Thursday, August 31, 2017

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

August 31st, 2017 Edition.
On the overseas front we now see President Trump seems losing staff right left and centre and doubling down with his alt-right neo-Nazi rhetoric. North Korea seems to be launching missiles and a huge hurricane seems to erasing most of coastal Texas is I type. This hurricane will be a real test of his leadership. Bush the younger never recovered after Katrina….
One gets the feeling all this this may not end as well, with the disaster not being well handled. There is great division in the US and it seems risks for social unrest on a large scale are rising. It is very sad to see all this happening.
My prayers are with those is the path of this monster.
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In Australia Labor continues to extend its lead in the polls. Equally letting same sex couples marry is causing havoc in the Coalition to the extent we are now having a postal plebiscite – subject to the High Court agreeing.  Additionally the queue for a High Court  determination of valid election continues to grow! Energy policy, tax policy and a few others are also seemingly up in the air. It is really hopeless how dysfunctional our politics it has come – pretty awful…..
Sorry I am becoming a bit like a cracked record – but we really need a circuit breaker big time and I am not seeing one on the horizon.
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Here are a few other things I have noticed.
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National Budget Issues.

Electricity, health and food the top worries in Choice Consumer Pulse survey

Lucy Cormack
Published: August 21 2017 - 8:49AM
Health expenses, electricity and groceries are the top three issues worrying more than half of all Australian consumers.
Add to that; fuel, car insurance, mortgage or rent, gas, home insurance and water, and the nation is pretty much worried about everything.
The top strains are revealed in Choice's latest quarterly Consumer Pulse Survey, which also found concerns about interest rates and superannuation consumed 56 per cent of Australians.
"I think cost of living concerns for consumers across the board are very high and we are in an environment now where wages are very flat," said Choice spokesman Tom Godfrey.
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Hope yet for economy despite dark days

Jessica Irvine
Published: August 21 2017 - 12:24AM
There can be no question these are challenging times.
Abroad, the scourge of terror leaves lash marks across our most loved global cities, while, in the words of The Economist magazine, a "politically inept, morally barren and temperamentally unfit" man rules the free world.
At home, the almost comedic dysfunction of our surprisingly multicultural Parliament last week overshadowed the more serious news that Australian living standards have stopped rising.
Pay packets grew just 1.9 per cent last financial year – gobbled up entirely by the 1.9 per cent rise in consumer prices.
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Bill Shorten is only the lesser of two evils

Tony Walker
Published: August 19 2017 - 11:45PM
Here's a question in light of the near disintegration of the parliamentary process in the past week: what do the late Gough Whitlam, Bob Hawke, Paul Keating, John Howard, and Jeff Kennett have in common?
All were prepared to lead, for better, or worse, and generally better, although all, with the possible exception of Hawke, overreached in the end – and paid the price.
Here's another question: what distinguishes Kevin Rudd, Julia Gillard, and Tony Abbott?
All, to an extent and for varying reasons, failed the leadership test if the yardstick is winning and sustaining the confidence of the electorate, maintaining internal discipline and advancing policy.
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‘Perfect storm of issues’ leaving Aussies on verge of mortgage crisis

Jennifer Duke
Expensive property markets, soaring levels of household debt and predatory lending practices have come under fire with experts warning thousands of households are on the verge of mortgage stress.
Australia now has the second highest housing debt in the world, after Switzerland, and almost twice that of the US – leaving the housing market ripe for a crash that “could be as bad as Ireland or the US”, Digital Finance Analytics’ Martin North said on Monday evening on the ABC’s Four Corners.
“I’ve been studying the market here for a good number of years and I have never seen this perfect storm of issues coming together,” he said, referring to a combination of record high house prices and larger mortgages.
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CBA failure only the tip of a much bigger problem

Michael Pascoe
Published: August 19 2017 - 11:54AM
Something rather important has been missed amid the outrage and sensationalism over the Commonwealth Bank money laundering scandal: as the system stands, successful money laundering and terrorism funding is inevitable.
The fever-pitch of hysteria was reached by The Australian newspaper's Bob Gottliebsen writing "the fate of the Australian sharemarket" rests on the shoulders of the CBA chairman, that if the CBA makes statements later proved to be false "then there is grave risk that the fines could wipe out the shareholders' funds of Australia's largest company" and the bank would return to government ownership. 
And a North Korean nuke could land on Martin Place tomorrow. Or perhaps not.
While scorn has poured down on the latest CBA failure, the focus has been on a relative skirmish and ignored the insight it provides into the war. The reality is that regulators are relying on banks with disparate systems to do their legwork while forever playing catch-up with the more organised criminals.
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CBA facing potential class action over disclosure of laundering allegations

Clancy Yeates
Published: August 23 2017 - 10:16AM
The Commonwealth Bank faces a potential investor class action over its disclosure of more than 53,000 alleged breaches of anti-money laundering laws, following a sharp fall in its share price when the scandal emerged earlier this month.
Plaintiff law firm Maurice Blackburn and litigation funder IMF Bentham on Tuesday said it would investigate a potential class action on behalf of CBA shareholders, citing the hit to the bank's share price. Maurice Blackburn said it was "astounding" the bank did not tell investors about the alleged breaches earlier.
The law firm said it could be the largest shareholder class action in Australian history.
The action is focused on how the bank disclosed allegations that it failed to properly report or monitor suspicious transactions, and that its ATMs were used by criminal gangs to wash millions of dollars. 
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Revealed: the minimum income for a healthy life and how the dole falls way short

Ross Gittins
Published: August 22 2017 - 11:26PM
Speaking of the cost of living, how much do you need to live on? Surveys show most people's answer is: just a bit more than I'm getting at present. Trouble is, they keep saying that no matter how much their income rises.
One way to convince yourself you're not doing all that well is to compare what you earn with people of your acquaintance who're earning a lot more than you.
A better assessment would be to compare your finances with those of people a lot closer to the bottom – if only you knew any.
Not to worry. On Wednesday, Professor Peter Saunders and Megan Bedford, of the Social Policy Research Centre at the University of NSW, will publish new "budget standards" for low-paid and unemployed Australians.
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Our obsession with tax deductions is peculiarly Australian ... and pointless

Peter Martin
Published: August 23 2017 - 11:45PM
Spare a thought this tax time for the pledge that was going to end the anguish. In 2010, still clutching his freshly printed copy of the Henry Tax Review, treasurer Wayne Swan promised to "remove the hassle of shoeboxes full of receipts".
From 2012 onwards everyone would get a standard deduction of $500 in lieu of claiming work-related and tax-preparation expenses. It would climb to $1000 from 2013.
Anyone who thought they could get more (and could be bothered) could keep receipts. The rest of us could tick, flick and get on with our lives.
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  • Aug 25 2017 at 5:32 PM
  • Updated Aug 25 2017 at 6:06 PM

A profit warning for everyone

by The Australian Financial Review
It's been a reporting season that has flattered to deceive. More companies than a year ago have reported higher profits. Almost 70 per cent of them have lifted dividends. But discount the stellar performance of rebounding miners, and most of the increases in profit were modest. Worryingly, the number of surprises on the upside were the lowest since 2012, while outlook guidance for the coming year was too frequently soft. The results have jarred with the upbeat business conditions surveys in the months before the reporting season, and they can only add to worries about growth, and the policy paralysis in Canberra.
The miners won out as their massive economies of scale and deep cost cutting have allowed them to leverage elevated post-boom iron ore export volumes to the surprise rebound of commodity prices. BHP quintupled its underlying profit and is set to shower investors with $US7 billion in cash next year. But in the punishment and accountability theme of the season, BHP surrendered to US shareholder activist pressure to sell its poorly performing American shale oil business. And local shareholder activists forced out newish BHP board member and Business Council of Australia president Grant King because of the massive writedowns on Mr King's LNG investments while running Origin Energy (due in part, like BHP's shale writedowns, to the Saudis allowing oil prices collapse in 2014).
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A super fail: 80pc retire on pension benefits

  • The Australian
  • 12:00AM August 26, 2017

David Uren

Despite 25 years of compulsory superannuation, about 80 per cent of people still retire on to at least a part Age Pension or benefits and half of all singles are retiring with total assets of less than $100,000.
Research obtained by The Weekend Australian reveals half of all couples retire on to a part-pension holding investment ­assets, excluding their home, of $500,000 or more.
One in five retirees receiving the Age Pension or other welfare benefits also access their super­annuation pension, while a similar number retain an investment property.
The analysis of Department of Social Services welfare appli­cations emerged as Revenue and ­Financial Services Minister Kelly O’Dwyer vowed that the Turnbull government would not make any further changes to superannuation taxation. The pledge followed the controversial move to put caps on contributions for high-income earners, which took effect on July 1.
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No more super tax changes, Libs vow

  • The Australian
  • 12:00AM August 26, 2017

Glenda Korporaal

The federal government would not be making any more changes to the tax treatment of superannuation, the federal Minister for Financial Services, Kelly O’Dwyer, said yesterday.
“The Coalition has done the job that we needed to do on the taxation of superannuation,” she said at a speech to the Tax Institute in Sydney. “The job has been finished and legislated.
“We have no further plans.”
The undertaking paves the way for super to become an issue in the next federal election, with O’Dwyer arguing that the government’s opponents will be the ones promising higher taxes on super.
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Treasurer, you're relieved until I fix this mess

Scott Phillips
Published: August 26 2017 - 5:04PM
Treasurer, I have some bad news. You've done a decent job, just like the last dozen treasurers before you.
Decent, but that's about it. Oh sure, you've all worked hard. You've handed down budgets, lectured us about jobs and GDP, and one or two of you have enjoyed a cigar from time to time - in your own time, of course.
But, frankly, where it mattered, you've all squibbed it. Some of you deserve the brickbats … you were ideologically blinkered. Others were too unwilling or unable to make the right changes because, well, your colleagues weren't prepared to risk re-election for something so difficult as - How do I put this? - doing the right thing.
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Health Budget Issues.

  • Updated Aug 20 2017 at 11:00 PM

Private health insurance premiums must rise 6pc to cope with margin pressures

Australia's largest private health insurers will be forced to raise premiums by 6 per cent in order to cope with the dual hit of fewer Australians taking out cover for the first time in 10 years and growing numbers of desirable low-claiming young people refusing to take out insurance at all.
Ahead of NIB and Medibank Private's results announcements this week, analysts warned that membership bleed would have direct implications for the sector's revenue growth.
"Our analysis of private health insurance data quantifies less obvious emerging inflationary pressures. These are age-based penetration mix changes and fewer lifetime health cover members as two less well-understood headwinds. These have accelerated over the past year," said UBS analyst James Coghill.
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Private health insurance 'junk' policies ripping Australians off, AMA says

Australian doctors have declared private medicine is "under siege", and are pushing the Federal Government to make "junk" healthcare policies illegal.
The Australian Medical Association (AMA) believes the policies, which do not cover treatment for many illnesses, are ripping people off.
AMA president Michael Gannon called for the law to be changed to ensure all policies contain a minimum level of cover.
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Twists and turns along the road to aged care reform: Legislated Review

Australia August 9 2017
In brief
Aged care reforms in Australia are directed at achieving over 10 years a market based, consumer driven and sustainable aged care system with equity of access based on assessed need. The Aged Care (Living Longer Living Better) Act 2013 (Act) provides for certain initial reforms to aged care from August 2013 to July 2014 with a review of the effectiveness of these reforms to be undertaken as soon as practical after 1 August 2013. To this end the Commonwealth undertook a consultation process during the period October to December 2016 (Review). A large number of submissions were made to the Review. We are particularly interested in home care and have considered a sample of the submissions to the Review representing the experience in relation to home care of care providers, care recipients and peak bodies of both. In this note we have focused on two policy settings in relation to home care: meeting unmet demand for home care and access to home care, and addressed two principal themes we see as emerging from the submissions as follows:
·         the unintended and distortionary impacts of some reforms, in particular fee arrangements and means testing;
·         challenges to the equitable allocation of scarce resources in the naturally imperfect market for aged care, in particular, the changing profile of care needs, the true costs of care, sustainable funding and access to information sufficient for choice.
Review process Submissions were sought in relation to the effectiveness of aged care reform by reference to a number of specific matters reflecting the policy settings of the legislation including the meeting of unmet demand, the balance between supply and demand drivers, means testing and alignment of charges, equity of access to care, facilitation of access to care and workforce strategies. The Review has received 145 written submissions. A report is scheduled to be tabled in Parliament in the middle of August 2017.
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Bulk billing hits record high

Updated: 12:10 pm, Monday, 21 August 2017
The number of Australians using bulk billing has reached a record high as the number of overall doctor visits hits a new peak.
GP visits rose by more than three million last year, as Australians use bulk billing GPs to avoid paying to see a doctor.
Medicare data shows bulk billing numbers increased by 0.6 per cent to 85.7 per cent.
The cost of Medicare benefits also soared by four per cent, to $22 billion.
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Turnbull struggles to deal with funding the nation’s soaring health care demands

  • The Australian
  • 11:51AM August 21, 2017

Sean Parnell

The Turnbull government will almost reach its cap on hospital funding in the first year of its latest agreement with the states, in another sign that rising health costs remain a political problem.
Before the last federal election, Prime Minister Malcolm Turnbull struck a deal with the states that the Commonwealth would fund 45 per cent of the growth in activity-based funding, capped at 6.5 per cent nationally each year.
The deal was only finalised in recent months and covers the period from last month to June 2020. The next hospital funding agreement — which normally covers five years but which Health Minister Greg Hunt has suggested could run for a decade — will be finalised in 2018.
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Medicare freeze ‘hits patients with rising scan costs’

  • The Australian
  • 12:00AM August 22, 2017

Sean Parnell

Patients face rising out-of-pocket costs and longer waiting times for scans due to significant financial and regulatory pressures on diagnostic imaging, according to an independent evaluation commissioned by the Turnbull government.
A draft report from the Deloittes Access Economics evaluation, dated April and obtained by The Australian under freedom-of-information laws, highlights widespread concerns over the impact of a Medicare freeze imposed more than a decade ago.
Medical practices told the evaluation that low Medicare rebates not only led to rising out-of-pocket expenses but threatened their commercial viability.
“There was a widespread concern that significant withdrawal of service provision by commercial providers could be the eventual outcome if non-indexation continues, which would have adverse consequences for patients and the Australian health system,” the report states.
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Health chief Martin Bowles quits amid ‘tensions’ with Greg Hunt

·         The Australian
·         4:42PM August 22, 2017

 Sean Parnell

Senior bureaucrat Martin Bowles has resigned, leaving the Turnbull government to find someone else to head the politically sensitive Department of Health.
After rumours of tensions between the department secretary and Health Minister Greg Hunt, Malcolm Turnbull yesterday ­issued a statement to announce Mr Bowles would be leaving his post on September 1.
Mr Bowles tendered his resignation on Monday after three years heading the Department of Health, under Peter Dutton, Sussan Ley and, most recently, Mr Hunt. His departure comes at a difficult time for the government, which has embarked on complex health insurance reform talks, ongoing efforts to make Medicare more sustainable, and vexed public hospital funding negotiations with the states.
Mr Bowles is the seventh department chief to quit since the start of last year, following Gordon de Brouwer (Environment), Dennis Richardson (Defence), Jane Halton (Finance), Peter Varghese (Foreign Affairs and Trade), Michael Thawley (Prime Minister & Cabinet) and Drew Clarke (Communications), who moved to Mr Turnbull’s office as chief of staff.
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  • Updated Aug 23 2017 at 11:00 PM

Debate: Are doctors or insurers to blame for health insurance price hikes?

by Michael Gannon v Terry Barnes

PUTTING VALUE INTO PRIVATE HEALTH

The peak body for the private health insurance industry, Private Healthcare Australia (PHA), has been warning that private health insurance is heading towards being unaffordable for many Australians. It says as many as one in five policy holders might leave the insurance pool in five to six years.
PHA says one big concern is out of pocket costs and specialist gaps – the difference between what a procedure costs and what Medicare or an insurer pays. This claim is both misleading and mischievous. Increases in out of pocket costs cannot and should not be blamed on doctors and other health professionals in the system.
The government and some private health insurers have not indexed benefits to match the increase in costs of providing a service for several years.
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Getting Rid of Junk Health Insurance Policies Is Just Tinkering At The Margins

Author

Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney
In media interviews and his speech at the National Press Club this week, the Australian Medical Association (AMA) president, Michael Gannon, has spoken out against “junk” health-insurance policies. He said these are “worth nothing more than the paper they’re written on”, and is pushing the federal government to streamline policies so people know what they are buying.
Organisations like Choice have detailed the type of private hospital policies that are bad value for consumers. Many of these “junk policies” exclude common procedures such as hip and knee replacements, provide little or no choice about which providers can be used, and effectively mean people must access care in public hospitals. So they do nothing to relieve pressures on the public sector.
The AMA and others are pushing for simplified insurance packages, with products classified as gold, silver and bronze, depending on benefits covered and cost. These would provide clarity on what procedures are included or excluded in the cover, and the level of excess you would pay.
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Medibank lifts profit, warns of further headwinds

  • The Australian
  • 9:14AM August 25, 2017

Sarah-Jane Tasker

Health insurance giant Medibank has warned tough conditions are set to continue in the sector as it books a lift in annual profit and cuts customer complaints.
The Australian-listed insurer (MPL) today reported a 7.6 per cent lift in net profit after tax to $449.5 million, which the company said was due primarily to net investment income increasing by $80m, which offset a lower operating profit for its health insurance business.
The results showed that health insurance operating profit decreased to $497.5m, from $510.7m, which Medibank said reflected higher management expenses from investments in customer focused initiatives and a new IT system.
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Medibank talks tough in costs battle with Australian Medical Association

Sarah Danckert
Published: August 26 2017 - 12:15AM
Medibank Private says the health system is at risk if doctors won't agree to disclose how much they charge for procedures.
Medibank's push for greater transparency came as it unveiled a 7.6 per cent lift in net profit to $449.5 million and spruiked much-improved customer satisfaction and disputes data.
The result pushed Medibank's shares up 6.7 per cent to $2.87 on Friday.
The company is readying for a fight with the Australian Medical Association, which is resisting the changes that would give consumers greater insight into how much a procedure will cost when it is conducted by certain specialist.
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International Issues.

China's global ambitions: are there lessons to be learnt from Tibet?

Peter Hartcher
Published: August 22 2017 - 12:05AM
The man who replaced the Dalai Lama as the head of Tibet's government-in-exile has brought a troubling message to Australia. The Chinese military forcibly annexed Tibet in the 1950s, sending the Dalai Lama into hasty exile in India. The Dalai Lama retains his role as spiritual leader. But the Tibetan diaspora elected Lobsang Sangay as their political leader six years ago. He spoke at the National Press Club in Canberra earlier this month. The Harvard-educated lawyer's message to Australia: "It happened to Tibet - you could be next."
This is a disturbing idea, but surely a fanciful one? As president of the Tibetan government-in-exile, Sangay's main agenda is to stir international empathy for Tibet. Encouraging us to identify with Tibet, putting us in Tibet's shoes, is surely a clever technique for achieving his aim.
Does have anything to support his assertion? His case: "If you understand the Tibetan story, the Chinese government [before the military takeover] started building a road – our first ever highway in Tibet.
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Trust deficit undermines Donald Trump's Afghanistan speech

Nick O'Malley
Published: August 22 2017 - 2:22PM
There were two remarkable things about Donald Trump's speech on Afghanistan. One was that after years of advocating that the war effort be abandoned, he had come to the conclusion that instead America's military presence needed to be expanded and deadlines for departure scrapped.
You could call this the victory of the generals over Trump's ousted chief strategist, Stephen Bannon.
The second was that he devoted so much time at the start of the speech to preaching about national unity.
"By following the heroic example of those who fought to preserve our republic, we can find the inspiration our country needs to unify, to heal and to remain one nation under God," he said. "The men and women of our military operate as one team, with one shared mission and one shared sense of purpose.'
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With Bannon back in charge, Breitbart unleashes fury at Trump for Afghanistan speech

Callum Borchers
Published: August 23 2017 - 9:44AM
It's officially on. Breitbart News, with former White House chief strategist Stephen Bannon back in charge, is ripping mad at US President Donald Trump after Monday's Afghanistan speech foreshadowed an increase in ground troops.
The homepage of the website that cheered Trump to victory had five incredibly critical headlines. The accompanying articles might be even tougher. Here are key excerpts from the stories:
Article 1: "The speech was a disappointment to many who had supported his calls during the campaign to end expensive foreign intervention and nation-building."
Article 2: "Using many of the same vague promises that previous presidents had used, including a repeat of [former US president Barack] Obama's promise not to give a 'blank check' to Afghanistan and a pledge to finally get tough on Pakistan, it was a far cry from the 'America First' foreign policy he laid out in the months before Election Day."
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Rex Tillerson says Pakistan must help get Taliban to peace table

Nick Wadhams
Published: August 23 2017 - 9:49AM
Washington: US Secretary of State Rex Tillerson said Pakistan must adopt a "different approach" to ending the 16-year Afghanistan conflict and play a central role in getting the Taliban to the negotiating table instead of supporting the group or harbouring terrorists.
Speaking to reporters a day after President Donald Trump addressed the war in a nationally televised speech, Tillerson filled out details of the diplomatic effort that will accompany the administration's move to grant more authority to military leaders on the ground and boost troop levels. He made clear that effort will focus on Pakistani leaders.
"We stand ready to help Pakistan address terrorist groups inside of their country, but they must -- they must -- adopt a different approach themselves," Tillerson said Tuesday in Washington.
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Donald Trump's Afghanistan strategy could see Australia asked to send more troops

David Wroe
Published: August 23 2017 - 7:14AM
The United States is expected to ask Australia to commit more troops to Afghanistan and Defence Minister Marise Payne has not ruled out returning to a combat role as part of a renewed strategy to beat back a resurgent Taliban.
Sources have told Fairfax Media they consider it likely Australia will receive a request for more military help beyond the present commitment of 300 training and advisory forces after US President Donald Trump vowed on Monday "we are not nation-building again, we are killing terrorists".
In his much-anticipated speech outlining a fresh strategy 16 years since the US-led coalition toppled the Taliban, Mr Trump pledged a boost to American forces and said he expected allies to do the same.
A further request is not regarded as certain, however. Senator Payne stressed Australia was already making a "very considerable contribution" to the fight against various Islamist groups around the world but said the government would discuss potential increases.
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Donald Trump: his rallies reveal why his country is in chaos

Josephine Tovey
Published: August 24 2017 - 2:50PM
 Consider it Donald Trump's very own safe space.
Far away from Washington DC, where his legislative agenda is sputtering and the Russia investigation rolls on, or New York City, where he can't go home without a horde of protesters gathering at the foot of Trump Tower, the American president is finding solace in campaign-style rallies far from the beltway.
On Tuesday night, he shook off the ongoing fallout from his mealy-mouthed response to a deadly white supremacist rally in Charlottesville – which has drawn out Republican critics and seen business leaders abandon his administration – to bask in the roar of a loving crowd thousands of miles away in Phoenix, Arizona.
It has only been six months since Trump was inaugurated, and it will be three and a half years before he faces re-election. Monthly campaign-style rallies might seem a curious strategic choice right now.
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'The Taliban is a very determined enemy': Trump's new Afghanistan plan explained

David Wroe
Published: August 26 2017 - 12:15AM
NATO aircraft are said to be flying once again out of the air base that was home to most of the Australian forces during the Afghanistan war, the longest this country has ever fought.
Even before US President Donald Trump's speech heralding a tougher stance in the country, the perilous situation facing Tarin Kowt, the provincial capital in Oruzgan where the Australian Defence Force was based, and where most of the 41 Australian fallen died, has forced an intervention by coalition air power, according to local aid worker Turyallai Sahim.
The 26-year-old says there is fighting every night within three or four kilometres of the city – a description consistent with Afghan media reports. And in the past week, NATO aircraft have been providing close air support to the Afghan National Army as they battle encroaching Taliban fighters, he said.
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I look forward to comments on all this!
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David.

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