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, May 17, 2018

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

May 17, 2018 Edition.
Well the Budget has happened this week and we are all now fully in the picture.
The easy summary is that combined with all the by-elections caused by the Citizenship Saga Part X is that the high and low tax parties will get to conduct a 500,000 people opinion poll quite soon. Late June is the guess. We also have to wait for the clever people to work through the really fine print and see what nasties we all missed!
In summary my view is that this budget is bloody risky. One economic hiccup and we will be in a recession I reckon.
Internationally things are not good with war brewing between Israel and Iran while Trump is causing all sorts of problems with China. This could all end very badly for little Australia and we need to be very careful I believe!
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Here are a few other things I have noticed.
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Major Issues.

Declining fuel reserves prompts Turnbull government security review

By Bevan Shields
6 May 2018 — 7:23pm
The Turnbull government will launch a review of Australia's fuel reserves amid warnings that conflict in the Middle East or South China Sea could disrupt supply and threaten record-low domestic emergency stocks.
Environment and Energy Minister Josh Frydenberg will announce the National Energy Security Assessment on Monday amid a backdrop of declining domestic production, diminishing refining capacity and geopolitical risks in the oil-rich regions Australia sources the majority of its fuel from.
Latest government figures show Australia has just 22 days supply of crude oil, 59 days of LPG, 20 days of petrol, 19 days of aviation fuel and 21 days of diesel.
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Time to take stock of Australia’s fuel security

By Josh Frydenberg
7 May 2018 — 12:16am
As the world’s eighth largest energy producer, Australia’s fuel supplies have proved to be remarkably reliable and resilient over the last four decades. The last significant disruption was in the 1970s with the OPEC oil crisis. But since then, much has changed both domestically and internationally, requiring a reassessment of Australia’s liquid fuel security.
Liquid fuel includes petrol, diesel and jet fuel and accounts for 37 per cent of Australia’s energy use and 98 per cent of our transport needs.
Led by the Department of the Environment and Energy, the Turnbull government will undertake a review to examine how fuel is supplied and used in Australia and our ability to withstand significant disruptions to the supply chain. The findings will be provided to government before year’s end and in turn be part of a more comprehensive national energy security assessment in 2019, which will also take into account the gas and electricity sectors.
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Rein in Google, Facebook before they kill the fourth estate

  • The Australian
  • 12:00AM May 7, 2018

Adam Creighton

The royal commission into financial misconduct has highlighted the problems of “vertical integration”, where banks buy related financial services firms, increase their market power and hone their ability to extract money out of unwitting customers.
The problem is arguably worse in the market for internet search and social media, where the digital leviathans Google and Facebook have stamped out competition and amassed unparalleled information about their customers, underpinning growth in revenue that only cements their position further.
Since 2005 Google has made around 200 acquisitions including mobile-phone interface Android, YouTube, and advertising technology firms AdMob and DoubleClick, ensuring its dominance of the advertising and search market. For all the money Microsoft has poured into rival search engine Bing, its market share is 3 per cent.
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Australian business conditions tap record high in April, NAB survey

  • The Australian
  • 11:30AM May 7, 2018

David Rogers

An upbeat NAB business survey today will be welcome news for the sharemarket and the Federal Coalition on the eve of the Budget.
Business conditions jumped 6 points to 21 index points in April, its equal highest level since the survey began in 1997.
Business confidence rose 2 points to 10 index points, well above its historical average of 6 index points.
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  • May 7 2018 at 12:23 PM

Sydney and Melbourne house prices could fall as much as 4 per cent, says SQM

The days of double digit growth in house prices for Sydney and Melbourne are over as the two big cities head for a house price tumble, new forecast from SQM Research confirms.
Property research group SQM Research, led by Louis Christopher who has successfully forecast house prices, has revised its prediction that Sydney prices will fall as much as 4 per cent in 2018. The best case scenario is a flat zero growth in prices for Sydney home owners.
The group's previous prediction for Sydney made in its Housing Boom and Bust report last October was a 4 to 8 per cent rise in prices for the full year.
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  • Updated May 8 2018 at 2:17 PM

Lowy Asia Power Index: Australia's Asian power to decline

Australia will have to work harder to maintain its influence in the region over the next decade as China is set to easily eclipse the United States as the most powerful player in Asia by 2030, according to a new index launched by the Lowy Institute.
The product of two years' work, the Asia Power Index maps the power of 25 countries in Asia across 114 different indicators – broadly in the categories of military, economic, cultural, diplomatic and political power.
Right now, the US comes out on top followed closely by China and after a significant gap, Japan, India and Russia. 
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Asia Power Index shows Australia to become an Asian minnow by 2030

By Nick O'Malley
8 May 2018 — 1:55pm
By 2030 Australia will shrink from being a significant middle power in Asia to a relative minnow, while the United States will retreat from its dominance to rank behind China, according to the most comprehensive study of shifting power in region ever undertaken.
The Lowy Foundation’s Asia Power Index ranks the 24 nations in Asia as well as the US against eight measures - ranging from such areas as economic resources to military spending to cultural and diplomatic influence - and 114 indicators.
The group’s findings confirm what most already understand about the changing dynamics in Asia - that China has arrived as a power in its own right - but in its detail it reveals trends that have not been so obvious to date.
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High Court rules Labor's Katy Gallagher ineligible and sets up four likely byelections

By Michael Koziol
9 May 2018 — 10:22am
The High Court has ruled Labor senator Katy Gallagher ineligible to sit in Parliament, in a test case that is likely to lead to a string of four byelections for MPs in a similar position in the ongoing dual citizenship crisis.
Senator Gallagher, from the ACT, had argued she took "reasonable steps" to renounce her British citizenship prior to the last election, but due to administrative complications, it had not been processed before the deadline.
The High Court rules ACT senator Katy Gallagher is ineligible for parliament under Section 44, becoming the latest casuality in the citizenship fiasco.
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  • Updated May 10 2018 at 10:28 AM

Banks and fintechs welcome government's open banking plan

Treasurer Scott Morrison says the major banks have been set a "challenging but realistic timeframe" to establish the government's 'open banking' regime, which is set to kick off in July next year.
At that time, customers will be able to transfer transaction account and credit card data to competitors to find better banking deals. Fintech disrupters say this will put downward pressure on borrowing costs.
FinTech Australia, which represents start-ups, and the Australian Banking Association welcomed the government's acceptance of the recommendations of the recent Farrell review, which created a data-transferring regime to give consumers greater access to, and control over, their data. It will allow accredited third parties to receive banking data when customers provide express consent for it to be used for a specific purpose. 
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Updated May 11 2018 at 6:30 PM

Annunities may be the wrong way to fix retirement incomes

There's an old political adage – usually, although perhaps erroneously, attributed to Winston Churchill – that one should never let a major crisis go to waste.
And Canberra is taking full advantage of the public outrage that has erupted in the wake of the Hayne royal commission's revelations of disgraceful conduct in financial planning industry to push ahead with its own plans for forcing superannuation funds to offer retirement income products.
The idea, of course, is not new. One of the key recommendations of David Murray's Financial System Inquiry was that super fund trustees should be required to pre-select a comprehensive income product for retirement (CIPR) for their members.
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A Tweetstorm that every investor should read

By Barry Ritholtz
12 May 2018 — 8:22am
This week,, James O'Shaughnessy posted a long and intriguing tweetstorm about investor ignorance. O'Shaughnessy is the chairman and founder of O'Shaughnessy Asset Management LLC, and the author of the classic investing book "What Works on Wall Street." The thread is worth reading from start to finish.
This post, as regular readers know, was about one of my favourite subjects. To be more precise, it was about our own lack of understanding of own lack of understanding. From the original work by Daniel Kahneman and Amor Tversky, as laid out in their famous 1974 paper "Judgment under Uncertainty," to the Dunning-Kruger concept of metacognition - the specific skill needed to recognize one's own skill set - this foible continues to be of great importance to investors.
O'Shaughnessy starts his discussion on a note of humility, writing there are "some things I think I know and some things I know I don't know." That simple observation places him ahead of oh, say, 80 per cent of all investors. This is not how way too many investors think.
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Welcome to the tax election. The fairness election. The enterprise election

With five certain byelections and a possible general election this year, Australian voters have a stark choice over key economic policies.

By Mark Kenny & Matt Wade
11 May 2018 — 8:03pm
Pauline Hanson stumbling over the words "government" and "budget" to produce “budgernment” (pron. budge-a-munt) seemed strangely appropriate for a week when the two constructs became indistinguishable anyway.
The slip-of-the-tongue did little to clarify her party’s final position in the febrile tax policy battle between the government and the opposition.
Whatever she decides, the battlers who make up One Nation’s base stand to gain, because the one thing the major parties agree on is relieving cost-of-living pressures for the bottom end. After that, the class war is on for young and old.
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Financial Services Royal Commission.

  • Updated May 6 2018 at 11:30 PM

ANZ scraps product-linked bonuses for financial planners

Financial planners employed by ANZ Banking Group will no longer get bonuses for pushing products and will be sacked if they fail a compliance audit twice, but chief executive Shayne Elliott admits the bank has been too slow to fix systemic issues that has allowed bad adviser behaviour to flourish.
"I think it's a fair criticism that that we haven't spent enough time on structural reform," Mr Elliott told The Australian Financial Review.
"We've been busy with remediation. It should have been done before, but at least we're getting on with it now," he said as the bank unveiled a range of changes to company's financial planning business.
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Banking royal commission: Pressure to break up banks as Treasury, ASIC lash model

  • The Australian
  • 12:00AM May 11, 2018

Michael Roddan

The corporate watchdog and Treasury have laid out stinging criticisms of vertically integrated financial players in responses to the royal commission that raise the pressure to break up Australia’s largest banks.
Treasury told the royal commission into financial services that the second round of hearings had made it “clear” that poor culture and misaligned incentives were the “key cause” of misconduct, and said there were many benefits that could come from the major banks splitting up their financial advice and wealth management arms.
In a cache of submissions to commissioner Kenneth Hayne, and released last night, banks and regulators had been asked to justify the entangled cross-ownership of businesses and address issues such as conflicted remuneration for financial advisers, the shunting of customers into in-house ­products and the breakdown in compliance between parent companies and rogue financial sub­sidiaries.
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  • Updated May 10 2018 at 7:11 PM

End grandfathered adviser commissions: ASIC

The corporate regulator is calling for an end to grandfathered commissions – still a major component of a financial adviser's bonus – saying it encourages advisers to keep clients in legacy products instead of moving them onto better products.
In a submission to the banking royal commission on Thursday, the Australian Securities and Investments Commission said it was concerned that almost five years after the Future of Financial Advice reforms that grandfathered commissions continue to form a "significant proportion" of adviser remuneration.
Conflicted remuneration for advisers was banned as part of the FOFA reforms but banks still pay billions of dollars in commissions that are "grandfathered".
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After banking royal commission, how can you be sure your money is safe?

By Alison and Jillian Barrett
11 May 2018 — 11:10am
With almost daily revelations coming from the banking royal commission about the bad behaviour of some of our most high-profile financial institutions, it’s increasingly difficult to know who you can trust for financial advice.
Investors, retirees and working families can lose their life savings through decisions based on misinformation given by people they perceived as trusted professionals. Some retirees have, unfortunately, been required to go back to work to make ends meet after losing everything.
Bad behaviour from some of our most high-profile financial institutions has made it increasingly difficult to know who you can trust for financial advice.
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National Budget Issues.

Increase the bank levy: how Scott Morrison could defuse doubts about big business tax cuts

By David Crowe
6 May 2018 — 7:19pm
The escalating argument about income tax is helping the government keep its powder dry on the bigger message in Tuesday night’s budget.
The government will cut personal income taxes after months of talk about easing the burden on workers, but it will also try to reset the debate over its wider economic message.
This includes company tax cuts, which will remain in the budget even though they appear doomed in the Senate in their current form.
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Crackdowns on tax avoidance, tax concessions to help fund budget spending

By Peter Martin
6 May 2018 — 11:45pm
A suite of measures to minimise tax avoidance will underpin the Turnbull government's promises of personal and company tax cuts and an early return to surplus in Tuesday night’s budget.
Some will flow from a report of the government’s black economy taskforce, which has not yet been released but was delivered to Revenue Minister Kelly O’Dwyer last year.
“Obviously we have a strong focus on tax integrity,” Ms O’Dwyer told Fairfax Media on Sunday. “That is something that has been a defining feature of our examinations of the tax system.”
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Tax cuts are a sideshow, spending is out of control

  • The Australian
  • 12:00AM May 7, 2018

Adam Creighton

Tomorrow Scott Morrison will ­announce with great fanfare a modest part-reversal of years of annual income tax ­increases. How generous.
Forget any serious effort to ­reform tax, spending or the dysfunctional federation; this will be the centrepiece of the Turnbull government’s pre-election budget.
Since 2009, workers’ average tax rates have risen by about 3.5 percentage points, with a further two to three percentage points pencilled in by 2021, according to the latest analysis by the ­independent Parliamentary Budget Office. Who knows how much further they’ll have to rise, as more and more baby boomers check out of paying income tax and the ­National Disability Insurance Scheme really cranks up.
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Whatever Tuesday's budget holds, it's sure to be fudged

By ROSS GITTINS
6 May 2018 — 10:02pm
It’s a sad truth that treasurers and finance ministers almost never avoid using creative accounting to make their budgets look better – or less worse – than they really are. But this fudging often costs taxpayers a lot more.
Governments of both colours, federal and state, have been doing this forever, after the bureaucrats show them how. It’s one of the less honourable services public servants provide their honourable masters.
The move from cash accounting to accrual accounting at the turn of the century should have made fudging harder, but federal Treasury solved that problem by sticking to cash while Finance moved to accrual.
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  • Updated May 7 2018 at 11:00 PM

Federal budget 2018: Fiscal fantasy entrenched by failing to tackle debt

In the US they call it "starving the beast". Typically, Republicans like Ronald Reagan and George Bush have slashed taxes to make it harder for future Democrat presidents to enlarge spending when they win office.
The goal is to create a straitjacket for fans of bigger government.
Treasurer Scott Morrison's mission to embed Australia's political economy with a "tax-to-GDP cap" of 23.9 per cent aims to do the same thing to Labor, which is set to win the next election, according to polls.
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Budget 2018: Biggest income tax cut since Howard’s day

  • The Australian
  • 7:41AM May 9, 2018

Adam Creighton

The government has unveiled the biggest income tax cut since John Howard was prime minister, worth $13.4 billion or slightly more than the $12.8bn Medicare Levy increase taxpayers had faced until it was recently scrapped.
The plan includes imminent ­relief for all workers of up to $10 a week rising over time to more than $5000 a year for earners in the highest income tax bracket.
The Turnbull government has shifted the focus from company to personal income tax, revealing a seven-year plan that will save workers on $90,000 more than $4600 in tax by 2024.
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Budget 2018: This budget is too good to be true

By Ross Gittins
Updated8 May 2018 — 8:50pmfirst published at 7:30pm
This budget is too good to be true. If you believe Malcolm Turnbull's luck can turn on a sixpence, this is the budget for you. From now on, everything's coming good.
This is the blue skies budget. Things will be so good that we can have everything we want. The government can increase its spending on all the things we want it to provide.
It's the government's last budget before the next federal election: who won from this budget, and who came out worse for wear?
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Budget 2018: Is ScoMo Santa or the budget surplus grinch?

By Peter Hartcher
Updated9 May 2018 — 9:53amfirst published 8 May 2018 — 7:30pm
All the earlier talk that Treasurer Scott Morrison was going to deliver a "Santa Claus" budget was quite wrong. We can now see that comparison is unfair to Santa.
Because Santa only gives presents to good children, not bad. The Treasurer, however, is not so discriminating, with goodies for just about all, whether naughty or nice.
On the 30th anniversary of the new Parliament House, Senior writer Tony Wright speculates that, if this budget were brought to the old one, 30 years ago, it would have been laughed out of the building.
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Risks greater than I can recall in my working life

By John Hewson
9 May 2018 — 10:58am
Budgets are about choices. With an unexpected surge in revenue, the government’s main options were to apply it to deficit repair, to spend it, or to give it back in tax cuts, or some combinations thereof.
The government’s base motive was political, to set the agenda for an election winning strategy, with an election possibly as early as August/September this year. The major challenge was their political standing, with the Abbott/Turnbull governments having lost more than 60 Newspolls, with an electorate having lost trust and belief in the major parties, and in our political system, unlikely to even listen to what Morrison might have to say, as it struggles to meet ever increasing costs of living.
Moreover, expecting the Labor Opposition to at least match any tax cuts, and to accept obviously necessary spending initiatives, and likely to attempt to define itself as “more fiscally conservative/responsible” (as Rudd did against Howard in 2007), the government couldn’t risk promising too much – ironically, it couldn’t afford to be too overtly “political”.
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Budget 2018: A surplus isn't all black and white

By Nicholas Stuart
9 May 2018 — 12:00am
On the one hand it seems churlish not to admit that the government has done a marvellous job in returning the budget to surplus ahead of previous forecasts. On the other, it's probably worth noting just how many times Treasury has previously promised budgets doing exactly this. The only constant has been a complete failure to deliver. So has our prolonged cycle of much-hyped promises turning into under-performing reality finally been broken?
Don't look at the quantum, feel the quality.
The depressing reality is that, ever since the Global Financial Crisis erupted a decade ago, we've all simply been engaged in an extended game of pass the (huge) parcel of debt. What's happened is simple: government’s bailed out business and taxpayers have bailed out government.
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Budget 2018: Morrison budgets for good times

By Peter Martin
Updated8 May 2018 — 9:31pmfirst published at 7:30pm
Rarely has a government so brazenly broken its compact with the Australian people.
Set down in every budget since the Coalition's first in 2014, and reprinted in this one, is a commitment that any boost to the budget due to better economic circumstances "will be banked as an improvement to the budget bottom line" rather than given away as tax cuts, or a package for Baby Boomers, or anything else.
It's a budget that's hard to take seriously, says Economics editor Peter Martin from inside Budget 2018.
That boost, bestowed on the budget in just the past six months since the December update, is an extraordinary $35 billion over four years.
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Budget 2018: How will today's 10-year-olds fare in the future?

By Matt Wade
Updated9 May 2018 — 12:47pmfirst published 8 May 2018 — 7:30pm
In his budget speech delivered to Parliament last night, Scott Morrison declared the government was "living within its means" and that Australians "can plan for their future with confidence".
Morrison's third budget will inevitably be viewed through the context of a federal election that must be held by May next year. But what if it was assessed with 10-year-olds like Nahla Saoud and Luca Chapman in mind?
"This will be the best budget outcome since the Howard government's last budget a decade ago, " says Treasurer Scott Morrison as he outlines the key financial outcomes in the 2018 budget.
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  • May 9 2018 at 4:02 PM

Federal budget 2018: Global risks, Trump trade war means AAA still not safe

Federal budget 2018: Is Scott Morrison too optimistic?
Claims the Coalition's income tax cuts will produce an economic boost have been met with scepticism by a former adviser to John Howard, as well as ratings agency S&P, which has pointedly put the Treasurer on notice that the credit outlook remains on "negative outlook" because of growing global risks.
While the budget position has benefited from stronger revenue flows, Scott Morrison's economic outlook is too rosy and leaves the nation vulnerable to a sudden downturn, said Peter Crone, chief economist at EY.
"The treasury narrative sees the combination of stronger wages growth and tax cuts supporting household incomes - and therefore consumer spending," Dr Crone said.
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Budget tax cuts: By 2027 top 20 per cent get 60 per cent of the benefit

About 60 per cent of the benefit from Treasurer Scott Morrison's 10-year tax cut plan will go to the top 20 per cent of income earners by the time it concludes in 2027, according to modelling by the Australian National University.
The first two stages of the three-step tax plan from 2018 to 2024  will more or less deliver on Mr Morrison's budget pledge to "protect low and middle income earners". Next year, for instance, the top 20 per cent of households will receive only 31 per cent of the benefits with the rest going further down the scale.
The tax cuts will shift slightly towards higher income earns in stage two after 2022 and then after July 1 2024 in the third stage  the benefits will skew much more sharply to higher income earners. The top 20 per cent will receive 60 per cent of the benefits and the top 40 per cent will receive 80 per cent.
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Welcome to the weirdest collection of tax cuts on record

By Peter Martin
9 May 2018 — 7:13pm
Has there ever been a more weird collection of tax cuts?
Ahead of the budget we were promised simple cuts. What we got was a collection of changes so eccentric they are almost impossible to explain quickly and even harder to make sense of quickly. Here goes.
Instead of concentrating tax cuts on low- and middle-earners as promised, Scott Morrison has changed a tax threshold, one faced by only the top 20 per cent of earners, and overlaid a new and bizarrely-shaped so-called tax offset on top of an existing offset to give Australians earning between $48,000 and $90,000 a year an extra $530 a year and Australians below $37,000 a lower sum of $200, and those earning something in between, something in between.
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  • Updated May 10 2018 at 11:00 PM

'Fairness' attack on budget tax cut fails to consider rising burden: economist

by Jacob Greber
A leading economist whose modelling has been portrayed as evidence the Coalition's seven-year income tax plan "unfairly" favours wealthier Australians has confirmed his figures don't account for the effect of "bracket creep" that would erode much of the gain.
"That's been missed in some of the coverage," said Ben Phillips, from the Australian National University. "The idea with tax cuts is to compensate for those moving up into higher tax rates over time.
"There's not a lot of point talking about $150,000 today and $150,000 in 10 years' time. They're very different things."
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Morrison's budget assumed a kinder, gentler world

By ROSS GITTINS
12 May 2018 — 12:15am
Have you heard the one about a physicist, an engineer and an economist stranded on a desert island, with only a can of baked beans to eat?
The two science-types spend ages arguing about the best way to get the beans out of the can without wasting any, until the economist is exasperated. “It’s simple,” he says. “Assume a can-opener.”
Don’t laugh. That old joke (which I first heard from Professor John Hewson) tells you a lot about how economists think and a lot about how this week’s budget was put together.
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Why is no one debating one of the budgets’ biggest spends?

By Andrew Carr
One of the largest and fastest growing expenditures in the federal budget, defence spending, will receive little or no debate, to the cost of our nation’s security.
Public debate on health funding, education or infrastructure projects is rightly seen as a good thing. So why is the normal contest of ideas and values not applied to the $36 billion dollar allocated in this year’s budget for the defence of the nation?
How Australia responds to today’s strategic challenges is not just a question of policy and spending, but also our institutions. We are 17 years into the War on Terror with little sign of it abating. Meanwhile Russia and China have the resources to provide decades of headaches for the West. Our democracy is an asset in this contest, but it in an underutilised one.
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Why Treasurer Scott Morrison’s budget outlook hinges on China

  • The Australian
  • 2:55PM May 9, 2018

Robert Gottliebsen

JPMorgan chief executive Jamie Dimon and Australia’s Treasurer Scott Morrison need to compare notes, because they have very different views about future trends in President Donald Trump’s America.
Both Morgan’s Dimon and Morrison’s Treasury people expect a surge of growth in the US this year. But Morrison’s people are more restrained and believe US GDP growth will only rise from the 2.3 per cent level of 2017 to 2.75 per cent in 2018. That’s at the lower end of most expectations.
But from there it’s all downhill and it seems Morrison and his people have embraced my scenario (reached with the help of veteran US economist Al Wojnilower) that 2019 will see a slowdown in US growth.
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Health Budget Issues.

Suicidal teens in emergency departments a sign Headspace is failing

By Kate Aubusson
7 May 2018 — 12:01am

Talking points

  • Teen self harm, suicide attempts, ideation or intentional poisoning presentations increased dramatically in NSW emergency departments. 
  • Mental health presentations tripled among 10-14 and 15-19 year-olds between 2008 and 2015 in Victorian emergency departments.
  • Self harm presentations rose by 53 per cent since between 2008 and 2015.
Rising numbers of suicidal and self-harming adolescents are washing up in NSW and Victorian emergency departments, new data shows.
These teenagers in crisis were the "canaries in the coal mine" that signalled community mental health services were failing, experts said, despite heavy government investment over the past decade in programs such as Headspace.
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Youth mental issues on rise

  • The Australian
  • 12:00AM May 7, 2018

Sean Parnell

More children and teenagers are attending public hospital emergency departments for serious mental health issues, a trend some experts fear is a sign that government investments in community services and programs have not gone far enough.
Two new studies out of NSW and Victoria reveal the increase has been most prominent among 10 to 14-year-olds, prompting calls for earlier intervention and a greater emphasis on prevention to stop the problem getting worse.
Professors Susan Sawyer and George Patton have used the latest Medical Journal of Australia to call for more funding for crisis support.
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Budget 2018: screening program wages war on genetic disease

  • The Australian
  • 12:00AM May 8, 2018

Ean Higgins

Scott Morrison will tonight unveil a bold initiative to design a large-scale pre-pregnancy gene screening program for couples planning a family, aimed at eliminating some of the most severe genetic diseases afflicting Australians.
Apart from avoiding the suffering and early deaths caused by genetic disorders, the move is ­motivated by the heavy drain on the public health system of treatment and the cost of up to $1 million per patient per year for drugs on the pharmaceutical benefits scheme for some illnesses.
The Australian can reveal the Treasurer will announce a budget allocation of tens of millions of dollars for the program, to be led by a Sydney team of genetic ­researchers and clinicians.
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  • Updated May 8 2018 at 11:00 PM

Turnbull government backs pharmacies over consumers, yet again

by Stephen Duckett
The government has totally squibbed the latest pharmacy regulation review, and consumers will be the losers.
Every five to 10 years in Australia, the government establishes a review of the regulations governing pharmacies. Those reviews invariably come to the same conclusion: community pharmacy is over-regulated, and a reduction in regulation would benefit consumers. Just as invariably, the government response is to do nothing.
Well, here we go again. Last week the government released its response to the latest such review, conducted over two years under the leadership of Stephen King, a former professor of economics who is now a Commissioner of the Productivity Commission. It's a do-nothing response: pharmacy owners, represented by the Pharmacy Guild of Australia, are the winners; consumers and taxpayers are the losers.
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Budget 2018: Health focus shifts towards older Australians

By Nicole Hasham
Updated9 May 2018 — 11:33amfirst published 8 May 2018 — 7:30pm
The Turnbull government will divert billions of dollars towards a health cash splash it says will give elderly Australians more choice and dignity, while life-changing new drugs will receive new taxpayer subsidies.
The spending, which aims to shore up support in the Coalition's older voting base, includes $1.6 billion to create 14,000 new home care packages for senior Australians. It will provide subsidised help for activities such as showering and dressing, meal preparation and transport.
It's the government's last budget before the next federal election: who won from this budget, and who came out worse for wear?
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What does the Budget mean for health? Six experts break it down

9 May 2018
The winners of this year’s health budget are aged care, rural health and medical research.
The government has announced A$1.6 billion over four years to allow 14,000 more older Australians to remain in their home for longer through more high-level home care places. For those in aged care, an additional A$82.5 million will be directed to improve mental health services in the facilities.
The budget includes A$83.3 million over five years for a rural health strategy, which aims to place more doctors and nurses in the bush and train 100 additional GPs.
There’s A$1.3 billion over ten years for a National Health and Medical Industry Growth Plan, which includes A$500 million for new research in the field of genomics.
Other key announcements include:
- A$1.4 billion for new and amended listings on PBS
- A$302.6 million in savings over forward estimates by encouraging greater use of generic and bio similar medicines
- A$253.8 million for a new Aged Care Quality and Safety Commission.
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Age-related frailty is not curable: expert

Australian surgeons and anaesthetists have been told they need to do better in recognising a dying person to avoid futile care.
Sarah Wiedersehn
Australian Associated PressMay  8, 2018 5:57pm
Professor Ken Hillman witnessed his elderly mum, Margaret, admitted to hospital 22 times in the last year of her life with a range of conditions.
His 83-year-old mum was frail due to her old age and had become vulnerable to infections after hip surgery.
It's a familiar story faced by many Australian families as the population ages.
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Budget 2018: We’re here to help save lives, says Hunt

  • The Australian
  • 12:00AM May 9, 2018

Sean Parnell

Investments in mental health programs, new drug subsidies and medical research grants showed the Turnbull government’s commitment to “saving lives and protecting lives”, Health Minister Greg Hunt said last night.
The budget handed down by Scott Morrison delivers new funding — in contrast to the Coalition cuts of 2014 — which Mr Hunt said he had used to target some of the most pressing health problems and also bolster the system long-term. Mental health funding will increase by $338.1 million, including money for beyondblue’s Way Back Support Service to help people after a suicide attempt and extra resources for the National Mental Health Commission and Royal Flying Doctor Service.
Distributions from the Medical Research Future Fund will include $125m over 10 years for the Million Minds Initiative. The MRFF is funded by the 2014 health cuts, and will reach its $20 billion balance in 2021-22, when, on paper, more than $2bn in annual flow-on savings will be able to be spent elsewhere.
-----

Duckett condemns ‘do-nothing response’ to King Review

Guild executive director David Quilty has hit back at an article which claimed the government “totally squibbed” the King Review

In an Australian Financial Review opinion piece titled “Turnbull government backs pharmacies over consumers, yet again,” the Grattan Institute’s Stephen Duckett has written that consumers “will be the losers” from the response to the Review.
Health Minister Greg Hunt announced last week, during the Australian Pharmacy Professional conference on the Gold Coast, that the Government had released its response to the King Review’s final report.
The Government did not accept most of the Review’s proposals, including:
  • Machine dispensing in small communities without community pharmacies;
  • Relaxation of location rules;
  • The banning of homeopathy and segregation of most complementary medicines from the S2/S3 area; and
  • Forbidding pharmacies from offering different prices (beyond the copayment) for PBS medicines.
-----

Federal budget 2018: Greg Hunt looks to the next health challenge

  • The Australian
  • 12:00AM May 10, 2018

Sean Parnell

Health Minister Greg Hunt will again turn his attention to reforming private health insurance and public hospital negotiations after the Turnbull government’s budget initiatives were largely welcomed by stakeholders.
However, four years after the incoming Coalition government made sweeping cuts to prevention and primary care, some still question the policy and budget focus on expensive acute care.
Tuesday’s budget included long-awaited rural workforce reforms, changes to the Pharmaceutical Benefits Scheme, medical research investments and funding for mental health programs.
-----
  • Updated May 10 2018 at 11:00 PM

Poor diagnosis for budget's health spending

The Turnbull government's claims of a record health budget have come under fire from health economists, who say spending is actually declining on a per capita basis despite soaring medical costs.
In its analysis of Tuesday's budget, Macquarie University's Centre for the Health Economy (MUCHE) warns Australians will either become sicker or be forced to pay more for medical care.
Health Minister Greg Hunt touted the health budget had been increased by $12.4 billion, with the total investment in health, aged care and sport worth $414.5 billion over the forward estimates.
-----

Health economists methodically dismantle government's Budget rhetoric

Real health improvements have been deferred, an analysis concludes
11th May 2018
The Federal Government’s claims of a record health budget don’t stand up to close scrutiny because funding is actually falling on a per-capita basis, health economists say.
In its budget analysis, Macquarie University's Centre for the Health Economy (MUCHE) warns that while the budget has no short-term losers, it has deferred the reforms and investment required to cope with an ageing and expanding population.
Medicare funding will rise by $4.8 billion as part of what the Minister for Health, Greg Hunt, described as a $414.5 billion investment in health, aged care and sport.
-----

International Issues.

The Navy is resurrecting a fleet to protect the East Coast and North Atlantic from Russia

Alex Horton May 5 at 4:45 PM Email the author
The U.S. Navy has reactivated a fleet responsible for overseeing the East Coast and North Atlantic — an escalation of the Pentagon’s focus on a resurgent Russia and its expanding military presence.
The 2nd Fleet, deactivated in 2011 to preserve funds for new ships, will resume operations in Norfolk on July 1, Chief of Naval Operations Adm. John Richardson told reporters Friday.
“This is a dynamic response to the dynamic security environment,” Richardson said onboard the carrier George H.W. Bush. “So as we’ve seen this great-power competition emerge, the Atlantic Ocean is as dynamic a theater as any and particular the North Atlantic, so as we consider high-end naval warfare, fighting in the Atlantic, that will be the 2nd Fleet’s responsibility.”
-----

China hits back on White House's 'Orwellian nonsense' claim

By Kirsty Needham
7 May 2018 — 6:23am
Beijing: China has hit back at the White House for labelling as “Orwellian nonsense” China’s demand that foreign airlines change their websites to describe Taiwan as part of China.
“No matter what the United States says, it cannot change the objective fact that there is only one China in the world and that Hong Kong, Macao and Taiwan regions are an integral part of the Chinese territory,” said Chinese foreign ministry spokesman Geng Shuang on Sunday.
The war of words between the White House and Beijing over the airline websites comes amid a worsening trade spat between the US and China.
-----

Scrapping Iran deal could trigger 'an uncontrollable chain of events'

By Amin Saikal
8 May 2018 — 12:05am
President Donald Trump has vowed to withdraw the US from the July 2015 Joint Comprehensive Plan of Action, or the "nuclear agreement", and reimpose sanctions on Iran unless it is renegotiated.
He wants the removal of the agreement’s sunset clauses, curbing of Iran’s ballistic missile program and regional influence, and more intrusive inspections of Iran’s nuclear and military facilities. Tehran has rejected any renegotiation of the signed multilateral agreement, which continues to be backed by the other four permanent members of the UN Security Council, plus Germany.
The JCPOA materialised after nearly two years of hard-hitting negotiations. The US and Iran had to move substantially from their original positions. Washington abandoned its insistence on Iran foregoing its entire nuclearprogram, and Tehran gave up its resolve to continue its uranium enrichment at a high level. Tehran also agreed to allow expanded IAEA oversight, to reduce dramatically its stockpile of enriched uranium and its centrifuges, and not to build heavy water nuclear reactors for the next 15 years. In return, the other signatories agreed to lift all the nuclear-related sanctions against Iran.
-----

Trump dodged the real heroes, but may yet come unstuck

By Nicole Hemmer
7 May 2018 — 11:00pm
Sometimes, you don’t get the hero you want. You get the hero you deserve.
US President Donald Trump's new lawyer, Rudy Giuliani, says Trump's personal attorney, Michael Cohen, could have paid more women than just adult film star Stormy Daniels.
That’s the case for Americans who believe that the current investigations into the Trump administration will expose political or criminal misdeeds, from co-ordination on election interference with Russia to corruption and obstruction of justice. But if special counsel Robert Mueller does eventually implicate senior officials in collusion or corruption, the heroes won’t be sober-minded defenders of the democratic order. They’ll be Stormy Daniels and James Comey, a porn star and a grandstander, both of whom are more products of the Trump era than a last stand against it.
Daniels has been at the heart of one of the most persistent scandals of the Trump administration. Trump lawyer Michael Cohen arranged to pay her $130,000 for her silence about an alleged sexual encounter between Donald Trump and Daniels that occurred just a few months after Melania Trump gave birth to their son. The danger to Trump is not the scandal itself – none of his bad acts have damaged him with his base – but that the payment likely violates US federal election law.
-----

Explainer: The Iran nuclear deal

8 May 2018 — 6:28am
What is the Iran nuclear deal?
The Joint Comprehensive Plan of Action was an agreement signed in 2015 under Barack Obama as president, and implemented in 2016 between six world powers and Iran. The deal lifted sanctions on Iran in exchange for Tehran slowing its nuclear research and development program and allowing UN weapons inspections. World powers feared Iran was on the path to making a nuclear weapon. The deal allowed Iran to sell its oil again and reintegrate into the global economy.
Who signed the deal?
Iran and the US, UK, Russia, France, China and Germany, sometimes referred to as the "P5+1" (the five permanent UN Security Council members plus Germany).
Why are we talking about it now?
Because US President Donald Trump has declared his intention to scrap the deal. He believes it doesn't go far enough in restraining Iran's nuclear ambitions, and helps enable Iran to become a player in other conflicts, particularly in Syria and Yemen. Trump has called it "the worst deal ever made" and has called on the US Congress and Europe to "fix" it. Trump has complained about UN inspectors not being allowed onto Iranian military sites; about Iran's ballistic missile program not being part of the agreement; and about a "sunset" clause which could see the agreement end in as little as 10 years.
-----

As Putin is sworn in for fourth term, his image changes subtly

8 May 2018 — 2:28am
Moscow: As Vladimir Putin begins his fourth term as Russia's president, his image is ubiquitous at home and effectively Russia's "brand" worldwide.
As he was sworn in, Putin promised Russians an "economic and technological breakthrough" and reappointed his long-serving Prime Minister, Dmitry Medvedev, amid the deepest standoff with the West in decades.
Alexei Navalny was detained by police alongside scores of other people protesting across Russia against President Vladimir Putin.
-----

Kim Jong-un travels to China for second time to meet Xi Jinping

By Kirsty Needham
8 May 2018 — 11:05pm
Beijing: North Korean leader Kim Jong-un has travelled to China for a second time to meet with Chinese President Xi Jinping.
Once known as the leader of the Hermit Kingdom, the 30-something Kim, accompanied by his sister Yo-jong, is now setting a fast pace in globe trotting diplomacy.
The latest visit took place in the northern Chinese city of Dalian, with Kim arriving by private plane on Monday and talks with Xi continuing on Tuesday.
-----
  • May 10 2018 at 6:41 AM

Mahathir Mohamad wins Malaysia election in historic power shift, shares dive

by Anisah Shukry and Anuradha Raghu
Mahathir Mohamad won a stunning victory in Malaysia's election, ending the six-decade rule of Prime Minister Najib Razak's party in a landmark shift for the Southeast Asian nation.
Mahathir, Malaysia's longest-serving premier who defected to the opposition to take on Najib, will return to power at the age of 92. His four-party Pakatan Harapan alliance won at least 112 of 222 parliamentary seats in Wednesday's vote, official figures from the election commission showed.
"We are not seeking revenge," Mahathir said. "What we want to do is to restore the rule of law."
-----

Mahathir sworn in as PM as Malaysia achieves first-ever power transition

By James Massola
Updated 11 May 2018 — 3:02amfirst published 10 May 2018 — 9:18pm
Kuala Lumpur: An extraordinary 24 hours that has upended the status quo in Malaysia and reshaped its political system has concluded with the installation of Mahathir Mohamad as the country’s seventh prime minister.
Mahathir, a 92-year-old former prime minister who led the country as head of the ruling Barisan National coalition for 22 years until 2003, has now done the almost unthinkable and led the opposition Pakatan Harapan (Alliance of Hope) to victory.
The 14th general election in Malaysia has opened the door to the first change of government in the 61 years since the country's independence, with Mahathir Mohamad claiming victory.
-----

Donald Trump’s America has just become a rogue nation

By Peter Hartcher
9 May 2018 — 6:16pm
The US has generally played the role of international security guarantor, but Donald Trump’s America has just become a rogue nation.
To now, the US President has broken American commitments on a wide range of trade deals, climate change promises and other matters.
But his announcement withdrawing the US from its international nuclear agreement with Iran and five other countries plus the European Union makes the US an active disruptor of international security.
-----

Mike Pompeo to return from North Korea with American prisoners, Donald Trump says

By Kirsty Needham
Updated9 May 2018 — 10:46pmfirst published at 7:10pm
Beijing: Three US citizens have been released from North Korean prison and are returning with US Secretary of State Mike Pompeo on his plane.
US President Donald Trump announced the breakthrough in a tweet, and said he would be at Andrews Air Force Base to meet the men.
"I am pleased to inform you that Secretary of State Mike Pompeo is in the air and on his way back from North Korea with the 3 wonderful gentlemen that everyone is looking so forward to meeting. They seem to be in good health," Trump wrote on Twitter.
-----

Prices could double: Trump's oil gamble comes at just the wrong time

By Ambrose Evans-Pritchard
10 May 2018 — 10:26am
Donald Trump could hardly have chosen a more treacherous economic moment to tear up the "decaying and rotten deal" with Iran. The world crude market is already tightening very fast.
Joint production curbs by Opec and Russia have cleared the four-year glut of oil.
There is no longer an ample safety buffer against supply shocks. The geopolitical "premium" on prices has returned.
The Maduro regime in Venezuela is entering its last agonies, and the country's oil industry is imploding. North America has run into an infrastructure crunch. There are not yet enough pipelines to keep pace with shale oil output from the Permian Basin of west Texas, and it is much the same story in the Alberta tar sands.
-----
  • May 11 2018 at 11:42 AM

Donald Trump to attack Australian-style cheap pharmaceutical prices

by ROBERT PEAR
President Donald Trump, poised on Friday to unveil his strategy to lower prescription drug prices, has an idea that may not be popular abroad: Bring down costs at home by forcing higher prices in foreign countries that use their national health systems to make drugs more affordable.
"We're going to be ending global freeloading," Trump declared at a meeting with drug company executives in his first month in office. Foreign price controls, he said, reduce the resources that U.S. drug companies have to finance research and develop new cures.
The White House Council of Economic Advisers said profit margins on brand-name drugs in the United States were four times as high as those in the more regulated markets of major European countries and Japan. Australia's Pharmaceutical Benefits Scheme also offers much cheaper prices than the US.
-----

US fed up with 'unfair, unprincipled' behaviour by China, former ambassador warns

By David Wroe
11 May 2018 — 5:20pm
Barack Obama’s former top envoy in Australia has backed Donald Trump’s tough approach to China, vowing the days of Beijing pursuing “unfair, unbalanced, unprincipled rules of the road” are over.
John Berry, the former US Ambassador in Canberra, told Fairfax Media that China could expect “straightforward competition” from the US on trade and strategic affairs.
He was speaking after giving an address in Canberra on Thursday night in which he warned that the “dreams are now over” that as China grows richer it will become freer, more democratic and fairer in its trade deals and sovereignty disputes.
-----
I look forward to comments on all this!
-----
David.

This Made Me Wonder Just What Was Happening With The “Bonfire Of The Faxes”?

This appeared last week:

He died alone after his medical test results were faxed to wrong number

By Melissa Cunningham
10 May 2018 — 6:08pm
Mettaloka Halwala was alone in a hotel room near Shepparton when he was found dead from complications that arose from his chemotherapy treatment of Hodgkin’s lymphoma.
Hotel staff opened the door of his room on the morning of November 17, 2015 to find the 58-year-old father of two deceased in his bed, fully clothed in jeans and a shirt, a lit torch beside him.
Now, a Victorian coroner has found Mr Halwala's lonely death could have been prevented had he not been let down by a series of systematic failures by the medical profession.
Four days before Mr Halwala's death, a scan conducted at the Austin Hospital showed signs of potentially fatal lung toxicity linked to his cancer treatment.
But a fax with the results of his scan was sent to the wrong number, Coroner Rosemary Carlin found.
This, combined with other "shortfalls in his medical management", meant neither Mr Halwala nor his haematologist Dr Robin Filshie at St Vincent's Hospital Melbourne was made aware of the results before a further fatal dose of same drug associated with the lung toxicity was administered.
While no one acknowledged responsibility for the communication failure, Ms Carlin found there had been "inadequate medical management" at the hands of both Dr Filshie and the physician responsible for sending the report, Associate Professor Sze Ting Lee.
"I cannot be certain that Mr Halwala would have survived even with optimal treatment but he may have," she wrote.
"The shortfalls in his medical management deprived him not only of his chance of survival but also of the opportunity to have a more comfortable death surrounded by loved ones."
In the months leading up to his death, Mr Halwala, affectionaly known as Mal, was living in a hotel in Tatura, a small town in the Goulburn Valley, due to his work as a civil engineer, while his family lived back in New Zealand.
Lots more here:
Now this is a sad story but really the specialist who ordered the scan and did not follow up is the one who should receive the most opprobrium.
That said the fax replacement program seems to have ground to a halt and I understand there are three contending views of the future slowing things down. Roughly there are those who want to finalise HL7 2.4, the pragmatists and the FHIR enthusiasts who want to move more quickly to the probable future.
Maybe we could have some leadership from the ADHA and move on, or is that too much to ask. It’s been almost two years now! That said my little Brother Multifunction (fax) has been a godsend in getting all my results during my recent travails! The fax sure is not dead yet…..
David.

The Privacy Foundation Comments On The myHR Opt-Out Period Implementation.

17 May 2018
—Media Release—
Government’s “My Health Record”: No Consent Required?
Opt-Out withdrawal of consent deadline is 15 October 2018

Has Canberra learned the wrong lesson from Cambridge Analytica: abusing ‘informed consent’ gives you a plausible excuse?  Exploiting ignorance, inaction and misplaced trust gets you the Big Data?

Our advice on My Health Record, like that of Dr Katherine Kemp, a specialist in data privacy [1], is to Opt-Out while you still can: we now know that your once-off chance to protect your medical confidentiality begins on 16 June and expires on 15 October 2018.

Just say “No” to this Clayton’s ‘consent’, this attack on the clinical relationship of trust.

Tell the government: “Come back when you can ask nicely!”

The Health Minister, Greg Hunt’s recent announcement [2] of the closing date for your
once-off chance to "Opt-Out" of the government's My Health Record is remarkable not for what it says, but what it doesn’t say. There is no mention that:
·         My Health Record was first released in July 2012 as "opt-in” (like all other forms of proper consent in the medical area, you must be explicitly asked for your permission before it happens,  and be told what it is, what the proven benefits are, and what your risks are)
·         When given a chance to Opt-In, few Australian did so, apparently not convinced of either any necessary benefit to them, or that it’s bypassing of medical confidentiality is trustworthy
·         Although there are over 5.77 million registrations, only 1.7million Shared Health Summaries have ever been uploaded, including updates. Those My Health Records that do exist have hardly, if ever, been used, perhaps because it is a mere grab bag of fragmentary extracts, not a usable or reliable clinical record
·         To try to get around this rejection by those asked for proper consent they changed the “consent” procedure to a consumer-hostile "Opt-Out” approach, so you will be registered for a My Health Record without your express or active consent
This is the ‘nanny state’ gone mad, a huge and risky invasion of your privacy. The government cannot persuade Australians and their GPs that creating a My Health Record is useful or safe (possibly because there is good reason to conclude it is neither), so they cheat by just giving themselves the right to do it anyway, unless you say no before the looming, newly announced date.
A major worry is that there is no mention of the costs or the risks to you of the government (and those to whom it is happy to disclose, whether in full or as easily re-identifiable ‘open data’) having bits of your health information. It’s like leaving out a full explanation of the possible side effects.

There is little evidence that an unreliable, incomplete, out of date summary health record system will be of any value to health professionals. The vast majority of doctors and clinicians already keep reliable electronic medical records for their patients – records they actually use daily to provide care, and can rely on for life and death decisions. The My Health Record is not for use as a medical record, it is designed for other purposes for third party users. In most clinical circumstances, the My Health Record creates an increased workload and a useless duplication, without solving the real problem of interoperable, highly secure, trustworthy clinical records. As a patient, watch your GP next time you have a consultation and observe just how much time the GP spends on their computer. My Health Record will just make this worse, without offering anything reliable or useful for clinical practice, and expose you to risk.

The Health minister doesn’t mention many key facts. This omission undermines the degree to which a decision to Opt Out by 15 October can be properly “informed". For instance, he doesn’t mention:
1.      The government advises health professionals not to rely on data in My Health Record; it is an adjunct to clinical systems, not a replacement. Its primary purpose is to enable those not in the clinical relationship of trust to access your medical information, not to help doctors and patients in the treatment setting.
2.      Once government has your health data, you cannot delete it. If you don’t Opt-Out now, you lose you chance forever. If you wish to change what you have added, a new copy is uploaded, but the old data stays in the system. If you want to cancel your My Health Record, all that will happen is that your record is deactivated (and perhaps hidden from you), but will still exist. This is social media’s idea of pseudo-deletion, not a proper right to withdraw your data from them.
3.      Data put into My Health Record by health providers may be incorrect or inaccurate, but the author of the documents is the only one who can alter it. It is up to you to check the accuracy of the data (how could most people do this?), and chase up those who uploaded it and ask politely if they will correct it. They are under no obligation to do so. In other words, any idea you own or control your data in My Health Record is an exaggeration. You control anything you add yourself, but that’s about it. It is not YOUR health record, the record belongs to the government, and the data is controlled by whoever entered it, and the government.
4.      Your GP will need to spend time summarising your health data, ensuring that it is consistent with what is already in your my health record before uploading it; time that could be better spent managing your health or the actual clinical record, not this unreliable duplicate.
5.      Some communities (e.g. those with mental health issues, drug abuse problems, the LGBTI community) have expressed concerns that there are risks of their health treatment information being readily available to a wide range of health care professionals. The My Health Record system does not deal with security, privacy, sensitivity or risk of excessive use.
6.      When Your health data are legally available from, or downloaded to, other systems they are not covered by the My Health Record legislation. And if they are abused, there is still no right to sue for breach of privacy in Australia.
 7.     You can only see which institution has accessed your record, not which individual – a major flaw in auditing, security and accountability. The minister doesn’t mention that 'the institution' could be a medical centre, a large hospital group, a pathology company or a pharmacy chain, with potentially hundreds or thousands of people able to access your record under the one name of that organisation.
8.      You (and everyone else) have to keep your health data up to date, or it may become inaccurate or out of date and potentially unsafe. This is a major design flaw – the whole point of reliable electronic health records is that they should solve the currency problem. My Health Record hides it and makes it worse, so it is potentially unsafe.
9.      Your health information may be linked with data from other government agencies looking for evidence of fraud or malpractice, or as the legislation says “the protection of the public revenue”.

10.   What happens after the three month "Opt-Out" period for people who have been abroad – students, returning off-shore workers, new citizens, or people who have no idea this record process is happening because they aren't currently living here? (They lose their one chance.)
11.      After the Opt-Out period, newborn babies will be given a My Health Record unless their parents opt them out. That child will then have a My Health Record for life, and will never have been given the opportunity not to have one.
12.       Any large-scale database of health information will be a highly attractive target to hackers. IT security can no longer be assumed to be able to repel a sufficiently motivated intruder. My Health Record creates a massive honeypot of duplicate data, a sitting duck.
13.      There are significant risks to patient privacy, and you need to assess that risk according to the benefits and costs or risks relevant to your specific circumstances. For most people, the breach of the clinical relationship of confidentiality and the lifelong loss of control of your data will not be worth any minor benefits – we believe this is why most people did not give consent when they were asked properly (the former Opt-In approach).


We have yet to see what information the government provides as part of its awareness-raising campaign so everyone knows the government will make a permanent My Health Record about them if they do no Opt Out by 15 October, and the full story so people can make a proper informed choice. The clock is already ticking, but the assumption is that they hope most people do not become aware of the looming deadline of your once-off chance to protect your medical information from a Cambridge Analytica-style data heist, or of the facts suggesting the limited benefit and clear risks of letting the moment pass. They will later be able to insist, like Google and Facebook (but with less cause) that it’s your problem now: silence means consent, so by doing nothing you have legally agreed to let them do it.


In the meantime, you should go to http://www.myhealthrecord.gov and register to be informed when and how to Opt-Out. 

The direct link is:

Media Contact:

Dr Bernard Robertson-Dunn
Chair Health Committee
Australian Privacy Foundation
Mobile 0411 157 113
Bernard.Robertson-Dunn@privacy.org.au

References
1. ABC. The World Today
Data privacy expert recommends opting out of proposed e-health scheme
http://www.abc.net.au/radio/adelaide/programs/worldtoday/data-privacy-expert-would-opt-out-of-proposed-e-health-scheme/9762820 
2. Media release - My Health Record opt out date announced
https://www.digitalhealth.gov.au/news-and-events/news/media-release-my-health-record-opt-out-date-announced
  
----- End Release

David.


Wednesday, May 16, 2018

I Think The European GDPR Is Going To Have An Impact Sooner Than We Thought.

This appeared last week:

Senate backs Greens motion for privacy laws based on GDPR

The Australian Senate has reversed its position and backed a motion by the Greens calling for the adoption of more stringent privacy protections in line with the EU's General Data Protection Regulation, acknowledging that it is world's best practice.
The EU legalisation is scheduled to take effect on 25 May and companies and institutions around the world are scrambling to be compliant with its stipulations.
Greens privacy spokesman Senator Jordon Steele-John said in a statement that the fact that privacy protections needed to be beefed up online was evidenced by the recent scandal over the leaking of Facebook data to the analytics firm Cambridge Analytica. The firm has now closed down but is believed to be operating under a different name.
Steele-John said: “Our privacy laws are woefully inadequate and the argument that Australians don’t care and are agreeing to sign away their privacy simply by engaging in online interactions is simply not good enough!"
…..
 “In March, the Senate opposed my motion calling for amendments to the Privacy Act 1988 to ensure individuals have rights of access, erasure and transfer of their personal data online," Steele-John said.
“I am heartened that the Senate has now back-flipped on their earlier position and supported, in principle, a move towards the European standard of online privacy protection and current world best practice.
…..
The full article is here:
Similar coverage is found here:

Senate backs Greens push for GDPR-style data laws

By Justin Hendry on May 10, 2018 1:30PM

Supports Privacy Act review.

The Senate has backed a motion from Greens senator Jordon Steele-John to improve Australia’s privacy regulations and bring local laws up to the level of the European Union.
Steele-John today moved that the federal government strengthen the protections in the Privacy Act, which he said were “woefully inadequate”.
He called on the government to “consider the impact of Australia’s insufficient and outdated privacy laws”, looking at the General Data Protection Regulation (GDPR) as a model of “as a potential model for privacy protection”.
The GDPR will come into effect on May 25, and is one of the single biggest shake-up of privacy rules since 1995.
Steele-John first put the motion to the Senate in March, but it was opposed.
More here:
As I said in a blog a week or so ago I think the game is changing and fast!
The Senate changing its mind so quickly would seem to be evidence that…
There is a useful explanation of just what the GDPR is and what is requires for anyone doing business with the EU as well as its impact on European Citizens found here:
The impact on the US multinationals has already been huge with Facebook, Google etc. making many changes both for EU clients but for all.
There are all sorts of implications for Australia depending on how far the Government finally moves.
The rights of access to your data, to know how it is being used and the right to erasure of data will be hotly debated I am sure.
The main point is that change is coming and I suspect it will be faster than we all expect.
David.

GDPR - How Europe's Data Law Works.

This video appeared a day or so ago from the FT:
Europe’s General Data Protection Regulation is a landmark law that forces companies and consumers to focus on how we treat the most valuable assets of our digital age: data. Understanding how it works is essential for individuals and business.
This is a really useful 3 minute or so video for anyone who wants to understand it.
I don’t think you need a subscription to watch.
David.

They Really Seems To Be Dragging Their Feet On Getting This Going!

This appeared last week:

No timeline to roll out service to end doctor shopping, court told

By Angus Thompson
10 May 2018 — 6:05pm
Health authorities have no timeline for the introduction of a real-time prescription monitoring service to stop doctor shopping in NSW, an inquest into opiate deaths has heard.
NSW Chief Pharmacist, Dr Judith Mackson, told Deputy State Coroner Harriet Grahame that, despite government commitments to rolling out the service, the potentially lifesaving system was still far from being realised.
The Health Council of the Council of Australian Governments last month determined that a national model for real-time prescription monitoring would be created, with states feeding the data from their own systems into a federal one.
The inquest, being held at the NSW Coroners Court in Glebe, is examining paths to regulatory change against the backdrop of six fatal opiate-related overdoses in 2016.
Three of the victims had consumed fentanyl, a synthetic opioid 100 times stronger than morphine, and typically restricted to palliative care.
Real-time prescription monitoring gives doctors and pharmacists a history of all Schedule 8 drugs, such as fentanyl, methadone and oxycodone, prescribed to a particular patient to prevent them doctor shopping and to help patients receive timely intervention and referrals.
Tasmania is the only state with real-time prescription monitoring, with the Victorian government working to introduce its own this year.
But Dr Mackson said NSW would wait for the federal government before it implemented its system, citing logistical difficulties in the state forging ahead by itself.
The court heard one predicted complication was patients crossing state borders to access prescribed medication without scrutiny.
In her written statement tendered to the court, Dr Mackson said the system required the building of a national data exchange, as well as a significant upgrade to the software that would be used to connect doctors, pharmacists and NSW Health.
“A timetable for implementation has not been developed, and the costs to NSW to implement real-time prescription monitoring have not been determined,” Dr Mackson said in the statement.
In September 2016, the health department introduced ERRCD (Electronic Recording and Reporting of Controlled Drugs) software, which processes authorisations for prescribe-controlled drugs, but would need major upgrades to support real-time monitoring.
More here:
This really is descending into farce with finger pointing and so on. I wonder where the strong national leadership on this from the ADHA is, or is this not their role.
Jeez Louise!
David.

Tuesday, May 15, 2018

I Am Not Sure The myHR Evangelists Have Thought Enough About The Consequences Of The myHR For Minorities Who Are The Subject Of Discrimination And Persecution.

This long article reminded me just how real the issue is:

 ‘Damaging our trust’: why My Health Record lets down sexual and gender minorities

It is critical that people—especially people from gender and sexual minorities and people living with HIV—are made aware of the potential risks of the My Health Record system.

My Health Record is a well intentioned policy but its execution discourages marginalised groups from confidently accessing healthcare.
It stokes fears of the forced disclosure of confidential health information—such as the results of sexual health tests and HIV status—which undermine public health outcomes and the individual wellbeing of people in the LGBTI community.
The Australian Digital Health Agency (ADHA) was created in 2016 to improve health outcomes for Australians using digital systems.
The cornerstone project of the Agency is a national digital health system, and so every Australian will have a My Health Record account by the end of 2018. The online account is a summary of your health information.
According to the ADHA website, its purpose is to deliver ‘safer, better quality healthcare’ and the initiative has many advantages.
Centralisation reduces the hassle of transferring documents between medical institutions and provides immediate access to information (e.g. allergies and prescribed medications) for efficient emergency treatment.
However, the problem is two fold. Firstly, once uploaded your confidential records are retained for 30 years after your death, or if that date is unknown, 130 years after your birth.
Secondly, and more pressingly, law enforcement agencies can access your confidential health information without oversight: the approval of a court or tribunal is not required [see: s. 17 and s. 70].
Health Department officials may release information included in a My Health Record if they believe it is ‘reasonably necessary’ to prevent, detect, or investigate ‘improper conduct’ or to prosecute criminal offences.
Additionally, your enrolment in the system is automatic so if you do not opt-out your consent to these details is presumed.
Privacy concerns are well founded. A My Health Record includes information such as discharge and event summaries, pathology and imaging reports, prescription documents, and specialist letters.
Medical data of this kind is highly sensitive, especially for people from gender and sexual minorities.
Things that are recorded could include a trip to A&E to obtain PEP, summaries of consultations with trans and gender diverse health specialists, notes from consultations with psychologists, the frequency of sexual health testing and the results of the tests, and prescriptions for such things as PrEP and HIV medication.
The Australian Privacy Foundation previously pointed out that the ATO and ABS have expressed an interest in accessing health data, and further warned that such information could be matched with your metadata. Indeed, one of the purposes of the system is to ‘provide de-identified data’ for research purposes.
Last year academics from Melbourne University demonstrated that it is already possible to identify people from supposedly de-identified health data from the Australian Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS).
Lots more here:
While this article focusses on the LGBTI community very similar issues arise with the mentally ill, those with other potentially stigmatising problems and so on. While the system has been opt-in it has been a relatively simple matter to avoid the myHR but with the opt-out plans rolling on this becomes less easy and straight forward.
I wonder where the research is on the potential downsides for such groups and the mitigation strategies that are needed. In a society as complex as ours it is never ok to assume that if something is alright for 95% of the population that the potential downsides for some do not demand consideration and mitigation.
Remember we were promised a voluntary system – have now been lumped with the opt-out process, still not fully clarified and defined as far as I know – and seem not to have any solid research or evidence on just what all the risks for the minorities are and how they are to be managed.
It really is not good enough for something as important as you private health information, especially in the era of massive data leaks from the likes of CBA and Equifax and information abuse from the likes of Facebook.
Can anyone who has such evidence and research let us all know?
David.

Monday, May 14, 2018

The Opt-Out Decision Period For The MyHR Has Been Announced.

This appeared a little while ago:

My Health Record opt-out period from July 16 to October 15, 2018


The window for Australians to opt out of an electronic health record has been announced by the government.

By Chris Duckett | May 14, 2018 -- 07:39 GMT (17:39 AEST) | Topic: Security

Australians will have from July 16 to October 15, 2018, to opt out of having an electronic health record.

Those choosing not to have a My Health Record can opt out at the My Health Record website or by calling 1800 723 471. So far, 5.7 million people are in the system.

"The protection of patient information is critical, and the My Health Record system has strong safeguards in place to protect the health data. It is also subject to some of the strongest legislation in the world to prevent unauthorised use," the Australian Digital Health Agency said in a blog post.

"Australians can cancel their My Health Record at any time after the end of the opt-out period -- or create one, if they opted out."

Here is the link:

https://www.zdnet.com/article/my-health-record-opt-out-period-from-july-16-to-october-15-2018/

So now you know.

David.