This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Quote Of The Year
Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"
or
H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."
Thursday, March 08, 2018
The Macro View – Health, Financial And Political News Relevant To E-Health And The Health Sector In General.
March 8, 2018 Edition.
There was really only one big bit of news this week with the Donald announcing punitive import tariffs on Steel and Aluminium.
Markets tanked and there was talk in Australia of a recession by the Trade Minister.
The received wisdom is that this plan is a wholly bad idea on Trump’s part – so we need to see how it plays out. Right now it looks to be a negotiating tactic on the NAFTA re-do!
In Australia it seems pretty clear our politicians have mostly gone off the reservation with a lack of interest in good policy and a ramped up interest in personal abuse etc. God help us all unless some sanity returns and quickly but I am hardly hopeful!
And to top it off, over last weekend Barnaby has wondered if the new child he is having is his? A ‘bit of a grey area’ he says. WTF! How nice for his new partner and the child……
Buffett warns that safe-looking bonds can be risky
Noah Buhayar and Katherine Chiglinsky
Published: February 25 2018 - 10:47AM
Sometimes the best lessons are worth repeating.
Billionaire investor Warren Buffett used his widely read annual letter to Berkshire Hathaway shareholders on Saturday to again call out the wasteful fees that many money managers charge. He highlighted the risk of bonds and emphasised the importance of sticking with a simple investment strategy.
"Performance comes, performance goes," Buffett wrote. "Fees never falter."
The letter was notably shorter than in years past, at 17 pages versus 29 in the 2016 version, and didn't include commentary on some of the company's largest stock holdings.
Malcolm Turnbull backs Donald Trump's new North Korea sanctions
David Crowe
Published: February 25 2018 - 2:07PM
Malcolm Turnbull is backing Donald Trump’s tough new sanctions against North Korea but will not say whether he will commit naval support for the measures, amid reports the Australian navy could join the program.
The Prime Minister said Australia needed to be “alert” to the way the
North Korean regime of Kim Jong-un was flouting existing sanctions by transferring goods between ships at sea.
“We have discussed a number of means of sanctions and enforcement against North Korea,” Mr Turnbull said in his last public remarks in Washington before returning to Canberra.
Soaring household debt points to a mortgage crisis on our doorstep
The Australian
12:00AM February 24, 2018
Roger Montgomery
There is always one theme common to the vast number of crises the world has experienced; excessive debt accumulation.
Irrespective of whether it is by the government, banks, businesses or consumers, this accumulation of debt almost always poses greater systemic risk than it seems during the boom.
It makes banks seem far more stable and profitable than they are, while the injection of cash makes the growth that results look more sustainable than it really is.
Borrowing binges that precede a crisis are, however, often dismissed or explained away by policymakers and commentators.
Updated 27 July 2017 — 1:42pm first published at 12:46pm
Australians remain surprisingly keen on landline phones, but if you're paying for one then you're probably spending money unnecessarily.
More than half of us (55 per cent) still have a landline, according to a recent finder.com.au survey of 2005 Australians.
Given the choice, though, we'll nearly always opt to call with our mobile phone instead. Just 29 per cent of us say that we use our landline phone regularly, and 13 per cent of us have a landline but never use it.
Outdated rule puts brakes on billions in infrastructure projects, says Grattan
By Peter Martin
25 February 2018 — 6:49pm
An outdated financing rule is forcing Australian governments to turn their backs on tens of billions of dollars of economically viable infrastructure investments, according to a new study by the Grattan Institute that urges the “unfreezing of discount rates”.
A discount rate is the annual rate at which future costs and benefits are downplayed in preparing benefit-cost studies. Because many infrastructure projects have big upfront costs balanced by benefits that take place many years into the future, a high discount rate will make projects appear unviable even if they could be comfortably financed at current interest rates.
The Grattan Institute says the common rate used by Infrastructure Australia and state and federal governments hasn’t been adjusted for 30 years, except during the global financial crisis when it was briefly lowered to allow projects that would have been declared unviable to get the go ahead in order to deliver economic stimulus.
Australian governments can borrow money more cheaply today than at any time in their history. The combination of cheap money and booming population growth has led to regular calls for more investment in transport infrastructure; with money so cheap, it is easier than ever for a project to generate a return that is greater than the cost of borrowing.
And yet Australian governments have been remarkably consistent in sticking with a 7 per cent central ‘discount rate’. Real borrowing rates are one of the key components of the discount rate, yet whether they have been 8 per cent or 1 per cent, government agencies have chosen to keep their discount rates at 7 per cent since at least 1989.
Indebted SMSFs a danger to the financial system: Industry Super
By Peter Martin
Updated 26 February 2018 — 7:17am first published at 12:05am
Self-managed super funds are adding fuel to Australia’s boom/bust property cycle and setting themselves up for big losses when the market retreats, an Industry Super analysis has found.
The analysis of Tax Office returns finds that in the year to June 2016, self-managed super funds with assets of less than $50,000 lost an average of 16.7 per cent and failed to achieve any gains between 2009 and 2016. The self-managed sector as a whole made 2.9 per cent in the year to June 2016, well below the 4.1 per cent achieved by industry funds.
Three in every five funds with balances up to $100,000 had 80 per cent or more of the funds invested in a single asset class, likely to be cash, term deposits, domestic listed shares or property.
Tony Abbott's economic argument against immigration is flawed
By Jessica Irvine
25 February 2018 — 8:13pm
Former Prime Minister Tony Abbott graduated with a bachelor's degree in economics from the University of Sydney in 1979.
But having since derided the dismal science as "boring", it appears he may have snoozed off at a crucial point in his lectures.
In a speech to the Sydney Institute last Tuesday, Abbott explained his logic behind his call for a reduction in Australia's annual rate of immigration from 190,000 to 110,000 a year.
For sheer hubris it’s hard to go past the “Australian Banks Belong to You” campaign — the Australian Bankers Association effort to soothe community anger against banks during a potentially incendiary royal commission.
You would have had to have lived under a rock not to have been reassured by Gracie, a Westpac receptionist for 33 years, that banks don’t keep all their profit: “Nearly 80 per cent go back to shareholders. The majority of those shareholders are everyday Australians.”
“Australian bank profits belong to Australians,” chimes in Jake, a home-loan specialist at SA Bank, while Wesley, a branch manager at National Australia Bank, tells us that the profits go to “everyday Australians”.
CRISPR will save lives - and technology can't come soon enough
By Fahad Ali
25 February 2018 — 4:34pm
Humans have been tinkering with genes for as long we know. It’s why we have edible bananas instead of bulbous things with hard seeds, or corn that looks like corn and not grass. Well before the discovery of the gene, we’ve been breeding them in and out of plants and animals with absolutely no way of knowing what our introduced modifications do, where they end up in the genome, or how they might affect the environment.
Here’s the paradox: modern gene technology is far less genetically invasive – and much better understood – than the time-worn practice of selective breeding, and yet so many of us live in fear of genetically modified organisms. Instead of adding, removing, or reshuffling thousands of unknown genes in order to breed traits in or out of organisms, we’re now able to act on just one well-characterised gene with precision.
We didn’t need high-powered biotech to create dachshunds or bulldogs from ancestral wolves. The same breeding techniques that gave us virtually all of the food we now eat also has given our companions a predisposition to spinal problems and breathing difficulties.
Less than two weeks ago, sports executives around the world received a nasty shock.
The incredibly popular English Premier League auctioned off most of its broadcast rights for games between 2019 and 2022. And for the first time in recent memory (ever?), the world's richest domestic soccer tournament didn't achieve a gigantic increase, or any increase at all, on the amount it gets from broadcasters.
For TV industry bean counters, it was a nice surprise, albeit superficial, since the structural forces underpinning the outcome were hardly encouraging.
Julie Bishop says indefinite leadership of Xi Jinping 'China's affair'
By David Wroe
26 February 2018 — 2:54pm
Foreign Minister Julie Bishop has refused to buy into China’s clearing the way for President Xi Jinping to stay in power indefinitely, describing Mr Xi as “a very effective leader” and saying the nation’s constitution is its own business.
Ms Bishop has also brushed aside questions on Australia’s carrying out naval patrols to challenge Beijing’s claims over artificial islands in the South China Sea, joining Prime Minister Malcolm Turnbull in refusing to comment on “operational matters”.
In a move that international commentators say consolidates Mr Xi as the most powerful Chinese leader since Mao Zedong, the Chinese Communist Party has flagged scrapping a rule that puts a two-term - or 10 year - limit on the presidency.
Talking points
Julie Bishop says Xi Jinping has been a "very effective leader".
Mr Xi could remain China's president indefinitely under proposed changes.
Don't be so sure about the best way to get a good job
By Ross Gittins
28 February 2018 — 12:05am
If you had a youngster leaving school, what would you encourage them to do? Get a job, go to university, or see if there was some trade that might interest them? For a growing number of parents, that's a no-brainer: off to uni with you. But maybe there should be more engaging of brains.
It's widely assumed that, these days, any reasonably secure, decently paid career must start with a university degree.
Don't be so sure. The latest projections by the federal Department of Employment (since renamed by Malcolm Turnbull's spin doctors as the Department of Jobs and Small Business) are for total employment to grow by 950,000 over the five years to 2022.
Honorary doctorates can leave real students feeling a little miffed
By Mitchell Landrigan
26 February 2018 — 11:00pm
In early February, Adam Spencer announced to his 85,000 Twitter followers that he was about to become “Dr Spencer”. Edith Cowan University in Western Australia awarded Spencer the degree of Doctor of Science honoris causa, in recognition of Spencer’s “passionate promotion of mathematics and science … for Australians of all ages”.
Spencer has never completed a research-based doctorate. Yet, Spencer has, without doubt, made the complexities of mathematics and science accessible to thousands of people who might otherwise take no interest. He is, by any measure, an excellent choice for such an honorary award.
Conferring an honorary doctorate on a well-recognised recipient does two things for a university. First, it gives the institution recognition – publicity – through a publicised affiliation. Secondly, universities need to attract talented students, staff and funds. Conferring a doctorate on a high-profile figure promotes the institution at little cost.
A rush to judgement won't benefit Australia in South China Sea dispute
By Nicholas Stuart
28 February 2018 — 12:15am
An enduring feature of our Facebook-driven world appears to be a new enthusiasm for binary divisions. There's no room for grey. Everything's quickly divided and categorised as either black or white; good or bad.
Algorithms push us away from civilised discourse and towards extremes. Instead of attempting to find common ground and some shared facts from which we can move forward together, the clamour of shrill, shouting voices occupies the civic space as each side attempts to drown the other out.
Unfortunately, attempts to bifurcate debate inevitably result in pointless conflict – exactly as is happening in the South China Sea at the moment.
Westpac’s chief financial officer has told the Productivity Commission that Australian banks are not highly profitable just because they make large profits.
Peter King has told the commission’s inquiry into competition in the financial industry that the $31.5 billion of profit amassed by Australia’s big four banks in their last full financial year were due to their size and efficiency, and that Westpac’s return on equity has fallen more than 40 per cent in the past decade.
In a wide-ranging discussion with lawmakers on the House Financial Services Committee, Federal Reserve chairman Jerome Powell painted a relatively optimistic picture of the US economy, even as he pointed to balanced risks to the "strong" outlook.
He dampened concerns about negative spillover effects to the economy from the recent spike in market volatility, reiterated prior policy guidance for a further "gradual increase" in policy interest rates, and signalled his commitment to cognitive diversity to enhance good decision-making. More specifically:
Powell observed that accelerating US expansion is occurring during a "moment of global growth", when headwinds have shifted to tailwinds. This is reinforcing the domestic pro-growth impact of favourable consumption and business investment, stronger sentiment and sales, and more stimulative fiscal policy. -----
November 11, 2007. September 21, 1987. Two dates that stick in the minds of some of us. They both marked significant peaks in the equity market. It is too early to call it but I am now wondering whether January 10, 2018 might not live in memory a bit longer as well. That was the recent top of the Australian market.
Why did the market peak on all these days? It is a very multifaceted conundrum, but they did, and the one thing they had in common was that the market had run extra hard in the prior year or more. But go back and read the news headlines on those days, and you will not find anything of any long-term significance that would indicate a top. These moments are only identifiable in hindsight. They were, in my book, “herd” moments, moments when the herd change direction. You can not predict them, but you can respond to them.
January 10, 2018 is no big deal so far. More likely than not it will amount to little more than another medium-term top like April, 11 2011, April 28, 2015 or May 1, 2017. But the performance of our markets since January 10, 2018 has been a much-needed wake-up call for all of us in the investment game.
I have never liked the expression "smart money". It is demeaning to individual investors and used by commentators to imply they are smart and the rest of you aren't. But a lot of supposedly smart professionals do some very dumb things, and a lot of non-professional investors do some very clever things.
There are only a few "smart money" activities inaccessible to the mortal investor. They include getting access to a large allocation of an over-subscribed IPO or share issue because you are a big institution, and the issuing brokers are sucking up to you to get or keep your secondary market business.
Another is writing call options over large existing holdings because you are very wealthy, can afford to be long term, and are looking for an incremental improvement in the total return on a large shareholding you do not need to sell. The rich get richer incrementally.
The effective tax rate paid by companies operating in Australia has deteriorated over the past 15 years from the fifth lowest in the Group of 20 nations to 12th, with further falls to come, highlighting the declining competitiveness of the tax system.
Finance Minister Mathias Cormann said the ranking, which unlike the 30 per cent headline rate takes into account deductions, would only get worse as planned tax cuts are delivered in the UK, France and United States.
"Arguing we won't lose investment if we keep corporate tax high is like saying there are no mountains in Switzerland, that you won't get wet if you walk in the rain, that the sun doesn't come up in the morning," Mr Cormann said, as he hit back at doubters of the benefits of the reductions.
Analysts have been left scrambling to find a plausible explanation for the vicious sell-off in late trading on the US stock exchange on Wednesday night, that left the blue-chip Dow Jones Industrial Average down 1.5 per cent, while the S&P 500 tumbled 1.1 per cent.
For weeks, analysts have been pointing out that US share and bond prices are now moving in tandem. But this correlation broke down overnight, as bond prices climbed – which pushed the yield on benchmark 10-year US bonds down to 2.87 per cent – while share prices tumbled. (Yields fall as bond prices rise.)
But one analyst who would not be surprised at all by the savagery of the sell-off is Russell Napier, an independent strategist and co-founder of investment research platform ERIC. He's long been arguing that the rapid tightening in US monetary conditions is simply not compatible with robust economic activity, stronger inflation and rising asset prices.
Federal Reserve chairman Jerome Powell said he sees no signs the US economy is overheating, and reiterated the central bank will continue to raise rates gradually to keep unemployment and inflation in balance.
"By continuing to gradually raise interest rates over time, we're trying to balance those two things and achieve inflation moving up to target but also make sure the economy doesn't overheat," Powell told the Senate Banking Committee on Thursday (Friday AEDT) in his second appearance before lawmakers this week. He added: "There's no evidence the economy is currently overheating."
Powell also said he doesn't see a tightening labour market causing wages to hit "a point of acceleration".
Don’t for a moment think the business cycle is dead. Following the global financial crisis, many investors came to expect a new normal of slow economic growth, negligible inflation and low interest rates. Cyclical swings in the economy, inflation and bond yields largely disappeared from the investment menu.
Last year, this orthodoxy was challenged by quickening growth in the global economy. In recent weeks, it’s been disrupted by inflation reappearing in the US. Bond yields quickly moved higher (to be fair, not just because of the renewed expectations for inflation: investors also focused on the “normalisation” of monetary policies in the big economies and on the increased supply of US bonds after the US Congress passed the fiscal package). Sharemarkets turned choppy and, for a while, extremely gloomy.
This isn’t the first time widespread predictions of the death of the business cycle have taken hold — only to be proven wrong. It brings back memories of Mark Twain’s famous observation on hearing rumours he’d passed away: “The report of my death was an exaggeration.”
Updated3 March 2018 — 6:14amfirst published at 12:05am
It’s been a busy week for the franchising industry.
In just a few days the market has reeled as oil giant Caltex devoured its franchise store network and the owner of the Gloria Jean's and Brumby’s Bakeries chains Retail Food Group announced it would close up to 200 of its outlets.
Wayne Hong, who owns a Michel’s Patisserie - another RFG chain - in Knox Shopping Centre in Wantirna, in Melbourne’s east, said he was not surprised to learn of the mass store closures.
If you take your problem to the doctor, it will be handled using the rules of the health system.
When a matter goes before the courts, it is dealt with using the logic of the legal system.
Likewise, if any subject is taken into the political realm, it is dealt with according to the norms of that system. And, as we all know, they're often ugly and vicious.
You may think spin-doctoring and economics are worlds apart, but they combine in that relatively modern invention the "free-trade agreement" – the granddaddy of which, the Trans-Pacific Partnership, is presently receiving CPR from the lips of our own heroic lifesaver, Malcolm Turnbull.
It's not surprising many punters assume something called a "free-trade agreement" must be a Good Thing. Economists have been preaching the virtues of free trade ever since David Ricardo discovered the magic of "comparative advantage" in 1815.
The prime minister says he's created a live option that would otherwise not exist for a negotiated US return to the Trans-Pacific Partnership.
Does it matter that the ratio of public relations professionals to journalists has passed 12:1 as traditional media firms lose their investigative clout? Does it matter that a couple of private foreign companies know more about us, including location, likes, dislikes and relationships, than any elected government ever could or should?
As Google and Facebook continue their wrecking-ball swing through the traditional media, regulators have cottoned on to the problems of not just an emaciated media but the threats to privacy and competition the digital behemoths pose.
Last year the European Commission fined Google €2.4 billion for giving its own shopping comparison service a leg up in the ordering of search results. In January Israel’s anti-trust regulator began an inquiry into the digital duopoly’s power in the advertising market. The French and German governments have found their collection of data could raise barriers to entry for new firms. A few weeks ago Britain announced an inquiry into the sustainability of its fourth estate.
Not even the IMF is worried by our huge foreign debt
By Ross Gittins
Updated 25 February 2018 — 9:46pm first published at 12:15am
In its latest report on Australia, the International Monetary Fund says it isn't worried by our net foreign debt, now just a squeak short of $1 trillion. Just as well, since none of us ever worries about it either.
Still, it's nice to have the fund's judgment that "the external position of Australia in 2017 was assessed to be broadly consistent with medium-term fundamentals and desirable policies".
Australia's negative "net international investment position" – consisting of our net foreign debt plus net foreign equity investment – has varied between 40 and 60 per cent of gross domestic product since 1988, it says. At the end of 2016, it was equivalent to 58 per cent.
But cash holdings do tell an interesting story. Self-managed super funds are much maligned for holding too much cash, but the latest figures from Multiport, the self-managed fund administrator owned by financial services group AMP, show that cash holdings can be overstated if they are recorded at certain times of the year.
The data shows that cash holdings tend to be higher at the end of June than at other times of the year, because do-it-yourself scheme members make substantial personal and after-tax contributions at the end of the financial year and invest it in other assets, such as equities, over subsequent months.
Full time median earnings grow by just 1.5 per cent
By Eryk Bagshaw
Updated26 February 2018 — 2:23pmfirst published at 1:46pm
The growth in full time wages has fallen below the cost of living, leaving the median working Australian with an effective pay cut in the past year.
Detailed figures from the Australian Bureau of Statistics show median full-time wages - which measure the pay rises of up to 70 per cent of the working population - have fallen below the increasing cost of a consumer basket.
The figures will further fuel the ongoing political debate about inequality.
Opposition Leader Bill Shorten has accused Prime Minister Malcolm Turnbull of being out of touch with the concerns of employees struggling with historically low wage growth, while Treasurer Scott Morrison has accused Labor of being socialists for blocking company tax cuts he believes will be passed on to workers in the form of higher wages.
The hardest thing about putting together a budget is finding the money. Scott Morrison’s task gets harder each year.
Back in 2000, the first year of the GST, tax takings amounted to 25 per cent of gross domestic product. Put another way, one quarter of everything we earned went to Peter Costello to hand back to us via the budget.
By the end of the latest financial year, Morrison's first as Treasurer, the proportion had slid to 22.1 per cent. Morrison collected a total of $388.6 billion in tax. If the tax system had performed as it did for Costello back in 2000 he would have collected $439.7 billion.
In a lethal intervention documenting the demise of rationality and integrity in our politics, former Treasury chief Ken Henry declares corporate tax cuts an obvious “no option” reform, damns the futile debate about the issue and calls for real tax reform.
The essential question Henry puts to the country today is: how much shame, craven self-interest and sabotage of the national interest will our political system tolerate?
In an interview with The Australian and in his speech, Henry says cutting the company tax rate is but “a small part” of a sweeping tax system restructuring that Australia needs. He warns that political failure has led to a “lost decade” on tax reform.
Mental illness among Australian children rises, immunisation rates fall
AAP
10:53AM February 25, 2018
Australian children are lagging behind when it comes to developing basic skills in primary school but they are staying in school for longer. The Australian Research Alliance for Children and Youth’s five-year snapshot, released on Sunday, shows Australia ranks 35th out of 40 OECD countries on preschool attendance, although the number of four-and five-year-olds who attend has dropped in recent years.
It also shows three in 10 Year 4 students aren’t meeting minimum maths standards while one in four are below standard in science and one in five are not at the required reading level.
The rate of parents reading to their two-year-olds at least once a week has stayed static, although there was an encouraging lift among indigenous families.
The chief executive of peak not-for-profit private health insurers has warned that it would be "dark day for consumers" if consumer choice was reduced by increased consolidation in the sector.
Matthew Koce, the boss of Members Health Fund Alliance (MFHA), said more mergers like last week's mooted HBF and HCF tie-up would be the exception not the rule across the 35-fund industry.
"I think consumers are voting with their feet and our funds are growing faster than the big funds. Those guys may want consolidation, but consumers are increasingly wanting smaller funds," he said.
A new report on the emotional, social and physical wellbeing of Australia’s young people shows we are leading the world in some areas, including low rates of youth smoking and life expectancy at birth.
The Hon Dan Tehan MP
Minister for Social Services
Member for Wannon
The Hon Ken Wyatt AM, MP
Minister for Aged Care
Minister for Indigenous Health
Member for Hasluck
26 February 2018
A new report on the emotional, social and physical wellbeing of Australia’s young people shows we are leading the world in some areas, including low rates of youth smoking and life expectancy at birth.
Minister for Indigenous Health, the Hon Ken Wyatt AM, launched the third Australian Research Alliance for Children and Youth (ARACY) Report Card in Canberra today.
Aldi and IGA score low in obesity prevention efforts, supermarket report card shows
By Esther Han
25 February 2018 — 3:30pm
Talking points
Unhealthy diets and obesity are leading contributors to poor health in Australia, the reports says.
The food industry has an important role to play in addressing obesity and improving population diets.
Australian supermarkets demonstrated some commitment to addressing health and nutrition issues but much stronger action is needed across the sector.
Aldi and IGA have received extremely low scores in a new study that assessed the efforts being made by Australia’s top supermarkets to help tackle the obesity crisis.
Medibank reveals what it pays for ‘rare and expensive’ operations
The Australian
10:19AM February 26, 2018
Sarah-Jane Tasker
Health insurance giant Medibank has paid more than $100 million in the past two years for “rare and expensive” procedures, new data has revealed.
The most common “rare” procedure the health insurer has funded was one to remove all, or part, of a kidney. More than 1300 Medibank members had that surgery in the past two years, with the insurer paying an average benefit of $16,000 per procedure.
The most expensive surgery was an aortic valve replacement at $48,000, with 781 Medibank customers needing that procedure to replace a damaged heart valve with an artificial valve.
Aspiring doctors begin Macquarie's 'cash grab' $250,000 medical degree
By Esther Han
26 February 2018 — 6:14pm
Amid outrage and controversy, Australia's newest full-fee medical school opened its doors on Monday, welcoming about 50 fresh-faced students who have the ability to cough up $250,000 for the privilege.
While they too welcomed the aspiring doctors, the Australian Medical Students' Association (AMSA) and Australian Medical Association (AMA) lambasted Macquarie University for its "short-sighted cash grab", saying the degree didn't come with a guarantee of an internship and would cause greater bottle necks in the training system.
“The pipeline is stretched and bursting; in 2016 we had 200 medical graduates left without an internship which you need to become a qualified doctor,” said AMSA president Alex Farrell.
One of the world’s most renowned researchers in personalised medicine, Ajay Royyuru, has added weight to calls for a shift in healthcare payment models to incentivise providers for results, not service.
New York-based Dr Royyuru, IBM’s vice-president of healthcare and life sciences research, said on a visit to Australia that the ongoing debate on rising healthcare costs was not unique to Australia.
He said there was a shift, globally, to improve the economics of healthcare services by better using data that was now available, adding that outcomes would drive the economics in future.
An inquiry by the Independent Commissioner Against Corruption into the handling of Adelaide’s failed Oakden nursing home has brought down findings of maladministration against five people but cleared former health minister Jack Snelling and former mental health minister Leesa Vlahos.
ICAC commissioner Bruce Lander says that, nevertheless, each minister who had responsibility for the Oakden Facility is responsible for its failures.
There is a suggestion in the final ICAC report that problems at Oakden may have been brought to cabinet’s attention as part of a privatisation plan before the 2014 election by health officials.
Australia’s largest health fund, Bupa, has advised more than a third of its members that the restricted cover they have for a series of costly medical services will be removed altogether amid concerns over unexpected gap fees.
From July, Bupa will amend about 720,000 policies so the restricted cover for certain services, paying minimal benefits, becomes an outright exclusion. This will include hip and knee replacements, pregnancy, IVF, cataract procedures, obesity and some plastic surgery, areas in which insurers have for years allowed members to downgrade in an effort to reduce their premiums.
The specialties that perform these procedures leave patients with some of the biggest average gap fees, or out-of-pocket expenses, after insurance benefits are paid. Restricted cover also means the insurer would only pay for private hospital care at a rate equivalent to that of a shared room in a public hospital.
Australia’s largest private hospital operator, Ramsay Health Care, is looking to add new clinical services to its portfolio as the growth in day admissions outpaces inpatient numbers.
Ramsay chief executive Craig McNally, who yesterday reported a 3.7 per cent fall in half-year profit to $246.5 million, said Ramsay was experiencing more growth in day admissions than it was in inpatient admissions. While that diluted revenue growth to a certain extent, it was not a concern.
“We just have to get our cost base to reflect that to service that appropriately but that is the trend,” he said.
THE squeeze GPs have felt with the freezing of the Medicare rebate is now being put on the only doctors that are still bulk billing in full in Mackay - the after hours doctors.
From today the Medicare rebate for after hours doctors' visits has been slashed from $129.80 to $100, with a further cut to $90 in January 2019.
The cuts have prompted service provider House Call Doctor to warn it will make doctors' jobs tougher.
One of Australia’s most important and highly paid medical specialities could soon have a new name, because of concerns that the public does not understand how skilled and crucial the job is.
Anaesthetists – the women and men who ease us into unconsciousness in the operating theatre – are considering changing their name to anaesthesiologists, after a survey found that one in 10 people did not realise they were doctors.
Despite undergoing more than a decade of medical training, some anaesthetists in Australia believe they are sometimes confused for lesser-trained medical professionals, including nurses.
A nationwide struggle to decide who pays for what services under the $22 billion National Disability Insurance Scheme has still not been settled more than four years after the project launched with “priority” work between officials from every state and territory and two federal agencies.
A senate estimates hearing yesterday also heard the extraordinary revelation that the flagship disability scheme asks service providers to work without pay when a person’s support plan runs out and has not yet been renewed due to delays in assessments or paperwork.
The Senate Community Affairs Legislation Committee heard that despite continuing delays with planning — the scheme consistently meets just 80 per cent of estimates — and a recommendation from the Productivity Commission last year, it will not adjust its timetable for when all 470,000 participants will get access.
A much-lauded move to gold, silver, bronze and basic categories of health insurance has yet to be finalised, with stakeholders still debating which services will be required to be covered in each category and how that will affect premiums.
Australia’s largest health insurer, Bupa, sparked controversy this week when it downgraded the policies of more than a third of its members amid concerns over unexpected gap fees. From July, Bupa will amend about 720,000 policies so that the restricted cover those members have for certain services, paying minimal benefits, becomes an outright exclusion. This will include hip and knee replacements, pregnancy, IVF, cataract procedures, obesity and some plastic surgery — areas in which insurers have for years allowed members to restrict their cover in an effort to reduce their premiums.
These procedures leave patients with some of the biggest average gap fees, or out-of-pocket expenses, after insurance benefits are paid. In one email to members, Bupa said “feedback from customers has shown the value of ‘minimum benefits’ (restricted cover) included in their health cover was not clear”.
Older Australians are increasingly capturing more of the value from private health insurance than younger people, a trend analysts argue has structural implications unless industry reforms are introduced.
The warning comes as a new survey reveals that the majority of young people want to see a significant reduction in the cost of health insurance before considering buying the product.
Macquarie’s analysts have highlighted that a deteriorating trend in risk equalisation illustrated that older people were increasingly capturing more of the value from private health insurance than younger and healthy people.
Updated 2 March 2018 — 9:37amfirst published at 12:01am
Weight gain for would-be mothers is a key focus of the federal government’s new national medical guidelines for pregnancy to be launched on Friday by health minister Greg Hunt.
Addressing the National Women’s Health Summit in Sydney, Mr Hunt will also announce $2.5 million in medical research funding as part of a national approach to combat the often misunderstood condition, endometriosis, and the development of a national maternity services strategy.
The Clinical Practice Guidelines on Pregnancy Care stress the importance of body mass index before pregnancy, weight gain during pregnancy for the health of both mothers and babies.
Australia’s largest health fund, Bupa, has shaken the system for the second time in a week, advising doctors that insured patients will qualify for so-called “gap cover” only if they are treated in a Bupa-contracted facility.
The move may expose patients to higher out-of-pocket costs if their doctor does not comply with the new terms.
It comes after Bupa this week told almost a third of its members that some policy restrictions would become outright exclusions from July 1 to remove confusion over who pays.
PARENTS who fail to vaccinate will be “micro-targeted” in a new Federal campaign that has identified WA as being the nation’s worst for low-immunisation “hotspots”.
The $5.5 million national six-week campaign starting today targets non-complying parents living in 30 of the nation’s lowest immunisation hotspot areas for one, two and five-year-olds.
WA has seven “hotspots” which are centred around Fremantle, Mundaring, Cottesloe-Claremont, Perth City, South Perth, Manjimup and Augusta-Margaret River-Busselton.
Experts predict Australia is likely to become the first country to effectively eliminate cervical cancer, expected within the next 40 years.
The latest research shows there’s been a dramatic decline in the rates of human papillomavirus (HPV) - the infection that causes about 99.9 per cent of cervical cancers - due to the effectiveness of the HPV vaccine.
Among Australian women aged 18 to 24, the HPV rate had dropped from 22.7 per cent to just 1.1 per cent over the past 10 years, according to research recently published in the Journal of Infectious Diseases.
Before the vaccination program, almost all sexually active people had contracted HPV. Because of the vaccine’s success the International Papillomavirus Society (IPVS) has for the first time outlined in a statement, published today, that cervical cancer could soon be eliminated as a public health problem. The IPVS is made up of the world’s leading cervical cancer and HPV researchers, including Suzanne Garland from the Royal Women’s Hospital and University of Melbourne, and who advises the WHO and global policy makers on cervical cancer prevention and screening. Professor Garland says Australia would was likely to be the first country to achieve the milestone of cervical cancer eradication.
WHEN Venetian traveller Marco Polo visited China in the 13th century, he was gobsmacked by the country’s wealth and industry, observing canals carrying thousands of trading vessels, iron production dwarfing that of Europe, and “stones” that were burned instead of wood.
Those stones were coal, a substance that still plays a crucial, though possibly declining, role in underpinning the Chinese economy.
More than seven centuries later, Western observers are still prone to awe, and often a certain degree of alarm, when it comes to contemplating China’s industrial might and global ambitions.
China trying to enforce claim to South China Sea: Trump advisor
By Peter Hartcher
26 February 2018 — 12:00am
China is turning its newly-built islands in the South China Sea into bases so it can enforce its claim to own the entire international waterway, according to a senior Pentagon official.
"It's not about finding 12 nautical miles more" territory for China around the edges of the controversial islands, "it's really about enforcing a very expansive sovereignty claim", said the top official for US military policy in the Asia-Pacific, Randy Schriver.
If so, the most serious confrontation yet between China and the US could be looming. China has laid claim to almost the entire South China Sea, the world's most valuable commercial route and a vital lifeline for Australia, among many other countries.
Naturally enough all the focus on last week’s US indictment against 13 Russians for interfering in the 2016 Presidential election has been on whether the trail leads to an impeachable offence by President Trump.
Not yet it doesn’t, but special counsel Robert Mueller’s posse appears to be closing in.
But as big a deal as that is for America and the world, there is more to what Mueller is uncovering than a potential political earthquake.
The 37-page indictment against Yevgeniy Viktorovich Prigozhin et al should be required reading for every government in the world, in fact every company, and organisation of any sort, for that matter.
On Sunday, the Chinese Communist Party Central Committee recommended ending the two-term limit on the presidency, paving the way for President Xi Jinping to stay in office indefinitely. This surely marks the end of an era — and not just for China, but also for the West.
For the West, the era in question started with the end of the Cold War, as old enemies became “emerging markets.” China had already started opening its markets to foreign investment since 1978 under Deng Xiaoping’s reforms. But only in the 1990s did the private sector take off there, and Western firms promptly rushed in to profit from the breakneck speed of Chinese economic growth.
The beauty of the post-Cold War emerging market story was that it was apolitical
The announcement on Sunday that China would abolish the two-term limit for the presidency, effectively foreshadowing current leader Xi Jinping’s likely status as president for life, had been predicted ever since Xi failed to nominate a clear successor at last October’s Communist Party Congress. But it still came as a shock in a country where the collective leadership established under Deng Xiaoping in the 1980s was once considered inviolable. Xi, like every leader since Deng, combines a trinity of roles that embody the three pillars of power in China: party chairman, president, and head of the Central Military Commission. But like every leader since Deng, he was once expected to hand these over after his appointed decade, letting one generation of leadership pass smoothly on to the next.
It’s virtually impossible to gauge public opinion in China, especially as censorship has gripped ever tighter online. But among Chinese I know, including those used to defending China’s system, the move caused dismay and a fair amount of gallows humor involving references to “Emperor Pooh” and “West Korea.”
U.S. President Donald Trump’s electoral victory in 2016 similarly prompted rounds of reflection about and criticism of American democracy. But the Chinese case merits significantly more alarm. For all the erosion of norms under Trump, he seems unlikely, despite the fears of some, to fundamentally change the way the United States is governed. Xi, meanwhile, appears to have entirely transformed Chinese politics from collective autocracy to what’s looking increasingly like one-man rule. This switch should leave everyone very worried, both inside and outside China. A country that once seemed to be clumsily lurching toward new freedoms has regressed sharply into full-blown dictatorship — of a kind that’s likely to lead to dangerous and unfixable mistakes.
In survey after survey, China's people are full of bounce. In comparisons with the people of other countries, the Chinese show an optimism and a confidence that puts them among the most positive on the planet.
Chinese consumers are brimful of confidence, outdone by only those in India, Indonesia and Iceland. China's people are the most optimistic in the world that they will have better living conditions in the future.
And among the world's young people, it's the Chinese and the Indians who feel most positive that the world is becoming a better place. One reason is that their economies are booming, But they also have great faith in the power of technology to do good.
The peculiar parallel universe in the Trump administration
By Peter Hartcher
26 February 2018 — 12:00am
As he stood beside Malcolm Turnbull on the weekend, Donald Trump painted a glowing picture of America's relations with China.
"My personal relationship, as Malcolm can tell you, with President Xi is I think quite extraordinary. He's somebody who I like and I think he likes me," said the US president.
"I don't think we've ever had a better relationship with China than we do right now. The only thing that can get in its way is trade."
Xi's Jinping's indefinite reign stokes fears China won't play by the rules
by David Tweed and Enda Curran
Xi Jinping's decision to cast aside China's presidential term limits is stoking concern he also intends to shun international rules on trade and finance, even as he champions them on the world stage.
The Communist Party's bid to repeal the constitutional prohibition enacted after the turbulent Mao Zedong era - allowing Xi to stay on indefinitely - is only the latest domestic standard discarded by the president. Since coming to power in 2012, he's jailed once-untouchable retirees of the country's top political body, declined to name a successor and created a series of party panels to take over government policy making.
Xi has demonstrated a similar willingness to challenge the rules overseas, despite casting himself as a defender of the post-World War II order in speeches to United Nations diplomats and Davos billionaires. Countries have accused Beijing of putting an economic embargo on South Korea, meddling in Australian politics and ignoring an international tribunal's ruling against Chinese claims to the disputed South China Sea.
Sometimes an announcement succeeds in being both unsurprising and shocking. It had long been evident that China’s Xi Jinping would not — indeed, could not — step down from power. He has made too many enemies, particularly through his anti-corruption campaign, even if he wanted to go, which seems unlikely. Yet the announcement that the two-term limit on the presidency is to go, is still shocking.
What seemed likely is now a fact. Mr Xi has discarded the attempt by Deng Xiaoping to institutionalise checks on the power of China’s leaders — itself a reaction to the wild excesses of the era of Mao Zedong. What is re-emerging is strongman rule — a concentration of power in the hands of one man. It now looks a bit like “Putinism with Chinese characteristics”.
True, even before this decision, it had been possible for Mr Xi to retain his positions as head of the party and commander-in-chief, indefinitely. The term limits applied only to the intrinsically less powerful office of president. Yet if he had lost the presidency, while retaining his other positions, a scintilla of doubt might have emerged over who was in charge. Mr Xi disliked this or, as likely, thought he could not risk it. He seeks power unbridled and undivided.
Within minutes, there were signs that people were not happy about the unprecedented move. Political criticism is rare in heavily-censored China, even on the messaging app WeChat - which is owned by Hong Kong-listed Tencent - where an individual's influence is limited by the number of "friends" they have.
In Syria, Russia is 'both arsonist and firefighter', US general says
By Idrees Ali & Phil Stewart
28 February 2018 — 10:11am
Washington: A senior US general has accused Russia of playing a destabilising role in Syria and acting as "both arsonist and firefighter," as a brief truce unilaterally declared by Moscow in the eastern Ghouta region collapsed.
The US and Russia have been on different sides of the multi-sided seven-year-war, with Russia being the key ally of Syrian President Bashar al-Assad whose forces are besieging eastern Ghouta, a rebel-held area near Damascus.
"Diplomatically and militarily, Moscow plays both arsonist and firefighter, fuelling tensions among all parties in Syria ... then serving as an arbitrator, to resolve disputes, attempting to undermine and weaken each party's bargaining positions," said US Army General Joseph Votel.
The book Xi Jinping wants you to read for all the wrong reasons
By David Brophy
27 February 2018 — 10:35pm
I've seen up close the repressive surveillance state that the Chinese Communist Party wields against vulnerable groups. My research has taken me to China's northwest region of Xinjiang where a panoply of checkpoints, digital monitoring, and political re-education camps keep the local ethnic group, the Uyghurs, in line.
Xi Jinping's impending coronation as president for life promises to only entrench China's high-tech authoritarianism. These realities make me all the more conscious of the need to think seriously about how we in Australia might contribute to positive political change in China. What I'm convinced of is that such change won't come about by ramping up military pressure on the PRC, or indulging in fears of a Chinese invasion of our country.
Unfortunately, those are the two themes that have dominated our recent discussion of the implications of China's rise. Clive Hamilton's new book, Silent Invasion, is the culmination of a steady stream of breathless reportage on China's imagined subversion of Australian institutions and freedoms. It leads him to the conclusion that the People's Republic is on the verge of turning Australia into a vassal state. That's not only wrong, but dangerous.
Chinese fear 'turmoil' from Xi's constitutional change
By KIRSTY NEEDHAM
27 February 2018 — 6:05pm
Beijing: As Chinese censors worked overtime to block social media dissent at Xi Jinping's move to scrap the presidential term limit, a number of intellectuals have tried to circulate an open letter calling for the proposal to be voted down.
Former Chinese newspaper editor Li Datong's letter was addressed to the 52 Beijing deputies of the National People's Congress, the annual parliament which opens this weekend, and it had a very focused message.
"The 1982 constitutional stipulation that the term of office of Chinese state leaders should not last more than two consecutive terms is a landmark political reform measure taken by the [Chinese Communist Party] and all the Chinese people through the great suffering of the Cultural Revolution," the letter, posted on WeChat, stated.
Updated 26 February 2018 — 6:26pm first published at 11:34am
Bangkok: Australia and East Timor will sign a landmark agreement aimed at opening the way to share revenue from the $50 billion Greater Sunrise oil and gas field in the Timor Sea at the United Nations next week.
But intense negotiations have so far failed to settle how the field could be exploited by a Woodside Energy-led consortium.
Recommendations by the Permanent Court of Arbitration at The Hague, which has overseen negotiations between the neighbouring countries, on how the dispute should be settled are expected to be released in mid-April.
An enduring feature of our Facebook-driven world appears to be a new enthusiasm for binary divisions. There's no room for grey. Everything's quickly divided and categorised as either black or white; good or bad.
Algorithms push us away from civilised discourse and towards extremes. Instead of attempting to find common ground and some shared facts from which we can move forward together, the clamour of shrill, shouting voices occupies the civic space as each side attempts to drown the other out.
Unfortunately, attempts to bifurcate debate inevitably result in pointless conflict – exactly as is happening in the South China Sea at the moment.
China is putting Australia into a diplomatic deep freeze, stalling on ministerial visits, deferring a trip by our top diplomat and putting off a broad range of lower-level exchanges to pressure Malcolm Turnbull over the new foreign interference laws and naval challenges to disputed Chinese claims in the South China Sea.
Critical reports about Australia and the Prime Minister have spiked in China following his visit last week to Washington, where he agreed to help enforce tough sanctions on North Korea and discussed “freedom of navigation” exercises in the South China Sea.
In recent weeks, China has made it difficult for lower-level exchange programs, education visits and, according to government sources, deferred a trip by Foreign Affairs departmental secretary Frances Adamson, Australia’s highest-ranking diplomat and a former ambassador to Beijing.
The next US recession could drag on longer than the last one that stretched 18 months. That's the assessment of former Treasury Secretary Larry Summers.
With the economy in its ninth year of expansion, even if one were to take a hawkish view of upcoming Federal Reserve tightening, it would be some time before the level of interest rates rates gets high enough to allow them to again be reduced by the 500 basis points typical for a US recession, Summers said at a conference in Abu Dhabi.
"That suggests that in the next few years a recession will come and we will in a sense have already shot the monetary and fiscal policy cannons, and that suggests the next recession might be more protracted," he said during a panel with Bloomberg Television.
One of Donald Trump’s closest aides, White House communications director Hope Hicks, has confirmed she will resign.
The move is an unexpected blow to the White House which has been embroiled in a series of rolling controversies in recent weeks, including the stripping this week of top secret clearances for senior adviser Jared Kushner.
It comes a day after Ms Hicks, 29, gave eight hours of testimony before the House Intelligence Committee in which she said she occasionally told ‘white lies’ on behalf of the president but never in relation to the Russia investigation.
Moscow: President Vladimir Putin unveiled an array of new nuclear weapons on Thursday, in one of his most bellicose speeches in years, saying they could hit almost any point in the world and evade a US-built missile shield.
Putin was speaking ahead of an election on March 18 that polls indicate he should win easily. He said a nuclear attack on any of Moscow's allies would be regarded as an attack on Russia itself and draw an immediate response.
The Russian president unveils an array of new nuclear weapons, in one of his most bellicose speeches in years.
It was unclear if he had a particular Russian ally, such as Syria, in mind, but his comments looked like a warning to Washington not to use tactical battlefield nuclear weapons.
Washington: Russian trolls used Facebook, Instagram and Twitter to inflame US political debate over energy policy and climate change, a finding that underscores how the Russian campaign of social media manipulation went beyond the 2016 president election, congressional investigators reported on Thursday.
The new report from the House Science, Space and Technology Committee includes previously unreleased social media posts that Russians created on such contentious political issues as the Dakota Access Pipeline, government efforts to curb global warming and hydraulic fracturing, a gas mining technique often called "fracking."
One Facebook post created by a Russian-controlled group called "Native Americans United" shows what appears to be a young girl in a braid peering out over an unspoiled prairie. "Love Water Not Oil, Protect Our Mother, Stand With Standing Rock," a reference to an Indian tribe that opposed the Dakota Access Pipeline. The post also said, "No Pipelines. No Fracking. No Tar Sands."
Washington: President Trump said on Thursday he will sign an order next week to impose 25 per cent tariffs on steel imports and 10 per cent tariffs on aluminum, potentially triggering an ugly trade war with China and other countries.
He promised US manufacturers that they will "have protection for a long time. ... You'll have to regrow your industries. That's all I'm asking."
"We are going to have much more vibrant companies," Trump added, during a listening session with several top US manufacturing executives.
The announcement came after a chaotic 12-hour period in which the president pushed for an announcement Thursday and abruptly summoned the executives to the White House.
Donald Trump, the President who measures his economic performance by the stock market, just got a taste of what investors think of his planned tariffs.
Investors fear a tit-for-tat trade war with China, as Beijing lines up its retaliation targets in Trump's voting heartland. Other countries including Australia could be hit by any blanket US tariffs.
When the Australian and New Zealand Prime Ministers gave speeches one after the other at the Australia New Zealand Leadership forum in Sydney on Friday Malcolm Turnbull was outplayed by his counterpart Jacinda Ardern.
It was a case of deja vu for Australians used to being flogged by the Kiwis in the pinnacle of trans-Tasman rugby union competitions, the Bledisloe Cup.
That is not to say that Turnbull did not earn praise from leading Australian business people among the 1000-strong luncheon audience. They liked his strong support for private enterprise and his pledge to continue trying to push corporate tax cuts through the Senate.
For decades, the Western world put its faith in a well-defined and broadly accepted economic paradigm with applications at both the national and global levels. But, against a background of declining confidence in the ability of "experts" to explain, let alone predict, economic developments, that faith has deteriorated. With a new paradigm having yet to emerge, the world economy faces a heightened risk of fragmentation, with already-vulnerable countries being left even further behind.
The paradigm that, until recently, dominated much of economic thinking and policymaking is embodied in the so-called Washington Consensus – a set of 10 broadly applicable policy prescriptions for individual countries – and, at the international level, in the pursuit of economic and financial globalisation. The idea, simply put, was that countries would benefit from embracing market-based pricing and deregulation at home, while fostering free trade and relatively open cross-border capital flows.
Deepening the economic and financial linkages among countries was viewed as the best way to deliver durable gains, enhance efficiency and productivity, and mitigate the threat of financial instability. This approach was also deemed to yield collateral benefits, from enhancing internal social mobility to reducing the risk of violent conflict among countries. And it promised to support the positive convergence of developing and developed countries, thereby reducing both absolute and relative poverty and weakening economic incentives for illegal cross-border migration.
The Turnbull government could face pressure to pre-emptively toughen barriers to shield local industry from a glut of cheap foreign metal, increasing risks Australia could be dragged into a global trade war after Donald Trump announced hefty tariffs on steel and aluminium exports to the US.
As Mr Trump's announcement drove the local market and Wall St down, Trade Minister Steven Ciobo warned it could spark a recession while local experts claimed South Korean steelmakers being squeezed out of the US were already eyeing off Australian sales.
Hundreds of millions of people in China were preparing to return to work after the extended Spring Festival break when an unsettling piece of news interrupted their afternoon last Sunday.
In an oddly-orchestrated exercise in media management the state-run Xinhua news agency released a report in English outlining changes to the country's constitution that would effectively allow President Xi Jinping to stay in power indefinitely.
In the George Lucas classic Star Wars, Obi-Wan Kenobi senses "a great disturbance in the Force". No planets have been destroyed, but three telling developments this week suggest serious tremors in an international system that for half a century has given us security and a long period of national prosperity.
In a surprise announcement over the weekend, the Chinese Communist Party foreshadowed the lifting of the country's two-term limit, which could allow strongman Xi Jinping to remain president indefinitely. The term limits were designed to prevent a repeat of Maoist excess. Their removal instead confirms China's drift from collective to one-man rule.
Then, in a sinister two-hour rant on Thursday – accompanied by images simulating a nuclear attack on the US – Vladimir Putin proclaimed that Russia had developed sophisticated new nuclear weapons capable of piercing any US defences and striking the American homeland.
London: In a major speech on Britain's exit from the European Union, Prime Minister Theresa May has warned her people that they must accept some trade-offs to achieve the independence their government seeks, even as she asked the Europeans to, please, seek compromise on the issues of trade, tariffs and borders she said are essential.
During her 45-minute speech on Friday, May set out her proposals for a future relationship between the United Kingdom and the EU.
The British prime minister delivers a speech on Brexit, against the backdrop of a dispute over the Irish border.
There is nothing but bad news flowing from Donald Trump’s extraordinary move to impose trade barriers on steel and aluminium imports on mythical national security grounds.
The confusion still surrounding the decisions says final comment must await the actual ruling when it comes down.
But the danger signs are everywhere, even if Trump has long warned of the move and in fact campaigned on the policy.
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