this election, and it was the Coalition that created and nurtured the fertile ground that allowed the scare campaign to grow and thrive.
  • Updated Jul 10 2016 at 9:39 PM

Election 2016: Both sides planning frontbench reshuffles

Prime Minister Malcolm Turnbull and Labor leader Bill Shorten are both planning to reshuffle their frontbench lineups ahead of the start of a new Parliament next month.
While Mr Shorten is planning to move people around to fill what he regards as gaps in Labor's performance, Mr Turnbull's hand has been forced by ministers losing their seats, the Nationals demanding as many as three more spots, pressure for conservatives to boost their representation, and speculation Health Minister Sussan Ley will be shifted.
Upon declaring victory on Sunday, Mr Turnbull acknowledged that he had said before the election there would be no changes to his frontbench if he won, given it had only been last settled in February. On Sunday, the Prime Minister said there would have to be "some changes" but they would not be "large scale".

Cost of visiting a GP may overload public hospitals

Date July 10, 2016 - 11:45PM

Anna Sublet

In the days straight after the federal election, I stood in a doctor's waiting room, with a sad, soon-to-be panicked child. As I looked around the reception area for notices regarding bulk billing eligibility and restrictions, I had the strange realisation that this small regional medical centre did not bulk bill.
The election had brought Medicare into sharp focus, and here we were, city dwellers, usually with a choice of medical services at our doorstep, at a small-town GP, shelling out $80 for a consult.
Money wasn't the main focus for me, luckily, but I was aware, in this post-election mess, that for many, such a trip to the doctor for a kid's school holiday injury could break the weekly budget. After the GP, there was the X-ray in a neighbouring town ($90), a return to the GP, and the instruction to "go to the hospital". Yes, there was a fracture. It might need surgery, she said, maybe inserting a wire.

Coalition returned, but what next for Ley, copayments?

With the Coalition returned in the narrowest of victories – at the time of writing, it had gained the 76 House of Representatives seats it needed to form Government – attention is now turning to who will be the Health Minister.

In May, Health Minister Sussan Ley told the ABC’s Fran Kelly on RN Breakfast that should the Coalition be returned to Government, the increased prescription co-payment and increased safety net would still be on the table.
“The measure is on the table and the reason why is that we are taking a responsible path back to a surplus,” the Minister said at the time.
“I had negotiations with my colleagues when the measure was in the Senate across the Independents, around where we might position additional payments and Safety Nets, that’s small, modest additional payments.”

Govt talks up Medicare record, but remains cautious

11 July 2016
THE coalition is determined to prove its commitment to Medicare but cautions any extra spending must come from cuts elsewhere.
The government will spend the next three years proving to Australians again that "the coalition is the best friend Medicare ever had", Cabinet Secretary Arthur Sinodinos told ABC TV on Sunday.
He acknowledged Labor's election campaign scare over privatising the service was "scratching away at an itch that people had about Medicare and our attitude to Medicare".
But Senator Sinodinos said whatever the cabinet decided to do about Medicare had to be looked at in terms of the overall budget because there's no blank cheque.

Coalition MPs seek to firm up policy on Medicare

  • The Australian
  • 12:00AM July 12, 2016

Joe Kelly

Coalition MPs are canvassing possible changes to health policy that will reaffirm the government’s commitment to Medicare while also pressing home the need for savings to ensure the system remains sustainable.
While some have questioned whether Health Minister Sussan Ley was absent in countering Labor warnings that a returned Turnbull government would privatise Medicare, others came to her defence yesterday.
The Australian understands that Ms Ley was ready to fight the Labor “Mediscare” tactic during the election period and had made clear her expectation before the May budget that Bill Shorten would seek to campaign on health leading into polling day.
West Australian Liberal senator Chris Back yesterday said Ms Ley had performed well and suggested she should negotiate with the Australian Medical Association to find agreed areas where savings could be found.

Most Australians pay too much for health care - here's what can be done

13 July 2016
HEALTH policy was an important factor in the election outcome, but one of the most important issues in the health sector – out-of-pocket costs – was mostly ignored.
Labor made health policy a battleground at this election, claiming the poll was a “referendum on Medicare”. The ALP tried to whip up alarm by highlighting the risks of “privatisation”, bringing out former prime minister Bob Hawke as part of its campaign.
The Coalition naturally tried to keep health off the front page, even avoiding the normal National Press Club debate between the health minister and her shadow.
In health policy, as elsewhere, the second Turnbull government’s wafer-thin majority constrains what is possible. Some changes can be implemented administratively or with immediate bipartisan support. Some will only occur if the government takes the time and political capital to build public support for the proposal. Other changes should simply be ditched.
13 July, 2016

Health funding: something else for PM to worry about

Posted by The Conversation
In turning its attention to health policy, it appears the Turnbull government has learnt from its near-death experience.
It now must reconcile the political sensitivity of Medicare and the need for fiscal discipline.
Turnbull could draw on the Menzies strategy of appropriating the best parts of Labor’s proposals. For example, a higher Medicare levy, as Victorian Premier Daniel Andrews proposed last year, could raise funds for health care. Long-term issues of equity and efficiency could be handled through a standing health care reform commission, as Labor proposed in the election campaign.
  • Updated Jul 13 2016 at 6:21 PM

Dispute over aged care cuts

The peak body for older Australians is demanding the government reveal the modelling that underpinned its surprise decision to cut $1.6 billion from residential aged care. 
What is known as the aged care funding instrument is being altered to save $1.2 billion over four years.
The cut in the May budget comes on top of $472 million in cuts to the sector announced in late 2015.
The measures are key elements of the government's budget repair plan. 
The perception is that providers are stretching the truth when assessing the needs of residents to attract more money. 

Dear PM, You have a health problem. Let us help…

Editor: Melissa Sweet Author: Melissa Sweet on: July 15, 2016
Dear Prime Minister
Clearly you are in some serious need of life-saving health advice. As you have yourself admitted, the Coalition has to “do more to reaffirm the faith of the Australian people in our commitment to health and to Medicare”.
Croakey to the rescue. We offer three ideas to help re-make you as a visionary leader for health.

1. Establish a new over-arching portfolio: The Ministry for Health in all Policies

This is a really tough gig, as the Minister will be charged with working across all portfolios to assess the impact of all policies upon the population’s health, and particularly upon health inequities.

Health Insurance Issues.

Time to review the $6 billion private health insurance subsidy, academic says

Date July 11, 2016 - 12:00AM

David Ellery

Reporter for The Canberra Times.

Cutting the private health insurance subsidy, increasing the Medicare levy and tackling the overuse of pathology and diagnostic imaging services are just some of the ways to tackle rising medical costs, the University of Canberra's Professor Laurie Brown has said.
Professor Brown, who said the Turnbull Government should drop the freeze on indexing the Medicare rebate for doctors if it is returned, told Fairfax many critics thought the $6 billion per annum private health insurance subsidy was poor value for money.
The Greens called for the subsidy to be abolished earlier this year, saying up $10 billion could be saved over the next four years.
A 2014 Grattan institute report put the savings at $3 billion a year at a time when the subsidy was costing about $5.5 billion a year.

Superannuation Issues.

Federal election 2016: Victory for Turnbull, now for the super battle

  • The Australian
  • 12:00AM July 11, 2016

Sid Maher

Sarah Martin

We have resolved this election: Turnbull

Malcolm Turnbull faces party pressure to review controversial superannuation changes amid fresh Treasury warnings about the need for budget savings after yesterday claiming election victory with an expected wafer-thin ­majority.
After eight days of counting put the Prime Minister on the verge of a majority, Bill Shorten yesterday telephoned Mr Turnbull to concede defeat in one of the closest elections in the nation’s history, following a marathon campaign.
With the Coalition holding leads in the Queensland seats of Capricornia and Flynn, and postal votes trending towards the government, Mr Turnbull is on track to hold at least a bare majority of 76 seats in the 150-seat parliament. His grip on power could be ­extended if trends continue and the Coalition overhauls Labor in the Townsville seat of Herbert.

Superannuation: Coalition’s changes undo the trust

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

Glenda Korporaal

Chances are the Turnbull government will get most of its May budget proposed changes to super implemented.
Its problem has never been support from the Labor Opposition, which would never have dared to propose such drastic changes to the system itself, and is more than happy to see the government continue to support its own low income super tax offset.
The real problem has always been with the Liberals’ own constituency which is the one hit hardest by the proposed changes.
It does seem that the Coalition leaders, particularly Malcolm Turnbull and Scott Morrison, will press to keep as much of the budget super package as possible — mainly from a revenue point of view.

Federal election 2016: PM stares down revolt on super reforms

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

David Crowe

Prime Minister Malcolm Turnbull is under pressure to modify the government’s reforms to superannuation.
Malcolm Turnbull is staring down backbench demands for drastic changes to the government’s tax hike on superannuation, launching phone briefings with colleagues to defend the $6 billion package and insist on the need to legislate the changes as soon as possible.
The Prime Minister is holding the line against growing pressure from Coalition MPs to scale back the reforms and remove a “retrospective” cap on lifetime super contributions, amid a damaging blame game over how the issue hurt the government’s election campaign.
Angry MPs are determined to press for changes at a partyroom meeting on Monday in the first major test of Mr Turnbull’s authority after the election came dangerously close to forcing him from power.
Mr Turnbull’s allies are insisting the super tax reforms should go ahead without dramatic change on the grounds they were outlined in the May 3 budget and subjected to weeks of election ­debate, giving the government a mandate to enact them.

Federal election 2016: Turnbull should cop it on the chin

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

Judith Sloan

It’s hardly surprising that Bill Shorten has agreed to pass most of the government’s budget changes to superannuation, subject to an independent review that assesses whether some of them are retrospective.
I have sitting on my desk an opinion — well, it’s actually ­gobbledygook — of a QC commissioned by Assistant Treasurer Kelly O’Dwyer concluding that none of the changes — even the backdated lifetime cap on non-concessional contributions — is retrospective.
Pull the other one, I say. Even Scott Morrison is aware of the duck rule: looks like a duck, quacks like a duck, is a duck. Earlier this year he described Labor’s proposal to impose a 15 per cent tax on superannuation pension earnings above $75,000 a year as retrospective.

ASFA’s Pauline Vamos urges 10-year freeze on super meddling

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

Glenda Korporaal

Pauline Vamos, the chief executive of the Association of Superannuation Funds of Australia, has called on the government to “promise in blood” it will freeze changes to superannuation for 10 years after it implements its current proposals.
She said a bipartisan agreement not to touch superannuation for a decade, after the proposals were put through the new parliament, was needed to restore confidence in the system.
“The government should say, ‘This is why we are making the changes’, and then promise in blood that they are not going to change things for 10 years,” she said in an interview with The Australian ahead of her departure this week from the job she has held for the past nine years.

Treasurer Scott Morrison to avert party revolt by offering costly exemptions

Samantha Maiden, National political editor, The Sunday Telegraph
July 17, 2016 5:00am
TREASURER Scott Morrison is preparing a super backdown that will offer big exemptions to a $500,000 lifetime cap to allow divorced couples, farming families and people who inherit from deceased estates to stash more cash.
The big exemptions under consideration to avert a Liberal Party revolt will allow the Treasurer to save face because the $500,000 cap on non-concessional contributions that was taken to the election will remain in place.
However, the exemptions will be so big that anywhere from half to 90 per cent of the $550 million in savings will be wiped out.
For example, women who get divorced would be able to breach the $500,000 lifetime cap if they put their divorce payout into super, relatives who inherit from a deceased estate may also be able to breach the lifetime cap. Another example might be the sale of farming assets.
I look forward to comments on all this!

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