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."
The first rule in the caring
professions is “first do no harm” and for this reason alone for-profit back
meddlers should stay away from all those who can’t provide informed consent for
their treatment on their own behalf!
A few days ago this appeared:
Chiropractors give themselves green light to crack
babies’ backs after four-year ban
Chiropractors
have given themselves the green light to resume manipulating the spines of
babies following a four-year interim ban supported by the country’s health
ministers.
In
a move that has been slammed by doctors as irresponsible, the Chiropractic
Board of Australia has quietly released new guidelines
permitting the controversial treatment for children under two.
The Royal Australian College of General Practitioners (RACGP) hit out at the decision, saying there was no evidence supporting the spinal manipulation of babies and children and that the practice should be outlawed. “There is no way in the world I would let anyone manipulate a child’s spine,” said Dr James Best, the College’s Specific Interests Child and Young Person’s Health chair.
“The fact that it hasn’t been ruled out by this organisation is very disappointing and concerning. It’s irresponsible.”
Spinal manipulation involves moving the joints of the spine beyond a child’s normal range of motion using a high-velocity, low-amplitude thrust.
In March 2019, the Chiropractic Board of Australia announced an interim ban on the spinal manipulation of children under two, following public outcry over a video of a Melbourne chiropractor holding a two-week-old baby upside down.
The chiropractor then used a spring-loaded device on the newborn’s spine and tapped him on the head. Then-Victorian health minister Jenny Mikakos described the footage as “deeply disturbing”.A Safer Care Victoria report at the time, which involved a systematic review by Cochrane Australia, found no strong evidence that spinal manipulation helped childhood conditions such as colic, back/neck pain, headache, asthma, ear infections or torticollis (twisted neck), despite it commonly being spruiked as a solution to these issues.
“The
major finding of this review is that the evidence base for spinal manipulation
in children is very poor,” it said.
A follow-up review last year by Cochrane Australia, commissioned by the
national healthcare watchdog AHPRA (the Australian Health Practitioner
Regulation Agency), reached the same conclusion.
The
initial review, provided to all Australian health ministers, recommended that
spinal manipulation should not be done on children under 12. It also
recommended urgent research to develop an evidence base for spinal manipulation
on children and advanced training for those providing paediatric care.
However,
in November the Chiropractic Board of Australia put out a statement to
“clarify” to members its expectations regarding paediatric care. It said a
range of care could be provided to children, including manual therapy, soft
tissue therapy and manipulation, if practitioners understand how children’s
needs differ from adults and modify their care appropriately.
Neurosurgical
Society of Australasia Board executive Dr Patrick Lo, who is also the Victorian
chair of the Royal Australian College of Surgeons, said children were
particularly vulnerable to injuries from spinal manipulation.
Melbourne
chiropractic Dr Ian Rossborough has been criticised for performing a
controversial technique on a four-day-old baby.
“Adults
have a balanced neck, head and shoulders – everything is supported – whereas
kids have a very big head-to-neck ratio,” the neurosurgeon said.
“If
you flick it around, the lollipop ball will fall off. That’s our major concern.
Those areas are so critical to the function and development of the child and we
are putting those at risk.”
Lo
said he had treated young adults who had suffered disc prolapses following
spinal manipulations performed by chiropractors. He said some of his colleagues
had treated patients who had experienced strokes following spinal manipulation.
Lo
will raise his concerns about the new guidelines for chiropractors at an
upcoming meeting with Safer Care Victoria.
Doctors
have been at war with chiropractors over the treatment of babies and children
for more than a decade.
In
2013, The Age reported on the disputed case of a Melbourne
paediatrician who claims he treated a four-month-old baby after one of her vertebrae was fractured
during a chiropractic treatment for torticollis, which causes the neck to twist
to one side.
And
in 2016, the RACGP urged its members to never refer patients to chiropractors
after a YouTube video emerged showing a
Melbourne chiropractor flexing a newborn baby’s back before pressing firmly on
her spine to produce a cracking sound. The movement, which was meant to treat
colic and reflux, caused the baby to cry.
A
spokesman for the Chiropractic Board of Australia said its updated policy would
ensure safe and appropriate care by chiropractors who treat children under 12.
He said this guidance was based on current evidence and information.
When
asked why Safer Care Victoria’s key recommendation – that spinal manipulation
not be performed on children under 12 – had not been incorporated into the new
policy, he said the board had considered the review’s common themes. He said
these included “best practice and evidence-based care, proper informed consent,
practice within the chiropractor’s skill”.
AHPRA
has received 335 notifications about chiropractors since 2021, with five of
these relating to child patients. A total of 96 notifications resulted in
regulatory action, such as cautioning a practitioner, imposing conditions on
their registration or accepting an undertaking from a practitioner.
A
Safer Care Victoria review identified very little evidence of patient harm
occurring in Australia, but noted “it was clear that spinal manipulation in
children is not wholly without risk”.
“We respect every parent’s right to choose appropriate healthcare options for
their child – when weighing up treatment options, you need to consider any risk
associated with that care against any potential benefits,” a Safer Care
Victoria spokeswoman said.
The
Australian Chiropractors Association said the review found that chiropractic
care for children was extremely safe. It said that in more than 29,000 online
submissions, there were no reports of harm to a child receiving chiropractic
care.
“Chiropractors
are registered professionals, completing a rigorous five-year university
degree-level course, equipping them with the expertise to appropriately tailor
their care to children of all ages,” a spokesman said.
The
association welcomed the board’s updated statement on paediatric care.
My view is that consenting adults
can do what they like with their bodies but they should not impose non evidence
based interventions on their progeny! It follows therefore that chiropractors should
stay away for all under 18 IMVHO!
This view is confirmed when we read
this saga:
Call for age limit after chiropractor breaks baby's neck
By Julia Medew and
Amy Corderoy
A
baby's neck has been broken by a chiropractor in an incident doctors say shows
the profession should stop treating children.
The injury was reported to the Chiropractic Board of Australia, which closed
the case without reporting it to the public and allowed the chiropractor to
keep practising as long as they undertook education with an ''expert in the
field of paediatric chiropractic".
The Sun-Herald has also seen evidence that chiropractors have been entering Sydney hospitals, including neo-natal intensive care wards and surgical wards, to treat patients without the required permission.
NSW Health has warned that any chiropractor working in a hospital without permission could put patients at risk, while the Australian Medical Association NSW says the behaviour is "outrageous".
Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis - an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery.
''Another few millimetres and there would have been a devastating spinal cord injury and the baby would have either died or had severe neurological impairment with quadriplegia,'' he said.
Dr Pappas complained to the Australian Health Practitioner Regulation Agency, which referred the case to the Chiropractic Board. Three weeks ago, he received a letter from AHPRA saying the case had been closed after the chiropractor committed to completing further education.
Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it.
''I think they have put the chiropractor's interests before the interests of the public,'' Dr Pappas said. ''[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage.''
A review published in the Pediatrics
journal in 2007 also found serious adverse events relating to spinal
manipulations in children, including a brain haemorrhage and paraplegia.
However, the president of the Chiropractors' Association of Australia,
Laurie Tassell, says chiropractic treatment is as safe for children as it is
for adults, and chiropractors should be able to treat patients in hospital, if
authorised.
"Chiropractic care can be remarkably gentle," he said. "Being
a five-year, university-trained spinal health expert, a chiropractor will
modify their adjustment techniques to suit the age and spine of each individual
child."
President of the Australian Medical Association Steve Hambleton said the
board needed to either produce evidence supporting chiropractic treatments for
children or rule out paediatric care. ''The AMA is not aware of any evidence
that chiropractic manipulative treatment of infants and children offers any
benefit at all,'' he said.
The Sun-Herald has seen Facebook
conversations in which chiropractors discuss methods of sneaking into
hospitals. Images, obtained by blogger Reasonable Hank, include one of a baby
being adjusted in a hospital.
AMA NSW head Brian Owler said it was "absolutely outrageous" for
chiropractors to treat patients in hospital without permission. "None of
us can go into an emergency department of a hospital and start treating
patients without proper credentials and medico-legal coverage," he said.
A spokeswoman for NSW Health said treating patients without notifying the
hospital may be improper conduct and it could be reported to the Health Care
Complaints Commission.
Chiropractors
have once again been banned from manipulating babies’ spines after a health
board reversed its controversial decision to allow the practice.
The about-face by the Chiropractic Board of Australia follows revelations in this masthead that
practitioners had quietly given themselves approval to resume spinal
manipulation of children younger than two from November after a four-year ban.
Does Australia Need To Develop Nuclear Power Capabilities And Nuclear
Reactors As The Coalition Is Claiming?
Yes16 (62 %)
No10 (38 %)
I Have No Idea0 (0%)
Total No. Of Votes: 26
A fairly clear cut vote but
seemingly of little interest considering the vote count! Seems a majority of people who read here are keen on nuclear reactor development. I am sure many would like a comment from the nuclear proponents explaining their thinking on this topic!
Any insights on the poll are
welcome, as a comment, as usual!
A poor voting turnout.
0 of 26 who answered the poll
admitted to not being sure about the answer to the question!
When
big history is self-evidently being written, and leaders face momentous
choices, the urge to find inspiration in instructive historical parallels is
overwhelming and natural. “The only clue to what man can do is what man has
done,” the Oxford historian RG Collingwood once wrote.
One of the contemporary politicians most influenced by the
past is the Estonian prime minister, Kaja Kallas, and not just because of her
country’s occupation by Russia
or her personal family history of exile.
She
lugs books on Nato-Russian relations, such as Not One Inch, with her on
beach holidays. And in her hi-tech office at the top of the old town in
Tallinn, she argued this was a 1938 moment – a moment when a wider war was
imminent but the west had not yet joined the dots.
She said the same mistake was made in 1938 when tensions in
Abyssinia, Japan and Germany were treated as isolated events. The proximate
causes of the current conflicts in Ukraine, the Middle East, the
South China Sea and even Armenia might be different, but the bigger picture
showed an interconnected battlefield in which post-cold war certainties had
given way to “great-power competition” in which authoritarian leaders were testing
the boundaries of their empires. The lesson – and necessity – was to resist and
rearm. “The lesson from 1938 and 1939 is that if aggression pays off somewhere,
it serves as an invitation to use it elsewhere,” Kallas said.
Her favourite historian, Prof Tim Snyder, adds a twist by
reimagining 1938 as a year in which Czechoslovakia, like Ukraine in 2022, had
chosen to fight: “So you had in Czechoslovakia, like Ukraine, an imperfect
democracy. It’s the farthest democracy in eastern Europe.
It has various problems, but when threatened by a larger neighbour, it chooses
to resist. In that world, where Czechoslovakia resists, there’s no second world
war.”
Snyder said such an outcome had been possible. “They could
have held the Germans back. It was largely a bluff on the German side. If the
Czechs resisted, and the French and the British and maybe the Americans
eventually started to help, there would have been a conflict, but there
wouldn’t have been a second world war.
“Instead, when Germany invaded Poland in 1939, it was
invading Poland with the Czech armaments industry, which was the best in the
world. It was invading with Slovak soldiers. It was invading from a
geographical position that it only gained because it had destroyed
Czechoslovakia.”
Snyder drove home his lesson from history: “If Ukrainians
give up, or if we give up on Ukraine, then it’s different. It’s Russia making
war in the future. It’s Russia making war with Ukrainian technology, Ukrainian
soldiers from a different geographical position. At that point, we’re in 1939.
We’re in 1938 now. In effect, what Ukrainians are letting us do is extend
1938.”
A return to Churchill’s ‘locust years’?
As Christopher Hitchens once wrote, much American
foolishness abroad, from Korea to Vietnam to Iraq, has been launched on the
back of Munich syndrome, the belief that those who appease bullies, as the then
British prime minister, Neville Chamberlain, sought to do with Adolf Hitler in
Munich in 1938, are either dupes or cowards. Such leaders are eventually forced
to put their soldiers into battle, often unprepared and ill-equipped – men
against machines, as vividly described in Guilty Men, written by Michael Foot,
Frank Owen and Peter Howard after the Dunkirk fiasco. In France, the insult Munichois
– synonymous with cowardice – sums it up.
But Snyder made his remarks in Tallinn last month at the Lennart Meri conference, which
was largely dedicated to Ukraine and held under the slogan “Let us not despair,
but act”. It was held against the backdrop of Russia and China hailing a new authoritarian world order
in a joint 6,000-word statement that intended to create an axis to undo the
settlement of the past two world wars.
Many at the conference wrestled with how much had gone
wrong in Ukraine, and why, and whether the west would shed its self-imposed
constraints on helping Kyiv. In a sense, everyone wanted an answer to the
question posed by the Polish foreign minister, Radosław Sikorski: “Ukraine has
bought us time. Will we put it to good use?”
In 1934-35, what Winston Churchill termed the “locust
years”, and again after the Munich agreement, Britain did
not put the time to good use, instead allowing Germany to race ahead in
rearmament.
Johann Wadephul, the deputy chair of the German Christian
Democratic Union’s defence policy committee, fears the answer to Sikorski’s
question is in the negative. “If the war goes on like it is, it’s clear Ukraine
will lose. It cannot withstand Russian power with its well-organised support
from Iran, China and North Korea and countries like India looking only at its
self-interest.”
Europe had simply not reorganised itself for war, he said.
Listing the consequences for the continent in terms of lost human rights,
access to resources and confidence in the west, he said simply: “If Ukraine
loses it will be a catastrophe.”
Samir Saran, the head of the Indian thinktank the Observer
Research Foundation, who described himself as an atheist in a room full of
believers, nevertheless agreed that something bigger than Europe was at stake
as he almost mocked the inability of the west’s $40tn economy to organise a
battlefield defeat of Russia’s $2tn economy.
He argued: “There is one actor that has reorganised its
strategic engagement to fight a war and the other has not. One side is not
participating in the battle. You have hosted conferences supporting Ukraine and
then do nothing more. But when it comes to action, Russia 2.0 is grinding
forward.
“It tells countries like us that if something like this
were to happen in the Indo-Pacific, you have no chance against China. If you
cannot defeat a $2tn nation, don’t think you are deterring China. China is
taking hope from your abysmal and dismal performance against a much smaller
adversary.”
Political will v ‘political won’t’
Yet it is paradoxical. Nato is bigger and stronger
than ever. The transatlantic alliance is functioning far better than the US,
France and Britain did in the 1930s – and, after five months of hesitation,
some of the extra $60bn in US arms may reach the frontline within weeks.
But from Kyiv’s perspective, everything remains too slow
and circumscribed, except for the apportionment of blame across Europe.
Germany’s Marie-Agnes Strack-Zimmermann, the Free Democratic party’s top
candidate for the European elections, takes one side, urging France to hasten
weapons deliveries to Ukraine. She said: “We have the problem that, while
Poland is doing a lot as a neighbouring country, while Germany is doing a lot,
France is doing relatively little.”
Others say the culprit remains Berlin, and that, despite
recognising what a threat Vladimir
Putin represents, it cannot accept the consequences in terms of the
nuclear risks of going all in for a Russian defeat. Benjamin Tallis, a senior
research fellow at the German Council on Foreign Relations, said: “For all of
this talk of political will, what we actually face is political won’t. We won’t
define victory as a goal.”
Without naming Germany, the French president, Emmanuel
Macron, reinvented over the past year as a scourge of Russian imperialism,
said: “Europe clearly faces a moment when it will be necessary not to be
cowards.”
Ben Wallace, the former UK defence secretary, had less
compunction about naming names. “[Olaf] Scholz’s behaviour has shown that, as
far as the security of Europe goes, he is the wrong man in the wrong job at the
wrong time,” he said of the German chancellor.
Eliot Cohen, a neocon never-Trumper, finds a wider
institutional and moral malaise that needs addressing through a theory of
victory and a specific practical plan to secure that victory, something akin to
Churchill’s call for a ministry of supply
that turned the UK into a giant armaments factory.
Cohen said: “It’s not about what people say, it’s about
numbers. Are you willing to lift the restrictions on arms factories to run them
24 hours a day? Are you willing to give them Atacms [missiles] and hit targets
in Russia, and get Germany to give them Taurus missiles?
“My chief concern is that war is so remote from our
societies that we have trouble grappling with what success requires.”
Would Putin turn off his war
machine?
Sabine Fischer, a political scientist at the German Council
on Foreign Relations, says behind these disputes is the pivot around which
every judgment turns: whether Europe believes a Ukrainian defeat can be
contained. In other words, what are the consequences for Europe, if any, if
Ukraine collapses or a Russian-dictated peace leads to its retention of land
gained by military conquest?
Would a victorious Putin husband his resources, turn off
the war machine and say the recapture of Kievan Rus had been a self-standing
Moscow objective and Russia’s imperial ambitions were now sated? After all, not
every state that makes demands has unlimited ambitions.
The Hungarian president, Viktor Orbán, for instance, said:
“I do not consider it logical that Russia, which cannot even defeat Ukraine,
would all of a sudden come and swallow the western world whole. The chances of
this are extremely slim.” An attack on an existing Nato state would be “crazy”
since the Nato alliance would have to respond.
But Russia’s foreign policy concept issued in 2023 focuses
on a global confrontation with the US and building the alliances to defeat the
west. Given Putin’s unrivalled record of broken promises, a Russian peace
guarantee might end up as reassuring as Chamberlain’s advice to the British
people to have a quiet night’s sleep after he
returned from Munich. The US president, Joe Biden, interviewed in Time magazine
this week, appeared to regard the consequences as vast. “If we ever let Ukraine
go down, mark my words: you’ll see Poland go, and you’ll see all those nations
along the actual border of Russia, from the Balkans and Belarus, all those,
they’re going to make their own accommodations.”
Others say the Polish response will be less conciliatory. One former Nato commander, who spoke on condition of anonymity, said eastern states would not wait to find out Putin’s next move. “If Ukraine fails, I am certain that our Polish allies are not going to sit behind the Vistula [River] and wait for them to keep coming. I think the Romanian allies are not going to sit behind the Prut River and wait for Russia to go into Moldova. So the best way to prevent Nato from being involved directly in a conflict is to help Ukraine defeat Russia in Ukraine.”
Fischer believes the consequences of a Russian-dictated peace will not be containable. “Ukraine will experience a new wave of refugees fleeing to the west. The terror regime of the Russian occupation will expand and hundreds of thousands will suffer as a result. The economic, political and security situation will change drastically throughout Ukraine. Partisan warfare could erupt, fuelled by the militarisation of Ukrainian society,” she said.
“The threat situation for the states bordering Ukraine would worsen massively. This is true for Moldova, which would again be in the spotlight, as it was in 2022, especially if Moscow were to take over the Ukrainian Black Sea coast. The cohesive power of the western alliance would be shaken to its core. Russia would continue to weaken Europe from within by building alliances with rightwing, chauvinist populist parties.”
Ukrainians, from President Volodymyr Zelenskiy down, have for more than a year tried to frame the consequences of defeat in lurid terms, in an attempt to shake European torpor and galvanise the west.
Olena Halushenka, the co-founder of the International Center for Ukrainian Victory, urged Europe to think about the bombardment of Kharkiv. “Imagine a city the size of Munich is likely to be without electricity this winter. The cost in terms of millions of migrants will overwhelm Europe.”
Wadephul fears even such framing has not worked. “If you ask the average German on the street: ‘Do you really recognise what is at stake? That we have to spend money not for health but for defence?’ the answers show there is still a lot of persuasion to do. Europeans think they can have this war without thinking they are themselves at war.”
He thinks the guilty men are the leaders who pander to voters who dismiss the Russian threat. That takes the debate back to Germany’s, and specifically the Social Democratic party’s, ambivalence about a Russian defeat. It is not a coincidence that the election slogan of Scholz’s SPD was “a secure peace”.
Scholz himself, for instance, refuses to set Russia’s defeat as an objective, and, after Ukraine’s failed offensive, peace advocates within his party have had a resurgence. The party believes its vote is being squeezed by two parties, one left and the other right, both saying the war is unwinnable. In a sign of the times, Michael Roth, the SPD chair of the Bundestag foreign affairs committee and a supporter of arming Ukraine, is quitting politics, saying he found it was like stepping into a refrigerator to hold the views he did inside his own party.
Dangers of chasing ‘illusions’
Five 20th-century historians, including the Weimar Republic expert Heinrich August Winkler, complained in an open letter that Scholz was not willing to learn the lessons of history or recognise that Russia was bent on the destruction of Ukraine. “The chancellor and the SPD leadership, by drawing red lines, not for Russia but for German politics, weaken Germany’s security policy and benefit Russia.” The government had to come up with a strategy for victory, they argued.
There is even a suspicion that anti-war politicians with access to intelligence reports are leaking pessimistic accounts of German intelligence assessments, reinforcing the impression that Ukraine’s position is hopeless. Ralf Stenger, an SPD member of the Bundestag’s intelligence committee, said Ukraine’s failed offensive last year showed “we can and must prevent Ukraine from losing, but we cannot ensure that it wins”. Anyone who “keeps demanding that weapon A must be delivered more quickly and weapon B in even greater quantities” was chasing illusions, he added. Always increasing the dose when the medicine was not working was “not convincing”.
Critics say this fatalistic narrative – dovetailing with Russia’s main objective, which is to convince the US that further aid is futile – also makes little attempt to identify the lessons of the past two years about the failure to organise a war economy in Europe. Macron coined the phrase “war economy” at the Eurosatory military technology conference outside Paris in June 2022, but there is little sign the promise of such a fundamental reorganisation of Europe’s armaments industry has taken place, or even that anyone was appointed to bring it about.
Liberal market economies are inherently likely to be slower to adapt to war than their authoritarian counterparts, but one of the lessons of the 1930s, and those locust years, is that organising for rearmament entails planning and not just false reassurances, which were the stock in trade of Chamberlain and his predecessor Stanley Baldwin.
The reality was that Britain, overstretched and in debt, fell behind, and calls for a ministry of supply to coordinate the flow of arms were spurned. Nevertheless, Chamberlain complacently predicted that “the terrifying power Britain was building” by boosting its defences “would have a sobering effect on Hitler”.
Something similar happened with regard to ammunition supplies for Ukraine in Europe. In 2023, leaders said they would have 1m shells ready for Ukraine by March 2024, only to admit they could reach only half that number. They promised to reach 2m a year in 2025.
One prominent Ukrainian military adviser said the reality was that the Russian arms industry could now churn out 4.5m shells a year, each costing about only $1,000 to manufacture. Meanwhile, in Europe and the US, a total of 1.3m shells were being produced at an average cost of approximately $4,000. That means Nato is 10 times less efficient, and struggling to locate explosives.
He said: “We need a central plan like in the first or second world war. If governments have an existential demand, a company should not have the ability to make as much profit as they want. It should be regulated. Industrial warfare requires national institutions and a Nato-level industrial warfare committee, which would regulate prices.
“Right now, we have dozens of really high-level, super-important targets each day. And we have only one missile we can use a week, and this is actually insane.”
Some say the picture is improving, but the stark fact, according to Sikorski, is that 40% of the Russian government’s budget is devoted to defence. It is Russia, not Europe, that has built a war economy.
The Ukrainian adviser predicts the west may have caught up in two to three years in drones and munitions, but that means the next few years are the most dangerous the region would face.
In the short term, it is the absence of Patriot batteries, a surface-to-air guided missile, and US-supplied F-16s, agreed in August 2023, that leaves Ukraine so exposed. Only six EU member states – Germany, Greece, the Netherlands, Poland, Romania and Spain – operate Patriot systems. Germany has offered a third battery, and the Dutch part of theirs, but Greece and Spain say they have nothing spare. The date for F-16 deliveries depends on the speed at which pilots can be trained.
But Michael Bohnert, an engineer at the Rand Corporation, sees no sign of a public coordinated military plan to raise the firepower needed, let alone new munitions factories. Incredibly, the adviser to the Polish chief of staff, Krzysztof Król, admitted to a conference last month that after two years “we have not yet created proper conditions for a Ukrainian victory with our plans because political leaders had not yet told them the objective”. If that objective was conveyed, he added, “the military leaders could easily decide what is required. As it is, we give enough only for Ukraine to survive.”
To the extent any European leader has grasped this lacuna, it is Macron, with his emergency meeting in Paris on 26 February to look at ammunition shortfalls and repeated speeches on the existential threat to Europe from the alliance between the far right and Putin.
It will take two meetings, one involving the G7 leaders in Italy next week and then the 75th anniversary Nato summit in Washington in July, to reveal whether the west wishes not to contain Putin, but to defeat him – with all the risk that carries, including for China.
Macron will know many in Europe see the external threat as coming from migration, not Putin, and above all as a French politician, he knows the popular lure of an easy peace. Flowers, not tomatoes, greeted the French prime minister Édouard Daladier, to his surprise, when he returned from Munich in 1938. Knowing full well the threat posed by Hitler, and that he and Chamberlain had betrayed Czechoslovakia, the only democratic country in central eastern Europe, he turned to his counsellor and said of the cheering crowds: “Bunch of fools.”
I hate to say it but I have a real fear the Russians are going to win this war - unless the West really gets is act together - as it did in World War II.
As best I can tell it is not going well and sadly Ukraine is not getting the speed and volume of help it needs. Biden et. al. need to get their act together and fast!!!
The reason fewer GPs are bulk billing as consult costs rise
Royal
Australian College of GPs Vice President Michael Clements discusses why fewer
doctors are offering bulk billing as consult costs continue to rise.
A
$24 million website meant to let Australians compare costs of medical
procedures has only been used by 20 doctors nationwide to display their fees,
it has been revealed.
Medical
Costs Finder, a $2.5 million initiative launched in 2019 under the Coalition,
was intended to allow patients to shop around for affordable care.
The
former government allocated a further $17 million in 2020 to enhance the
website and encourage individual doctors to list their fees, in an attempt to
give patients greater transparency around out-of-pocket costs.
But
a Senate Estimates hearing on Thursday heard that so far only 20 doctors had
voluntarily listed their fees, equating to, in the words of independent Senator
David Pocock, “over a million dollars per doctor on the website”.
The website
was set up in 2019 under the Coalition.
The
revelation, which is reminiscent of the Rudd Labor government’s failed
GroceryWatch and FuelWatch websites, came while the ACT Senator was quizzing
Health Department officials about the “astounding” out-of-pocket surgery costs
paid by private patients in the territory, citing data from Private Healthcare Australia.
According
to the private health insurance peak body, ACT residents pay at least 50 per
cent more than other parts of the country — a typical knee replacement in the
ACT costs $4508, cataract surgery $1575, prostate surgery $2568, shoulder
reconstruction $3500 and gallbladder surgery $2165.
Mr
Pocock said he found the difference “staggering”, noting that gallbladder
removal in other states costs $600 or less.
Health
Department deputy secretary Penny Shakespeare replied that the higher
out-of-pocket costs were a result of prices set by individual surgeons, and
recommended patients use Medical Costs Finder to compare fees.
When
Mr Pocock then asked how many doctors’ fees were shown on the website, he was
left stunned when Health Department official Brian Kelleher confirmed the
national number was just 20.
“Ms
Shakespeare, you just told me people can go to the website and see the
different fees and make their mind up and now you tell me your website has 20
doctors in Australia with their fees,” Mr Pocock said, as first reported by The Guardian.
Ms
Shakespeare replied, “There are different parts to the website. There are
individual doctors able to disclose their particular fees and then we have
average fees broken down by jurisdictions.”
The
Senator pressed, “How does that assist people to shop around if there’s 20
doctors with their fees?”
Mr
Kelleher said 640,000 people had visited the website, which provides
information on 1300 medical items and 150 services, but Mr Pocock suggested
“the vast majority of people who visit (are) bitterly disappointed”.
Health
Minister Mark Butler pointed the finger at the Coalition.
“The
former government did nothing to make the Medical Costs Finder a useful tool
for consumers,” Mr Butler said in a statement on Friday.
“It’s
a service that has been left gathering dust and doesn’t provide transparency of
out-of-pocket costs. I’ve asked my department for advice on how we can improve
the current Medical Costs Finder and transparency.”
Mr
Butler said the government was “committed to working with consumers, the
colleges and private health providers to improve transparency of out-of-pocket
costs for medical specialist services”.
The
opposition has been contacted for comment.
Morgan
Begg, director of policy at the Institute of Public Affairs, said the fact that
“millions of dollars have been wasted on a frivolous medical cost finder
website is yet another reminder of the utter disregard governments have for the
money which belongs to hardworking taxpayers”.
“This
latest example follows the revelations the NDIS has wasted $2 billion on items
not in client packages, but has instead been spent on cars, holiday, and even
illegal drugs, as well as over $600,000 on a speechwriter,” he said.
“The
federal government continues to find new innovating ways to waste our money in
the midst of a cost-of-living crisis on things that don’t actually provide a
service or benefit to the community at all.”
In
a statement on Thursday, Private Healthcare
Australia called on the government to force doctors to list their fees on the
website.
The
peak body said its data showed out-of-pocket costs for common procedures in
private hospitals had increased by up to 300 per cent over the last five years.
“It’s
simply not possible for health funds to continually chase rising out-of-pocket
costs without contributing to hyperinflation in health, which leads to higher
premiums,” said Private Healthcare Australia chief executive Dr Rachel David.
“With
cost of living hurting and medical out of pocket fees spiralling, it’s time for
the government to intervene and publish doctors’ fees on the Medical Cost
Finder website. In Senate Estimates today it also was revealed that only 20
doctors had listed their fees on the Medical Costs Finder website, which cost
taxpayers $24.2 million to set up. As ACT Senator David Pocock pointed out —
that’s $1 million per doctor.”
Dr
David said consumers “should be able to check what doctors are charging and
shop around, even if it means crossing state borders”.
“Paying
more for treatment doesn’t guarantee a better outcome,” she said.
“We
need to do everything possible to protect consumers with private health
insurance from bill shock. This will keep our private sector strong and keep
pressure off the public system.”
What a saga – showing that even
Coalition Governments can attempt to implement stupid ideas – and thinking doctors
would take time to disclose their fees on a public web-site was as stupid as
they get.
!t was never going to work and
anyone who gave the thing a moments’ thought would have predicted what
happened!
The stagnating economy and shocking revelations this week about widespread defrauding of the $44 billion National Disability Insurance Scheme have more in common than it seems.
Nine out of 10 NDIS plan managers surveyed showed signs of fraud, and the justice system would be overwhelmed if all the scams were prosecuted, Dardo said in explosive testimony to the Senate.
Opportunists are setting up businesses purportedly to service people with disabilities, only to line their own pockets. The cost of the NDIS has surged from $13 billion in 2018-19, to $30 billion in 2021-22, to $44 billion in the current financial year, and is projected to hit $61 billion by 2027-28.
The NDIS actuary has warned that unbridled growth could take the scheme to $125 billion a year by the early 2030s, unless the government takes drastic action on eligibility rules. Belatedly, NDIS Minister Bill Shorten introduced proposed changes to parliament this week.
The rapidly growing scheme, which started about a decade ago with broad community support, is not only a concern for taxpayers. The out-of-control NDIS partly explains why the nation has a productivity and inflation problem.
Employers in aged care, childcare and cleaning are losing staff to $70-an-hour, self-employed NDIS jobs, they say.
Warehouse operator Carla Ryan says her business has suffered from a constant stream of workers leaving for higher-paid, unskilled NDIS work. “It leaves us to constantly push up pay rates, well above award, to keep finding and retaining good staff,” she says.
“I see and hear constantly about people who are choosing to work three nights a week, sleeping over at an NDIS-funded caring role where both the carer and cared-for person are mostly asleep, for $2400 gross, or $800 a night.
“This is versus a large range of alternative jobs they are prioritising this over, including tradie jobs, warehouse jobs, waiting jobs, accountant jobs, jobs of all types.”
Ryan also questions the impact of the NDIS on productivity and wage inflation. “Then on total inflation? Then on RBA rate rises?” she asks.
The national accounts published this week reveal that labour productivity, measured as GDP per hour worked, has flatlined over the past 12 months and is sitting 5 per cent below its pre-pandemic peak.
Productivity is the key determinant of living standards. The higher it goes, the higher real wages can sustainably rise as workers become more efficient at producing goods and services in a low-inflation way.
Reserve Bank of Australia governor Michele Bullock reiterated on Wednesday the importance of a productivity recovery to ensure wage rises were sustainable and don’t fuel inflation in a full-employment economy.
But there is a twist in the productivity numbers that comes back to the NDIS problem.
Productivity in the private sector is growing reasonably healthily and is back above its pre-pandemic level. But productivity in industries where governments set or highly regulate prices – healthcare and social services, public administration and safety, and education and training – has been going backwards.
This is the so-called “care economy” that Treasurer Jim Chalmers has talked up as key to Australia’s productivity aspirations. The care economy, particularly the NDIS, is becoming a bigger share of the overall economy as more people join the NDIS and an ageing population puts more demands on aged care and healthcare.
But the social assistance sector is also becoming less productive relative to the private sector.
Australia is now suffering a version of what economists know as Baumol’s cost disease.
Named after American economist William Baumol, his theory from the 1960s explains why prices for the services offered by people-dependent professions with low productivity growth – such as the NDIS and aged care – keep going up.
Almost one in three jobs created last year were in NDIS-related sub-industries like allied health and non-childcare social assistance, according to investment bank Jarden.
At a time of high inflation, policy economists now believe the uncontrolled growth of the NDIS is contributing to Australia’s inflation and productivity problem.
Former Treasury economist and former National Disability Insurance Agency executive Hassan Noura says labour shortages across the economy are contributing to supply side capacity constraints and putting upward pressure on inflation.
“Given this context, an important economic policy priority is to facilitate the smooth reallocation of labour from low to higher productivity jobs and sectors,” says Noura, now director of People Economics.
“When it comes to the NDIS, we need to talk about the quality of jobs and the quality of supports delivered, not simply the number of jobs and supports. Many of the jobs being created by the NDIS are not frontline care jobs directly benefiting people living with disability.”
Noura adds that a lot of the jobs that have been created are low-paying administrative and intermediary jobs, such as support co-ordinators and plan managers that help participants to submit their NDIS invoices and navigate the excessively complex NDIS ecosystem.
“Other jobs are being created to help combat and police the growing fraud in the sector,” he says. “The far better solution for participants and for the productivity of the economy would be to simplify and re-design the NDIS so that these jobs would not be needed in the first place.”
He says that while frontline care jobs “are more productive and more directly benefit participants”, caution and nuance are needed when creating jobs.
“For example, it’s great for people living with disability, and the productivity of the economy, if we create 1000 more allied health jobs that deliver hundreds of thousands of additional therapy sessions that are truly needed and effective and that lead to better outcomes.
“It’s less great, if not wasteful, and bad for the productivity of the economy, if we are creating these jobs to over-service NDIS participants with additional and/or ineffective treatments that do nothing to improve outcomes.”
Since June 2020, the number of businesses in social assistance and healthcare has exploded by about 49,000, according to the Australian Bureau of Statistics. The rate of business growth in health and social assistance is nearly three times the pace of population growth. Healthcare and social assistance businesses grew at a faster rate than any other sector in the year to June 30, 2023, expanding by 6.7 per cent.
While much of this is a natural evolution of the ageing population and a symptom of a wealthy nation demanding more personal care services, Australia is indisputably expanding jobs and businesses in low-productivity sectors that are funded by taxpayers. The NDIS has more than 170,000 unregistered providers receiving payments from an NDIS plan manager.
Queenslander Jim is critical about the services provided by the taxpayer-funded NDIS.
“A friend of mine who lives with his mother in a massive Queenslander overlooking the Brisbane river, with Rolls-Royces and Range Rovers in the driveway, has received tens of thousands of dollars from the NDIS because his mother is in a wheelchair,” he says.
“Anything remotely associated with the upkeep of the house is paid for by my tax dollars. A new pathway and driveway costing tens of thousands, paid by the NDIS because he rolls his mum down there once a week, despite the fact that he rolled his mum down the old one, with no problems, for 20 years.”
The NDIS has also paid for new airconditioning, a new fridge, and fixed half the property’s roof, he claims.
Meanwhile, Sheryl Brady, a mother of two sons with Down syndrome who receives help from the NDIS, says the government sets the prices providers can charge at too high a rate.
“Therapists were immediately able to charge a much higher rate than before, when the NDIS began,” she says. “And charges for support workers are also too high.”
She is also sceptical that higher pay attracts superior workers. “Inexperienced therapists are going into private practice too soon to get the higher pay,” she says. And support workers “find it’s good pay where they can sit on their phone and not do much, and the client/participant hasn’t always got the knowledge or skills to complain.”
Since the end of the pandemic, the economy has been running at full tilt. Demand in the economy is running ahead of the economy’s capacity to supply goods and services in a low inflation way, a point made by RBA governor Bullock this week.
At the same time, federal government spending has expanded from 24.5 per cent of GDP before the pandemic to about 26 per cent – the equivalent of about $35 billion a year more in spending, in addition to increases by state governments and large nominal wage rises.
The NDIS, which is a program with 650,000 people, now costs more than universal Medicare and rebates for private health insurance for the entire population.
Australia is now among the biggest government spenders on disability in the world, outlaying more than $84 billion a year (more than 3 per cent of GDP), for items such as the NDIS, disability support pensions, and carer payments.
This is more than double the share of GDP in the United Kingdom and Canada, and around the same levels as the European welfare states of Iceland, Finland and Sweden. So much for the claim a decade ago the NDIS would “pay for itself”.
Workforce participation rates of family carers have barely budged and some family members double-dip on the $44 billion NDIS and separate $13 billion carers payment.
When government consumption grows at a time when the economy is at full capacity, then household consumption has to fall to make room. Inflation and a higher income tax burden on households is the equilibrating mechanism.
One disability service employer says: “All the dirty secrets about fraud and dodgy providers have been known in the sector for years. The media stories now coming out are still only scratching the surface.
“We’ve been trying to get the government to listen that our sector does not have a regulatory system, which is pathetic,” they say. “It’s the fastest-growing government scheme and biggest cost blowout, but it has the least regulation, with no checks and balances.
“Someone can get out of jail today, get an ABN and start providing services tomorrow.”
He declines to be identified because he says disability advocates are “sensitive” to anyone publicly criticising the NDIS, and that being named could hurt his business.
The NDIS is fast becoming Australia’s equivalent of the UK’s once-treasured but arguably broken National Health Service.
It has become a monster, and appears to be slowly killing the economy.
This really feels like an uncontrolled financial disaster and I fear the impact on the health sector is going to be enormous!
There is only so much money in the Federal Budget and you can bet that, already, funds are being shifted from Health to try and cope with this emerging humongous blowout.
I do not believe “this will end well” for the health sector - or the economy in general! Finding the will to reign in the cost of the NDIS is, I suspect, just too hard for Government until we are all pretty much ruined!
