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, July 13, 2017

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

July 13, 2017 Edition.
The G20 meeting has wrapped up and we see Trump as an isolated and distrusted and see world policy development basically on hold. Now, with the story of what must be close to treason re his son's working with the Russians during the campaign to damage Hilary Clinton it seems all bets are off. Where is goes from here who knows??
The North Korean problem is yet to be sensibly addressed and is seemingly utterly intractable. Trump is being noisy and chest beating but clearly has no solution.
In Australia we now have discussions regarding missile defence while seeing the SA Government buying a great big battery and losing the political capital (and votes) to pass their bank levy.
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Here are a few other things I have noticed.
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National Budget Issues.

Property investors should expect more interest rate pain

Clancy Yeates
Published: July 3 2017 - 6:06AM
For all the political heat on banks, the last few weeks have shown toxic relations with government are no barrier to an old-fashioned unilateral hike in interest rates.
The big difference this time around is banks have been more tactical about it, by targeting rate hikes at one group in particular: property investors.
And I'd bet it's not the last time the banks will make property investors bear the brunt of higher interest rates this year. 
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'It's a national disgrace': Federal government slammed on PRRT

Eryk Bagshaw
Published: July 2 2017 - 5:31PM
The federal government has been accused of abandoning tax reform of the $200 billion gas export industry after it failed to consider replacing a regime that allowed some multinationals to never pay a cent in tax for the Australian resources they extract.
Treasurer Scott Morrison ordered a sweeping review of the petroleum resource rent tax in November following revelations that multinational companies exporting $60 billion worth of Australian gas overseas would not pay tax for decades. 
Australia is set to eclipse Qatar as the largest exporter of gas in the world by 2020 but will receive just a fraction of the revenue, $800 million compared to Qatar's $26.6 billion, under the current arrangements. 
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John Roskam blasts 'lazy, self-indulgent' Liberal Party facing 'existential crisis'

Michael Koziol
Published: July 2 2017 - 12:28AM
The "lazy" and "self-indulgent" Liberal Party is facing an existential crisis after a horror week that exposed deep wounds from which it may never recover, the head of the influential Institute of Public Affairs think tank has warned.
John Roskam, who on Tuesday hosted Tony Abbott for a speech in which he directly challenged Malcolm Turnbull's policy agenda, on Friday blasted both men for failing to deliver philosophical direction to the party, and took aim at "so-called conservatives" Peter Dutton and Mathias Cormann.
He said the significance of frontbencher Christopher Pyne's leaked comments was seismic because they addressed "the elephant in the room" of factional warfare and "let loose" the boiling tensions between moderates and conservatives.
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  • Updated Jul 3 2017 at 7:10 PM

Record debt burden raises stakes ahead of RBA meeting

The average debt of every household has soared to almost twice annual incomes and rising, according to data that increases pressure on the Reserve Bank of Australia and bank regulators to avoid a property market disaster.
Treasurer Scott Morrison said on Monday that he was confident this year's APRA crackdown on interest-only loans to property investors would ensure a "safe landing" by encouraging households to reduce their overall debt levels.
"There's a lot at risk," Mr Morrison said of the property market and current debt levels. "A hard landing in our housing market would have a quite devastating effect on our economy."
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  • Updated Jul 3 2017 at 9:54 PM

Australia to take a hit from MSCI changes

by Giselle Roux
The announcement to include China A shares in the MSCI indices was described variously as "symbolic" and "immaterial". At a 0.1 per cent weight in the MSCI All Country benchmark and 0.7 per cent of the emerging market index in the first round, the relevance is not in the short-term numbers but in the long-term trend. 
For those whose attention has wandered, China A shares are those listed in China. China stocks through Hong Kong (H shares) and listed in the US (as ADRs or American Depositary Receipts) are already represented in the global indices.
The MSCI, as the predominant base for measuring active fund performance and as the index for passive funds, is taking incrementalism to a new art. Of the 222 Chinese A stocks that qualify for inclusion, the process will only start in May 2018 with a 2.5 per cent partial inclusion (as a proportion of free float market capitalisation and accessible to overseas investors) with a similar amount to be included a few months later in August. To avoid a rush on the day, a provisional index is now available.
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The jobs puzzle: bad news for those waiting for a pay rise

Clancy Yeates
Published: July 4 2017 - 6:21AM
There's a paradox in the labour market, and it makes unhappy reading for those hanging out for a big pay rise.
In the past three months, official figures show the economy created about 140,000 jobs, and the unemployment rate has fallen to 5.5 per cent, a four-year low.
Indicators of future hiring are also strong. ANZ Bank on Monday said the number of job advertisements had also grown by 10.5 per cent in the year to June, more than double the rate of growth from six months ago.
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SA bank tax blocked by opposition

Clancy Yeates
Published: July 3 2017 - 6:01PM
South Australia's opposition has vowed to block the state government's bank tax in the upper house, after a fierce campaign against the $370 million levy from the powerful banking industry.
After a party room meeting on Monday afternoon, opposition leader Steven Marshall said the party would vote against the levy, which he described as "toxic" and "job destroying".
The opposition's decision means there will be enough upper house votes to block the tax, which shocked banks when it was announced last month. Several minor party MPs have also said they will oppose the levy.
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Morrison says housing policy is working, despite super warnings

  • The Australian
  • 1:02PM July 3, 2017

Rachel Baxendale

Treasurer Scott Morrison has cited new figures he claims show the government’s housing policy is helping to boost affordability, despite a warning to young Australians from the superannuation sector today that they cannot count on the Coalitions’s budget promise to help them save faster for a home deposit unless it is legislated.
The first-home super-save scheme started on Saturday and allows people to make up to $30,000 in voluntary super contributions over two years, with the expectation they will be able to withdraw those savings — plus earnings made — to put towards a house deposit.
The government wants first-home buyers to be able to be able to withdraw their super-saver savings from next July, but the superannuation sector has today warned that legislation will have to pass parliament for that to happen.
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Petroleum tax: Warning of 'significant damage' to Australian economy if PRRT is replaced

Eryk Bagshaw
Published: July 3 2017 - 5:43PM
The author of a landmark report into Australia's petroleum tax regime has warned replacing the existing tax would have damaging consequences despite claims Australia is missing out on billions of dollars in tax from multinational gas exporters.
Economist Michael Callaghan, who was selected by Treasurer Scott Morrison to chair a review into the petroleum resource rent tax, defended his findings at a Senate hearing on Monday.
"In an increasingly competitive marketplace for investment, I would place a high weight on avoiding policy changes that could potentially significantly damage Australia as an attractive investment location," he told the hearing by phone.
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RBA keeps cash rate on hold as retail rates rise and fall

Peter Martin
Published: July 4 2017 - 2:52PM
The Reserve Bank has kept its cash rate on hold at 1.5 per cent as retail banks push up rates on investor and interest-only loans and push down rates charged to owner-occupiers.
The Bank's decision, announced at 2.30 pm eastern time, means the cash rate will stay steady at the record low of 1.5 per cent for the twelfth consecutive month.
On balance, the forecasters taking part in the mid-year Scope BusinessDay survey released on the weekend expect another full year of steady rates, with the number expecting an increase roughly balancing the number expecting a cut.
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How China's debt binge threatens Australia

Matt Wade
Published: July 5 2017 - 12:16AM
No country can be indifferent to China's economy, especially not Australia. We're more exposed to what goes on in it than just about any other nation. China has long been the biggest market for our commodities, such as iron ore, coal and wool. And now it is the largest foreign buyer of our services, especially education and tourism. The upshot? Many thousands of Australian jobs depend on the health of the Chinese economy.
Big Asian economies in our region – China, India and Indonesia – are bound to become even more important to us during this, the Asian Century. Our politicians like to dwell on the opportunities presented by the historic economic transformation to our north. But we'll also need to be prepared for some nasty bumps along the way.
The aftermath of China's enormous corporate debt bubble could well be one of them. For some years now China's economic growth has been underpinned by an explosion in corporate lending. China has accounted for half – yes half – of all new credit created globally since 2005 according to the New York Federal Reserve. That's a huge share for an economy that now only accounts for about 15 per cent of the global economy.
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Tough rules on unions have stifled Australian wages

Josh Bornstein
Published: July 5 2017 - 12:05AM
When Reserve Bank governor Philip Lowe recently declared a "wages crisis" following a prolonged period of low wages growth, it appears to have caught the federal government on the hop. Quick to respond to crises about border protection, terrorism and rising energy prices, this is one crisis that renders the government mute. There is no plan, no working group, or commissioning of a white paper from the Productivity Commission. Instead, the government has announced a plan to pay up to 10,000 "interns" to work in the retail industry for as little as $4 an hour. This plan will only exacerbate the wages crisis.
Phillip Lowe is not the first prominent mandarin to observe that stagnant wages threaten economic growth. A new consensus has emerged since the Global Financial Crisis that anaemic wages growth and increased income inequality is retarding economies and stoking political volatility in developed economies. Nevertheless, Lowe is the first in Australia to join the chorus. His suggested remedy – that employees need to speak up more to request higher pay – is strikingly naive, inviting the obvious question. What if the boss says "no"?
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  • Jul 5 2017 at 9:43 AM

Risks remain amid the global recovery

by Martin Wolf
The Bank for International Settlements is the stopped clock of international economic institutions. It has argued for monetary and fiscal tightening, whether that makes sense, or not.
Fortunately, policymakers, or at least the central banks that are members of the BIS, have ignored its apparent conviction that the world needed an even deeper and more prolonged recession.
Yet now, precisely because central banks wisely ignored its advice, a synchronised recovery has finally arrived.

Aussie bonds go to one mystery whale with record $800 million appetite

Garfield Reynolds
Published: July 5 2017 - 2:50PM
A single buyer snapped up all $800 million of Australian government bonds sold on Wednesday, the largest ever amount bought by one bidder in auctions that date back to 1982.
The sale of a nominal bond to just one entity hasn't happened since August 2013, according to data from the Australian Office of Financial Management, the government funding arm.
The 3.25 per cent notes maturing in April 2029 went off at a yield of 2.72 per cent, the office said on its website, without identifying the buyer.
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AustralianSuper 'not concerned' about bank tax

Clancy Yeates
Published: July 6 2017 - 12:15AM
The country's biggest superannuation fund has not changed its view on investing in banks as a result of the federal government's major bank tax, despite bank claims the policy will hit all Australians' retirement savings. 
As AustralianSuper reported returns of 12.4 per cent in its key investment option last financial year, chief investment officer Mark Delaney said he was unconcerned by the impact of the federal bank tax on the country's five biggest lenders.
Although he predicted overall returns would be softer in the year ahead, he said that, for a long-term investor, policy changes such as the bank tax were part of the regulatory environment banks faced.
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Top rate to swamp 1.2m taxpayers by 2028

  • The Australian
  • 12:00AM July 6, 2017

Adam Creighton

The number of Australians paying the top tax rate will more than double to almost 1.2 million within 10 years, according to new modelling that has ignited a ferocious Liberal attack on Bill Shorten’s election manifesto to increase the highest bracket to an effective 49.5 per cent.
Scott Morrison last night seized on the analysis based on the release of Parliamentary Budge­t Office figures.
“Labor’s goal to have both one of the highest personal income tax rates and the highest corporate tax rates in the world is a dark economic vision for Australia,’’ the Treasurer told The Australian last night.
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NAB extends crackdown on interest-only home loans

Clancy Yeates
Published: July 7 2017 - 12:15AM
National Australia Bank will start automatically rejecting customers who want to borrow a high multiple of their income and only pay interest on their home loan, amid concerns over the growing risks created by rising household indebtedness.
From this Saturday, the bank will decline any customer applying for an interest-only loan who has a high loan-to-income ratio – an approach that banking sources said was not used by other lenders in the mortgage market.
NAB would not say what loan-to-income ratio it considered to be "high", but the move signals a further toughening in its stance towards interest-only borrowers, who are already facing higher interest rates, larger deposit requirements and shorter loan terms.
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Fears of a housing bubble in Australia are overblown, says HSBC economist

Emily Cadman
Published: July 7 2017 - 1:20AM
Soaring home prices in Australia's biggest cities are driven by strong demand and a lack of supply, rather than indicating a "bubble," according to one of the nation's top economists.
"At a national level, a key reason for rising housing prices has been housing under-supply," HSBC Holdings'  local chief economist Paul Bloxham wrote in a research note on Thursday.
"This also suggests that a significant fall in Australian housing prices, as occurred in the US and Spain during the global financial crisis, is unlikely."
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  • Jul 7 2017 at 10:40 AM

Traders left bewildered by huge spike in global bond yields

Beware overly tranquil markets; there are hidden dangers lurking in their depths treacherous.
That was the bruising lesson for investors overnight as a huge sell-off rippled through global bond markets, amid growing fears that the massive tide of liquidity created by central banks' bond-buying programs - and which has buoyed bond and equity markets worldwide - is finally beginning to ebb.  Europe bore the brunt of the sell-off with the yield on benchmark 10-year German bunds climbing to an 18-month high. (Yields rise as bond prices fall).
Investors fear that bond markets could be in for even more pain, with the US central bank preparing to start whittling back the size of its massive bond portfolio, the Bank of Japan quietly reducing the amount of bonds it buys each month, and even European Central Bank likely to signal a further tapering in its bond purchases by the end of the year.
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  • Jul 7 2017 at 10:00 AM

Once safe Australian fixed-rate bonds suffer losses

Australia's main fixed-income index — against which almost all superannuation funds benchmark — delivered its fourth worst return in modern history over the 12 months to June 30. In particular, the exclusively "fixed-rate" (rather than "floating-rate") AusBond Composite Index returned just 0.25 per cent over the last year before you deduct fees.
After accounting for Australia's 2.1 per cent inflation rate, investors in these fixed-rate bonds actually suffered a "real" return loss of 1.85 per cent from what is supposed to be a bullet-proof asset class dominated by super-safe bonds.
Indeed, the AusBond Treasury Index (which is made up of 20-plus AAA rated Australian government bonds) suffered an outright loss with a terrible return of minus 1 per cent over the year to June 30 (or minus 3.1 per cent after inflation).
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In search of the elusive American Dream

Ross Gittins
Published: July 8 2017 - 12:15AM
Recent political shocks – Brexit, Trump and the failure of Theresa May – are prompting much soul-searching and rethinking among the world's leading economists.
Last week, for instance, Ben Bernanke, former chairman of the US Federal Reserve, gave a speech to a forum of the European Central Bank in which he admitted that "recent political events" had "cast a bright light on some disturbing economic and social trends in the United States".
"Unfortunately, policymakers in recent decades have been slow to address or even to recognise these trends, an error of omission that has helped fuel the voters' backlash," he said.
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Australia should consider missile defence to counter North Korea: Kevin Rudd

Peter Hartcher, James Massola
Published: July 8 2017 - 1:43AM
Australia needs to consider deploying a missile defence system to defend against attack from nuclear-armed North Korea, according to former prime minister Kevin Rudd.
Mr Rudd has reversed the position he held in office, saying that North Korea's newly demonstrated ability to reach northern Australia meant it was time to consider homeland defence.
And top regional security and defence experts have backed that call, arguing Australia and its regional allies must invest heavily in missile defence as the "only alternative".
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Australia cuts resources export revenue forecast on iron ore outlook

Published: July 7 2017 - 1:30PM
Australia has revised down the value of its resources and energy export earnings in the financial year ended June by 4.6 percent, or nearly $10 billion, due largely to falling prices for iron ore, its most valuable export.
The downward revision to $205 billion mainly reflects an earlier than expected decline in iron ore prices since the previous forecasts were published three months ago, the Department of Industry, Science and Innovation said.
Iron ore, Australia's top source of export revenue, should average $US62.40 in calendar 2017, down from an earlier forecast of $US65.20, the department said.
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Elon Musk’s Tesla to build giant battery for SA

'World's biggest battery' to be built in SA

Verity Edwards

US-based Tesla and French company Neoen will build the world’s largest lithium ion battery in South Australia with plans to complete construction before summer.
The 129 MW per hour plant will be built at Jamestown, expanding Neoen’s Hornsdsle Wind Farm, two hours north of Adelaide.
Tesla owner Elon Musk, who is worth more than $US16 billion, arrived in Adelaide this morning for the announcement, where he pledged to build the battery storage facility within 100 days or provide it for free to the South Australian government. Mr Musk refused to say how much the battery system would cost.
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Health Budget Issues.

Healthcare: Call for royal inquiry into medical devices costs

  • The Australian
  • 12:00AM July 6, 2017

Sarah-Jane Tasker

Health insurance industry head Matthew Koce has called for a royal commission into the high cost of medical devices in Australia, arguing “powerful interests” were delaying reform.
Mr Koce, chief executive of hirmaa, which represents 22 not-for-profit and member-owned health funds, made the request yesterday when he fronted a Senate hearing into private health insurance.
“Every day big multinational national companies are permitted to obfuscate and delay and to continue charging grossly excessive prices in Australia (for medical devices),” he told the committee, which is chaired by Greens senator Rachel Siewert.
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Pharmaceutical Benefits Scheme 'left behind' by changing cancer treatments

Katie Burgess
Published: July 6 2017 - 7:25AM
The face of cancer treatment is changing and the Pharmaceutical Benefits Scheme is failing to keep pace, one rare cancer sufferer says.
When Matthew Owen was given less than a year to live in December 2014, he did a lot of living in between bouts of chemotherapy.
He jumped out of a plane, bungee-jumped, swam with whale sharks and had his last Christmas with wife Karen and son Will. 
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7 July 2017

Sonic pulls out of pharmacy pathology plan

Posted byJulie Lambert
Sonic Healthcare has dissolved a lucrative tie-up to supply pathology testing for a new business expansion by pharmacies, bowing to scathing opposition from GPs.
 The in-store pathology screening program, launched last month by Amcal pharmacies, was slammed by the AMA as “wasteful and opportunistic” and a risk to patient care.  
 In recent days, a number of influential GPs informed Sonic that they would boycott the company’s services in protest.
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Health cover at ‘tipping point’

  • The Australian
  • 12:00AM July 8, 2017

Sarah-Jane Tasker

Medibank Private boss Craig Drummond has warned that the health insurance sector is at a “critical juncture”, saying the time for policy reform is now, but industry heads say that the volatile political environment dents any hope of change.
Mr Drummond, fresh from a tour of European and US health systems, said affordability concerns were accelerating, adding it was not just a private health insurance issue but one that spread across industries including banks, telecommunications and utilities.
“The issue is more about the ­financial shape of Australian consumers relative to their debt burden,” he said. “We are at a critical juncture and the time to act on reform and change is now, for many industries, before the challenge gets even bigger.
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Drug companies spent $287 million in four years on 'educational' events for doctors

Esther Han
Published: July 7 2017 - 5:31PM
The drug industry is spending $72 million a year "educating" doctors, with one company splashing $750,000 on a weekend conference.
A new database of pharmaceutical company-funded events created by Sydney University researchers shows 42 companies shelled out $286 million on 117,000 events for doctors and nurses over a four-year period. The average cost of an event was $2500.
"This suggests an epidemic of drug company influence that is extremely unhealthy and extremely worrying," said Dr Ray Moynihan, an over-diagnosis expert at Bond University.
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International Issues.

'Provocative operations': US Navy sends warship into South China Sea

Elizabeth Dexheimer
Published: July 3 2017 - 7:06AM
Washington: The Trump administration has sent a guided-missile destroyer near Triton Island in the South China Sea, according to a US official, possibly complicating President Donald Trump's meeting with his Chinese counterpart this week.
The US Navy sent the destroyer USS Stethem within 22 kilometres of Triton Island on Sunday, said the official, who wasn't authorised to speak publicly. The warship was passing through those waters on the basis of innocent passage, the official said.
China, Taiwan and Vietnam all lay claim to Triton, a tiny speck that's one of the Paracel Islands in the waters between Vietnam and the Philippines. Operations such as this are typically planned at least weeks in advance, the official said.
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Qatar won't back down over Saudi ultimatum and returns fire on terrorism claims

Nadeem Hamid
Published: July 3 2017 - 12:42AM
The Qatari government, under a Saudi Arabia-led blockade of its air, sea and land links, is unwilling to concede to any demands that threaten its sovereignty or violate international law, Foreign Minister Mohammed bin Abdulrahman al-Thani said.
The small Persian Gulf emirate is prepared to let pass the deadline for complying with 13 demands set down by four nations in the region. The demands include closing the al-Jazeera television network and cutting back ties with Iran, Thani said on Saturday in Rome, where he met with his Italian counterpart.
"There is no fear from our direction. We are ready to face the consequences," he said. "There is an international law that should be respected and not violated."
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Radical new plan to remove ‘incapacitated’ President Trump

July 4, 201711:27am
US politicians are so seriously concerned about President Donald Trump’s sanity they are making a plan that could see him removed from the White House over it.
A group of Democrats has put forward a bill to propose a committee that could declare Mr Trump “incapacitated” and remove him from office.
The increasing level of concern over the deteriorating situation in the White House comes as questions have been raised over the President’s state of mind following a series of bizarre and even aggressive tweets.
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North Korea talks: US requests closed-door UN Security Council meeting

David Brunnstrom and Christine Kim
Published: July 5 2017 - 6:37AM
New York: A US spokesman said the United States has requested a closed-door meeting of the United Nations Security Council for urgent discussions regarding North Korea and its latest ballistic missile test.
The spokesman said the meeting of the 15-member council was likely to be scheduled for Wednesday.
Pyongyang said on Tuesday it had successfully test-launched a first intercontinental ballistic missile, or ICBM, which analysts said could put all of Alaska in range for the first time.
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North Korea claims ICBM launch, bringing US and Darwin within range

Kirsty Needham, Michael Koziol
Published: July 5 2017 - 12:26AM
Beijing: North Korea has claimed its first successful launch of an Intercontinental Ballistic Missile, defying a tweet by US President Donald Trump in January that "It won't happen!".
Experts estimated that if the missile had been launched at a "normal" angle, instead of the steep trajectory used in the test, it could have flown more than 6000 kilometres, a distance that would see it reach the US mainland.
This range also brings Darwin within reach.
A joint statement from China and Russia, released as presidents Xi Jinping and Vladimir Putin met in Moscow, called on North Korea to freeze its nuclear and missile activity, but also called for the United States to halt its military exercises with South Korea on the Korean Peninsula.
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In trying to tackle North Korea, Donald Trump risks creating a crisis with Beijing

Paul McGeough
Published: July 5 2017 - 3:28PM
Washington: North Korean dictator Kim Jong-un has seemingly crossed a threshold - he now has missiles that go halfway around the world, despite a January warning, when then president-elect Donald Trump declared: "It won't happen!"
If Trump's tweet was an implicit threat of a pre-emptive strike by Washington, it stands out in the administration's menu of possible responses as the only one that has not been attempted.
All the others - containment, sanctions, negotiations and cyberwar - have been tried in various configurations by previous administrations, to little effect.
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US ambassador Haley threatens force against North Korea

Michelle Nichols
Published: July 6 2017 - 7:34AM
United Nations: The United States said on Wednesday it was ready to use force to stop North Korea's nuclear missile program but said it preferred global diplomatic action against Pyongyang for defying world powers by test launching a ballistic missile that could hit Alaska.
US Ambassador to the United Nations Nikki Haley told an emergency meeting of the UN Security Council that North Korea's actions were "quickly closing off the possibility of a diplomatic solution" and the United States was prepared to defend itself and its allies.
"One of our capabilities lies with our considerable military forces. We will use them if we must, but we prefer not to have to go in that direction," Haley said.
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Donald Trump's tweets have suddenly grown a lot more dangerous

Sarah Posner
Published: July 6 2017 - 7:45AM
The Los Angeles Times reports Wednesday morning that foreign policy experts are worried that President Donald Trump could be caught flat-footed at his upcoming meeting with Russian President Vladimir Putin at the Group of 20 summit in Hamburg on Friday.
Even Trump's aides acknowledge the president's unwillingness to read the briefings they have compiled about his cunning Russian counterpart.
As a result, they have opted for their best chance of penetrating the president's consciousness: "a list of tweet-length sentences that summarise the main points Trump could bring up with Putin."
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Ready or not, Trump may be about to face his first full-blown international crisis

Paul Waldman
Published: July 6 2017 - 10:21AM
On the many occasions over the last five months where President Donald Trump demonstrated his deep ignorance, his alarming impulsiveness, his bottomless need for praise, or his tendency to lash out when criticised, one common response has been to ask, "What happens when he faces a genuine crisis with the need to make difficult decisions and lives at stake?"
Well it looks as if we may be about to find out.
North Korea has launched what appears to be its first genuine intercontinental ballistic missile. Though it landed near the Japanese coast, it was launched on a high arc that American analysts say indicates it has the capability to reach the United States (Alaska, at least). This is an outcome national security experts have worried and warned about for some time, and one that Trump himself pledged would never happen under his watch. We could be headed for a military crisis with the potential to cost thousands or even millions of lives, the outcome depending on Trump's strategic thinking and good judgment.
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North Korea: there is only one acceptable endgame

Michael Pembroke
Published: July 6 2017 - 12:05AM
 It is a truism that there is nothing much to like about North Korea. It is harsh, authoritarian, repressive and secretive. And its economic structural problems are largely of its own making - a direct result of the huge expenditure on its "military first" policy, its socialist economic principles and the greed, graft and moral obloquy of the ruling elite. But there has never been a popular uprising and the regime is likely to continue. And China has a vital interest in its ongoing survival.
As with Mark Twain's death, predictions of North Korea's imminent collapse are misplaced. Such imaginings tend to be the preserve of enthusiasts in the Pentagon and the State Department; the same ones who insist foolishly that Kim Jong-un is irrational; who refuse to deal with Pyongyang, hoping for collapse.
The geopolitical reality is that North Korea is committed to being a nuclear state. At some point in the not too distant future, it will miniaturise nuclear warheads on intercontinental ballistic missiles. Refusing to engage with it will not make that prospect go away. Washington's policy of non-engagement serves only to maximise the fear, antagonism and pugnaciousness that have characterised North Korean policy for years. The Pentagon's frequently expressed mantra that it will not reward bad behaviour is unwise. China's recent criticism was pointed. It counselled the United States that by not talking to Pyongyang "you will only drive them in the wrong direction", and that a policy of non-engagement is "only making things worse".
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North Korean missiles can strike Australia and we can't stop them

Peter Hartcher
Published: July 8 2017 - 12:00AM
This week we learnt that the rogue state of North Korea has the ability to launch an intercontinental ballistic missile with the range to reach northern Australia. And we know they are working to miniaturise nuclear warheads to put on top. Question: If the North Korean regime were to fire a nuclear weapon at Australia, what would stop it? Answer: Nothing.
This will come as a surprise to many Australians who trust their government to protect them and trust that the $34.6 billion in the annual defence budget will cover it. But Kim Jong-un's new capability did come a lot sooner than expected. A year ago, the US government said its best guess, based on CIA assessments, was that the North Koreans were about four years away from an intercontinental ballistic missile. This week we watched it streak across the sky on TV, three years early.
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Trump isolated again as G20 sees US slowly detach from rest

Josh Wingrove, Gregory Viscusi and Arne Delfs
Published: July 9 2017 - 4:24AM
World leaders forged a fragile compromise at a summit in Germany that failed to conceal the reality that Donald Trump's America is increasingly going its own way.
The Group of 20 nations meeting in Hamburg agreed to fight protectionism while tacitly recognising Trump's concerns about excess steel capacity and what he says are unfair trade practices. On climate change, the US was again isolated, with all 19 other members agreeing that the Paris accord on cutting emissions was "irreversible."
"I always said that this wouldn't be easy and that we shouldn't hide areas of discord," Chancellor Angela Merkel, the summit host, told reporters on Saturday at the end of two days of talks. "The communique has to reflect those areas where there is no consensus."
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I look forward to comments on all this!
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David.

The Wall Street Journal Looks At Some Digital Health Futures. Fun Stuff.

This appeared from a well-known Guru last week:

The Smart-Medicine Solution to the Health-Care Crisis

Our health-care system won’t be fixed by insurance reform. To contain costs and improve results, we need to move aggressively to adopt the tools of information-age medicine

By  Eric Topol
July 7, 2017 12:04 p.m. ET
The controversy over Obamacare and now the raucous debate over its possible repeal and replacement have taken center stage recently in American politics. But health insurance isn’t the only health-care problem facing us—and maybe not even the most important one. No matter how the debate in Washington plays out in the weeks ahead, we will still be stuck with astronomical and ever-rising health-care costs. The U.S. now spends well over $10,000 per capita on health care each year. A recent analysis in the journal Health Affairs by the economist Sean P. Keehan and his colleagues at the federal Centers for Medicare and Medicaid Services projects that health spending in the U.S. will grow at a rate of 5.8% a year through 2025, far outpacing GDP growth.
Our health-care system is uniquely inefficient and wasteful. The more than $3 trillion that we spend each year yields relatively poor health outcomes, compared with other developed countries that spend far less. Providing better health insurance and access can help with these problems, but real progress in containing costs and improving care will require transforming the practice of medicine itself—how we diagnose and treat patients and how patients interact with medical professionals. In medical training, private sector R&D, doctor-patient relations and public policy, we need to move much more aggressively into the era of smart medicine, using high-tech tools to tailor more precise and economical care for individual patients. This transition won’t be easy or fast—the culture of medical practice is famously conservative, and new technology always raises new concerns—but it has to be part of the solution to our health-care woes.
Radical new possibilities in medical care are not some far-off fantasy. Last week in my clinic I saw a 59-year-old man with hypertension, high cholesterol and intermittent atrial fibrillation (a heart rhythm disturbance). Before our visit, he had sent me a screenshot graph of over 100 blood pressure readings that he had taken in recent weeks with his smartphone-connected wristband. He had noticed some spikes in his evening blood pressure, and we had already changed the dose and timing of his medication; the spikes were now nicely controlled. Having lost 15 pounds in the past four months, he had also been pleased to see that he was having far fewer atrial fibrillation episodes—which he knew from the credit-card-size electrocardiogram sensor attached to his smartphone.
In my three decades as a doctor, I have never seen such an acceleration of new technology, both hardware and software, across every dimension of medical practice. I have also had the opportunity to advise and collaborate with several companies on these developments. The new tools are not just more powerful, precise and convenient; they are more economical, driven by the information revolution’s ability to deliver, as Moore’s Law holds, ever-increasing computing power for less money.
Consider the biggest line items in the 2016 national health-care budget, according to Mr. Keehan and his colleagues: more than $1 trillion for hospital care, $670 billion for doctor and clinician services, $360 billion for drugs. And compare the often sorry outcomes: more than 1 in 4 patients harmed while in the hospital; more than 12 million serious diagnosis errors each year; a positive response rate of just 25% for patients on the top 10 prescription medications in gross sales.
We don’t have to resign ourselves to this outrageous situation. Smart medicine offers a way out, enabling doctors to develop a precise, high-definition understanding of each person in their care. The key tools are cheaper sensors, simpler and more routine imaging, and regular use of now widely available genetic analysis. As for using all this new data, here too a revolution is under way. Algorithms and artificial intelligence are making it possible for doctors to rapidly apply relevant medical literature to their patients’ cases, while “natural language processing” (that is, talking to computers) holds the promise of liberating them from keyboards during office visits.
One obvious practical effect of these developments will be to replace hospital stays with remote monitoring in the patient’s home. The Food and Drug Administration has already approved wearable sensors that can continuously monitor all vital signs: blood pressure, heart rate and rhythm, body temperature, breathing rate and oxygen concentration in the blood. The cost to do this for weeks would be a tiny fraction of the cost for a day in the hospital. Patients will be able to avoid serious hospital-acquired infections and get to sleep in their own beds, surrounded by family.
Pages more here:
Dr Topol has some fun ideas and is well worth a read.
David.

Wednesday, July 12, 2017

It Seems At Least One Medical Student Is Not At All Fond Of The myHR.

This appeared last week:

Data, distrust, and the disastrous My Health Record

Amy Coopes |  05 July 2017

Plagued by sluggish uptake, clinician reticence and a substantial privacy backlash, the $1.2 billion My Health Record has proven, thus far, something of a lemon.

No amount of rebranding away from the unfortunately-acronymed PCEHR ('pecker') to My Health Record, or push to a coercive opt-out model can overcome the simple fact that it isn't very popular. After five years just five million Australians — one in five of us — have signed up for a record, and only 10,000 doctors, hospitals and other health providers are on board.
The putative benefits of an electronic health record have been expounded at length by the government, and are purported to include: less fragmentation of health data across a heavily siloed system; improved availability and quality of information; fewer adverse events and duplicated tests or treatments and improved coordination and quality of care overall.
Savings, of course, feature prominently — some $7 billion in direct costs every year, according to modelling done for the government. Untold billions more could be leveraged through sale of deidentified data (something that is already taking place).
But for success there must be buy-in, and for buy-in, there must be trust, according to the Productivity Commission. Both are lacking, and it is important to consider why.
In general terms, Australians have little reason to trust the government when it says it can protect their data. The 2016 Census distributed denial of service fiasco exposed fundamental infosec flaws; indeed, Cyber Security Minister Dan Tehan speculated that Australia had only managed to dodge the recent WannaCry ransomware attack because it fell locally on a weekend.
Wannacry threw Britain's National Health Service into disarray, highlighting the vulnerability of online systems hosting some of the most sensitive data about a country's citizens. A similar attack crippled the Ukraine and sent ripples across the globe last week, with hospitals among those affected.
Serious doubts were raised about the sanctity of health data already held by the Australian government this week after The Guardian revealed the Medicare details of any citizen were available for sale from the darknet, in real time — implying a live and active leak. Electronic health records are estimated to be 100 times more valuable than stolen credit cards, and healthcare is second only to financial organisations as the top target for data breaches worldwide.
Lots more here:
Amy has done a great job putting together all the Health IT privacy invasive things that have happened in the last year or so. There sure have been a lot of mess-ups in the last year or so.
After the last few days this contribution seems more than prescient.
Enjoy the read! It is hard to think things with the myHR can remain the same absent an extreme level of stubbornness on the part of the Government / ADHA! Some major sensible change is sorely needed,
David.

A Press Release From eHealth Privacy Australia - More Grist To The Mill

I was sent this today:

------

MEDIA RELEASE

Medicare data breach and My Health Records: Inquiry is not enough.

(For immediate release)

While the government's announced inquiry into a problem with Medicare data access is to be applauded, fundamental questions remain.

“A centralised eHealth database accessible over the Internet to over 100,000 legitimate access points, (#1) each of which has access to the entire database, is fundamentally indefensible,” said eHealth data consultant and eHealth Privacy Australia principal, Paul Power, as quoted in the media. (#2)

Unless a public inquiry urgently investigates the fundamental vulnerability of the proposed database of the My Health Records system and recommends appropriate changes, we will be no further forward with either safety or security.

It is insufficient to recommend changes that will merely lead to an improvement in security. There is a need to understand what is technically possible and how that will allow illegitimate users to access the database.  Changes then need to be made which make such access virtually impossible.

While the Guardian exposé of the vulnerability of the Medicare card database demonstrates what has actually happened, the technical risks of such an intrusion have always been evident to information technology experts.

The technical ease of unwanted access to the proposed My Health Records system is similarly evident. A change to the implementation method, rather than an “improvement” in security, is necessary to protect the private health information of every Australian citizen from the Prime Minister to the newborn child.

The eHealth Record system currently being deployed in Germany has addressed these issues, by avoiding a centralised health data repository, with the master health data of each citizen being held on an encrypted memory chip in the equivalent of Australia's Medicare card. (#3)

An investigation of the fundamental security issues, rather than “recommendations for improvement” is required for our private health data to be secure.

eHealth Privacy Australia calls for a Senate Inquiry or Australian National Audit Office investigation. Anything less will leave the government open to the accusation that they have "doubled the locks on the front door, but left the back door wide open."

eHealth Privacy Australia calls for widening the terms of reference of the "Independent review of health providers' accessibility to Medicare card numbers", announced 10 July 2017, to make the findings public and allow input to the review by organisations representing Australian citizens' privacy interests and others.

eHealth Privacy Australia

ENDS

0408 387 978

(#1) There are more than 100,000 registered medical practitioners, but over 670,000 are registered to access Medicare numbers, including pharmacists, allied health practitioners and 14 other class groups.

(#2) 1. Sue Dunlevy, The Daily Telegraph, 3 July 2017, et al.
2. Daryl Manzies, Territory FM, 4 Jul 17,
3. Chris Maher, 7 News, 6pm, 4 Jul 17 
4. Adam Gartrell, Sydney Morning Herald, 4 Jul 17, 
5. Karen Barlow, Huffington Post, 5 Jul 17,
6. Fiona Wiley, ABC, Statewide Drive, 5 Jul 17

 
----- End Release.
 
Seems reasonable to allow others the read and react.
 
David.
 

Recent Breaches Are Focusing Attention On The Need To Think About Your Privacy.

This appeared after all the breaches got into the news:

Breaches serve as a reminder of your rights to privacy

Alison and Jillian Barrett
Published: July 6 2017 - 9:59PM
The "Mediscare" event this week, where it is alleged Australians' Medicare details can be purchased online, has no doubt made many of us question to whom we provide our personal information.
It seems our children may not be immune, with fears that students' personal and educational information is being shared to private companies who contract to schools.
In an age where we entrust so many different people, businesses and government departments with our personal information, what right do we have to demand these organisations keep our personal information confidential?
The Australian Privacy Principles govern how most Australian government agencies, businesses (including not-for-profit) with an annual turnover of more than $3 million, private health service providers (eg. doctors, any holistic or alternate therapy businesses, gyms, childcare centres) and some small businesses must collect, retain and use personal information.
Each state and territory have their own laws, which are similar to the APPs, covering organisations like schools, public hospitals, and media organisations.
Personal information is any information or an opinion about an identified individual, or an individual who is reasonably identifiable. It is irrelevant if the information is true or not.
Personal information would generally include things like:
  • Information about a person's private or family life: personal particulars, medical records, and bank details.
  • Information about a person's employment: work address, salary, job title and work practices.
  • Information that provides an opinion about a person: such as a referee's opinion about a job applicant, opinions about an individual's preferences or tastes based on online purchases or web browsing history.
More here
It is good to be reminded of the protections we are all entitled to, what your rights are, and how they work.
David.

Tuesday, July 11, 2017

Just When You Thought News On Government System Leaks Might Stop We Get This! What A Mess.

Since Tuesday was have seen a lot of column inches spent on the leak of Medicare Numbers and their purchase from the ‘dark web’
Here is the first exclusive article.

The Medicare machine: patient details of 'any Australian' for sale on darknet

Exclusive: A trader is offering Medicare card details for less than $30 each on a popular auction site for illegal products
A darknet vendor is offering Medicare patient details of any Australian on a popular auction site. Photograph: AAP
A darknet trader is illegally selling the Medicare patient details of any Australian on request by “exploiting a vulnerability” in a government system, raising concerns that a health agency may be seriously compromised.
An investigation by Guardian Australia can reveal that a darknet vendor on a popular auction site for illegal products claims to have access to any Australian’s Medicare card details and can supply them on request.
The seller is using a Australian Department of Human Services logo to advertise their services, which they dub “the Medicare machine”.
Medicare card details are not publicly available. They are valuable to organised crime groups, because they allow them to produce fake physical Medicare cards with legitimate information that can then be used for identification fraud.
These identification cards have been used by drug syndicates to buy goods and lease or buy property or cars. The card details could also be used to defraud the government of Medicare rebates. In 2015 a police strike force targeted a group that was using Medicare card details to direct rebate payments into fraudulent bank accounts.
Organised crime groups regularly use darknet auction services, which are more difficult for law enforcement agencies to track because they are not indexed or searchable like other parts of the internet.
The darknet vendor has sold at least 75 Australians’ Medicare card details – describing them as “marks” – since October 2016. The listing page suggests they may have also been selling a large number before October 2016 but were forced to change their method for accessing the data.
The price for purchasing an Australian’s Medicare card details is 0.0089 bitcoin, which is equivalent to US$22.
Guardian Australia has verified that the seller is making legitimate Medicare details of Australians available by requesting the data of a Guardian staff member.
Lots more here:
The best summary of what has happened for the rest of last week is here (from the original reporter):

Data breaches undermine trust in government's ability to protect our information

Darknet sale of Australians’ Medicare details – revealed by the Guardian – follows census debacle, malware attacks and hacking attempts
The government found itself facing heavy criticism this week over how it handles Australians’ personal information, after a Guardian investigation revealed a darknet trader was illegally selling the details of any Medicare card holder on request by “exploiting a vulnerability” in a government system.
The data had been for sale since at least October 2016, and the seller appears to have sold the Medicare details of at least 75 Australians.
The human services minister, Alan Tudge, admitted he and his department had only become aware of the breach when contacted by Guardian Australia. Nobody from his department – or apparently from the Australian security services – appears to have been actively monitoring this posting on the darknet auction site.
This is just the latest data security and privacy scandal to rock the Australian government. While it has tried to reassure the public, there has been a flurry of concern about Medicare, health data and the use and storage of Australians’ personal information more broadly.
It comes off the back of a string incidents including the census debacle, malware attacks and other high-profile hacking attempts that have served to undermine confidence in the government’s handling of information.
“What’s happening is the community is wrapping these attacks together and seeing them as a threat, and it adds to a perception that their data is not safe,” said Australia’s privacy commissioner, Timothy Pilgrim. “All the players need to work out a way to build up that trust.”
But why do these breaches keep happening? And is the government doing everything it can to stop them, and reassure the public when they do happen?
After being alerted by the Guardian to the Medicare breach, the minister took swift action, referring it to the Australian federal police for investigation. Pilgrim welcomed this as an appropriate response.
Tudge also did several interviews, seeking to reassure Australians that their actual medical records stored online as part of the My Health Record system had not been compromised.
These were useful and important clarifications. But they missed the main risk of this breach, and the opportunity to curb similar incidents.
The most critical risk to Australians from the misuse of Medicare card data is one of identity fraud. A fake Medicare card with legitimate details can get a criminal a quarter of the way to an entire fake ID. This could then be used by organised crime groups in any number of ways, for example by leasing property or equipment. It could also be used to fraudulently obtain services from Medicare itself.
Lots more here:
The best commentary I have seen so far comes from the Conversation:

After the Medicare breach, we should be cautious about moving our health records online

July 5, 2017 5.18pm AEST

Author Robert Merkel

Lecturer in Software Engineering, Monash University
The Australian government is digitising the country’s health system, but a serious Medicare security breach suggests we may not be ready.
The Australian Federal Police are investigating after the Guardian discovered that the Medicare card details of Australians were available for purchase on the “dark web”.
The dark web – a collection of websites that are only accessible through anonymising systems such as Tor – allows vendors to remain largely hidden from law enforcement. There is a long-standing trade in illicit goods and services, including hacked personal data, on eBay-like dark web marketplaces.
As journalist Paul Farrell pointed out, criminal groups can use Medicare numbers to create fake Medicare cards with the details of real people. In combination with other personal information, these cards or simply the Medicare numbers themselves, could be used to commit a wide variety of fraud.
The Medicare system has security issues, but the number of fallible people and systems who will have access to our medical records in the future is also concerning.

Security weaknesses

It is not yet clear how the Medicare details were obtained. In a press conference on Tuesday, Minister for Human Services Alan Tudge said he had been advised “that there has not been a cyber security breach of our systems as such, but rather it is more likely to have been a traditional criminal activity”.
He would not explain what “traditional criminal activity” might include, but emphasised that the Medicare details available were insufficient to gain access to personal health records.
In my view, the Department of Human Services’s (DHS) Health Professional Online Services (HPOS), which provides health professionals with access to Medicare details, has weaknesses in its security.
HPOS is an online system for healthcare and disability service providers, such as medical practices, to interact with the department, including by electronically submitting Medicare claims. It can also be used to find a patient’s Medicare card number based on their name and date of birth.
Any staff member at a healthcare provider with a HPOS login as well as somebody’s name and date of birth can look up the Medicare number of anyone in Australia. This matches the details requested from Farrell by the dark web vendor.
Importantly, the mechanism for protecting HPOS from unauthorised logins does not follow modern security practices. Logins to HPOS are managed through another online system called Provider Digital Access (PRODA). This was recently rolled out as an alternative to Human Services Public Key Infrastructure certificates (PKI) that also give access to online services.
PRODA uses “two-factor authentication” to, in theory, ensure that simply stealing a username and password is insufficient to gain illicit access.
Many people are now familiar with two-factor authentication codes sent via SMS when using online banking, or authentication apps on smartphones that generate a secret code used to log in. PRODA offers both options. However, it also supports sending the code via email.
Even SMS-based two-factor authentication has security problems sufficient for the US National Institute of Standards and Technology to no longer recommend it for new systems. However, it is much better than email-based two-factor authentication. Sending a “secret token” via email is almost completely useless as a security measure.
Any compromise of a computer used for HPOS access, which gives a criminal access to the PRODA username and password, would likely give access to the email account to which the PRODA authentication codes are sent. Subsequent accesses to HPOS by the criminal would merely require them to use the stolen username and password, and to monitor the compromised email account.
In response to a request for comment, a DHS spokesperson said HPOS was designed “with security at the forefront”.
“Health providers must undergo a stringent registration process to gain access to HPOS,” she said in an email. “Access is granted to individuals (not to whole medical practices) when they have proven their credentials.
"The department treats the security of personal data extremely seriously and conducts thorough investigations into any claims of misuse.”
More here:
And it seems what is being looked up is valuable!
  • Updated Jul 7 2017 at 11:00 PM

Medical data more valuable than credit card details on the dark web

Medicare details sold by cyber criminals
Australia's browbeaten insurers say medical records are now even more prized by cyber criminals than financial data following recent dark web scandals.
Breaches of privacy, such as the illicit sale of Medicare card details for less than $30 online that was exposed this week, and the ransomware attack that froze computer's across the UK's National Health Service, are becoming worryingly common.
Insurers say they are not feeling adequately prepared to cope with the fallout as health records become a hot commodity on a hidden part of the internet known as the dark web.
Search engines cannot search and do not index this unlisted section of the internet, meaning illegal items, including personal data and drugs, can be traded with relative ease.
Lots more here:
There are a zillion other articles on all this that have appeared in the last week!
I have to say that from my perspective all this was rather inevitable – and it is interesting that it is now reported that the Government has been worried about this issue for a number of years.
See here to read more:

Government was warned three years ago about Medicare security

Adam Gartrell
Published: July 5 2017 - 5:21PM
With the commentary published on Sunday and all this I reckon you would be a mug not to opt-out of the myHR and come up with some other way to have an accessible medical record (USB Key or a card in the wallet say).
Your choice.
David.